Understanding the Difference Between Psychological and Physical ED

Today in this episode I'm going to talk about how do you know whether your ED is physical or psychological? So stay tuned. Next episode we're going to dive into it.

This podcast is for you. The modern man. I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside.

Hey there. In this episode we're going to talk about whether your ED is physical or psychological and I'm going to tell you the differences between the two and just some quick strategies you can do today. So stay tuned for this episode to the end and I'm going to give you some quick strategies that you could do to tell the difference if it is psychological. So first, how do you know that your ED is physical or psychological? What are some ways to tell? But let's first go over that sex is just not about intercourse only and performance anxiety is more likely to occur. If you think about it, you think about sex as always, penetrative sex, and it's the only kind of sex there is. However, sex is made up of different kinds of sexual activity, not just intercourse. There is outer course, which is for play and enjoying pleasurable things and putting yourself in the moment, enjoying each other and not worrying about your erection and not worrying about just whether it's going to be firm enough for penetration or not. So that way you're just enjoying the senses and getting into more of thinking about the moment rather than am I firm enough? Is this going to happen again? Because the more you think about it, the more you can think about your penis. And I'll show you why that is not good. So when you get together with your partner, you think about whether you perform and you consume with it. And then when you're consumed with it, guess what? You may lose your erection because you're not enjoying the moment at all. And so do you know that the penis is most sensitive when it's 60% erect and that you don't have to be fully erect to feel good? That it's also quite normal for erection to wax and wane during sexual play, in fact, and that focusing on pleasure will lead to more pleasure. Now how is that? Because the brain is the largest sexual organization, erection starts in your Brain not in down below the belt. Because an erection starts with getting aroused with the five senses, such as the sense of smell, what you see, what you taste, what you hear, what you touch. And these signals are what sets off the whole cascade that goes on in your brain with your emotions and, and your hormone. And then the chemical that gets released that stimulate the nerve and then stimulate the blood vessels and finally the penis muscle. So there's cascade that happens, but it all starts in the brain. And so when you start to have emotion that involve and negative thoughts, that's going to dampen the whole cascade. It's okay if you feel that your penis go from less stiff than not. Because when you have an erection you want to be in a relaxed state. You want to be in the feed or breathe nervous system, which is called parasympathetic nervous system. And the parasympathetic nervous system is what make your penis muscle relax. So that way you can have an erection. And so when you start feeling negative thoughts and you start feeling panicky, whether you're going to be firm enough or whether you am I going to be able to form this time? Just start thinking about some negative thought which then stimulate the sympathetic nervous system, which is the fight or flight system, which then will cause your penis to be flaccid. You're going to be distracted. So causes of psychogenic or psychological ed. It sometimes it present as sudden onset of ED and that occasionally you'll have morning erection. You'll, you can still have erection with masturbation, but you have no medical history that can contribute to ed. And I'll go over what some of those are. And you're not on any type of ED medication. You have a history of anxiety and or depression and that may be relationship tension or loss of intimacy as well too. So you want to rule out physical cause. And what are some of the physical causes that you want to rule out that you do not have is that you don't have any pain or numbness around your pelvis area, which is the area around your penis. Because that could signal you may have some nerve loss or that you needing to urinate every 15 to 20 minutes. Because that can signal that you have prostate problem or that you feeling incredibly thirsty, you're drinking a lot. That could signal that you may have diabetes or you may have tight heavy chest pain when you exercise. That could signal that you have a circulation problem or even heart problems and difficulty controlling your pee your poop, which can mean that you have nerve damage in the pelvis area. So that's one of the reasons why I always advocate that when you have ed, go see the doctor, get your blood work. I can't tell you how many times I will see men with ED and then diagnose them with new onset diabetes or that find out that they have some prostate problem or that they have low hormone such as testosterone or even high cholesterol. And some of these guys are never even had blood work done in like decade. And also you always want to make sure that you don't have any type of pelvic injuries like sports or fall or prolonged cycling that may be affecting the testicle function as well. There are many, many medications that can contribute to ed and some of them are the usual. Anti blood pressure medication, antihistamine, antidepressant medication, diuretics such as water pill and antiarrhythmia, meaning the medication that controls your heart rhythm, tranquilizers and sedative sleeping medication, medication that relaxes your muscle in case you have pain, anti inflammatory drugs, even naprosyn or ibuprofen, anti anxiety medication like Xanax or stomach ulcer medication, and even some medication that will help with infertility, chemotherapy medication, prostate medication and painkillers such as opioids medication and anti seizure medication. So what's the difference between physical and psychological ED is that ED happen whenever a mental or physical link in the erection chain is broken and you can't do the job properly. So like I said, you know, the erection starts in the brain. And the 6 system that's involved with creating an erection is the brain, the emotion, the hormone, the nerve, the blood vessels and the penis. Psychological ED happens when the brain fail to send a signal which starts to cascade. And it could happen any point during sexual activity. That's why your penis can go soft when things start out well. However, physical ED happens when something isn't right in the body. Any problem that block or restrict blood flow to the penis is a good culprit for physical ED. Luckily, 90% of ED comes from physical and only about 10% is really more psychological and have. Sometimes ED can have a mix of the two causes as well and they play around with each other. So there are two systems for erection and I mentioned that earlier, is that the parasympathetic is the feed or breed and and then the sympathetic is a fight or flight system. And the fight or flight system help your body deals with threat or emergency or trying to run away from threat. And when the fight or flight or sympathetic nervous system takes over, your heart rate goes up your blood rushes to your muscles so you can get away from the threat. And this help you deal with the problem emergently. However, it takes the blood flow away from your penis. And so when the fight or flight is triggered, you're not going to be able to get an erection. So for instance, when you're stressed or when you're distracted, it's hard to to be in the mood and to have an erection. And your brain don't know the difference between real threat and being anxious in the bedroom. So that's very important. The brain recognizes fear. And then the brain switches from fight or flight mode and, you know, from being a stimul mode. And then distress direct blood away from the penis. And this is really the model of every psychological erection issue. So how do you combat that? I'm going to give you a couple tips today. One, the first tip is box breathing. This is what the Navy SEALs do in order for them to be calm to accomplish their mission. What it is is that it activate the fetal breed mode, which is the parasympathetic nervous system. This parasympathetic nervous system is the system that help you get an erection. So how do you do that? Do that with me. So if you are able to watch this video or even the podcast. Box breathing starts with taking deep breath in for. It takes four seconds, then you hold it for four seconds, then you breathe out for four seconds, and you hold it for four seconds. So when you take your deep breath in, you want your stomach to kind of come out. Even though you pull down your diaphragm, your stomach puff out. And then when you breathe out, you want to puff in your stomach, kind of bring in your stomach. So let's go ahead and do this. So that's called box because you breathe in for second, hold for four seconds, breathe out four seconds, hold for four seconds. Let's go ahead and do that together. We're going to breathe in four, hold for four, breath out for four, and hold for four. You can breathe into your nose and then breathe out through your mouth and do this for five minutes. And you can do this before sexual activity, during sexual activity, or when you start having that negative thought come to your brain that's gonna say, oh, my God, am I gonna be able to get stiff enough today? Am I gonna be able to perform? Is this gonna happen again? When that thought occurred in your mind, start this box breathing, all right? And you can do it without anybody even noticing that you do it. In fact, you can do it every day. In fact, I Do this every day when I want to get into better focus and have more energy. One thing that's very important is that at least one in three men have erection problem. So does that make you any less of a man? Now studies have shown that men between the age of 40 to 70, 50% of them have ED. In a study in 2008 called the Men's Attitude to Life Event and Sexuality or the Male study M A L E S found the answer to this. So does having ED make you less of a man? No, because it showed that the most important part of being a man are honor, self reliance and being respected by friends. It's exactly the same for men with and without ed. So this might not be the definition of a man, but it's a good reminder that sexual performance isn't as important to manliness as messages from the media or porn that we see. So media or porn may not be the reality of what manliness is. So the manliest thing you can do is to realize that you know, your manliness does not have to correlate with your erection and get into pleasure versus obligation. When sex is about fulfilling obligations or living up to something, it puts stress in the mind, so it triggers that sympathetic nervous system and it's hard to get things started below the bell. So you want to be prioritizing that, you know, sexual relationship be pleasure for you and for your partner. And stop the negative talk in your mind. Stop the negative talk and just don't get these type of thoughts in your mind. Like don't lose your erection again, don't ruin the moment, don't enter that awkward situation again. You're not going to keep it up. This isn't going to work if you're having those thoughts. Stop those thoughts, recognize it and start your box breathing. Get out of your head and into your body. All right? The more you wash your penis firmness, the more you'll have erection issues. The more you have erection issues, the more you'll wash your penis. So get out of your head into your body and paying attention to your senses and enjoying pleasure. One thing you need to know is that the penis can change firmness during intercourse and and still remain functional. If you weren't watching it, you would notice it. So it's okay to have changes in firmness throughout the whole sexual activity and know that situational anxiety triggers or ruin your erection, all right? And it just break the flow of the sexual activity. All right? Get out of your head, get into the moments, stop talking critical self talk and change it to be more of physical contact, sexy, keep the sexual flow going and maintaining. And recognize when you start having negative thoughts, all right? Because negative thoughts inhibit erection. And you don't want to have these thoughts become present in your mind during this moment. And that's how you kind of stop the psychological ed. I can't tell you how many times that I've treated patients and they're able to get better blood flow going. They're getting morning erection, they're getting firmness, and then they start talking negative thought. They start thinking about negative thoughts. And they depend upon, you know, the little blue pill to help them with their confidence. And it's almost like it's their security blanket. So first of all, stop the ED medication. And second of all, give yourself the pat and say that, you know, you can do this, all right? You're not less of a man if you do have ed because you can get out of those negative thoughts. You can practice box breathing. You can focus on the moment. Get out of your head and into the moment, enjoying the pleasure and the senses yourself and with your partner. You'll be amazed how fast this is going to work. And if you just start just one strategy, and I hope that you will do at least one, and I will leave in the show, note that study about manliness, and I hope to see you next time. And thank you for being with me today.

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