Erectile Dysfunction, Premature Ejaculation, and Delayed Ejaculation
Erectile problems or concerns about ejaculation are extremely common — especially during periods of stress, aging, or relationship change. While these concerns are often framed as medical problems, sexual response is shaped by a combination of physical health, mental state, and relational contexts.
Many men notice that sexual difficulties:
Come and go depending on stress or confidence
Appear in partnered sex but not during masturbation
Worsen after a few frustrating experiences
These patterns often point to treatable psychological and relational factors — even when medical treatment is part of the picture.
Erectile Dysfunction
Erectile dysfunction involves trouble getting or maintaining an erection that feels reliable or satisfying. For some men, this occurs occasionally; for others, it becomes more consistent and distressing.
Common contributors include:
Performance anxiety or fear of “not working”
Stress, fatigue, or burnout
Relationship tension
Depression or anxiety
Medical conditions or medication side effects
Medications can support erections, but anxiety and self-monitoring often keep the problem going.
How therapy helps:
Sex therapy focuses on reducing performance pressure, restoring confidence, and shifting attention away from monitoring erections toward experiencing pleasure and connection.
Premature Ejaculation
Premature ejaculation involves ejaculating sooner than desired and feeling a lack of control over timing. This concern is often driven by anxiety, conditioning, and nervous system sensitivity, rather than lack of skill or willpower.
Common contributors include:
Fear of disappointing a partner
Habitual rushing from earlier sexual experiences
Heightened arousal sensitivity
Stress or emotional pressure
Trying to “hold back” often increases tension and makes the problem worse.
How therapy helps:
Therapy helps men learn to regulate arousal, reduce anxiety, recognize early cues, and develop a more relaxed and responsive sexual pace.
Delayed Ejaculation
Delayed ejaculation involves difficulty reaching orgasm or ejaculating during partnered sex, even when arousal and erections are present. Many men with DE find they can orgasm more easily during masturbation.
Common contributors include:
Over-control or staying “in your head”
Performance pressure
Long-standing masturbation patterns
Depression or emotional blunting
Medication effects (especially antidepressants)
This concern is often misunderstood and can feel isolating.
How therapy helps:
Sex therapy works on reducing over-control, increasing bodily awareness, addressing anxiety or emotional inhibition, and helping sex feel less effortful and more present.
