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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Most men have at one point or another wondered how their penis measures up, and research suggests this has left about 55% feeling dissatisfied, although only 12% (about 1 in every 8) consider their member to be small (Lever, Frederick, & Peplau 2006).

Informally known as Penile dysmorphia disorder (PDD) or Small Penis Syndrome, officially, concerns that your penis is too small are classified as a form of body dysmorphia by the primary arbiter of psychological diagnosis the DSM-5 (Villines & Luo 2019).  All of which tells us that penis size anxiety is a common phenomenon, but perhaps a not well understood one.

As a therapist I have encountered patients with concerns about the size of their penis many times, usually as part of my work with erectile dysfunction but occasionally as the presenting problem. As with most issues, knowledge of the problem can be helpful both in treating it and for those looking to overcome it.

Note – as most of the research I have used assumes heterosexual relations and gender conformity this blog is written with those assumption unless otherwise stated.

Why is penis size an issue? – what men say  

When men were asked this question, they identified three causes, (Sharp & Oates 2019).

• Pornography – Porn isn’t known for its subtly when it comes to the human form and as most people know this extends to the male member. In fact for various reason, some practical, some aesthetic, pornography vastly favors abnormally large penis (Spitznael 2015). It appears that knowing that the performers are unusual doesn’t prevent this leaving an impression.
• Comparison with peers – the only other source of information which most men appear to have is a swift comparison in the changing room. This is unlikely to be reassuring, after all they are checking because they are insecure about it which will skew perceptions.
• Indirect appearance related teasing – The small penis is a staple of comedy, both in popular media and during bawdy talk. The current use of the phrase “big dick energy” to describe a confident man is just one example. These ambient social signals of big equating to good and small equating to bad are absorbed by any concerned male. What is interesting to note is that there is little evidence that direct mocking of the penis is common, either by men or women.

However, what men say about sources which heighten penis size anxiety tells us little about why it is an issue at all?

Why is penis size an issue? – Evolutionary theory  

First thing to note; Human penis’s are massive! … at least compared to our nearest relatives, the other primates, you literally have a bigger dick than a gorilla (Maslin 2017). This suggests a deep evolutionary reason for cock size. One theory is that at some point in our evolution penis size was used as a sign to potential partners of our general health and well-being (Mautz, Wong, Peters,& Jennions 2013).  There is some evidence that women do find slightly larger penis’s more attractive, although the emphasis is on ‘slightly’, as the extra attractiveness benefit tops out quite quickly (Mautz, Wong, Peters,& Jennions 2013).

It can be seen that penis size, along with erectile function, is likely to have been an evolutionary adaptation used to demonstrate health and wellbeing to potential mates (Cellerino & Jannini, 2005),*¹ So is it any wonder that it is a source of anxiety for so many men. Considering this, the existence of anxiety around penis size makes sense. However, in a world where clothing conceals the penis and the only serious chance most  get to measure up is the distorted world of pornography, what men really need is good quality data.

Penis Size – how big is an average cock

A recently published landmark systematic review and meta-analysis of studies of 33 studies from around the world which included some 36,883 participants found that average global penile length is  is 5 inches or 12.8 cm (see table 1) when erect and 3.6 inches or 9.2 cm when relaxed, with a circumference (girth) of 4.7 inches (Mostafaei, Mori, Katayama, Quhal, Pradere, Yanagisawa, Laukhtina, et al 2025).

Table 1. World average penis size (human)

Penis size – growers and showers

Commonly men are categorized into either being ‘growers’, men whose penis is small when at rest, but may grow substantially when erect and men who are ‘showers’, relatively big when relaxed but does not necessarily grow that much. Some men who are ‘growers’ are self-conscious of how small their penis is when at rest, however, what evidence we have indicates that being a ‘grower’ is quite normal, with more than a quarter of men fitting this category. Further, on average ‘growers’ appeared to have larger penis’s when erect (Yafi, Alzweri, McCaslin, Libby, Sangkum, Sikka & Hellstrom 2018).

Hopefully you can now measure yourself up against the world average from base to tip and conclude that you are fairly close to normal, but does it really matter? For many men, its what their partner or potential partner thinks that really matters.

Penis size – what do women want?

For men the issue of penis size can largely be summarized as assuming that bigger is better, but is this what women think?

As was noted above, women do appear to find slightly larger cocks attractive, but the emphasis really is on the ‘slightly’ and very quickly bigger stops being better (Mautz, Wong, Peters,& Jennions 2013). A study which may throw additional light on this found that women looked for slightly larger penis size in transitory partners, (Prause, Park, Leung, & Miller, 2015) such as one night stands, where the larger appendage may have a novelty value . However, when considering life partners women found a penis closer to the average more attractive (Prause, Park, Leung, & Miller, 2015). All of this may reflect what I’m calling the ‘Right key for the right lock’ phenomena, in which women preference the penis which fits their vaginal capacity (average 5.1 inches [13cm] with 1 inch [3cms] elasticity, meaning there is room for 6.1 inches before it starts to get uncomfortable) (Matthes & Zucca-Matthes 2016).

Further, most women express satisfaction with their partners penis size  (Lever, J., Frederick, D. A., & Peplau, L. A. (2006) and the vast majority consider length unimportant, but are more interested in girth (Francken, Van de Wiel, Van Driel & Schultz, 2002)

Summary

We have seen that penis size anxiety probably has deep evolutionary roots, which are brought forward and embedded by distorting portrayals in pornography, poor information and reinforced by expressed cultural attitudes. Subsequently, we have found out how big the average penis actually is and that the issue appears to be much less important to women than men. In the subsequent blog I will examine how Small Penis anxiety can be treated

Footnotes

*¹ This may also be the root of the male urge to display their erect penis to people perceived as potential sexual partners, its current form being the sending of ‘Cock shots’.

References 

Blake, E (2016) https://www.scientificamerican.com/article/human-monogamy-has-deep-roots/

Cellerino, A., & Jannini, E. A. (2005). Male reproductive physiology as a sexually selected handicap? Erectile dysfunction is correlated with general health and health prognosis and may have evolved as a marker of poor phenotypic quality. Medical Hypotheses, 65(1), 179-184.

Costa, R. M., Miller, G. F., & Brody, S. (2012). Women who prefer longer penises are more likely to have vaginal orgasms (but not clitoral orgasms): Implications for an evolutionary theory of vaginal orgasm. The Journal of Sexual Medicine, 9(12), 3079-3088.

Francken, A. B., Van de Wiel, H. B. M., Van Driel, M. F., & Schultz, W. W. (2002). What importance do women attribute to the size of the penis?. European urology, 42(5), 426-431.

Lever, J., Frederick, D. A., & Peplau, L. A. (2006). Does size matter? Men’s and women’s views on penis size across the lifespan. Psychology of Men & Masculinity, 7(3), 129.

Maslin (2017)  https://theconversation.com/why-did-humans-evolve-big-penises-but-small-testicles-71652

Matthes, A. C. S., & Zucca-Matthes, G. (2016). Measurement of vaginal flexibility and its involvement in the sexual health of women. J Women’s Health Care, 5(302), 2167-0420.

Mautz, B. S., Wong, B. B., Peters, R. A., & Jennions, M. D. (2013). Penis size interacts with body shape and height to influence male attractiveness. Proceedings of the National Academy of Sciences, 110(17), 6925-6930

Mostafaei H, Mori K, Katayama S, Quhal F, Pradere B, Yanagisawa T, Laukhtina E, König F, Motlagh RS, Rajwa P, Salehi-Pourmehr H, Hajebrahimi S, Shariat SF. A Systematic Review and Meta-Analysis of Penis Length and Circumference According to WHO Regions: Who has the Biggest One? Urol Res Pract. 2025 Mar 7;50(5):291-301. doi: 10.5152/tud.2025.24038. PMID: 40248849; PMCID: PMC11923605.

Prause, N., Park, J., Leung, S., & Miller, G. (2015). Women’s preferences for penis size: a new research method using selection among 3D models. Plos one, 10(9), e0133079.

Sharp, G., & Oates, J. (2019). Sociocultural influences on men’s penis size perceptions and decisions to undergo penile augmentation: a qualitative study. Aesthetic Surgery Journal, 39(11), 1253-1259.

Spitznael (2015) https://www.menshealth.com/trending-news/a19548129/becoming-male-porn-star/

Villines & Luo (2019) https://www.medicalnewstoday.com/articles/324569

Yafi, F. A., Alzweri, L., McCaslin, I. R., Libby, R. P., Sangkum, P., Sikka, S. C., & Hellstrom, W. J. (2018). Grower or shower? Predictors of change in penile length from the flaccid to erect state. International Journal of Impotence Research, 30(6), 287-291.

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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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Erectile disorder (ED) is a common problem and the potential causes of ED are many and varied. In this blog we look at the biological and physiological risk factors and causes, if you are looking for ‘Everything you need to know about ED’ click here .

Psychological Vs. Biological causes of ED

For most men the reality will be a bit of both. However, there is an easy way to tell which one is the main cause of ED. If morning erections or erections for masturbation happen, then it’s mostly psychological. If no erections occur, or they are always soft then it is probably biological.

Psychological –  The most common psychological factor in my experience is anxiety. Anxiety works in direct opposition to erection. Any fear response will minimise all unnecessary functions to move blood to the heart, legs and arms. This is so you can fight or flee, but it’s not great for sex. Why men experience anxiety varies. Some men get anxious because they have had ED before. Some men get anxious because they are worrying about what their partner is thinking. These are two of the most common, but there are dozens. Below is a list of potential psychological causes of ED.

Find out about natural and psychological treatments for ED

Psychological causes of ED.

• Performance anxiety.
• Strong emotions (Anger, Guilt, Shame).
• Relationship problems (power struggles, lack of intimacy, guilt over affairs).
• Mental health issues (depression, schizophrenia, panic disorder).
• Addictions – including Smoking.
• Generalized anxiety disorder, personality disorders or traits.
• Poor self-esteem.
• Negative or distracted thoughts.
• Bereavement
• Loss of status (such as the loss of a job)
• Sexual-orientation conflicts.
• Gender identity conflicts.

(List compiled from Balon 2006, Araujo et al 1998, Nobre 2010, Beck & Barlow 1986)

Biological factors – a number of medications, medical interventions and medical condition are associated with ED. Of course associated does not mean that you will get ED if you have any of these conditions. However, when consulting your doctor about ED it is a good idea to mention these.

Medical conditions which can be causes of ED

• Diabetes.
• Heart and circulation problem.
• Liver and kidney problems (usually chronic or severe).
• Penile anomalies or diseases (including Peyronie’s disease).
• Spinal cord injuries.
• Multiple sclerosis.
• Parkinson’s disease.
• Sickle cell anaemia.
• Decreased androgen production.
• High cholesterol (risk of ED rises with LDL Cholesterol and drops with increased HDL – Wei et al 1994).
• Sleep apnoea.

Medical interventions that can be causes of ED.

• Pelvic (i.e., prostatic) surgery.
• Psychotropic drugs.
• Antidepressants.
• Antihypertensives.
• Antiulcer drugs.
• Beta-blockers.
• Hypolipidemics.
• Antiarrhythmics.

(List compiled from Shin et al 2013, Delgado et al 2005, Balon 2006, Wylie 2007)

Risk factors for ED

The risk of Ed rises dramatically with age (Braun 2000). One study found a 9% risk factor of occasional to severe ED in men aged 40-44. This rises steadily with age to 54% for men 65-70 (Nicolosi et al 2003). However, if this is an inevitable part of the aging process or a representation of the build-up of other factors which tend to accompany aging (reduction in activity, Cholesterol build up, increased body mass, underlying medical issues etc) is currently unclear.

Find out about lifestyle approaches to ED

Risk factors – these are factors which are associated with an increased risk of ED but do not necessity cause it.

• Low physical activity.
• General high alcohol consumption.
• Low level education.
• High body mass.
• Increased age.

(List compiled from Nicolosi et al 2003, Esposito et al 2004, Chew et al 2000, Derby et al 2000)

References

The post Causes of ED appeared first on Matthew Krouwel Hypnotherapist.

Commonly known as Erectile Dysfunction, ED is the persistent or recurrent loss of or inability to achieve an erection to completion of sexual activity (DSM-V & ICD 10 & Beitia 2000).

How common is ED?

Large numbers of men have mild or occasional ED (Johannes et al 2000, Rosen et al 2004, Nicolosi et al 2003).  As many as 22% of men in some parts of the world may experience it on a regular basis (Rosen et al 2004)

• Risk increases substantially with age (Johannes et al 2000).
• 5-12% of men seek help (Wylie 2007 & Hatzimouratidis et al 2010).

ED scales and measures

A number of scales exist to measure strength of erection and longevity of erection (Wincze 2004). You can find more detail on this here .  If you have suffered for 3 months or more, you can consider it a problem which you may wish to seek help for (Feldman et al 1994 & NIH 1993.)

Causes and risk factors of ED

There are literally dozens of potential causes for ED, these include both biological and psychological causes. You can get more detail about these here . If you want to tell if ED is psychological or physical in nature ask yourself;

‘Do I get hard in the morning or for masturbation? ‘

If you do then it is probably primarily psychological. If you don’t then it is probably physical.

Treating ED

You maybe interested in  treatments  and there are a lot of options out there. Below you will find an over view of many of them from the common to the unusual. You can find a lot more detail here .

Medical treatments for ED

You will probably be aware of Viagra (Sildenafil), less well known are Tadalafil and Vardenafil. Each has its strengths, limitations and side effects, and as such you should consult your doctor before using them. Testosterone supplementation has also been used but there is little evidence to support it works (Aydin et al 1996). For the most serious cases there are;

• Self-administered penile injection (Wylie 2007).
• Vacuum constriction device (Hatzimouratidis et al 2010).
• Inflatable Penile prostheses (Hatzimouratidis et al 2010).

The lifestyle approach to ED

• Weight loss and exercise – Weight loss has been seen to improve sexual function in younger men, but once in midlife exercise appears to be the most important thing (Esposito Et al’s 2004, Esposito et al 2009, Derby et al’s 2000).
• Diet – levels of Low-density lipoproteins (LDL cholesterol) are directly related to ED (Feldman 1994). Some evidence exists that adopting a diet which promotes lower LDL levels and higher High-density lipoproteins (HDL cholesterol) can improve erectile performance (Aldemir 2011).
• Smoking – Although not a guaranteed cure giving up smoking has been seen to improve erectile function in as little as 24 hours (Gual et al 1998).
• Alcohol consumption – Small amounts of alcohol can aid erectile function (Bacon et al 2006). Sadly larger amounts can cause ED (Miller & Gold 1988).
• Male Kegal exercises – Also known as pelvic floor exercises (PFE). After 12+ weeks practice, about half of men with ED can maintain an erection by tensing these muscles (Dorey et al 2005, Dorey et al 2004, Claes & Baert 1993). Lots of websites show how to do Male Kegal exercises, but a physiotherapist is the best person to  teach them.

For more detail

Psychological Approaches to ED – over the years lots of different approaches to ED have been employed, these include

• Couples therapies – a  counsellor helps open up discussion between partners. Rarely used on its own these days couples therapy has proven benefits if used in addition to other therapies (Aubin, et al 2009).
• Systematic Desensitisation (SD) & Sensate focus, are forms of graded exposure in which the therapist guides the patient through a  series of stress or anxiety producing situation in a state of distraction or . Eventually the relaxation will over ride the anxiety. This can be done either in the  imagination or real life. Although not universally effective it can be very powerful with anxiety induced ED. (Kockott  et al’s 1975 (Auerbach & Kilmann,1977).
• In Cognitive Behavioural Therapy (CBT) a therapist helps you to examine your beliefs and assumptions, seeking to logically adjust them and then reality test them. In one study, combining couple’s therapy and CBT the majority of participants achieved improvments (Xueqian & Heqin’s 1990).
• Hypnotherapy is an approach which combines the use of any number of psychotherapeutic approaches (including CBT & SD) with the state of hypnosis, to enhance its efficacy. One hypnotherapist treated over 400 ED patients reporting an 80% success rate (Crasilneck and Hall 1985).

For more detail

References

The author – Matt’s a hypnotherapist working in Birmingham with a specialism in ED

The post Everything you need to know about ED appeared first on Matthew Krouwel Hypnotherapist.

Of the many choices available: drugs, hormones, penile prosthetic’s, herbal remedies and acupuncture, many men are opting for psychological approaches, particularly hypnotherapy. This is especially the case for men who can achieve an erection for masturbation but not when with a partner.

Can hypnosis cure erectile dysfunction?

Put simply, Yes, you can cure erectile dysfunction with hypnosis, there is a wealth of evidence to support the choice of hypnotherapy and the techniques employed by hypnotherapists, such as:

• Systematic desensitisation – The patient imagines various anxiety provoking situations whilst in a hypnotically induced state of relaxation. This is most effective for anxiety induced ED (Auerbach & Kilmann,1977).

• Cognitive approaches – The internal thought processes are adjusted and re-focused away from erection onto something more useful: giving pleasure, enjoying sex, how stimulating your partner is. Often this will be combined with systematic desensitisation to make a form of cognitive behavioural therapy (CBT) which has proven effective with erectile dysfunction even without the addition of hypnosis (Xueqian & Heqin’s 1990).

• Psychodynamic approaches – these involve exploring relationships, both past and present and traumas. Pioneered in hypnosis by Harold Crailneck (1982 & Crasilneck and Hall 1985), who treated over 500 men using these approaches, 83% of whom were still enjoying full erectile function a years later.

For a free consultation regarding your erectile disorder contact Matt on 0778 909 7741 / +44778 909 7741 (outside of the UK) or via mattkrouwel@gmail.com.

 Dr Matthew Krouwel is a hypnotherapist  with over 25 years experience, and is a Diplomate member of the BSCH.  His practice is based in Birmingham (UK) and he also works online.Matt has considerable experience of working with Erectile dysfunction (ED) along with other sexual problems such as pornography addiction and has lectured and trained hypnotherapist on the topic internationally. To find out more about what a hypnotherapy session is like, tap here! 

References

Auerbach, R., & Kilmann, P. R. (1977). The effects of group systematic desensitization on secondary erectile failure. Behavior therapy, 8(3), 330-339.

Crasilneck, H. B. (1982). A follow-up study in the use of hypnotherapy in the treatment of psychogenic impotency. American Journal of Clinical Hypnosis, 25(1), 52-61.

Crasilneck and Hall (1985) Clinical Hypnosis Principles and Practice 2^nd edition Grune & Stratton

Hatzimouratidis K, et al. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. Eur Urol (2010), doi:10.1016/j.eururo.2010.02.020

JOHANNES, C. B., ARAUJO, A. B., FELDMAN, H. A., DERBY, C. A., KLEINMAN, K. P., & McKINLAY, J. O. H. N. (2000). Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of urology, 163(2), 460-463

Nicolosi, A., Moreira Jr, E. D., Shirai, M., Ismail Bin Mohd Tambi, M., & Glasser, D. B. (2003). Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction. Urology, 61(1), 201-206

Rosen, R. C., Fisher, W. A., Eardley, I., Niederberger, C., Nadel, A., & Sand, M. (2004). The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence oSf erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion®, 20(5), 607-617

Wylie, K. R. (1997). Treatment outcome of brief couple therapy in psychogenic male erectile disorder. Archives of sexual behavior, 26(5), 527-545.

Xueqian, L., & Heqin, Y. (1990). Cognitive behavioural therapy for erectile disorder: A study from the People’s Republic of China. Sexual and Marital Therapy, 5(2), 105-114.

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