Understanding Erectile Dysfunction: A Compassionate Guide for Men and Couples
You're not broken. You're not alone. And there's a path forward.
By Adrian Scharfetter, Licensed Marriage and Family Therapist & Certified Sex Therapist
Introduction: You're Not Alone
If you're reading this, chances are you or someone you care about is dealing with erectile dysfunction (ED). Maybe it's happened once or twice and now you're worried it'll happen again. Maybe it's been going on for a while and you're feeling frustrated, ashamed, or even hopeless.
First, let me say this clearly: You are not broken.
ED is incredibly common, more common than most people realize. It affects men of all ages, backgrounds, and relationship statuses. And while it can feel isolating and scary, it's also treatable, understandable, and often improvable with the right support.
This guide is here to help you understand what's happening, why it's happening, and what you can do about it. Whether you're dealing with this alone or with a partner, my hope is that by the end of this guide, you'll feel less shame, more clarity, and ready to take the next step toward feeling like yourself again.
Let's dive in.
What Is Erectile Dysfunction?
Erectile dysfunction is the persistent difficulty getting or maintaining an erection firm enough for sexual activity. Notice the word persistent, having trouble once in a while is completely normal. ED becomes a concern when it's happening regularly and causing you distress.
Some important things to know:
It's not just "in your head." ED can have physical, psychological, and relational causes, often a combination of all three.
It's not a reflection of your masculinity. Your worth as a man, partner, or lover is not determined by your erections.
It's treatable. Most men see improvement with the right approach, whether that's medical support, therapy, lifestyle changes, or a combination.
What Causes Erectile Dysfunction?
ED doesn't have just one cause. It's usually a mix of factors. Here are the most common:
Physical Causes
Cardiovascular issues: Poor blood flow to the penis (often linked to heart disease, high blood pressure, or high cholesterol)
Diabetes: Can damage nerves and blood vessels
Hormonal imbalances: Low testosterone or thyroid issues
Medications: Some antidepressants, blood pressure meds, and others can contribute
Neurological conditions: MS, Parkinson's, spinal injuries
Substance use: Alcohol, smoking, and recreational drugs can all impact erections
Obesity and lack of exercise: Affect circulation and hormone levels
Sleep disorders: Poor sleep impacts testosterone and overall health
Psychological Causes
Performance anxiety: Worry about "failing" creates a self-fulfilling cycle
Stress and overwhelm: Work, finances, life pressure
Depression and anxiety: Mental health struggles directly impact sexual function
Relationship issues: Unresolved conflict, lack of intimacy, or communication breakdowns
Past trauma: Sexual trauma or negative sexual experiences
Body image or shame: Feeling disconnected from or critical of your body
Relational Causes
Lack of emotional connection: Feeling distant from your partner
Unspoken resentment or hurt: Unresolved issues showing up in the bedroom
Mismatched desire: Different levels of interest in sex
Communication breakdowns: Not talking openly about sex, needs, or fears
Often, it starts with a physical issue (like stress or a medication), then performance anxiety kicks in, which makes it worse, which increases the anxiety, and the cycle continues.
The Shame Spiral (and How to Break It)
Here's what happens for a lot of men:
You have trouble getting or keeping an erection.
You feel embarrassed, ashamed, or "less than."
You start worrying it'll happen again.
The worry creates anxiety, which makes it more likely to happen again.
You start avoiding sex altogether to avoid the disappointment.
The distance grows. The shame deepens. The cycle continues.
This is the shame spiral. And it's one of the biggest obstacles to healing.
Breaking the cycle starts with this truth: Erections are not the measure of good sex, intimacy, or your worth as a partner.
When you can separate your self-worth from your sexual performance, everything shifts. That's where real healing begins.
Redefining Sex Beyond Erections
One of the most important shifts you can make is expanding your definition of sex.
Sex is not just penetration. It's not pass/fail based on whether you get hard or stay hard.
Sex can include:
Touch, massage, sensuality
Oral sex
Manual stimulation
Emotional intimacy and presence
Pleasure for its own sake, not just toward a goal
Play, experimentation, curiosity
When you stop making erections the centerpiece of intimacy, two things happen:
The pressure comes off, which often helps erections return naturally.
You discover new ways to connect, give pleasure, and feel good that don't hinge on performance.
Many couples find that working through ED actually deepens their intimacy because it forces them to communicate, explore, and prioritize connection over mechanics.
What You Can Do Right Now
1. Talk to Your Doctor
Get a full checkup. Rule out or address any underlying physical causes (heart health, diabetes, hormones, medications). This is essential and not something to skip.
2. Reduce Performance Pressure
Try taking penetration off the table for a bit. Focus on pleasure, touch, and connection without the goal of an erection. This can help reset your nervous system.
3. Talk to Your Partner (If You Have One)
Silence makes shame worse. Sharing what's going on, even if it's scary, creates space for support, understanding, and teamwork. Your partner likely wants to help, not judge.
4. Address Mental Health
If you're dealing with anxiety, depression, or trauma, treating those directly will often improve sexual function. Therapy can be a game-changer here.
5. Make Lifestyle Changes
Move your body regularly (exercise improves circulation and mood)
Eat well (heart-healthy diet supports erectile function)
Reduce alcohol and quit smoking
Prioritize sleep
Manage stress through mindfulness, therapy, or other practices
6. Consider Sex Therapy
A sex therapist can help you navigate the emotional, relational, and psychological aspects of ED. We don't just treat the symptom—we help you understand what's underneath it and rebuild confidence, communication, and connection.
Common Myths About ED
(Let's Bust Them)
Myth: ED only happens to older men.
Truth: Men of all ages experience ED. Younger men often deal with performance anxiety, stress, or porn-related issues.
Myth: If you have ED, you're not attracted to your partner.
Truth: ED is rarely about attraction. It's usually about stress, anxiety, health, or relational dynamics, not desire.
Myth: You just need to "relax" or "get out of your head."
Truth: While anxiety plays a role, ED is complex. Telling someone to relax rarely helps and can add to the shame.
Myth: Medication (like Viagra) is the only solution.
Truth: Medication can help, but it doesn't address underlying causes. Therapy, lifestyle changes, and relational work are often just as important.
Myth: ED means the end of your sex life.
Truth: Absolutely not. With support, most men find their way back to satisfying intimacy, and often discover it's richer than before.
When to Seek Help
You don't have to wait until things are "bad enough" to reach out for support. If ED is:
Happening regularly
Causing you distress or shame
Affecting your relationship or self-esteem
Making you avoid intimacy altogether
...it's worth talking to someone.
Start with your doctor to rule out physical causes. Then consider working with a sex therapist who specializes in ED. We create a shame-free space to explore what's happening, build skills, and help you reclaim confidence and pleasure.
A Final Word: There's Hope
ED can feel like the end of something. But for many men and couples, it becomes the beginning of something better, deeper communication, more authentic intimacy, and a healthier relationship with sex and self.
You don't have to carry this alone. You don't have to stay stuck in shame. And you don't have to let erections define your worth or your sex life.
There's a path forward. And I'm here to walk it with you.
Next Steps
Ready to talk?
If you're struggling with ED and want compassionate, expert support, I'd love to help. Reach out to schedule a consultation, and let's start building a plan that works for you.
Want to learn more?
I recommend reading Coping with Erectile Dysfunction by Michael E. Metz, Ph.D. and Barry W. McCarthy, Ph.D.—it's the best resource out there for understanding and healing ED.
Have a partner?
Share this guide with them. Healing happens faster when you're working together.
Dr. Adrian Scharfetter PhD, LMFT CST
628-400-6362
www.atheniancounseling.com