Article 43: Types of Erectile Dysfunction, Psychological Causes, and Sensate Focus Therapy

7. Psychological adjustment for erectile dysfunction

Erectile dysfunction (ED) is one of the most common male sexual dysfunctions. It refers to the inability to achieve or maintain an erection sufficient for sexual intercourse, or the inability to achieve an erection of sufficient rigidity for intercourse. The psychological distress caused by ED is immense, far exceeding the physical pain, making the treatment and prevention of ED of great importance in terms of mental health.

Types of erectile dysfunction

(1) Primary erectile dysfunction and secondary erectile dysfunction

Based on the course of the disease, erectile dysfunction can be divided into two categories: primary erectile dysfunction and secondary erectile dysfunction.

Primary erectile dysfunction (PE) refers to the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse, even with minimal or no erection. The vast majority of cases of PE are caused by organic factors, and it accounts for a very small percentage of the total population.

Secondary erectile dysfunction refers to a condition where a person has previously had successful sexual intercourse but subsequently experiences erectile dysfunction and is unable to complete sexual intercourse due to various reasons. Most cases of erectile dysfunction are secondary erectile dysfunction.

(2) Organic erectile dysfunction, psychogenic erectile dysfunction, and mixed erectile dysfunction

Based on the causes, erectile dysfunction can be classified into organic erectile dysfunction, psychogenic erectile dysfunction, and mixed erectile dysfunction.

Psychological mechanisms of psychogenic erectile dysfunction

Most experts believe that the main cause of erectile dysfunction is performance anxiety. This manifests as anxiety and tension during intercourse due to excessive focus on one's sexual ability and fear of failure. This suppresses the natural functioning of sex, resulting in the penis being unable to achieve or maintain an erection sufficient for satisfactory sexual intercourse. This failure further exacerbates the anxiety and tension, creating a vicious cycle of "anxiety-failure-anxiety."

(2) Lack of sex appeal

Some cases of erectile dysfunction are clearly related to a lack of male sexual desire, meaning a partner who is sexually unattractive to the man. Factors such as the wife's illness, her frigidity or lack of cooperation, and marital discord can all affect a man's sexual desire and ability to achieve an erection. Some men who have extramarital affairs experience erectile dysfunction because they are unable to arouse sufficient sexual desire during intercourse with their wives.

In addition, some men's erectile dysfunction is caused by fear resulting from inappropriate sex education in childhood, psychological influence from their wives' cries of pain during intercourse, homosexuality in sexual psychological disorders, or excessive or impatient sexual demands from their wives.

Psychotherapy

(1) Sensitive Concentration Method

The sensual focus method requires both partners, especially the man, to focus their attention not on whether the penis is erect, but on the intimate and pleasurable experience of being together.

This method can be implemented in the following steps:

Step 1: Both husband and wife should work together to find the cause of the illness.

The most direct way to find the cause is to recall the circumstances of the first time erectile dysfunction occurred and then analyze the reasons.

The second step is for both partners to find ways to eliminate the causes of the illness. The couple can synthesize the above analysis and jointly design improvement measures for each possible cause. For example:

● From now on, I will not have sex when I am in poor physical condition, in a bad mood, or after drinking too much alcohol.

● Couples should care for, cooperate with, and comfort each other, and avoid blaming, getting angry, or being sarcastic towards each other.

● The couple worked together to create favorable conditions so that the disease could be cured as soon as possible.

The third step involves formal operational therapy-non-sexual contact. First, the couple engages in physical contact without undressing, such as hugging, touching, and kissing. During this process, both partners try to experience pleasure through verbal communication and understand what elicits pleasurable responses from themselves and their partner. Then, they undress and gradually expand the contact to all erogenous zones of the body, but the genitals do not touch, thus avoiding intercourse. Due to skin-to-skin contact and the stimulation of erogenous zones, the intensity of sexual attraction increases significantly; since intercourse is not the goal at this stage, the man's anxiety is greatly reduced, so he may experience an erection, but not necessarily orgasm.

Two points should be noted during this treatment process: First, both partners should participate equally, regardless of who takes the lead, which can reduce the anxiety caused by the man's historically dominant role; second, the speed of treatment progress depends on the degree to which the man's sexual anxiety decreases, the degree to which his confidence is restored, and the speed at which he masters the procedure.

The fourth step is to attempt intercourse. After completing the training steps above, you can try intercourse. At the beginning of intercourse, the contact between the sexual organs should not be too deep; deeper penetration can be achieved after you become accustomed to it. Here's a key technique: adopt the woman-on-top position. This position makes the woman the protagonist of the sexual activity, reducing the man's responsibility and pressure, and naturally alleviating his performance anxiety.

Step 5: Actual intercourse. Once intercourse is successfully attempted, the vast majority of psychogenic erectile dysfunction can be essentially cured. To prevent relapse, both partners must adhere to the jointly established preventative measures (see Step 2). Avoid intercourse when physically unwell, emotionally distressed, or after excessive alcohol consumption. Focus on improving the quality of intercourse; sometimes, intimate acts can be used as a substitute.

(2) Other methods

In treating psychogenic erectile dysfunction, the wife plays a crucial role. This is because, besides the husband's own sexual ability and fantasies, the wife's grooming, physique, caresses, comfort, playfulness, flirting, and prior preparation can all stimulate sexual arousal. These factors can help the husband eliminate psychological concerns and burdens, strengthening his confidence in recovery. For example, the external conditions for intercourse (room, bedding, lighting, etc.) should meet the husband's requirements; the woman should take on all the hassles of contraception, perhaps temporarily switching from condoms to birth control pills; to reduce the husband's difficulty and responsibility during intercourse, the wife can adopt the woman-on-top position or personally insert the penis into the vagina; the wife should constantly reassure her husband in various ways that he will not become sexually impotent! She should never show any resentment, anger, or impatience in front of her husband.