Erectile Disorder is a common sexual arousal disorder. Erectile dysfunction is the inability to achieve or maintain an erect penis that is sufficient for sexual intercourse. Symptoms are present for at least six months, and are not better accounted for by relationship difficulties, life stressors, a substance, medical problem, or mental health disorder.

This disorder is the most untreated condition in the world even though treatment is effective 95% of the time. It is likely that patients with this disorder are resistant to taking the problems to their doctor or mental health professional. Many men feel inadequate or ashamed to discuss the problem. The most frequent cause of erectile dysfunction is vascular or blood vessel disease, such as hardening of the arteries. Smoking is a common cause of vascular degeneration. It is vital that a full medical evaluation be completed before beginning therapy to rule out organic medical conditions. While mental health treatment is effective for some forms of erectile dysfunction, medically induced problems are not improved by psychosocial treatment.

Theoretical approaches associated with this disorder are behavioral, cognitive-behavioral, systemic approaches, psychoeducational, and psychodynamic. The goals of therapy are to enhance sexual arousal, lower the anxiety felt regarding sexual performance, and address issues that limit sexual satisfaction. Behavioral and cognitive-behavioral therapy seem to be the most effective methods of treatment. Some techniques that are applied with the mentioned therapy are systemic desensitization, relaxation, reframing, modification of maladaptive sexual attitudes, and working through unconscious conflicts. Sensate focus is most commonly and most effectively used therapeutic technique.

You will need to conduct an assessment and establish a therapeutic rapport with the client. Reducing feelings of shame, anxiety and blame in relation to the problems is very important when starting the therapy. When doing the assessment you need to get a thorough clinical history in reference to the onset and past history of the disorder as well as the frequency and severity of the symptoms. Another important assessment will be to look for possible pre or co-existing disorders like depressive and substance abuse disorders that may be contributing to the symptoms. Another referral may be needed to rule out medical causes of the disorder, (you will need a release). You will want to discuss and make an agreement with the patient in reference to the treatment. You should determine whether treatment will be individual or couple based or both. Treatment tends to be more effective and successful if the afflicted individual has a willing and cooperative partner

Clinicians can teach sensate focus to a couple. Sensate focus involves non-genital and non-demanding caressing by the partners without intercourse. The couple should be encouraged to focus on pleasurable feelings rather than sexual culmination. Gradually, the partners move to pleasurable genital (oral or manual) contact without intercourse. As the patient becomes more relaxed and arousal is sufficient for a full erection, intercourse is permitted. Intercourse often occurs as a natural course of treatment and as arousal increases.

Couples therapy may be useful to reduce conflicts between the couple that may interfere with sexual arousal. Psychodynamic therapy may be helpful to address intrapsychic conflicts that cause erectile dysfunction. Any measures that reduce anxiety about sexual performance including group therapy, hypnotherapy, or systematic desensitization can be effective.