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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Several years ago, I was checking out of one of central London’s many shabby hotels. As I did so, the twenty-something man working on the desk was casually flicking through nude images on his phone. Clearly a guy who might benefit from therapy for pornography addiction. Two things came from this

1) I started to use better hotels

2) I began to think more about treating pornography addiction.

In this blog I am going to explore what we currently know about compulsive pornography use, its associated effects and therapy for pornography addiction.

Therapy for pornography addiction – What is pornography addiction?

There is currently no agreed upon definition of pornography addiction. This is no surprise as some people dispute the use of the word ‘addiction’ for it (Ley, Prause, & Finn 2014) . However, diagnostic tools have been describes, such as the 8 questions, but no level has yet been set to give a clinical definition. Essentially, it is the client who defines the condition by stating they have it.

Therapy for pornography addiction – is pornography addiction bad?

Whatever your personal opinions about the use of pornography, it seems pretty clear that it is a part of our world and it’s here to stay. There is a long standing debate regarding the pro’s and con’s of pornography which we will not engage in depth with here. Suffice to say that some studies have found that it is associated with a number of positives, (Watson 2012) such as;

• Greater sexual adventurousness (Häggström-Nordin, Hanson & Tydén  2005 & Štulhofer, Buško  2010),
• Greater open-mindedness on social issues (Diamond 2009) .

The idea that pornography use leads to abusive behaviour has never been demonstrated. There is some evidence suggesting the opposite to be true. (Baron 1977 & Kutchinsky 1973, Brannigan, Kapardis 1985). This chimes with my experience of clients for pornography addiction, who I generally find to be more sedate than aggressive.

The consequences which most often affect clients and drive them to therapy in my experience are;

• Erectile dysfunction and associated issues with sexual performance, which come from over masturbation. Often, they find they are avoiding sex or their partner so that they never have to risk being a failure in bed.
• Relationship issues. These most commonly arise when the partner is offended or insulted by the pornography use, seeing it as either a criticism (“am I not enough for you!”) or they feel in competition with the porn-stars. Relationship issues can also occur when the constant exposure to adventurous sexual behaviour or highly attractive people stimulates a dissatisfaction in the user with their current life.
• Religious and spiritual issues. The deeply spiritual are not immune to the temptations of pornography, indeed the thrill of ‘breaking the rules’ may even be part of the attraction. Such people tend to present for therapy when they fear the rejection or chastisement of their community, or when their own spiritual or moral compass will no longer tolerate the lack of integrity.
• Time issues. A lot of people use pornography for long periods, jumping from scene to scene without ever reaching climax. The result of which is that hours of otherwise useful time are lost to them.
• Relationship substitution. This is where the client is aware that they are using pornography instead of pursuing a relationship. Often they will be aware that a real relationship will be more fulfilling but have little drive to get a partner, their sexual desires being sated.

Therapy for pornography addiction – Treatment

My personal preferred approach is Acceptance and Commitment Therapy (ACT). Although, it is unwise to be wedded to any one therapy approach, I use the ACT model as a starting point. ACT had one of the best evidence basis for treating pornography addiction at the time I wanted to learn how to treat it, (Twohig, Crosby & Cox 2009, Twohig, & Crosby 2010) but others have proven effective. The basic’ of this treatment involve

• Focusing the client on the things of emotional value to them over the long term.
• Helping the client to change their relationship with pornographic thoughts and feeling. This may be done through mindfulness exercises, desensitisation work or metaphors.
• Lifestyle changes which seek to reduce the problem behaviours or focus energy into ‘healthy’ environments.

There is far more to this kind of work than this, rapport is essential. The therapist needs to be comfortable conversing in crude terms and acknowledging the human desires which drive pornography use as valid. As with all therapy the creation of a non-judgmental environment is essential. The techniques themselves may be quite straightforward but it is only in rapport that you will be able to effectively deploy them.

Because rapport is so important to this kind of work I offer potential clients a free consultation so we can get to know each other before they decide if they wish to go forward. If you would like to begin your journey to a healthier relationship with pornography feel free to get in touch.

The author – Dr Matt Krouwel PhD is a hypnotherapist in Birmingham (UK). He has extensive experience working with sex and pornography addictions and has taught the use of hypnotically enhanced ACT and CBT. He works both in-person and online with clients in Europe, Africa, Asia and America.

Therapy for pornography addiction – references

Baron RA, Bell PA. Sexual arousal and aggression by males: effects of type of erotic stimuli and prior provocation. J Pers Soc Psychol. 1977;35(2):79–87. doi:10.1037/0022-3514.35.2.79.

Brannigan, Kapardis. The controversy over pornography and sex crimes: the criminological evidence and beyond. Aust N Z J Criminol. 1986;19(4):259–84. doi:10.1177/ 000486588601900406.

Diamond M. Pornography, public acceptance and sex related crime: a review. Int J Law Psychiatry. 2009;32(5):304–14. doi: 10.1016/j.ijlp.2009.06.004.

Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS. 2005;16(2):102–7.

Kutchinsky B. The effect of easy availability of pornography on the incidence of sex crimes: the Danish experience. J Soc Issues. 1973;29(3):163–81. doi:10.1111/j.1540-4560.1973.tb00094.x.

Ley, D., Prause, N., & Finn, P. (2014). The emperor has no clothes: a review of the ‘pornography addiction’model. Current Sexual Health Reports, 6(2), 94-105.

Štulhofer A, Buško V, LandripetI. Pornography, sexualsocialization, and satisfaction among young men. Arch Sex Behav. 2010;39(1):168–78. doi:10.1007/s10508-008-9387-0

Twohig, M. P., Crosby, J. M., & Cox, J. M. (2009). Viewing Internet pornography: For whom is it problematic, how, and why?. Sexual Addiction & Compulsivity, 16(4), 253-266.

Twohig, M. P., & Crosby, J. M. (2010). Acceptance and commitment therapy as a treatment for problematic internet pornography viewing. Behavior Therapy, 41(3), 285-295.

Watson, M. A., & Smith, R. D. (2012). Positive porn: educational, medical, and clinical uses. American Journal of Sexuality Education, 7(2), 122-145.

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Lamont developed a graded scale to classify Vaginismus.(in Pacik 2011)  the scale is based upon response to a genealogical examination, however it may still be useful to those wishing to get some idea of the severity of their vaginisimus.

Grade 1 – The patient has noted tight vaginal muscles, but is able to relax enough with coaxing to have a gynaecologic examination.

Grade 2 – The muscles are tight, the patient is unable to relax, but an examination is still possible

Grade 3 – The patient lifts her buttocks to avoid examination.

Grade 4 – The patient elevates her buttocks, retracts and adducts her thighs to avoid examination.

A grade 5 has been discussed (Pacik 2011) in which visceral expressions and responses; such as crying, shacking, trembling, hyperventilation, vomiting.  Examination may become impossible.

References – The Lamont scale of Vaginisimus

Pacik, P. T. (2011). Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic plastic surgery, 35(6), 1160-1164.

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3 Behaviours to adopt to limit the effects of pornography addiction

1) Fasterbation

For many people with  a pornography addiction a major part of the problem is the amount of time spent viewing. Many addicts will spend hours online. Often underlying this behaviour is a desire to find fresh stimulation or to find an ideal image. In most cases a simple behaviour change is to decide in advance how long to spend viewing, or how much.  A typical target might be;

• To orgasm within ten minutes
• On the second video viewed.

2) Dumb phone

3) Synchronised sleep

For a lot of the Pornography addiction patients I see the main motivation for coming is their partner, often their partner will be sick of their porn use because they find it offensive or because they feel that they are being forgotten. Someone who is committed to making a change can endeavour to get more in tune with their partners daily rhythm, such as ;

• Getting up in the morning with them.
• Watching TV with them.
• Eating meals together.
• Going to bed with them at night.

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Considering porn addiction therapy? In this article we take a look at 3 of the most well researched porn addiction therapy approaches (What is porn addiction?) . 

Porn addiction therapy

1. Family based therapies

How it works?  – Family based therapies seek to explore the family dynamics and assumptions. The therapist will often ‘become a member’ of the family in order to understand its workings and  then they will look to help the family to challenge unhelpful behaviours and unspoken rules which may create or sustaining the problem.

Does it work? – Family based therapies has enjoyed some success as a porn addiction therapy (Ford, Durtschi, Franklin 2012, Wonder 2013), however a lot of people presenting for porn addiction therapy are embarrassed by their behaviour (Chrisholman 2015) and are not ready to challenge this in an open family setting. 

    2.  Acceptance and Commitment Therapy (ACT)

How it works? – ACT works as a porn addiction therapy by helping a person to accept their desires without having to act upon them. Practical behaviour changes and desensitizing exercises are often used to reduce temptations and the therapist helps the person to identify their values in life so they can direct more energy towards what they want. The aim of therapy is flexible and often will look to reduce porn usage to ‘normal’ levels rather than completely stop, although this can be considered.

Does it work?  – Although it is early days there is a growing body of evidence that ACT is effective as a porn addiction therapy (Twohig 2010, Wetterneck et al 2012, Twine 2015) 

    3. Cognitive Behavioural Therapy (CBT)

How it works? –  CBT works by challenging assumptions and beliefs and then adopting new beliefs, which are then reality tested. As a porn addiction therapy CBT will often concentrate on assumptions around the ability to control biological impulses and the strength of those impulses. As with ACT practical lifestyle changes are likely to be part of the therapy.

Does it work?  – Although currently there appears to be little direct evidence for CBT’s efficacy as a porn addiction therapy it is looking promising (Fjerkenstad 2012, Twine 2015). 

Hopefully this article will help you to decide for yourself which therapy approach is right for you.

The author – Matt Krouwel is a hypnotherapist in Birmingham (UK). He has extensive experience working with sex and pornography addictions and has taught the use of hypnotically enhanced ACT and CBT.

 References – Porn addiction therapy 

Chisholm, M., & Gall, T. L. (2015). Shame and the X-rated Addiction: The Role of Spirituality in Treating Male Pornography Addicition. Sexual Addiction & Compulsivity, 22(4), 259-272.

Ford, J. J., Durtschi, J. A., & Franklin, D. L. (2012). Structural therapy with a couple battling pornography addiction. The American Journal of Family Therapy, 40(4), 336-348.

Fjerkenstad, J. (2012). In my opinion: Treatment that mirrors the dark world.Sexual Addiction & Compulsivity, 19(1-2), 156-160. 

Twine, S. L. (2015). ANCOVA Study of Psychotherapy Treatment of Internet Pornography Addiction in Heterosexual Men. Fidei et Veritatis: The Liberty University Journal of Graduate Research, 1(1), 3.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of consulting and clinical psychology, 78(5), 705.

Wonder, N. (2013). TREATING PORNOGRAPHY ADDICTION WITH IFS.Internal Family Systems Therapy: New Dimensions, 159.

Wetterneck, C. T., Burgess, A. J., Short, M. B., Smith, A. H., & Cervantes, M. E. (2012). The role of sexual compulsivity, impulsivity, and experiential avoidance in internet pornography use. The Psychological Record, 62(1), 3.

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It’s unknown how many people experience and suffer from sex addiction or seek out sex addiction therapy as there is no clear definition of what sex addiction means. Certain behaviours and tendencies are common, for example;

• Obsessive thinking about and planning sex.
• Using sex as a distraction from poor mood or in response to stress.
• Failure to take control of sexual behaviour and thoughts.
• Repetitive sexual behaviour with disregard of physical, social and emotional risk.

What we do know for sure is that you can get better.

Considering therapy? here is what you need to think about:

• Am I ready to work? – therapy is not easy, your therapist will expect you to work, possibly doing meditation or relaxation exercises, making lifestyle changes. You may have to change social groups. Whatever it may be it will take time and effort.
• What is the best type of therapy? – there is no simple answer to this are many approaches to sex addiction therapy and few have been rigorously tested .However, I recommend active therapies like Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and hypnotherapy.
• Does the therapist have the skills and experience? – There are no hard and fast rules about identifying the right therapist for the job but generally look for someone who says they specialise in sex therapy, psychosexual work or sexual issues … and then phone them up and talk to them. Most therapists will be willing to discuss briefly on the phone or arrange a free consultation that will allow you to get to know them and make up your own mind. Just because someone has done some specialist training doesn’t mean they are the best, talk to them first to find out if you could get along.
• How long does it take? Again this may vary, I personally tend to say that 6 sessions are a good starting point for the way I work and most people find this is sufficient to enable change. Some people do long term support work beyond this to prevent relapse.

The most important thing towards a successful life change is picking up the phone and asking for help.

The author

Dr Matt Krouwel is a hypnotherapists with over 25 years experience and is a Diplomate member of the BSCH who specialises in sexual issues and problems including sex addiction and pornography addiction

Further reading - 

Binik, Y. M., & Hall, K. S. (Eds.). (2014). Principles and practice of sex therapy. Guilford Publications.

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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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Vaginismus is a condition in which the vagina tightens or spasms in response to penetration or attempted penetration. This tightening causes discomfort, pain and often prevents sexual activity.A number of potential causes have been suggested, and it is widely considered to be an anxiety condition  . What are the main vaginismus treatment options?

Vaginismus effects between 0.5-1% of women, (Simons, & Carey’s 2001) meaning 10’s of thousands of women in the UK are prevented from enjoying a full sex life. However, there are many highly effective ways to treat vaginismus, in this blog we examine 5 of the most popular.

The 5 main vaginismus treatment options;

 1)    Couples therapy

One study of 56 couples achieved an 80.3% success rate as defined by achieving penetration. (Munasinghe, et al 2004) A similar study achieved a similar outcome, which was sustained at a three month follow up.(Hawton & Catalan 1990). Despite this high level of success, couple’s therapy has a drawback, it requires both partners to cooperate. Further, it requires them to  coordinate their time table, which may prove difficult with two busy lives.

2)    Pelvic floor exercises

Pelvic floor exercises are widely used exercises intended to strengthen and improve control over bladder. They may also help you to gain a greater control over your vagina. Research into pelvic floor exercises for vaginismus has found broadly positive out comes. One study of 23 women found that 69% moved in to total remission and almost all improved (Kokate & Bulbuli,2025). Another study demonstrated an additive effect when pelvic floor exercies were combined with dilator therapy. Dilator therapy is a form of desensitization (see below) (Reissing et al 2013).

3)    Systematic Desensitisation

This is graded exposure to vaginal penetration, often by the use of a series of different sized dilators (essentially dildos) or the insertion of fingers (1 finger, then 2 fingers etc). This is accompanied by relaxation exercises to counter the tensing which comes with vaginismus. In addition, often new thought patterns will be introduced. Most commonly the relaxation and new thoughts are taught in a session with a hypnotherapist or Cognitive behavioral therapist and then put into practice in private at home. Success rates are extremely high. With one study (Jeng et al 2006) finding that 83.3% of the participants were having regular intercourse with orgasm at one year follow up. Many studies of desensitization for vagnismus report 100% of participants achieve full intercourse at or before the completion of the study (Biswas & Ratnam 1995, ter Kuile et al 2007, Reamy 1982).

4)    Surgery

Hymenectomy, the surgical removal of tissue which partially or full obstructs the vagina, may at first appear to be a sensible treatment option for vaginismus. However, this is based on idea that penetration is likely to cause traumatic rupturing of the hymen, which is a common belief, but it may be that the belief is causing the symptom more frequently than the symptom causes the belief (Ward & Ogden 1994). Evidence suggests that for vaginismus hymenectomy is mostly ineffective (Katz & Tabisel 2001). Doubtless, for a small number of women surgery will be the right option, but for most there are easeir and safer options.

5)    Botox

Botox for vaginismus involves the injection of a controlled dose of botulinum toxin to freeze the pelvic floor muscles (Pacik 2011). Success rates vary from 75% (Ghazizadeh &, Nikzad  2004) up to 100% (El-Sibai 2000), at completion of therapy, with many studies showing a good retention of benefits at 1 to 2 year follow up (Pacik 2011, Bertolasi et al 2008). However, as with any intervention side effects have been reported including vaginal dryness and stress incontinence (Velayati,, Jahanian Sadatmahalleh,, Ziaei, & Kazemnejad,2019).

The Author

Matt Krouwel is a hypnotherapist in Birmingham who works with a variety of issues including specialisms in psycho-sexual disorders, including vaginismus and  Erectile dysfunction.   Contact him for a free consultation on 0778 909 7741or via email at mattkrouwel@gmail.com, sessions can be in-person or online.

References

Bertolasi, L., Frasson, E., & Graziottin, A. (2008). Botulinum toxin treatment of pelvic floor disorders and genital pain in women. Current Women’s Health Reviews, 4(3), 180-187

Biswas, A., & Ratnam, S. S. (1995). Vaginismus and outcome of treatment. Annals of the Academy of Medicine, Singapore, 24(5), 755.

El-Sibai, A. S. O. (2000). Vaginismus: results of treatment with botulin toxin. Journal of Obstetrics & Gynecology, 20(3), 300-302.

Hawton, K., & Catalan, J. (1990). Sex therapy for vaginismus: characteristics of couples and treatment outcome. Sexual and marital therapy, 5(1), 39-48.

Ghazizadeh S, Nikzad M (2004) Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol. 2004 Nov;104(5 Pt 1):922-5.

Jeng, C. J., Wang, L. R., Chou, C. S., Shen, J., & Tzeng, C. R. (2006). Management and outcome of primary vaginismus. Journal of sex & marital therapy, 32(5), 379-387.

Katz, D., & Tabisel, R. L. (2001). Is surgery the answer to vaginismus?. Obstetrics & Gynecology, 97(4), S27

Kokate, V. A., & Bulbuli, A. (2025). Effect of Pelvic Floor Rehabilitation in Women with Primary Vaginismus: A Clinical Trial. Journal of South Asian Federation of Obstetrics and Gynaecology, 17(4), 475-480.

Munasinghe, T., Goonaratna, C., & de Silva, P. (2004). Couple characteristics and outcome of therapy in vaginismus. Ceylon Medical Journal, 49(2), 54-57.

Pacik, P. T. (2011). Vaginismus: review of current concepts and treatment using botox injections, bupivacaine injections, and progressive dilation with the patient under anesthesia. Aesthetic plastic surgery, 35(6), 1160-1164.

Read, S., King, M., & Watson, J. (1997). Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general practitioner. Journal of Public Health, 19(4), 387-391.

REAMY, K. (1982). The treatment of vaginismus by the gynecologist: An eclectic approach. Obstetrics & Gynecology, 59(1), 58-62

Reissing, E. D., Armstrong, H. L., & Allen, C. (2013). Pelvic Floor Physical Therapy for Lifelong Vaginismus: A Retrospective Chart Review and Interview Study. Journal of sex & marital therapy, 39(4), 306-320.

Simons, J. S., & Carey, M. P. (2001). Prevalence of sexual dysfunctions: results from a decade of research. Archives of Sexual Behavior, 30(2), 177-219.

ter Kuile, M. M., van Lankveld, J. J., Groot, E. D., Melles, R., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors. Behaviour research and therapy, 45(2), 359-373.

Velayati, A., Jahanian Sadatmahalleh, S., Ziaei, S., & Kazemnejad, A. (2019). Can botox offer help women with vaginismus? A systematic review and meta-analysis. International Journal of Sexual Health, 31(3), 233-243.

Ward, E., & Ogden, J. (1994). Experiencing vaginismus–sufferers beliefs about causes and effects. Sexual and Marital Therapy, 9(1), 33–45. https://doi.org/10.1080/02674659408409565z

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