Holistic Approaches to Addressing ED, PSSD, and Restoring Erectile Confidence
I know some men find the topic of sexual health uncomfortable.
And most men would rather keep quiet. They may joke about, but it’s rare you hear a serious conversation that isn’t on a mainstream medical site. Masculinity is often associated with stoicism and emotional restraint, with some studies showing that testosterone impacts language processing in the brain (leading to the stereotypical “man of few words” trope). So men’s physiology, coupled with the prevailing culture of what it means to “be a man,” unfortunately leads many to bottle up their feelings about health and wellbeing.
For all the men reading - it isn’t weak, ever, to talk about how to keep your body strong.
Men who bottle up their feelings, irrespective of sexual health, are more prone to depression, anxiety and suicide. With rates of suicide among men on the increase, often demonstrated through reckless, self-endangering behaviour as well as self-harm, the need to discuss the links between mental and physical health is essential.
Men blame themselves for their sexual dysfunction. They see it as something inherent to who they are, almost as if they are the “type of man” who experiences early ejaculation, or the “type of man” who has difficulty getting aroused. And though personality plays a big role in sexuality, in terms of your frequency and desire level, physical factors and mental health issues actually have the biggest impact on your sexual health. If you’re experiencing anxiety, low self-esteem, perversion of your sexual interests or relationship strain, then there may be some underlying sexual dysfunction.
When these signs aren’t acknowledged, men engage in negative behaviours that lead to worsening sexual dysfunction, like alcohol misuse or increased consumption of pornography, in the quest to feel the way they think they should feel, or feel like themselves again. This can lead to physical maladies, such as high blood pressure, heart disease and lowered immunity, among other problematic health issues, which compound the problem.
It’s crucial that men realise that there is great strength in self-care. Sexual dysfunction can be an early sign of a more serious condition, or medication toxicity such as Post SSRI Sexual Dysfunction. Caring about your health isn’t complaining; it’s treating yourself with respect.
Erectile dysfunction (ED), is a condition that affects millions of men worldwide. And many men are turning to approved pharmaceutical treatments, even with their troublesome side effects, and the potential long-term impact of decreased sexual function.
Research into longevity studies say that couples should have fulfilling sex lives well into their 80s and 90s, with copulation taking place at least twice a month. Most of the reason people aren’t is not because of a lack of desire for their partners, but age related issues such as arthritis, and not surprising, an inability to get an erection.
So, no matter your age, ensuring sexual health is essential for your mental, physical, and spiritual wellbeing, and it factors into living a longer and healthier life.
Understanding Your Penis
Specifically, erectile dysfunction (ED) is the inability to achieve or sustain an erection sufficient for sexual intercourse. The average amount of time people spend having sex is 3-7 minutes, so that’s roughly the amount of time the erection will need to be sustained. The conversation around ED is often expanded to talk about a number of symptoms, such as genital numbing, pleasureless or absent ejaculation and loss of libido.
It helps to understand how the body supports pleasure, so below I’ll briefly discuss the anatomy.
There are three cylindrical masses of specialised erectile tissue, which is a smooth muscle that surrounds the spongy penis shaft. It’s not under voluntary (your own mind’s) control. It fills with blood to cause the rigidity during sexual arousal and rapid eye movement (REM) sleep (i.e., when you dream). Once it’s engorged with blood, it provides a pleasurable sensation, but also the the sensory nerves within the penis are highly sensitive, to touch, temperature and pressure. There are also numerous nerve endings within the area that contribute to the pleasurable sensations during orgasm.
The “fight or flight” state keeps the penis flaccid - e.g., stress hormones help stabilise the organ when you’re trying to concentrate on what’s stressing you. And this is how chronic stress can interfere with your ability to have an erection even if aroused, because the stress hormone is maintaining it’s flaccidity. Relaxation or the “rest and digest” state allows for blood flow into the region, thereby allowing arousal to result in an erection.
Understanding ED and How it Manifests
ED manifests in numerous ways:
Trouble getting an erection
Trouble sustaining an erection
Genital numbing
Premature ejaculation
Delayed ejaculation (difficulty reaching an orgasm)
Anorgasmia (inability to achieve orgasm)
Low libido
Emotional disconnect, leading to low sexual desire
Sexual pain
Note: Paraphilias (obsessive recurrent and intense arousal, at it’s most severe, can manifest in consent and violence issues, such as rape, voyeuristic disorder, and extreme perversions, such as paedophilia and fetishistic disorders, etc.)
These categories are not always distinct, and individuals may experience a combination of symptoms or issues. The underlying causes of these different types of ED can vary, ranging from psychological factors like anxiety and stress to physical factors such as cardiovascular diseases, hormonal imbalances, and side effects of medication.
The most common cause for erection and completion ED issues is nitric oxide deficiency. Nitric oxide is the principal substance in the body that facilitates the relaxation effect. That’s how the major pharmaceutical drugs that treat ED work, by enhancing nitric oxide. But in order to do that, it has to inhibit a key immune system enzyme responsible for recognising DNA aberrantly located within the cell, which is a potent trigger for inflammation. And inflammation is a potent trigger for many chronic diseases such as arthritic conditions, heart conditions, cancers and autoimmunity. The drugs themselves also carry a great deal of side effects, including headaches, hot flashes and flushing, nasal congestion, indigestion, gastrointestinal issues such as nausea, dizziness, and, in rare cases, more severe complications like priapism (a prolonged, painful erection).
The good news is that many foods are naturally rich in nitric oxide without the side effects, including beets, cabbage, cauliflower, and more …
Aside from a nitric oxide deficiency in your diet, ED can result from a combination of physical and emotional factors, and it’s often intertwined.
Emotional Factors
Stress and Anxiety: High levels of stress and anxiety can interfere with sexual performance by triggering the release of stress hormones that constrict blood vessels.
Depression: Depression can reduce sexual desire and impact performance. Depression is often linked to stress, which keeps the body in a “fight or flight” state, reducing the ability to relax.
Porn Induced Erectile Dysfunction: Studies in young men have shown that high cyber pornography addiction “resulted in a higher probability of ED*”. With 50% - 70% of adult men engaging in pornography on a regular basis, and adolescents at 80%, it’s no surprise that ED rates are doubling. In the USA, states that have the highest rates of ED are where there are older people and those with progressive ideals. The latter could potentially be linked to a greater perception that “sex-work” is a consensual and legitimate vocation. Studies have shown that a combination of porn and masturbation decreased libido, sexual desire and sexual satisfaction.
Childhood sexual abuse or trauma: Statistics vary on childhood sexual trauma, from 1 in 20 boys to as high as 1 in 6 boys experiencing sexual abuse or assault before the age of 18. Long-term impact of abuse encompasses mental health issues, physical health conditions, and issues in brain development.
Relationship Issues: Men often think of themselves as being purely “visual” in their sexual desires. But problems in a relationships, such as feeling unloved, falling out of love, unresolved conflicts, the big R (resentment), or communication breakdowns can have a significant impact on sexual function. Also, there are a growing number of men experiencing emotional and physical abuse in relationships, which can also result in ED.
Physical Factors
Vascular Issues: Reduced blood flow to the penis due to conditions like atherosclerosis (narrowed arteries) or high blood pressure can hinder the ability to achieve and maintain an erection.
Neurological Conditions: Conditions such as multiple sclerosis or nerve damage resulting from diabetes can disrupt the brain's signals to the penis.
Hormonal Imbalances: Low testosterone levels can lead to ED. The testosterone hormone plays a crucial role in sexual function.
Medications: Some medications, like antidepressants or antihypertensives, list ED as a potential side effect of taking the medication.
Post-SSRI Sexual Dysfunction, Post-Finesteride Syndrome, or Post-retinoid Sexual Dysfunction*: This means there are enduring sexual difficulties following treatment with selective serotonin reuptake inhibitors (SSRIs) which are a common class of antidepressants to treat depression, anxiety and obsessive compulsive disorder (OCD). Finesteride is a common hair-loss medication, and isotretinoin (Roaccutane) is commonly used to treat acne. Both have been implicated in sexual dysfunction post discontinuation of the drug.
Age: ED becomes more common with age, but it's not an inevitable part of aging. This is often due to other conditions, such as obesity, Type 2 Diabetes, poorly controlled Type 1 Diabetes, smoking, excessive alcohol use, sedentary lifestyle and poor diet.
Surgical complications: prostate surgery, pelvic surgery and colorectal surgery can all lead to increased risk of sexual dysfunction.
Chronic illness: Chronic Kidney Disease and Liver Disease also impacts sexual function.
Natural Alternatives to ED Medications
ED can have various underlying causes, and it is essential to identify these causes to determine the appropriate treatment and prevention regime. The most important step is to start talking about it - get to the emotional root cause of the issue, and it will open up avenues for addressing the condition physically. Avoiding it or laughing it off will not improve your mental or physical health. Don’t block yourself from enjoying your life with notions of shame or embarrassment, just move forward and reclaim your life.
Key next steps:
Lifestyle Changes: Maintain a healthy weight, engage in regular physical activity, and adopt a balanced diet rich in fruits, vegetables, lean proteins and healthy fats. Reducing alcohol consumption and giving up smoking can also improve ED symptoms.
Stress Reduction: Practicing gentle relaxation techniques like meditation, tai chi, breath work, water-exercise or yoga can reduce stress and anxiety.
Herbal Supplements: Some herbal supplements, such as ginseng, L-arginine, and maca root have shown potential in improving erectile function. Consult with a complementary practitioner before using these supplements, as high street / drug store brands may have harmful additives and not the active ingredients needed for a change. There may be reactions when combined with other medications.
Pelvic Floor Exercises: Male kegel exercises, usually recommended to help with urinary incontinence in men, can also help strengthen the pelvic floor muscles in general, improving the longevity and strength of erections. Within the resources section, you’ll find my guide on kegel exercises and other useful information for sexual health.
Support Networks: Depression, anxiety and stress require a good support network of likeminded people. Play sports with a group of friends, start a hobby with a group of people, join a support group, talk to friends and family - remove the isolation around the condition and your life.
Counselling: Porn addiction, relationship issues, abuse, trauma and paraphilias need to be treated. Don’t suffer alone, get the appropriate help and support. These conditions are treatable, and you can live a better life.
Loving and Committed Partnership / Marriage: As a man you need to feel safe and cherished too. Partners that you are not bonded with, in which neither of you has an investment in each other, will not necessarily be sensitive to what you’re going through. Engage in mutually caring and respectful relationships. Casual sex and promiscuity will only worsen the condition.
Conclusion
ED is a common condition that affects millions of men - but it doesn’t have to define you. It’s crucial to recognise that there are multiple causes, both physical and emotional, and there are many achievable, holistic ways to treat the condition. While pharmaceutical treatments can be effective, they come with side effects and may impact your long term sexual function.
Exploring natural alternatives, such as lifestyle changes, stress reduction, and herbal supplements, can provide additional options for managing and potentially reversing ED. For complex issues, explore natural options with a complementary medicine practitioner and counsellor, and find the most appropriate approach for your individual situation. Stay strong.
References
*Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill. 2021 Oct 21;7(10):e32542. doi: 10.2196/32542. PMID: 34534092; PMCID: PMC8569536.
