Erectile Dysfunction

Author: Dr. Robert W. Birch Ph.D. © 2001

Sexologist & Adult Sexuality Educator


Used With Author(s) Permission



It used to be called IMPOTENCE but now is referred to as ERECTILE DYSFUNCTION. It doesn't matter what it is called, it is a major concern for men (and the partners) when it happens. An erectile problem is defined as the inability to get or to maintain an erection sufficiently hard enough to make penetration. Thus, it might be that a man is unable to get an erection, even with stimulation. Another man might get an erection, but lose it before ejaculating. Finally, a man might get partial filling of his erectile tissue, but his penis does not firm up enough to be useful. All of these men are said to have an erectile dysfunction.

Failure to get an erection might happen every time, or sporadically. A man might fail to get an erection with one partner, but not another. The onset of his erectile dysfunction might be gradual or might seem to happen suddenly. The nature of erectile dysfunction vary.


Age is a major factor. As a man ages, there is a gradual decline in his ability to get and secure a firm erection. The process slows and the quality begins to wax and wane. Perhaps the biggest cause of erectile problems for older men is the narrowing of their blood vessels. As young men they were pumping blood into their penises through a garden hose, but at 70, they are trying to accomplish the same thing through a soda straw!

Other illnesses and disabilities will disrupt the process of becoming erect. Certain medications also will cause sexual dysfunction. Stress, anger and relationship problems will also interfere.

Perhaps the biggest cause of erectile failure among younger health men is PERFORMANCE ANXIETY. This has been called the "I gotta" syndrome. The man is worrying about his performance and saying to himself, "I gotta get it up... I gotta get it in... I gotta finish the performance." With a severe case of the "I gottas," a man isn't going to! The FEAR OF FAILURE, although psychological, can devastate a man's ability to become erect... and even to stay erect. Such men are monitoring their penises, watching to see how they are doing. Masters and Johnson called this "spectatoring." The man actually becomes a spectator of his own performance (or lack thereof).

The fear of failure is a form of mild panic. For some men, this is enough to trigger their built-in, hardwired"fight of flight panic response." Their bodies automatically flood with adrenaline, and this causes superficial blood vessels to constrict, forcing blood into the larger muscles that would be needed to run or fight. In the process, the vessels carrying blood to the penis are unable to do their job and the erection fails. The fear of failure often precipitates what it was that was feared!


When erectile dysfunction is the result of a physical cause, it is called BIOGENIC or ORGANIC. When the problem is caused by anxiety or other psychological factors, it is referred to as PSYCHOGENIC erectile dysfunction. Often there is an overlapping of the biogenic and psychogenic, as with an aging male who would naturally be taking more time, but begins to worry that he is no longer responding as he did when he was twenty years younger. His age might have slowed him down, but his worry can wipe him out completely! Sex therapy is very effective in treating the psychogenic aspects of erectile dysfunction, particularly if there is a cooperative partner. Of course, today there is Viagra!


Dr. Birch's Web Site: Oral Caress




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