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Is Your Erectile Dysfunction Due to Mental or Physical Reasons

    Many men experience erectile dysfunction sometime in their life. In fact, anywhere between 5-20% of men experience it (that they've admitted to) in their lifetime. Yet, for some reason, it seems to be considered a mark of shame on one's manhood. That's nuts (no pun intended). There is nothing wrong with having ED, and we've discussed many ways to combat the problem itself. According to Dr. Joel Block, our resident erectile dysfunction expert (with over 2 decades medical training), the first step is to identify the problem. Where does this problem come from, anyway? Is it a mental or physical issue. Curious? Read on!

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    If you have concerns about your erections, ask yourself the following questions. Before you seek help it is important to determine the origin of your condition:

    1. Do you have an erection at least once a week when you wake up in the morning?

    The answer to this question is important because it indicates whether your problem is psychological or physical. In an investigation conducted at the University of Chicago's Sexual Dysfunction Clinic, 32 men who said they were suffering with ED were asked about morning erections. They were also given a thorough urologic examination. Of the men whose exams indicated psychogenic (psychologically based) ED, 86% reported having morning erections.

    In contrast, 100% of men who were found to have an organic (physical) basis for ED did not have morning erections. If you frequently have morning erections, or nocturnal erections—it is often incorrectly assumed that these are related to a need to urinate-your problem is most likely psychogenic in nature.

    2. Are you able to get an erection firm enough for intercourse under some circumstances—for example, during masturbation or with a different partner?

    Your answer to this question distinguishes between situational and global erection disorders. A man with a situational disorder can get an erection in some circumstances but not in others. For example, if you are able to stimulate yourself to erection, you are capable of having an erection with your partner and your problem is situational. If you are unable to get an erection under any circumstances your problem is global.

    3. Did something in particular happen in your life that seems to have triggered your erection difficulties?

    If your erection difficulties started at the same time you began a new job, moved, retired, or lost a loved one, your problem is likely to be caused by stress. Sometimes when ED persists for several months after the triggering event, you can be caught in a self-perpetuating cycle of erectile failure: Stress leads to erection failure, the episode of ED creates anxiety, and this leads to another failure. Anxiety and the anticipation of failure interfere with sexual responsiveness.

    4. Do you get a firm erection but usually lose it when you attempt to penetrate for intercourse?

    If you are getting sufficient stimulation, that loss of firmness may signal a slowly developing physical problem. Poor diet, sedentary lifestyle, heavy smoking or drinking, and other behaviors may be catching up with you. But the abrupt loss of a firm erection on penetration may also indicate a psychological conflict. If this happens frequently, have a urological examination to eliminate any physical cause before you begin looking at personal and relationship issues. Gradually losing your erection after several minutes of intercourse is not a cause for concern. You may be tired, or you may need to vary your sexual routine.

    5. Can you feel mentally aroused even if you have trouble with erections?

    Almost every man has had some period in his life when he didn't feel his normal desire for sex. In most cases, this is temporary, and desire soon returns. When loss of desire persists, look for an underlying psychological cause. Stress, fatigue, boredom, fatigue are all possibilities.

    These questions can help you evaluate your situation and determine if the erectile dysfunction problem is more physical or psychological. They can also be used as talking points to open a discussion with your partner. Your erection problems affect her too. So keep those lines of communication open, and try not to assume the worst.

    Joel D. Block, Ph.D., is an award-winning psychologist-excellence in couple therapy-practicing couple and sex therapy on Long Island, New York. Board Certified in Couple therapy by the American Board of Professional Psychology, Dr. Block is a senior psychologist on the staff of the North Shore-Long Island Jewish Medical Center and an Assistant Clinical Professor (Psychology/Psychiatry) at the Hofstra North Shore-LIJ Medical School.

    For 20 years he was the training supervisor of the Sexuality Center at Long Island-Jewish Medical Center. Dr. Block is the author of over 20 books on Love and Sex, his specialty. Check out for more information.

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