Psychogenic erectile dysfunction

Various aspects of psychogenic erectile dysfunction (ED), its pathogenetic mechanisms are considered. Psychogenic sexual dysfunctions, which include ED, are the result of a systemic interaction of a number of adverse factors: situational, traumatic, partner problems and characteristics of personal response. As a rule, several of the above reasons play a role in the development of psychogenic erectile dysfunction in men. Treatment for psychogenic ED includes psychotherapy and pharmacotherapy. The main group of drugs used for ED are type 5 phosphodiesterase inhibitors, the progenitor of which was sildenafil (Viagra).

Of all the physiological sexual reactions of a man, an erection is the simplest and phylogenetically ancient, since it is mediated only by vascular and neurogenic mechanisms. An erection can occur due to reflex mechanisms even without sexual desire and arousal. This distinguishes it, for example, from ejaculation, in which motor and excretory functions are also involved. Paradoxically, at the same time, an erection is also the most vulnerable link in a series of psychosexual reactions of a man.

Male sexuality is, in fact, -phallocentric- (phallus - erect penis as opposed to penis - penis at rest). The presence of an erection (phallus) proves -male competence-, -potency-, that is, the possibility of sexual intercourse itself. In all human cultures, the phallus, in symbolic and mythological terms, has always been a symbol of power, strength and power. On a subconscious psychological level, for a man, the most significant is not the actual sexual intercourse, but the possibility of carrying it out. Therefore, erectile dysfunction is perceived not only as a sexual failure, but also as a collapse of male solvency in general.5 That is why the Latin term impotentia coeundi has outlived its usefulness and has not been used in international literature in the last decade. It is viewed as outdated, inaccurate and unreasonably having a judgmental overtones that humiliate human (personal) dignity. Instead of -impotence- today they speak of-erectile dysfunction- or -erectile dysfunction- (ED).

At a young age, psychogenic erectile dysfunction is 4-5 times more common.

ED refers to the inability to achieve an erection or keep it at a level sufficient for copulation in at least 25% of attempts to have intercourse. Psychogenic ED can occur at any age and manifests itself in many forms. More often men complain of a weak erection, which does not allow them to insert the penis into the vagina. Sometimes the patient has a fairly strong erection, but when trying to copulate, it quickly disappears. In other cases, a man is able to achieve a normal erection only under certain specific conditions.

Erection is controlled by two mechanisms. The first is a reflex erection that occurs when the penis is touched, the second is a psychogenic erection that occurs as a result of erotic stimuli. Reflex erection is controlled by peripheral nerves and centers located in the lower part of the spinal cord. A psychogenic erection is controlled by the limbic system of the brain. With the development of a reflex erection, stimulation of the penis causes the release of nitric oxide, which in turn leads to relaxation of the vascular walls in the cavernous bodies of the penis. They fill with blood and an erection occurs. For the development of an erection, a sufficient level of testosterone in the blood is also required. Thus, erectile dysfunction can occur due to disorders of the hormonal system, diseases of the nervous system, insufficient blood supply to the penis, or psychological problems. In any case, sexual response is a psychosomatic process, and both psychological and somatic factors are usually involved in the origin of sexual dysfunctions. Most often, especially with erectile dysfunction in adulthood, it is difficult to determine the relative importance of certain factors; then such disorders can be defined as mixed.

Worldwide, more than 80 million young men suffer from ED; over the age of 40, their number doubles.

According to European 7 and American 6 researchers, more than 80 million young men suffer from ED worldwide; over the age of 40, their number doubles. There are constant disputes between specialists: what is more common - erectile dysfunction for psychological reasons or for organic, that is, due to vascular, neurological, urological, endocrine diseases? Psychotherapists, especially psychoanalytic ones, confidently estimate the ratio of psychogenic and organic disorders as 80: 20. The leading urologists cite the exact same ratio, but in favor of the organic nature of erectile dysfunction.In fact, both indicators are correct, but only taking into account the age aspect: at a young age, psychogenic disorders are 4-5 times more common, at the age of 40-45 years, the ratio becomes 50: 50, and then organic reasons begin to steadily prevail, and by 65 -years old they account for 90% of all causes of erectile dysfunction.

Some failures (lack of an erection or its loss at the most inopportune time) can occur in any man - this is quite normal. Such isolated episodes do not indicate sexual weakness; they can be the result of temporary physical stress or some psychological factors (tension, lack of privacy, or the need to get comfortable with a new partner). If a man, instead of taking such incidents calmly, begins to experience his failure, to think about whether he will be able to achieve an erection the next time, he thereby creates the basis for the emergence of real difficulties. A man's reaction to erectile dysfunction is very diverse - from horror and confusion (probably the most common reaction) to complete indifference (the least typical).

A man's reaction to erectile dysfunction is very diverse - from horror and confusion (probably the most typical reaction) to complete indifference (the least typical).

Psychogenic sexual dysfunctions include functional psychogenic sexual disorders that arise with the direct participation of psychological mechanisms and are manifested by qualitative or quantitative disorders not associated with organic pathology. Here it is necessary to clarify that erectile dysfunction, which occurs in severe mental illness, sexual perversion, are actually not psychogenic, but psychopathological (psychiatric) disorders. Most often they are mediated by endogenous mechanisms and are not associated with psychological stress. This is becoming especially relevant at the present time in connection with the change in the attitude towards depression as an endogenous disease, not psychogenic. That is, erectile dysfunction with obvious depression should not be considered psychogenic and, accordingly, should be treated according to completely different principles, which will be discussed below.

Situational factors include the lack of conditions for complete privacy; the ability to be caught off guard by other people; fear of unwanted pregnancy; fear of contracting a sexually transmitted disease; an actual mental or physical - weakened state - due to fatigue, previous stress, somatic malaise, alcoholic intoxication; improper conduct of the preliminary period of sexual intercourse, when the occurrence of transcendental inhibition as a result of super-strong excitement of the genital centers from too long caresses leads to a breakdown of the physiological program; external stimulus of considerable strength (sudden shout, knock, scream, shot), leading to the disruption of sexual intercourse by the mechanisms of external inhibition; a very long period of -sexual abstinence- (provided there is no masturbatory activity), when due to -training- it takes time for a gradual full recovery of function.

Psychogenic ED can develop as a result of even a seemingly insignificant fact such as the impossibility of having intercourse with a condom. The policies of many pharmaceutical companies, heavily influenced by the media, lead many young people to believe that sex without a condom is completely unacceptable. Meanwhile, for a number of psychological reasons, putting a condom on the penis is a certain stress for a man, which is often completely incompatible with a normal erection.

Traumatic experiences can be painful memories of previous sexual failures, including the partner's dissatisfaction with the quality of sexual intercourse; anxious fears about one's own sexual inferiority and fear of being rejected if it is not possible to - satisfy - the partner properly; fear of losing an erection or premature ejaculation.

Partnership problems are a violation of interpersonal relationships, frequent conflicts, growing negative emotions; mutual distrust or cooling of partners; inappropriate behavior of a sexual partner who behaves inappropriately, aggressively, derisively, or demonstrates coldness and unwillingness to intimacy; difference in sexual preferences (range of acceptability, sexual technique) and disharmonious sexual interaction between partners.

Personal characteristics include anxious and suspicious character traits; decreased self-esteem; the tendency to constant self-control during intercourse; an unattainable in reality setting for maximum satisfaction from each sexual contact; erroneous attitudes regarding sexuality (due to the lack of correct knowledge about sexual life, due to improper upbringing or one's own negative experience of intimate contacts); unconscious hostility to the opposite sex; feelings of guilt in connection with sexual pleasure, as well as a deep fear of intimacy in a romantic relationship.

Sexual disorder can also be caused by sexual illiteracy and blind faith in myths. An example of the influence of cultural myths on the formation of people's attitudes towards sex and their sexual behavior is, in particular, the conviction that sexual functions necessarily fade with age, or that a man must necessarily be the initiator and leader in sexual relations.

As a rule, several of the above reasons play a role in the development of psychogenic erectile dysfunction in men. Of great importance is also the so-called. the sexual constitution of a particular man. Sexual constitution in sexology is understood as a set of innate properties (anatomical, physiological, hormonal, etc.) of the body, which determines the individual need for sexual activity, its maximum value and resistance of the genital area to pathogenic influences. Of course, the weaker the sexual constitution of a particular man, the easier external mental influences can serve as an impetus for the development of sexual dysfunctions.

Fear of possible failure - - Will I be able to keep an erection? - - Will I be able to satisfy my partner? - - leads to depression of sexual arousal and loss of erection.

The most common form of psychogenic disorder leading to ED is anxiety-inducing failure syndrome. A typical stereotype of the development of this disorder is as follows. An accidental, often situationally conditioned sexual failure in the form of a sharp decrease or even disappearance of an erection raises doubts about one's own strengths, prevents the next sexual intimacy. Fear of possible failure - - Will I be able to keep an erection? - - Will I be able to satisfy my partner? - - leads to depression of sexual arousal and loss of erection. The stronger these fears, the higher the likelihood that they will come true (on the principle of self-hypnosis), and the man will begin to feel a genuine inability to achieve an erection and keep it. Over time, fear of failure can cause a weakening of interest in sex (avoidance), loss of self-esteem and attempts to overcome insecurity (this usually violates the immediacy of intercourse, turning it more and more from pleasure into some kind of "action").

In addition, fear of failure often turns one or both partners into observers, watching and evaluating their own sexual response or the response of a partner. Distracted by observing and evaluating what is happening, a man usually gets less pleasure from sexual activity, which further inhibits his ability to react physically. Thus, a vicious circle arises: a weak erection causes fear of failure, which prompts you to become an observer, and this distracts and contributes to erectile dysfunction, increasing the fear of failure. If you do not break this circle, then it is very likely that the erectile dysfunction will be firmly fixed. With the long-term existence of obsessive fear, many men compensatory begin to seek pleasure in other spheres: they overeat, abuse alcohol, look for new hobbies, become workaholics, etc.

Very often psychogenic influences are leading in combined erectile dysfunction. For example, the first manifestations of insufficient blood supply to the genitals (due to athero-, arteriosclerosis, arterial hypertension, diabetes mellitus) can lead to a slightly reduced erection, its periodic weakening during intercourse, an increase in the time period until a new erection appears after completed coitus. Sometimes reproaches from a partner, fixation of attention on their own sexual reactions lead to an increase in erection breakdowns by the mechanism of anxious-obsessive expectation of failure, which is significantly aggravated by insufficient blood supply. Even an effective correction of genital blood flow with the restoration of a sufficient supply of arterial and venous blood does not lead in most patients to normalization of sexual intercourse as long as the obsessive fear of anticipating a fiasco persists.