Psychological Erectile Dysfunction Treatment Effectiveness
NOTE: There's a fair amount of overlap between some of these approaches (i.e. you might work with a sex therapist who uses cognitive behavioral techniques). As much as possible, we've broken them into distinct categories based on the supporting research.
Cognitive Behavioral Therapy (CBT)
CBT focuses on restructuring negative thinking and behaviors associated with psychological ED. Therapists work with guys to identify and challenge their irrational beliefs related to performance, intimacy, and self-worth.
Benefits
By altering negative thought processes, guys can reduce performance anxiety. Ideally this improves sexual confidence and function.
Pros
Structured and straightforward. Usually covered by insurance.
Cons
Some guys will say they can deliberately think about things differently, but they don't feel any different.
Effectiveness
CBT is effective for resolving psychological ED. A 10-session CBT program that focused on enhancing communication between partners, increasing sexual skills, and reducing sexual anxiety, found that ED decreased by 50% by the end of the program (5). Another study showed that CBT completely resolved ED for 41.7% of men and largely resolved it for a further 27.8% (6).
Sex Therapy
Specialized sex therapists offer education and strategies to improve guys' sexual experiences. Usually they emphasize improved communication and intimacy within relationships as a way of reducing performance pressure. They often suggest specific exercises for enhancing arousal and intimacy.
Benefits
These practices help guys get into a better emotional state for sex that results in better performance.
Pros
Tailored approach. Good mix of therapy and coaching. Therapist who specializes in these types of issues.
Cons
Can be challenging to a qualified therapist. Cost/time. May require partner participation.
Effectiveness
Sex therapy is gaining greater recognition as an effective treatment for psychological ED. One study found that 67% of guys suffering from ED were satisfied with their improvement when assessed 6 months to 6 years after treatment (14). The results from another study (15) on young men (average age 31 years), showed sex therapy to be equally as effective as Viagra for the treatment of ED, with sex therapy providing the additional benefit of a reduction in anxiety.
Hypnotherapy
Hypnotherapists use a number of techniques to help guys resolve their ED. Some involve delving into subconscious issues that could be affecting their sexual performance. Others can involve building on psychological strengths and challenging/resolving limiting beliefs.
Benefits
By addressing emotional barriers and fostering healthier coping mechanisms, psychotherapy improves overall well-being, indirectly impacting sexual function.
Pros
Fast and particularly effective at identifying and resolving deeper issues.
Cons
Challenging to find a qualified practitioner with ED client experience. Can be costly.
Effectiveness
Hypnosis is a well-established treatment for psychological ED. One study found that an average of just 5 sessions was sufficient to get the symptoms under control and a year after completing the treatment, 87% of patients no longer suffered from ED (7). The results of a similar study showed that all the patients who completed their course of hypnotherapy were able to perform sexually at the time of their discharge (8). In the follow up, all but 2 patients stated that they were doing well.
Mindfulness and Relaxation Techniques
Mindfulness practices for ED teach guys how to be present in the moment. Therapists teach deep breathing exercises, progressive muscle relaxation, and guided imagery help guys reduce anxiety.
Benefits
These practices help guys get into a more relaxed state for better sexual function and improved overall well-being.
Pros
Pleasant and relatively easy to learn. Learnings can apply in many areas of life.
Cons
The techniques aren't "strong" enough to make a difference for many guys.
Effectiveness
Mindfulness-based therapies are being used increasingly to treat ED. One study found that men with ED reported significant improvement in sexual function after attending a four-week program that included education about ED, psychological counseling, and mindfulness meditation (9). Mindfulness has been shown to benefit ED in a number of ways. These include improving overall sexual satisfaction, self-esteem, arousal, desire, and non-judgmental observation of one’s own experience, while reducing the anxiety associated with sexual activity (9,10,11).
Apps
Apps like Mojo and Lover offer the same type of information and exercises a sex therapist would give a guy with erection issues. All the tools are based on the idea that if your brain can relax, your body can get an erection.
Benefits
Ideally the same as sex therapy: a better emotional state for sex that results in better performance.
Pros
Inexpensive and convenient.
Cons
Lack of tailored approach makes it "not enough" for some guys.
Effectiveness
Technology-based interventions provide effective, easily accessible evidence-based treatment. A study employing a smartphone app to target the psychological causes of ED, found that 33.3% of the guys who completed the treatment had a significant improvement in erectile function and 66.7% in intercourse satisfaction and overall satisfaction (16).
Viagra & Cialis
Drugs like Viagra and Cialis (a class of drugs called type 5 (PDE5) inhibitors don't directly treat the psychological causes of ED, but for some guys, knowing that they have an "insurance policy" will increase their confidence and reduce their anxiety. Less anxiety usually means better erections.
Benefits
Sometimes giving the physical side of an ED issue a significant boost can be enough to positively affect the psychological side.
Pros
Can be a confidence booster.
Cons
Doesn't address any of the underlying mental/emotional drivers to the problem. If the mental side of the issue is significant, the drugs won't work.
Effectiveness
Viagra and Cialis are a type of medication known as phosphodiesterase type 5 (PDE5) inhibitors. These are used to treat ED by enhancing the blood flow to the penis. One study found that guys suffering from psychological ED who received Viagra, experienced a significant improvement in the frequency, hardness and duration of erections, and greater enjoyment of sexual intercourse and satisfaction with their sex life (17). Another study (18) showed that PDE5 inhibitors can be used in cases of psychological ED to reduce failure anxiety and increase self-confidence as a first step to regain control over their erectile function. However, while such medications treat the symptoms of psychological ED, i.e., restore erection, they do not address the underlying psychological causes (18).
Acupuncture
If an acupuncturist believes stress and emotional issues are helping to drive a patient's erectile dysfunction, they may incorporate counseling both with the patient and with the patient’s partner, if applicable.
Benefits
Stress reduction, improved blood flow, hormonal balance.
Pros
Holistic approach. A way giving support to a guy's underlying physical state along with, potentially, some counseling.
Cons
Variable results - not everyone responds well to acupuncture. Usually considered an adjunct treatment rather than a standalone approach.
Effectiveness
Acupuncture is one of the most effective and commonly used complementary and alternative medicine approaches for treating ED, and has been approved by the World Health Organization. The results of one study showed that after an average of 11 treatment sessions, 68.4% of patients suffering from psychological ED could obtain a full erection without further therapy (12). Similar results were achieved in another study, which showed a 60% success rate (13).
Group Therapy
Group therapy for psychological erectile dysfunction (ED) involves a group of men who have ED coming together under the guidance of a professional therapist. .
Benefits
The chance to share experiences, discuss common issues, and learn from each other’s coping strategies.
Pros
A supportive environment, lots of perspectives, not feeling so alone with the problem.
Cons
Effectiveness varies (hard to tell in advance who it will/won't work for), privacy concerns, time commitment and variability of group dynamics. Higher dropout rate than traditional therapy.
Effectiveness
Preliminary data suggests group therapy is effective in treating psychological ED. A meta analysis of studies showed that group therapy improves ED in selected patients. 95% of participants had some kind of benefit. Guys who received group therapy plus sildenafil showed more improvement than guys doing just the drug. Another study found that behavioral sex therapy was effective for treating a range of sexual dysfunctions. However, more research is needed to confirm these findings and determine which group therapy interventions are most promising.
Couples Therapy
Couples therapy focuses on improving communication between partners. Open, honest discussions about feelings, desires, and concerns can help reduce anxiety and tension, which might be contributing to ED. It might involve examining past experiences, conflicts, or expectations that might be affecting intimacy.
Benefits
In some cases, exploring the causes of psychological ED within the relationship can be crucial.
Pros
If the problem is relationship driven, it's a highly effective way to solve the problem.
Cons
If the relationship isn't the driver for the ED, couple's therapy isn't going to help much. Emotional vulnerability.
Effectiveness
No data. We couldn't find any studies that indicated anything one way or another.
Coaching
Coaching for psychological ED involves an action and goal-oriented approach to help individuals resolve ED. Usually it involves identifying triggers, setting goal, behavioral technique, improving communication skills and accountability and support.
Benefits
Structured and goal-driven method of resolving psychological factors contributing to ED.
Pros
Personalized strategies, focused approach, practical tools and techniques.
Cons
Not covered by insurance. Not regulated.
Effectiveness
No data. We couldn't find any studies that indicated anything one way or another.
Psychoanalysis
Techniques
Psychoanalysts help guys delve into emotional conflicts that could be affecting their sexual performance. They explore past experiences, traumas and/or relationship dynamics that impact guys' sex lives.
Benefits
By addressing emotional barriers and fostering healthier coping mechanisms, psychotherapy improves overall well-being, indirectly impacting sexual function.
Pros
Good way of addressing the "root cause" of the issue.
Cons
Timelines can be long and it can be expensive.
Effectiveness:
No data. We couldn't find any studies that indicated anything one way or another.
