Do you ever wonder if issues with erections are all in your head? Well,
sometimes psychological factors or problems in your head are actually the cause. I'm Dr.
Rena Malik urologist and pelvic surgeon and if you're new here i make content on sexual health
bladder health and so much more so make sure you subscribe and share this channel with your friends
today we're going to cover a few different things we're going to start off talking about the three
different kinds of erections we're also going to talk about the link of psychogenic erectile
dysfunction with mental health disorders other causes of psychogenic erectile dysfunction how
we diagnose it and what treatments are available if you're suffering from it
did you know that there are three different types of erections well the first type is reflexive
erection so that's erections that happen due to physical stimulation so sometimes you may not be
turned on at all but you might get an erection due to some sort of physical stimulation
another kind is nocturnal erections so erections that occur at night nocturnal erections are
usually non-sexual and are not really noticed by men and they start in early adolescence and will
occur throughout your life usually you'll have three to four nocturnal erections throughout
the night and usually you wake up with a morning erection that's when most people will notice it
very often that erection will also go away after urinating but that's not exactly related to why
the erection goes away so psychogenic erections are the third type of erections and these are due
to a mental or visual image or something that is essentially causing you to have desire or sexual
desire psychogenic erections are ones that are triggered in response to some sort of physical
image or mental image of something that's arousing you when you get an erection in a very specific
environment you have need to have an intact nervous systeming that all your neural connections
from your brain to your penis are working well you need good blood flow to the penis you also
need your hormones to be working correctly so those are chemical messengers that play a role
in producing erections and lastly you need a good mindset psychogenic erectile dysfunction is the
inability to get or maintain an erection during sex due to psychological factors and there's a
whole host of them these can include things like self-esteem depression anxiety relationship issues
and we'll go over all these in a little bit more detail in fact mental health disorders
and erectile dysfunction are very commonly linked when you look at a multitude of studies you'll
find that people who have erectile dysfunction are somewhere between two to four times more likely
to have conditions such as depressive symptoms or have a pessimistic or negative outlook on life and
have more emotional stress but how do you know if you have depression well there are certain
characteristic symptoms that you can have that are indicative of maybe being depressed
symptoms of depression can include feelings of feeling sad or down for a prolonged period of time
at least two weeks or longer very often this can also be with feelings of anxiety or feeling
negative and feeling generally hopeless about your life you might find that if you're suffering from
depression you're not as interested in the things that you used to enjoy like your normal hobbies
or activities you may also find yourself moving a little slower either physically moving slower or
actually having a slower speech some people will notice that they're having a change in
their appetite and their sleep they might either have difficulty sleeping or sleeping for longer
periods of time you may have strong feelings of hopelessness or guilt or feeling like you're not
worth anything and lastly in very severe cases you can have feelings of wanting to end your
life if you find yourself suffering from any of these symptoms particularly if you're feeling
like ending your life please make sure to call the suicide hotline right away and get help but
what happens are people depressed and so they get erectile dysfunction or does erectile dysfunction
cause the depression well in fact it can go both ways when people are depressed they can often have
really difficulty engaging with their partner and difficulty getting interest in having intercourse
which can then make it harder to get erection on the other side of it erectile dysfunction can be
really damaging and it can make people have a lot of depressive or anxious symptoms which can become
clinical depression so what are some other causes outside of depression that can cause psychogenic
erectile dysfunction well certainly having a significant amount of stress can make it very
difficult to focus on pleasure or having desire for intercourse which can lead to issues with
erectile dysfunction similarly having feelings of anxiety or in particular performance anxiety so
what happens when you have performance anxiety you may have an issue where you don't perform as well
as you'd like that causes stress and that takes your focus instead of enjoying the pleasure or the
sensations that you're having during intercourse you're actually focused on trying to perform
which then causes it to be more difficult to actually perform and that actually continues
to compound itself and gets really into a bad cycle and it can be very difficult to break
relationship issues if you're not communicating with your partner or you're having difficulties
in your relationship that can also lend itself to having difficulty getting erections
and particularly if you're having difficulties communicating with each other about what you need
other things can be feelings of guilt so if you're having feeling guilty about your performance
abilities or stress or other things in your life you can bring that with you to the bedroom as well
as self-esteem issues so if there's reasons that you're feeling down on yourself for other causes
that can also make it more difficult to perform in the bedroom sometimes cultural issues can
become a problem if your culture has certain beliefs about intercourse particularly if it's
you know not having sex before marriage or other things like that can also contribute if you've had
previous trauma in relation to sexual activity or rape or things like that obviously that can
cause difficulties with performance and lastly excessive pornography use for some people who get
really used to a certain type of stimulation either manually or visually seeing a certain
type of stimulation it can then be difficult to achieve erection due in other types of scenarios
where you're having stimulation with your partner if you want to learn more about pornography pros
and cons make sure you check out my video where i talk about that and if you're having difficulties
with pornography make sure you check out my video about how to break the cycle of addiction
interestingly having psychogenic erectile dysfunction may not be as simple as it sounds
there's actually new data that suggests there's actually changes in the brain of men who suffer
from psychogenic erectile dysfunction that can contribute specifically in areas like the cerebral
cortex the nucleus accumbens and the prefrontal amygdala pathways first when you meet with your
doctor if you're suffering with issues of erectile dysfunction we'll kind of want to understand more
about when this is happening is it happening all the time or is it in specific situations so we'll
look at is it generalized erectile dysfunction or is it situational erectile dysfunction so
generalized means that it occurs all the time then we want to think about other medical causes that
might contribute to it to make sure that that's maybe the cause more commonly in psychogenic
erectile dysfunction it's more often situational that can be due to your partner that can be due
to the performance anxiety or that can be due to psychological disorders as we talked about already
like mood disorders depression anxiety those sorts of things and the other things that kind of clue
us into it being more of a psychologic cause is that it occurs all of a sudden whereas people who
have medical causes of erectile dysfunction typically it occurs more gradually and you
will continue to have nighttime erections they'll usually be quite rigid so you'll still wake up in
the morning with a good solid erection whereas when you're having other causes of erectile
dysfunction you may notice it's more sporadic that you're waking up with a good erection in the
morning also because we know erectile dysfunction can lead to problems in the relationship we
kind of want to figure out did these problems of anxiety or mood disorders or partner issues start
after the erectile dysfunction or did they start before them because typically if they started
before them it's more likely that the erectile dysfunction is psychogenic than if they've started
after them another test that sometimes urologists will use is looking at nocturnal penile tumescence
and you may have seen kind of a home rigged version of this on sex in the city
she went to sleep hoping her mail had sufficient postage to deliver his package into her box
the next day charlotte woke up as excited as a little girl on christmas morning
and she couldn't wait to see if trey's package was unwrapped
but the test that we have available to us in urology can let us know
how many erections you're having at night how long they're happening and how rigid they get
and obviously if you're having continued nocturnal erections but during the daytime when you're
trying to have intercourse with your partner you're unable to get rigid firm erections and we
know that it's psychological however this test has many flaws it's very expensive and so it's
very infrequently used so most of the time we'll diagnose psychogenic erectile dysfunction based
on discussions with you rather than doing any sort of testing so now let's move on to treatments what
sort of treatments are available for psychogenic erectile dysfunction well the first one is if you
see a psychologist or psychiatrist you can undergo something called cognitive behavioral therapy so
what that really focuses on is understanding your knowledge and your expectations of what sexual
intercourse should have and to then realize what's possible what's impossible and what's realistic
and work on kind of reframing your mindset about sexual intercourse another option is sex therapy
with what we call sensate focus exercises and what that is is basically focusing on what they call
non-genital and non-demand pleasuring exercises so it focuses on physical touch but not with
any expectation of intercourse to try and really recalibrate your brain on focusing on the pleasure
of touch and rather than thinking about the other things because the expectation of intercourse is
now off the table in the description down below you can find a website where you can look for
sex therapists in your area if you think this is the right option for you the other thing is
if you are suffering from depression or anxiety you can see your primary doctor or psychiatrist
to get treatment for depression or anxiety you do have to be careful because some medications for
depression actually cause as a side effect low libido so you want to talk to your primary doctor
about that whoever is prescribing it for you to make sure that you know because you're having
a lot of erectile dysfunction or a lot of issues with sexual function that you want to steer clear
of any medications that give you that side effect it's very difficult sometimes to talk about these
issues with your psychiatrist or your primary care doctor because they're not typically asking
you about it but it's important to bring it up so you get started on the right medication and
lastly you can try medications for what we call medical erectile dysfunction like sildenafil or
tadallophil if you want a little bit more about how those work you can check out my video which
covers those what i found sometimes in patients is that it can kind of break the cycle of performance
anxiety or stress related to having difficulty with erections if you can get erections with
medication it can then give you that confidence back and allow you to have intercourse without
the stress of having issues with erections however you need to be careful with this because it's not
always a home run particularly if you and your partner have not had intercourse or satisfactory
intercourse in a very long time you can both come to the table with different expectations and you
may have a very narrow view of what exactly is going to happen during the sexual encounter
you may want to incorporate more foreplay and make sure that you have low expectations and
try to enjoy the process rather than thinking about sex the way we see it on mainstream media
also the best option is to do some form of cognitive behavioral therapy or sex therapy
at the same time as medical therapy that's going to give you the best outcomes i hope you guys
found this video helpful as always remember to take care of yourself because you're worth it