Is your ED Physical or Psychological?

When a guy calls me for help, I always start the conversation with these questions: 

#1: Have you talked to your doctor?  I don't want to work with a guy who hasn't seen a doctor.   ED can be a sign for some pretty serious health issues - diabetes, heart issues, hormonal problems...it's a long list.  So don't mess around.  Talk to your doctor, make sure you're 100% healthy. 

If someone's got the 'all clear' from their doctor, 

#2 the number two thing I want to know is: Do you wake up with erections?  If your morning wood is consistent, good chance your ED is psychological.

#3  The third thing I ask is: Do you get good strong consistent erections when you're alone.  If you can masturbate and you're 100% fine, there's a good chance your ED is psychological.  

If the answer to those three questions is yes, chances are the ED is psychological.  They're someone I can probably help, I'd be willing to take them on as a client. 

The textbooks get a little more technical.  The Diagnostic and Statistical Manual of Mental Disorders, the book psychologists and psychiatrists use to diagnose psychological issues, uses this as criteria: 

"A marked difficulty in attaining or maintaining until completion of sexual activity an erection or a marked decrease in penile rigidity on all or almost all sexual occasions that persists for a minimum duration of approximately six months, causing significant distress in the individual."

So they define it as having to go on for six months or so before they'll give it as a diagnosis.  But from what I read, they don't get specific about the distinction between physical and psychological.

The book Coping with Erectile Dysfunction has a pretty extensive set of questions...dozens of them.  They get really specific about the type of ED they guy experiencing - 

First for the potential physical issues-

• medical illness
• physical system
• physical injury
• lifestyle issues
• drug side-effects

Then for the potential psychological ones...

• psychological system ED
• psychological distress ED
• psychosexual skills ED
• relationship distress ED

If you want to get a really clear sense of what type of ED you have according to a couple of sex therapy experts, that book would be a good source for you.  But if you just want a quick sense of if it's physical vs. psychological, it might be more than you need.

From a practical standpoint, I think most guys probably just want to get it solved. If it's a physical issue or illness they want medical treatment.  If it's a psychological issue, they want to know it so they can find  an app, a book, a course, a therapist or someone like me to give them some help in getting it solved.