Penis size anxiety can present as anything from a concern that it isn’t big enough to impress, which may contribute to performance anxiety in sex and erectile disorder, to a form of body dysmorphia characterised by an obsession with the organ and frequent checking and measuring of it (Veale, Miles, Read, Troglia, Wylie & Muir 2015). Either way, for some men it’s enough of an issue that they may seek help from a therapist.

Small penis anxiety – What sort of therapeutic interventions might help?

As a hypnotherapist I take an integrated approach to addressing issues like small penis anxiety which involves selecting therapeutic techniques that suit the specific needs of the person I’m working with. Certain elements occur more frequently than other.

Treating small penis anxiety – Trauma

Although rare, a man may have lived experience of their penis size being criticized or mocked. Typically this is traumatizing if the person mocking them has reason to know their penis size, for example if a sexual comments or if they are teased by people whom they have shared a locker room. This can take what might otherwise be an amorphous dissatisfaction with their penis size and turn it into a specific trauma which creates an anxiety. If the person hasn’t processed this it is likely to be an active component powering their anxiety, as such techniques like EMDR can be employed to process the trauma.

Treating small penis anxiety Cognition and undermining inner voice

The patient may have developed beliefs which undermine his confidence. Typical examples might be “I’m too small”, “with my small cock I can’t please a women” or “she’ll laugh at me when she sees my small cock”. These beliefs are examined with the patient to assess how realistic they are, and often a new, more acceptable, belief will be agreed.

Identified beliefs can then be addressed in hypnosis by replacement with new ones. To do this a hypnotherapist may use suggestion or visualizations, which combine amnesia for the old idea and acceptance of the new one. Alternatively, EMDR may be used to remove the emotional power from the old belief, and to install a new one.

When a belief is in the form of an inner voice, be that the patients own or someone else’s, it can be disrupted with various visualizations or through the use of parts therapy. New voices can be introduced which replace the old voice with more helpful material, for example if an ex partner has complemented their penis in the past, then reminding them of that experience can be quite beneficial.

Treating small penis anxiety – Systematic desensitization

Systematic desensitization is based on relaxation which makes it especially helpful with sexual problems as sexual response is mediated by the parasympathetic nervous system, the bodies relaxation system, so being relaxed tends to make everything sexual work better.

The therapist helps the patient to create a structured group of situations which may involve a degree of penis size anxiety. These are organised  into the least anxiety provoking (for example, wearing baggy trunks at the beach) to the most anxiety provoking (such as getting naked in front of a new sexual partner). The therapist then takes the patient through these situations, one at a time, whilst giving suggestions for relaxation. With each situation the body and mind are learning to be relaxed about the situation. When a person is relaxed, they feel safe, which allows them to transfer this feeling of relaxation into their life.

Treating small penis anxiety with hypnotherapy

It can be seen that between reducing trauma, challenging unhelpful beliefs and retraining the bodily response to anxiety that much can be done to help the man whose penis size anxiety has become problematic. However, we have detailed only a few of the most common approaches that a hypnotherapist may take to help someone with small penis anxiety to become more relaxed and confident about themselves.

Always remember that the therapist is an expert on therapy, and the patient is an expert on themselves, and that choice of techniques used should involve both sets of expertise.

References

Veale, D., Miles, S., Read, J., Troglia, A., Wylie, K., & Muir, G. (2015). Sexual functioning and behavior of men with body dysmorphic disorder concerning penis size compared with men anxious about penis size and with controls: a cohort study. Sexual Medicine, 3(3), 147-155.e

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There are several potential psychologe. Any one of which could trigger a traumatic learning .

1. Pedestalling. I remember working with a guy who was describing his partner. “She’s a goddess, she’s an angel’s” he said, as he raised his hands and looked up as if worshiping. Pedestalling is when a man puts his partner on a psychological pedestal, above him in some way. In so doing he is making himself less by comparison, inferior. Feelings of inferiority are generally bad for male sexual functioning.

2. Intimidating partner. This is like pedestalling in that it creates feelings of inferiority, the difference is that it is based on something quantifiable. Although the intimidation could be based on the partner’s higher social status, education or wealth the one I find that causes most men problems is if their partner has a greater wealth of sexual experience than they do. This one is especially problematic because the guy may question how he compares to those previous experiences, usually suspecting that he is deficient in some way (smaller penis, less stamina, too conservative etc). Once the thought occurs the guy is now focused upon his deficiencies rather than the great time he’s about to have.

3. Guilt, Shame. A guy I worked with many years ago always sticks in my mind. On his second marriage he was off at a work’s event and the colleague he’d been flirting with for the last few months comes up to him with a couple of drinks in her, she whispers in his ear what she wanted him to do to her that night… and his cock shrivels up to nothing. As much as he had been enjoying the flirtation, that is all it was to him flirtation. Once the reality hit him, the fear of the guilt that would be caused by cheating on his wife, fed by the guilt from cheating on his first wife, caused a strong defensive reaction in his body. Sadly, this carried over into his marital relations. By no means a typical example, most guys get the guilt and shame when trying to have sex with the partner they are cheating on, but the principle stands. Affairs cause guilt, guilt inhibits enjoyment, which present as ED with the official partner.

4. Relationship problems. Beyond the specifics of cheating, wider relationship problems can cause tension in the bedroom, which translates into ED. This can lead to one or both partners not being excited by sex. As such they may carrying negative emotions into the bedroom. This distracts and inhibits excitement. If the guy is not excited, then arousal for erection may be difficult to achieve. If the partner is not excited, the guy may become aware of this and feel unpleasant, thus inhibiting erection. Even with couples who have a history of ‘make up sex’ the problems may be too big.

5. Poor environment for sex. Often overlooked by both guys with ED and the professionals who are there to help them is the environment in which sex can occur. If the environment is unsexy (cold, with damp issues etc) or constrained (no sex till the kids are asleep) then this can affect the mood.

6. Stress and Trauma. Both current life stress and personal history of trauma can induce problems. Usually these prevent the guy from being fully focused on sex, but they also mean that his sympathetic nervous system (the opposite of the para sympathetic nervous system – see the trauma-focus response above) is easily triggered. Stress or trauma don’t have to have anything to do with sex they simply prevent the guy from getting into a fully sexual situation. To give an example I once worked with a man who developed ED after being abducted by a business rival, who let him go unharmed several hours later. Trying to shake the experience off he attempts to distract himself with sex with his wife and finds he simply cannot get into it.

7. Stimulation failure. This happens to guy’s who are into something which isn’t present when they are having sex. The classic example would be a gay guy trying to have sex with a woman, which still occasionally happens. Other examples include guys with strong specific fetishes who are unable to access the fetish during sex. Insufficient attraction to the partner is rare but can occur in arranged marriages or when the physical or psychosocial attractiveness of the partner is compromised in some way.

Help is available, psychological ED responds very well to treatment.

The author – Matt Krouwel is a clinical hypnotherapist with a specialism in psychological ED

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When a man has difficulty achieving or sustaining an erect penis he has ED. ED is considered psychological if there is no obvious physical reason for this difficultly. Commonly a man with psychological ED will be able to get erect in some circumstances (watching porn) and not others (with his partner). The biology which underlies psychological ED is tied to the interactions of the nervous system. Essentially, something has interrupted the action of the parasympathetic nervous system, the relaxation side of the nervous system, which is also the sexual side. Once this has been interrupted, most commonly by anxiety, then it becomes increasingly difficult to activate the sexual responses.

I’ve worked with psychological ED for most of my 18-year career as a therapist and I’ve always found it to be a highly responsive condition. In this blog I’m going to examine the underlying process which causes and maintains psychological ED, a process called traumatic learning. You may be interested in specific psychological causes, if so take a look at 7 psychological causes of ED.  

Psychological ED – Traumatic learning

Traumatic learning is process whereby the guy has an upsetting experience which sets up a negative though pattern. It consists of 2 stages, the trauma and failure focused thinking.

Psychological ED – Trauma

This starts with a guy not getting an erection when he would otherwise expect to. Embarrassment and/ or confusion take hold. Sometimes they will be able to explain it away to themselves (“I’d had waaay too much to drink”) and thus often it doesn’t become a problem. However, whatever the cause, sometimes it is not so obvious. This lack of clarity can lead a guy to question themselves, “will this always be the case?”, “Will I ever get erect again?” Most men subconsciously assume that they will be able to get hard should they want to. This assumption is shattered. Embarrassment becomes shame as a fear of failing as a man comes upon them. This may be immediate or take a few days. The result of which is they become apprehensive of sexual situations and enter a state where they become failure focused.

Psychological ED – Failure focus.

Usually the result of the experience of not getting a sufficient erection failure focus maintains the problem. Typically, the guy’s attention around sex moves from focused upon how badly he wants to do X, Y or Z act, or how ‘hot’ his partner is, to focusing on his own sexual response. This manifests as doubt thoughts, like “will I get hard?” “will I stay up?” Sometimes it will manifest as fear of mockery “Will she laugh at me if I don’t get hard enough?” There is usually an implied disaster element to these thoughts, i.e. “if I don’t get hard it will be awful”, “if it doesn’t stay up then I’ll feel a failure as a man” All of which creates anxiety which inhibits sexual response.

Psychological ED is usually highly responsive to treatment. You may be interested in my blogs on treating ED and 7 psychological causes of ED

The author – Matt Krouwel is a clinical hypnotherapist with a specialism in psychological ED

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In this blog we look at the major natural ED treatment approaches. These include;

• Exercises,
• Psychological therapies,
• Lifestyle changes.

None of which require you to put anything unnatural into your body. To read ‘Everything you need to know about ED’ click here

Natural ED treatment – exercise

Male Kegal exercises – A lot of guys try these for two weeks and then give up, well I’m here to tell you to carry on with them.

Also known as pelvic floor exercises (PFE), these flex the PC muscles, which are the ones which allow you stop peeing mid stream. These focused exercises may well benefit you. In one study of 55 men it was found that after 3 months’ practice over half of those had normal erectile functioning (Dorey et al 2005).

Practice typically consists of;

1. Practicing tensing these muscles, and only these muscles, for 10-15 repetitions a day until this becomes relatively easy, then progressing to stage 2.
2. Lengthen the time of squeeze from to 1 or 2 seconds.
3. Add 5 repetitions each week.

After 12 or more weeks your erection can be maintained by tensing these muscles.

The above guidance is given for your understanding only. Learning male kegal exercise is best done under the supervision of a physiotherapist.

Natural ED treatment – Psychological

Because a lot of ED has a significant psychological component we take a look at the various options available. If you are unsure if the psychological approach is for you consider if you get erections at any time, such as in the morning or for masturbation, if the answer is yes then read on.

Systematic desensitisation (SD).

SD is where you are exposure to anxiety producing stimuli whilst in a state of relaxation. The anxiety stimuli is mild at first, for example the thought of flirting with a girl, and once the relaxation has made it so this situation no longer gives you anxiety, you move on to another, slightly less mild situation. Eventually you work up to full sex, but only once all the build up has been gone through and you are totally relaxed. The relaxation state then replaces the old anxiety response. It is frequently used by hypnotherapists who use the hypnosis to produce the relaxation. Its best results are for ED which has a large emotional or anxiety component (Kockott et al’s 1975, Auerbach & Kilmann,1977).

Hypnotherapy.

It’s hard to tell you exactly what a hypnotherapist will do. Many hypnotherapists use a variety of approaches, including SD, CBT, sensate focus exercises which are all covered here. Some will look to use age regression to the start of the problem, others will look to use suggestions or imagery to directly create hardness.

A number of case studies support the idea that hypnosis can be effective with ED (Diment 1984, Goguen 1985), with small scale studies confirming that it has a statistically significant effect over placebo and is superior to testosterone and acupuncture (Aydin et al 1996, Aydin et al 1997). The most substantial claim of success come from Crasilneck (1982) who achieved an 87% success rate at one year follow up with 100 men. In another report he found an 80% success rate at end of treatment in a group of 400 (Crasilneck and Hall 1985).

Sensate focus exercises.

Senate focus exercises are a set of tasks for you and your partner to go through which focus on touch, not sex. They are graded, so initial exercises have no sexual element and as the process goes on they gradually become more sexual. To give you an example, a program might start out with simple touching of the back, face, legs and arms but nothing more. Later exercises may involve, playing with your erectile response to see what kind of touch produces a reaction, but not looking for orgasm. Penetration only occurs after several exercises have been completed and even then orgasm may be avoided for some time . Overall a programme may have as many as nine different steps to work through. Usually this is done as part of couple’s therapy, but it can also be done by any willing couple.

There is a lack of evidence for their effectiveness (Linschoten, Weiner& Aver-clark 2016) which just means no one has studied it.

Cognitive Behavioural Therapy (CBT).

In CBT the therapist helps you identify and change thoughts and beliefs which are unhelpful to you. A typical example may be a distracted mind whilst having sex or predicting a disastrous outcome should you not achieve full erection. New beliefs are actively adopted which you then put to test in reality.  The CBT for ED is a combined couples and individual’s therapy which;

• Encourages cooperative exercises.
• Mutually agreed upon strategies.
• Uses sexual intimacy and erection exercises.

(List complied from McCarthy 1986 & 1992).

Small scale studies suggest success; One study of 21 couples achieved a 61% success rate (Xueqian & Heqin’s 1990).  In addiction,

• CBT is most effective on the performance anxiety elements of ED (Mehrabi et al 2006).
• Studies using CBT as an adjunct to Sildenafil (Viagra) have shown significantly enhanced results (Banner & Anderson 2007).
• Web-based CBT programmes have been studied with modest but positive results (Andersson et al 2011, Price (2007).

Over all it can be said that CBT is a good option.

Couples therapy

In couples therapy you and your partner are brought together in a to openly discuss problems. Therapists argue that open discussions will cut down on underlying tensions. There is some evidence to suggest that couple’s therapy may be a useful part of therapy but only if your partner is;

• Willing to fully participate.
• Displays interest in improved sexual relations.
• Is generally well adjusted sexually.

(list compiled from Catalan & Fagg 1992, Wylie 1997).

Evidence exists that couple’s therapy has additive benefits to medical approaches (Aubin, et al 2009). Couples therapy can of course be problematic if you,

• Have no long-term partner.
• Are in an ongoing affair.

Natural ED treatment – Lifestyle changes

Exercise –  Exercise is good for you in just about everyway and the evidence suggests that it is a good natural ED treatment (Derby et al 2000, Esposito Et al 2004, Esposito Et al 2009). If you are not currently doing significant exercise, then it’s an easy place to start. Interestingly losing weight does not appear to have anything like the same benefit (Derby et al 2000).

Diet – If you are over 40 there is a good chance you’ve had a cholesterol test. Evidence exists that adopting a cholesterol healthy diet can improve erectile functioning (Aldemir 2011). This means you should decrease solid fats and creams and swap in oils nuts and seed (NHLB 2014 & NHS 2014b).

Smoking – Oddly enough in addition to letting you live longer there is evidence that giving up may help with ED (Derby et al 2000, Gual et).

Alcohol consumption – You might have tried a bit of ‘Dutch courage’ to help get things going. The evidence suggests that a bit of alcohol may help you (Bacon et al 2006), but be warned too much ad it can go downhill fast (Miller & Gold 1988).  Best to keep it to no more than 3 units of alcohol (a generous glass of wine, pint of cider or pint and a half of beer or larger).

I wish you all the best of luck in finding your natural ED treatment – read more about ED

REFERENCES

The author – Matt is a hypnotherapist working in Birmingham with a specialism in treating Erectile Dysfunction

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Many men need a little ED help from time to time. Ed help comes in three forms;

1. Medical.
2. Psychological.
3. Lifestyle.

In this blog we concentrate on the medical ED help. The psychological and lifestyle can be found here.

ED help – Medical approaches

Sildenafil (Viagra), Tadalafil and Vardenafil. These enjoy success rates in the 70% and 80% range at producing erection within a few minutes or hours (Hatzimouratidis et al 2010).  Some men even continue to benefit after withdrawal form long term use (van Lankveld et al 2003), unfortunately there are some significant drawbacks, for example;

• Sildenafils (Viagra) can be negated by a fatty meal.
• A lot of men simply don’t know if they are going to have sex in two hours.
• Some men don’t like taking medication for ED (Althof & Wieder 2004).
• Some studies have found that 10-16% of men experience headaches (Hatzimouratidis et al 2010).
• 4-12% get dyspepsia (Hatzimouratidis et al 2010).

Whatever the causes may be it has been observed that there are high withdrawal rates (van Lankveld 2003).

Ed help – Secondary and other medical treatments;

These are used in the more severe cases, often when nerve damage has occurred preventing natural erection.

• Self-administered injection.  The patient injects themselves in the corpus cavernosal bodies, which is the long body of erectile tissues which runs along the shaft of the penis (Wylie 2007).
• Vacuum constriction device. These provide ED help by drawing blood into the penis. They have a high rate of satisfaction amongst users, however, 36-50% of men quickly stop using them.  This may be due to the large numbers of men who experience pain. (Hatzimouratidis et al 2010)
• Penile prostheses. These are usually inflatable units which are surgically implanted into the penis. They are highly effective, however the surgery appears to be off putting (Hatzimouratidis et al 2010).

For more on ED go to ‘Everything you need to know about ED’

The author – Matt is a hypnotherapist in Birmingham. He has years of experience in providing ED help.

References.

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