The Psychology of Erectile Dysfunction Part 2

Continued from Part 1 here...

Drugs

If you remember what I said about the male body’s complex balancing act, it’s no wonder that drugs can influence our sexual behaviour. Let’s start with prescription drugs, which include; medications to control high blood, antihistamines, pain medication, muscle relaxants, antiarrhythmic drugs, medications used to manage Parkinson’s and chemotherapeutic drugs.  Then we have the drugs that everyone knows and loves, i.e. psychotropics, which are chemical substances that change brain function and result in alterations in perception, mood, or consciousness. These include stimulants like amphetamine, cocaine, caffeine and nicotine, depressants like alcohol, barbiturates, benzodiazepines and heroin, hallucinogens such as marijuana and LSD, antidepressants, and antipsychotics. Each of these drugs acts on different neurochemical pathways in the brain that are important for sexual desire, performance and orgasm. Some these substances increase desire but completely wipe out our ability to experience sexual pleasure and climax.

Performance Anxiety

Those who frequently struggle with performance anxiety understand how debilitating it can be. Performance anxiety cripples our ability to experience sexual satisfaction in not only the here and now but the future. But where is this all coming from, why does performance anxiety even exist? The problem is that we’ve been socialized to think that sex is an act with a clear set end goal, i.e. the orgasm. We’ve been programmed to think that a component of our masculinity is tied to our performance in bed. So we set up unrealistic expectations, usually established by what the media portrays as a sexy body and fantastic sex, fail to reach those expectations, and experience guilt and shame as a result. Think about it, do other animals experience performance anxiety in the context of sex?

 They don’t and it’s probably because of what I like to refer to as the SEXIEST structure in the human brain, the prefrontal cortex. While the evolution of this brain structure has allowed for advanced human cognition, it also brought with it the ability to fear judgement, to experience embarrassment and shame, and to project ourselves into the future and worry about things that may or may not even be threatening. That’s an oversimplification, since other animals do in some cases show signs of emotions that we once thought couldn’t exist in our furry friends, but I’m trying to make a point here.

Speaking of the animal kingdom, why is it that in many animals sex is actually controlled by females and not males, yet in humans we have this perception of females playing a passive role? For instance, in the wild female rats control the number of intromissions a male rat makes in order to reach an optimal vaginal code for fertility. Male black widow spiders engage in copulatory suicide, where they sacrifice their body as sustenance for the female to ensure that their genes live on. Some insects will even present their female partners with nuptial gifts, i.e. food items or inedible tokens that are exchanged during courtship or copulation. But in our “advanced” human species we have repressive gender roles that portray females as passive partners. Hopefully you’re beginning to understand that these gender norms also contribute to performance anxiety. Imagine if sex could be a judgement free space filled with euphoria, mutual respect, care and concern for each other? What if sex was an experience that emphasized developing a deep routed bond as opposed to just experiencing an orgasm? Would performance anxiety still exist?

So what do we do now? As with last time, let me leave you with some neuroscience-guided wisdom.

1. Ease the stressors in your life.
2. Practice mindfulness and relaxation techniques.
3. Openly communicate with your partner.
4. Sex is not a race – take your time.
5. Try to increase your self-efficacy and confidence through positive self-talk, since behaviour influences our attitudes you’ll actually begin to believe what you tell yourself.
6. Focus on the pleasure and explore other zones of stimulation apart from just your genitals.
7. Explore new options while being realistic about your lovemaking – having sex in an airplane bathroom when you’re afraid of flying is probably not the most productive idea.
8. Forget about the erection – let your body do the hard work.
9. Switch it up a bit – don’t always take the active or passive role in sex.
10. Take charge of your own body and your own orgasm – if it doesn’t feel right communicate that to your partner and change to a position that works for the both of you.

If you’re continuing to experience performance anxiety, speak with a professional. They’ve got a whole toolbox of psychotherapeutic techniques that can help.

Daniel Michaels holds a bachelors of science in psychology and is currently a PhD candidate in neuropsychiatry. His expertise as a scientist includes not only his work on sexual trauma, but also all things to do with sex and the brain. He has collaborated and trained with some of the leading scientists in the field of sex neuroscience. Daniel is also a regular contributor to PornHub’s Sexual Health and Wellness website, which you can find here. He is passionate about psychoeducation and has spoken at various academic and public events. If you have any questions about your brain on sex you can reach him at [email protected].