Psychogenic ED and Sex Therapy

Erectile dysfunction is a complex condition involving both physical and mental factors. Sound overwhelming? It can be but don’t worry. This reality also increases the options and possibilities for effective management and treatment of ED and may help you achieve more satisfying sexual experiences.

Many men don’t realize that factors in their lives including thoughts, feelings, and relationships can lead to erectile dysfunction. This is often called psychogenic erectile dysfunction.
There are several ways to categorize the causes of erectile dysfunction. The following breakdown may help you better think about how to best address your ED:

  • Psychogenic ED
  • Organic ED
  • Psychogenic ED and Organic ED

Psychogenic ED

Erectile dysfunction with completely psychological origins is psychogenic. Psychogenic ED makes up roughly 10% to 20% of all ED cases. If you are young and healthy, there is a strong possibility your ED is psychogenic. Treatment of pure psychogenic ED can be rather quick and yield positive results without using medications or having surgery. This generally involves talk therapy or self-help processes.

Organic ED

Organic ED means there is a strong biological, neurogenic, or other medical basis causing your ED. 80% to 90% of all ED cases are thought to be organic in nature. There are a number of ways a doctor can identify or rule out specific medical causes. The vast majority of these men can find success with medications, devices, or prosthetic implants.

Mix of Psychogenic and Organic ED

Most cases of organic ED include psychogenic elements. Understanding the specific physical and psychological issues contributing to your erectile dysfunction can help you establish the most effective treatment plan. For best results treatment generally involves a combination of medication and psychological interventions.

The Thought Pendulum Swings

There is a tendency to assume that ED has a singular cause. It’s easier to think about that way and easier to treat. We like things to be simple and clear. There are also historical reasons why most men assume the only approach to fixing ED is through medication.

The dramatic shift in thinking from psychogenic to organic ED is not always fair, accurate, or helpful

Before the FDA approval of Viagra® (sildenafil) in 1998 ED was considered to be a psychological condition. “It’s all in your head, right?” Wrong. Effective medications changed the thinking about erectile dysfunction. Most cases of ED were now considered to be organic, with only a small percentage considered purely psychological. The dramatic shift in thinking from psychogenic to organic ED is not always a fair, accurate, or helpful way to describe the condition.

Psychological and behavioral treatment in the decades prior to the availability of the little blue pill resulted in high rates of success helping men resolve their ED. Those treatments were more challenging than taking a pill, which may be why they became a less popular option.

Then It Swings Back

Today, medical and mental health professionals are beginning to view conditions such as ED as more complex. It is likely almost every situation of erectile dysfunction involves parts of your psychology and environment. Addressing these factors will not only put you in a better position to improve erections, it can also result in better relationships and a more positive outlook on life.

Binary Treatment Approach

If your ED has a strong organic basis, medical intervention should be part of your treatment plan. However, even if you respond to the medication alone, you can still benefit from improving psychogenic and environmental factors and improve consistency and overall satisfaction.

Working on the mental aspects now, will also help if your medication becomes less reliable in the future. When underlying conditions like heart disease and diabetes worsen the medications used to treat ED may become less effective or ineffective.

Almost all men with organic ED will benefit from understanding more about the role their mind plays

Erectile dysfunction can be very distressing for men. Even with appropriate medical solutions, anxiety, fears, and the negative impact ED has on relationships can persist. Almost all men with organic ED will benefit from understanding more about the role their mind plays in the erection process.

Individual Guidance to Help you Resolve ED

You may want to speak with someone about how to make things better in bed. Individualized and specific guidance can be the difference between ED and getting the erection you want.

  • Every man is unique and the components contributing to ED do vary
  • A trained professional can help you identify and overcome factors you may have not considered or overlooked
  • Unlike medication, working on yourself as a way to address your ED can help improve your general well-being, relationships, and sexual pleasure in addition to erections

What is Sex Therapy?

Sex therapy is a specialized form of psychotherapy designed to help people resolve sexual issues including low desire, sexual dysfunction, and out of control sexual behaviors, among many other things.
Human sexuality is a complex experience and process. It is shaped by your thoughts, feelings, environment, society, and relationships. When things are not going well, sex therapy can help you address these issues and increase your sexual performance and pleasure.

Do I Need to See a Sexual Therapist?

It depends. Many therapists who work with individuals and couples will gain some skills around sexual processes, but they may not be experts. Sexuality is a part of the human condition and it affects everyone to some extent.

Some sexual issues can be resolved by addressing common underlying issues. If someone has low self-esteem stemming from a childhood issue, they may be able to positively influence their sexual issues through standard therapy. However, in many instances, sexual issues are more complex and are better addressed with someone who has an expertise or certification in specific areas of need.

How Sex Therapy Can Help Resolve ED

The process of gaining and maintaining a sufficient erection is complex. You need to optimize your physical body with lifestyle changes and proper medical treatment. In addition to a working body, a well-balanced mind and supportive relationships are important parts of the erection process.

Sex therapy helps you to identify and address the thoughts, feelings, beliefs, and relationship components that can impact your performance in bed. Whether you know it or not most erections start in the brain. Sex therapy helps you focus on addressing the mental, emotional, and relationship issues that may be affecting your erectile function.

How Long Does Sex Therapy Take?

One of the advantages of sex therapy is that it is specific and goal oriented. Clearly, reaching your goals will depend on your unique factors. Some men will make significant progress within a few short meetings. Other men will choose to work on enhancing their process and addressing more components to ensure sustainable outcomes.

With an issue as important as erections, you should not leave anything on the table

Your erectile dysfunction may have organic components to it but addressing the organic components alone can leave many potential benefits and solutions unaddressed. With an issue as important as erections, you should not leave anything on the table.

With a little investment in understanding the mental side of your ED, you can find a lasting solution that works best for you.


Mark Goldberg, LCMFT, CST

Mark Goldberg, LCMFT, CST

Licensed Sex Therapist
Center for Intimacy, Connection and Change

10751 Falls Rd. Suite 439
Lutherville, MD 21093