Urologist and pelvic surgeon Dr. Rena Malik creates educational content on her YouTube channel that she hopes will help people enjoy a safe and healthy sex life. In a new video, she tackles a particularly sensitive subject: erectile dysfunction. While there can be a number of physiological issues that can cause erectile dysfunction, Malik adds that psychological factors can also contribute to this issue.

She begins by categorizing the three different types of erection: reflexive, caused by physical stimulation; nocturnal, occurring during sleep; and psychogenic, provoked by a mental image or a desire. As Malik explains, mindset is just as important as hormonal and neurological components when it comes to getting and maintaining an erection.

“Psychogenic erectile dysfunction is the inability to achieve or maintain an erection during sex due to psychological factors,” she says. “These can include things like self-esteem, depression, anxiety, relationship issues… In fact, mental health issues and erectile dysfunction are very often linked.”

Malik cites studies that have shown that people with erectile dysfunction are disproportionately more likely to also struggle with depressive symptoms and emotional stress. As for whether depression causes erectile dysfunction or vice-versa, she says it can go both ways: a depressed person may have a reduced libido and find it difficult to connect with their partner, or someone suffering from erectile dysfunction can end up feeling depressed as a result of its impact on their sex life.

If erectile dysfunction has become a sudden and recent problem, that’s also a clue that the cause may be psychological, adds Malik. “While people who have medical causes of erectile dysfunction, it usually happens more gradually.”

A common treatment for psychogenic erectile dysfunction is cognitive behavioral therapy (CBT), which focuses on understanding, managing, and reframing the individual’s expectations for sex. Another option is sex therapy with sensory focus exercises, which focus on the pleasure of touch outside of the expectation of sex. And finally, if ED is caused by a mental or mood disorder, Malik explains that psychiatric treatment for these conditions may become necessary.

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