Mental health articles

Aetiology of erectile dysfunction

Psychodynamic explanations

According to Janssen, erectile failure results from an oedipal confl ict constellation involving fear of castration or incest, uncertainties in sexual identity, incestuous object choices, latent homosexual tendencies and fear of aggressive-phallic impulses. These may develop as a result of factors that inhibit appropriate passage through the oedipal stage of psychosexual development. In a case example, Janssen described one man who reported that as a child his mother had turned to him to discuss matters relating to her relationship with his father. When his father became aware of this, he became angry and abused his mother. The client feared that he too would become the focus of his father’s wrath and experienced a confl ict in wanting to defend his mother, but to avoid confrontation with his father. This prevented his successful resolution of the oedipal confl ict. In adulthood, the fear of his aggressive father prevented him developing appropriate emotional and sexual relationships with women. Treatment involved dealing with his relationship with his father, not any explicit sexual function.

Cognitive explanations

In a more cognitive explanation, Bancroft argued that anxiety adversely affects sexual performance as a result of cognitive and perceptual factors. He suggested that men’s sexual excitement depends on a delicate balance between excitatory and inhibitory mechanisms. Two key inhibitory processes are performance anxiety and fear of negative outcomes. Both may lead to a process coined by Masters and Johnson as spectating in which the individual becomes so concerned by the adequacy of their performance or the consequences of potential failure that they distract from sexually arousing cues, and lose their erection. Evidence in support of Bancroft’s model can be found in a number of laboratory studies which have shown performance demand to increase sexual arousal in most men, but to have the opposite effect on those with erectile dysfunction. In addition, the presence of non-sexual stimuli is more disruptive to men with the disorder than those without.

Many men set themselves inappropriately high levels of performance to which they aspire. Zilbergeld, for example, noted that men frequently buy into the fantasy that their performance is the ‘cornerstone’ of every sexual experience and that a fi rm erection is the key element of every sexual encounter: views not necessarily subscribed to by their female partners. According to Zilbergeld, a failure to achieve this ideal results in fears of dysfunction, loss of masculinity, and declining interest in their partner.

Tags: dysfunction, erectile dysfunction