Redefining Masculinity: A Psychotherapeutic Perspective on Erectile Dysfunction

Written by: Grace Dominguez

Edited by: Christy Qu

Approximately 30 million males in the United States are affected by erectile dysfunction (ED) most often caused by medication intake, rising age, or pre-existing health conditions (Definition & Facts for Erectile Dysfunction, 2017). The most common treatment of ED is medication, however, individuals with ED often face a multitude of obstacles in attaining the necessary medication. In addition to drug accessibility, efficacy issues, and financial constraints, there are a lot of societal stigmas that may prevent them from seeking treatment. Oftentimes patients with ED report feeling less masculine and a sense of “depreciating manhood” (Hart, 2021). These stigmas result from societal beliefs that men should be the initiators of sexual activities and are expected to perform them successfully and adequately. The assistant Editor for Urology Times spoke with Dr. Arthur Burnett who states that the social ideas of weakening manhood and diminishing masculinity are major problems that must be addressed (Hart, 2021). Dr. Burnett also states that negative stigmas surrounding sexual dysfunction often hinders individuals from continuing or receiving treatment at all. 

One solution to combating the maladaptive feelings and beliefs that develop in individuals with ED is the utilization of psychotherapy techniques. Psychotherapy is “a healing practice that involves the relationship as the vehicle by which the treatment is administered” (Wampold, 2014). This means that psychotherapy emphasizes interpersonal relationships between the therapist and the client, in a social context, to deliver treatment methods. Additionally, it can be effectively utilized with or without medication. The most common technique a psychotherapist will use during such a session is education. Helping clients understand their physiological and psychological experiences not only helps them better understand their body and brain, but also provides greater insight into their own experiences and  allows them to adapt and make beneficial changes to their daily life.

Sensate focus, a technique used to improve intimacy, can also be successfully utilized by psychotherapists to treat ED. The goal of sensate focus is mindful and sensorial absorption for oneself, not for any particular response including sexual arousal (Trapnell et al., 1996). During this treatment clients undergo exposure therapy, in which both partners initiate non-sexual contact while focusing on and feeling the sensations. Each touch is attended to mindfully without any concern for sexual response or arousal. Psychotherapists also help patients identify cognitive affective patterns to address fears of inadequacy. This fear distracts the individual from the sexual interaction and instead refocuses their attention on what is expected of them as a sexual partner. This behavior is also known as spectatoring (Trapnell et al., 1996). Identifying and addressing cognitive affective patterns in clients, the psychotherapist is able to improve the individual's quality of life by effectively reducing anxiety, distractions, and self-monitoring behavior during sexual activities. 

Erectile Dysfunction, in accompaniment with societal stereotypes and stigmas, affects millions of men in the United States, and the mere presence of this ailment often exacerbates feelings of diminishing masculinity. It is critical to combat these maladaptive beliefs and emotions to enhance the quality of life of individuals with ED and encourage treatment-seeking behaviors. Psychotherapy is an invaluable method of treatment, on its own or as an addition to medications. This method provides clients with techniques and practices such as education, sensate focus, and cognitive-affective pattern identification to help individuals gain confidence and greater understanding of their condition, and thereby learn how to better manage it. This not only fosters healthier interpersonal relationships, but also healthier intimate relationships. Overall, through the acceptance of psychotherapy, a multidimensional approach that combines medical and psychological treatments, we can encourage individuals with ED to reclaim agency over their sexual health.

References:

Hart, J. (2021, October 27). The stigma of depreciating manhood in men with sexual dysfunction. Urology Times. Retrieved from https://www.urologytimes.com/view/the-stigma-of-depreciating-manhood-in-men-with-sexual-dysfunction 

National Institute of Diabetes and Digestive and Kidney Diseases. (2017, July). Definition & Facts for Erectile Dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts

Trapnell, P. D., Meston, C. M., & Gorzalka, B. B. (1996, October 28). Spectatoring and the relationship between body image and Sexual Experience: Self-Focus or Self-Valence?. JSTOR. Retrieved from https://www.jstor.org/stable/3813386?seq=1 

Wampold, B. E. (2021, June 10). Healing in a social context: The importance of clinician and patient relationship. Frontiers. Retrieved from https://www.frontiersin.org/articles/10.3389/fpain.2021.684768/full