How can psychogenic erectile dysfunction be managed?

Question

Hello doctor,

I have been married for the past six years, but due to job location reasons, I have only spent approximately two years with my wife during this period. My wife has now requested a divorce due to the inability to engage in vaginal intercourse over the course of these six years. I have undergone several tests, including semen analysis, erectile dysfunction assessments, and testosterone level evaluations. Additionally, I do not experience premature ejaculation.

Despite this, I encounter difficulties when attempting vaginal penetration, as my penis tends to bend at the tip. I find that I am able to achieve an erection more readily during masturbation compared to intercourse. At the age of 35, I am still a virgin and am unsure whether my erection is adequate for penetration. My erections do not sustain for a prolonged period during attempts at intercourse, which has led to a loss of confidence in my ability to engage in sexual activity. Since my wife has left, I am unable to make further attempts to address this issue at home.

Please guide me.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern regarding the ongoing issues with your sexual life.

After reviewing all the relevant information (attachments removed to protect the patient’s identity), it is not possible to provide a definitive diagnosis. However, based on the available description, it appears that you are experiencing erectile dysfunction. The inability to sustain an erection during intercourse and the bending of the penis at the base during attempted intercourse suggests a problem.

Nonetheless, the presence of morning erections, normal biological reports, and the ability to achieve successful erections during masturbation indicate that the issue may be psychogenic rather than organic. Given these observations, I recommend consulting a psychiatrist without delay, as the problem seems to be psychogenic erectile dysfunction. I understand that you may have lost confidence, but I want to assure you that the issue is largely treatable. With the advances in medical care, there is little cause for concern. In my experience, more than 80 percent of individuals with psychogenic erectile dysfunction experience significant improvement after a few sessions of psychotherapy.

I hope this helps you.

Thank you.