Interview with Mónica Dosil: on the psychology of erectile dysfunction

Psychologist Monica Dosil talks about the link between erectile dysfunction and the mind.

Erectile dysfunction is one of the most common sexual disorders, and its causes are not always purely psychological.and its causes are not always purely biological. Therefore, it is important to know the psychological factors that lead to its appearance and maintain it.

Interview with Monica Dosil: causes and psychological consequences of erectile dysfunction

On this occasion we talked to Monica Dosil, a psychologist based in Castelldefels with more than two decades of experience working in psychotherapy and sex therapy, to talk to us about the link between erectile dysfunction and the psychological.

To what extent does sexuality shape our identity?

Sexuality defines our life and also our identity. When you describe yourself, you do so in terms of tastes, hobbies, qualities and interests, but it is your sexuality that makes sense of it all. Sexuality is a state that encompasses all of our personality traits, an energetic quantum that implicitly and explicitly describes how we behave.

If you are a dedicated person in your personal or work relationships, you also behave in a dedicated way with respect to your sexuality, if you are an introverted person, and you reserve information or emotions, you are also an introverted person with respect to your sexuality.

We can affirm that sexuality shapes our identity, and this is fundamentally because it originates before the constitution of our way of being, and it is one of the bases on which the personality is built.

The eroticization that our body undergoes in its first moments of life when it is caressed and cared for generates the first experiences of pleasure, which will later be the germ of our more or less magnificent sexuality.

How does what we believe about ourselves, our self-esteem, affect us in the sexual sphere?

It is fundamental. If you feel good and confident you act accordingly, feeling free to develop naturally and boldly in the field of sexuality, if you feel insecure in the way you are. That is, if your self-concept is low, you will see it reflected in your sexuality.

Insecure people have difficulties in showing their bodies, they make love with the light off, they feel uncomfortable in some positions related to the sexual act, they do not want to be caressed in some parts of their body... In short, they cannot flow freely and their thinking, in some limiting way, has a direct impact on the pleasure they experience, as they try to manage to control all situations and cannot focus on enjoying their body or indulging in the art of giving pleasure.

Many people believe that erectile dysfunction is a purely medical problem. Is it common for its causes to be basically psychological?

It is true that there is a percentage of cases that have organic etiology, which is why the urologist has to make a priority function in ruling out organic pathology. The second step is to go to a specialist in sexology, who may be a doctor or a psychologist in his or her constitutive training, and it will be this professional who will assess the origin of the difficulty and program a treatment.

Erectile dysfunction, commonly and inappropriately called impotence, is the inability to achieve or maintain an erection firm enough to sustain full sexual intercourse. It is common for it to occur occasionally in men, and it is nothing to worry about.

It is when it begins to occur continuously that action must be taken, since it is then that it is considered a symptom, that is, the body manifests itself and indicates that something is happening. In addition, it is important to intervene in its resolution, as it produces undesirable consequences such as stress, lack of self-confidence and ultimately persistent decrease in sexual desire.

The psychological causes of erectile dysfunction are varied and sometimes it is a combination of physical and psychological issues. Regarding the psychological causes, it must be taken into account that the brain plays a key role in the activation of the physical events that cause erection, and that the first necessary factor is sexual arousal.

If for example you suffer from depression, the first thing that disappears in that circumstance is sexual desire, and then this will probably affect the ability to have erections.

The most common causes of erectile dysfunction are depression, anxiety and general mental health disorders. Stress is considered a combined case of physical and psychological origin. On countless occasions, relationship problems due to communication difficulties or any other type of discomfort in the relationship, also cause erection problems as a consequence.

In my private practice I observe on multiple occasions that infidelity, in the case of men, results in a high percentage of erectile dysfunction.

Is erectile dysfunction a problem that, when experienced first-hand, is reflected even in social relationships of any kind, however subtly? For example, in the tendency to appear insecure.

Of course. It is a situation that produces personality retraction.

It is common in social groups to find references to the sexual potency of men, in all kinds of more or less casual conversations. Being a man is related in the biology of the species as well as in our society with sexual potency. In the case of being affected by this dysfunction, the effect on self-esteem is total.

Every time life expectancy increases in human beings, and other relevant circumstances such as the physical decline resulting from the years lived give as a consequence, in men, a decrease in their ability to maintain an erection.

It is important not to reinforce this situation with an excessive concern about this experience, since the good news is that there is always a solution.

In our society, sexual conversations happen regularly, the man who suffers from these difficulties is ashamed and tries to conceal the situation, hiding it and pretending to be normal.

Then, flaws begin to appear in his personality, which in principle were not happening, such as incapacitating stress caused by the problem situation.

Does this problem also affect the way in which this sexual dysfunction is perceived? For example, if it affects self-esteem, the person may believe that it is something that has no solution and that it is part of his or her body.

This is true. It is true that in many cases men present erection difficulties since adolescence and, as this person has always experienced this reality, he ends up thinking that he is like that and that what happens to him is normal, so he does not expect any improvement and does not ask for help. It is then that resignation to the problem appears.

In the man who begins to suffer this situation later on is the one who fears that it is irreversible and begins a process of resignation.

This type of sexual difficulties are consulted to us, the professionals of sexuality, after a long time of evolution, this is what hinders the recovery, since the nervous system gets used to the previous and usual situation.

In the end, shame is what makes the person unconsciously choose to resign himself rather than tell his trusted doctor or anyone else who can encourage him to find a solution.

How can psychologists intervene to treat erectile dysfunction?

Psychological treatment has been shown to be highly effective in this type of case. First of all, the personality profiles that tend to be affected by impotence are particularly perfectionist. These people are so busy doing things so well that they are disconnected from their own desire, and are even overly concerned with the pleasure of their sexual partner.

Obviously, this does not happen to all perfectionists, but only to those who have great difficulty in managing their anxiety. Depression and anxiety are the major causes of impotence, when you suffer from these symptoms is when it is time to intervene from psychotherapy.

Sometimes, people have depressive symptoms and are not even aware of it. Realize that not all depressions are caused by not being able to get out of bed, there are many people who suffer from subclinical depressive symptoms, which go unnoticed, because they do not show their face.

The psychologist offers specific exercises and tools such as relaxation exercises, cognitive restructuring and others, always with the aim of eliminating the irrational thoughts that limit the man suffering from the disorder. The treatment is definitely effective, and it is important to keep in mind that it requires a lot of personal work and daily effort. It is like going to the gym, it requires dedication and exercise routines.

In too many occasions people expect the changes to be made by the sexology professional, but it is the person who comes to consultation who has to start training his mind daily to achieve noticeable and profitable changes.

If the man with erection difficulties sets himself the goal of achieving it and puts all his efforts into it and provides himself with a good orientation, be sure that he will achieve it.

As a result of the work, the person will obtain longer lasting erections, prevention of incontinence, more pleasurable ejaculation, and the ability to delay ejaculation. These are all obvious improvements that are the result of the effort in recovering from erectile dysfunction.

How does recovery occur and how long does it take to achieve improvement?

Recovery occurs progressively, and the focus should always be on improving cardiovascular flow. A clean diet of inappropriate fats and an exercise routine of approximately 30 minutes a day will be essential.

The exercises have to be oriented to cardiovascular activity, to improve the circulatory flow, in addition to incorporating in your daily life the Kegel exercises, which are an exercise routine for the pelvic floor. These are exercises for the Pubococcygeus muscle (PB) which is located between the anus and the testicles. When the PB is exercised, a better Blood circulation is achieved in the whole area that covers the pelvis.

As stress and complex emotional processes affect the erection, psychology works to manage the levels of emotional pressure to which the person submits himself. to which the person subjects himself.

The management of anxiety and stress with competence is possible, and produces excellent effects in the improvement of this difficulty. The more you train the sooner you improve!