There are many causes for ED. In this chapter we will help you understand the complexity of what can at first look like a fairly clear-cut and straightforward problem. You will need to look deeper than simply observing what is going wrong with your penis. Real-life problems are rarely simple, easy to solve, or magically fixed, in spite of quick-fix promises.
While the experience of ED is pretty much the same for all men – difficulty getting or keeping an erection sufficient for intercourse – there are actually ten different types of ED. Causes of ED fall within four general groups: physical, psychological, relational causes, and those stemming from psychosexual skills deficits.
In addition to understanding the multiple causes of ED, it is important to appreciate that ED is multidimensional. There is an interaction between the physical, psychological, relational, and psychosexual skills dimensions. For example, ED that results from a vascular problem (physica1) may influence your self-esteem (psychological), affect communication with your partner (relational), and even influence your feelings about work (psychological). This intermingling and intertwining of the facets of our personalities and lives is normal. There is also a subtle intermingling of your and your partner’s thoughts, feelings, and behaviors which adds to the complexity. This is why ED can feel so confusing, so difficult to sort out.
It’s not just the causes and dimensions of ED that are complicated. The effects or consequences are complicated too. ED can have a devastating impact on your self-esteem, your sex life, and your relationship. These effects, in turn, make ED worse. It’s a vicious cycle.
In this chapter we will help you understand all of the possible causes of ED and explain the multiple dimensions that can make ED seem so confusing, as well as illuminate the negative effects that ED may have on you and your relationship. The psychological and relational features are particularly complex and intertwining, so we’ll offer you a model to help you understand how these dimensions fit together and how to develop a change plan. Then, in chapter 5, we’ll help you determine the causes of your ED so that you’ll be prepared to develop a comprehensive and effective approach to remedy your ED.
The “Big Four” types and causes of ED
ED may be caused by extensive and complicated factors or by subtle and seemingly insignificant ones. While there may be one cause for your ED, commonly there are several occurring simultaneously to produce and maintain ED, with reverberating effects on your personal well-being as well as your relationship.
To help you understand the possible causes of your ED, we’ll consider the “big four” groups. The physical group of causes includes physiological system problems, medical illnesses, physical injuries, personal lifestyle risks, and drug side effects. The psychological group is composed of psychological system characteristics and individual psychological distresses. The relatioall group involves difficulties in relationship identity, cooperation, and emotional intimacy. In the psychosexual skills group, ED results from a lack of cognitive, emotional, or behavioral skills or from using these skills ineffectively. Be aware that what may cause or maintain your ED may also be an effect of it. For example, distressing relationship conflict may cause ED, but it may also be a consequence of ED caused by another factor.
In classifying rhe types and causes of ED, it is helpful to distinguish two dimensions of ED: the onset and the context. The onset of ED distinguishes between lifelong (“primary”) and acquired (“secondary”). The vast majority of ED experiences are acquired; that is, ED develops after a period of satisfactory erections. The context of ED distinguishes between global (occurring in all situations, including masturbation, and with all sexual partners) and situational (occurring in some situations but not others: for example, with a partner but not during masturbation, with one partner but not another, or during intercourse but not oral sex). These two features – onset and context – will help you sort out what type of ED you have.
ED with Another Sexual Dysfunction (Mixed ED)
ED coexists with another sexual dysfunction (such as low sexual desire, premature ejaculation, or ejaculatory inhibition) about one-third of the time (Loudon 1998) and can reflect a combination of physical and psychological causes. For example, a vascular cause for ED may combine with psychological and relationship distress to create a loss of sexual desire. Occasionally, men try so hard to prevent premature ejaculation that they unintentionally cause ED, which can lead to inhibited sexual desire. Treating the premature ejaculation can, in turn, help resolve the ED. In addition, your reaction to your partner’s sexual dysfunction (such as low sexual desire, inhibited arousal, sexual pain, or nonorgasmic response) can cause or exacerbate your ED.