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Strategies, Techniques, and Helpful Information for Erectile Dysfunction

At Arise Counseling, we work with a number of males clients struggling with erectile difficulty or erectile dysfunction. Struggling with arousal or erections can be a very isolating experience, especially as this is not a common topic among men. Several of the men I have worked with often are surprised when they hear that many men struggle with arousal and erections, even before the age of 40. Unfortunately, there many misconceptions about male arousal and erections, leading to isolation and shame.

If you find you are struggling with erectile difficulties (also referred to as erectile dysfunction), it may be beneficial for you to work with an experienced therapist who can help you with the psychological and relational factors that may be contributing to the issue. Typically, there are several factors that can influence arousal, and having someone who is specialized and can provide a clear road map for you is essential to finding the outcome you’d like. Our therapists are open, positive, and specialize in working with men who struggle with arousal.

Below you’ll find 20 guidelines regarding arousal and erectile difficulty. These have been adapted from a paper published by Dr. Barry McCarthy (2001), titled “Relapse Prevention Strategies and Techniques with Erectile Dysfunction.

1. It is normal for men to experience erectile failure at least once by the age of 40. Statistics have shown that 90% of men have.

2. For men under the age of 50, the majority of erectile problems are related to psychological and relationship factors. Working with a sex therapist can help you determine the psychological and relational influence. Medical factors should be evaluated by a urologist.

3. Other factors that can lead to erectile problems include alcohol, mood (i.e. anxiety or depression), medication, hormonal imbalance, attachment, desire, and factors with current partner.

4. While medications such as Viagra may be helpful, many times other interventions are needed (i.e. therapy) for the best outcome.

5. The idea that men should be ready to have sex at any moment, with any person, in any situation is a harmful myth. Arousal is not a button that can be pushed to be turned on. Believing this myth can be detrimental to the man and the relationship.

6. The way you react to the to yourself is crucial. It’s important to view the erectile difficulty as a situational problem rather than a personal failure. Do not criticize yourself or call yourself names. Additionally, how your partner responds is equally as important.

7. Another harmful myth is that the loss of an erection indicates the man is no longer turned on. It is normal for erections to change during sexual pleasure and intercourse.

8. It is normal for an erection to wax and wane two to five times in a 45 minutes period.

9. Sex tends to be considered as a penetration focused activity, however, there are many ways sex and pleasure can be experienced with or without an erection. Consider implementing other alternatives for pleasure; if an erection is lost, move into your other plan…it’s typical that the erection can be regained in this situation, therefore, do not stop the sexual interaction. Stopping a sexual interaction due to the loss of an erection can be emotionally and psychologically harmful to both individuals involved.

10. An erection cannot be forced; arousal requires active involvement in the experience. It’s important for both partners to understand that an erection cannot be willed and that sex can continue without the erection.

11. Grow in your comfort level to communicate your needs to your partner. If you are feeling pressure to perform, share your need for sex to be different. If you want a different pace or need the room to be a certain way, share that information. If you need a certain stimulation or feedback from your partner, this information can be helpful for you both. An example from Dr. Barry McCarthy: “I want sex to be pleasurable and playful. When I feel

pressure to perform, I get uptight and sex is not good. Let’s make sexuality enjoyable by taking it at a comfortable pace, and enjoy playing and pleasuring and being an intimate team.”

12. Orgasm and ejaculation are possible without an erection.

13. A helpful exercise to regain confidence is through masturbation. Practicing gaining and losing erections, pleasurable stimulation, and visualizations of ideal performance and confidence can be helpful ways to improve confidence.

14. Did you know it’s common for a man to experience three to five erections during a night of sleep? During conscious hours, erections can be blocked by anxiety, distraction, and lack of self confidence.

15. Grow in your comfort to directly ask for the sexual stimulation you need and desire. Whether it’s certain touch, verbal affirmation, or positions, share with you partner verbally and nonverbally how you like to experience pleasure and arousal.

16. When an erection is lost, continue to engage in sensual and playful stimulation with your partner. It is not necessary to focus on stimulating the penis as this can create preoccupation and distraction creating a counterproductive experience.

17. Focus on rewiring your thoughts about yourself and attitude about sex. Though it has been portrayed in media and societal expectations, sex is not about performance, but about sharing pleasure and connection through sex.

18. It’s important to measure a sexual experience by enjoyment, pleasure, and connection, not by performance, number of orgasms, or erection status. If both partners can change measure sex in this way, changes in self-esteem are less likely to be at risk.

19. Not every sexual experience will be a 10/10. Find comfort in knowing that each sexual experience is different and not a reflection of you or your partners self-worth.

20. Consider practicing daily sexual affirmations. There is a lot of research regarding the relationship between affirmations and rewiring the brain. Overall, the way you view yourself has a huge impact on your self confidence and sexuality. Here is an example list of sexual affirmations.

If you are ready to develop your road map to overcoming difficulties with arousal, you can book an appointment with one of our therapists here. If you’d like to learn more about the process and approach, all of our therapists offer free phone consultations. You can read more about each of our therapists under the “About” tab on our website.


Barry W. McCarthy (2001) Relapse Prevention Strategies and Techniques with Erectile Dysfunction, Journal of Sex &Marital Therapy, 27:1, 1-8, DOI: 10.1080/00926230152035804

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