COMMON CONCERNSTherapy for Erectile Dysfunction in Sydney
If you feel pressure to perform in a specific way sexually by getting and maintaining an erection for a prolonged period before ejaculating, that pressure can activate your nervous system stress response, known as sympathetic dominance.
While you are in sympathetic dominance, your body is performing exactly as it should by NOT having an erection.
Your body is not supposed to have an erection while you are under threat, and this is what our sympathetic system ( fight, flight, fawn) believes is happening.
Most people who present to therapy for what they describe as ‘erectile dysfunction’, often don't actually meet the diagnostic criteria for it. What is more important than a diagnosis of an erection or ejaculation issue, is that if you are experiencing any stress, anxiety and/or impacts to your relationship(s) or confidence, this is worth exploring further.
In situations of erection and ejaculation concerns, it is best to seek support as soon as you notice yourself becoming concerned about it, as the more you worry about it and build anticipatory anxiety, the more likely it is to keep happening.
What counts as an erection concern?
There are lots of misconceptions about how a penis ‘should’ perform during sex. This is largely due to a lack of proper sex education, and a reliance on porn, which is not a true reflection of sexual performance and satisfaction.
The average penetrative sexual experience lasts for 4-minutes, (not 20+ like porn may have you believe), and if sexual intimacy is going on for a prolonged time, it is possible that regardless of how aroused you are, that an erection may come and go due to the bodies natural circulatory system redirecting blood to other areas of the body.
It's not just an older person's issue
Problems with gaining and maintaining an erection have long been considered an older person's issue, but that's changed. Since the late 2000s, reporting rates among under-40s have risen sharply, and the highest rates now come from 16-21 year olds, 50% of whom report difficulty gaining or maintaining an erection (partly explained by a lack of sex education leaving young people with limited understanding of what influences erections).
Among 18-40 year olds specifically, 1 in 5 now report ongoing difficulty, compared to roughly 1 in 20 in the late 1990s.
Erectile dysfunction: signs & causes
Erectile dysfunction as a formal diagnosis under the DSM-5 requires certain criteria to be met. These are that for a period of at least six months, someone is experiencing:
Difficulty obtaining an erection during sexual activity
Difficulty in maintaining an erection until the completion of the sexual experience or until ejaculation
Decrease in erectile rigidity
To be clear, if any of these are happening but you are not concerned about it, that's okay!
The main factor we would see in those seeking support for erection issues is that it is causing significant distress to the person experiencing it.
There are many physical, psychological and situational factors that contribute to erectile dysfunction, and treatment involves identifying what is happening for you specifically, and developing a tailored approach.
Psychological & situational causes
Most erection issues, especially for those under 50, aren't physical. They're usually rooted in psychological, situational, emotional or relational factors, most often performance anxiety: stress or worry about how you'll perform in the moment.
The most common contributors we see at Good Vibes Clinic:
Home life and relationship dynamics or conflict
Porn use
Poor sex education and pleasure awareness
Stress, poor sleep and other lifestyle factors
Smoking, drinking and low activity levels (these affect circulation, fitness and presence)
Physical causes
Physical causes of erectile dysfunction include biological, neurological, hormonal and medical factors:
Circulatory issues, often an early marker of conditions like COPD, diabetes or other arterial and cardiovascular disease
Neurological conditions such as brain or spinal cord injury, or pelvic trauma, which affect the nerve pathways involved in erections
Prostatectomy (removal of the prostate) for prostate cancer
Hormonal factors like endocrine or thyroid issues and low testosterone (rarely the root or only cause)
If you're experiencing erection issues complete our free questionnaire AND our team WILL provide advice on which specialist you're best to connect with for support.Considering erectile dysfunction surgery? Read this first
Due to the traditional medical model of treatment, most people experiencing erection concerns assume the issue is physical, without seeking proper investigation or support for situational and psychological factors first. There have been instances of clients presenting to sex therapy at Good Vibes Clinic who have previously undergone unnecessary (and sometimes irreversible) medical procedures to treat an erection issue that was not physical or medical to begin with.
The most common reason for someone to seek surgical intervention for erection concerns would be following prostatectomy (removal of the prostate), or other brain or spinal cord injury. Before agreeing to any surgical intervention, we highly advocate speaking to a sex therapist who can identify any additional factors that might support your sexual function, confidence and satisfaction, as surgery is invasive, expensive and often can't be reversed regardless of outcome.
There are many ways to experience sexual pleasure and satisfaction with self and others that don't require any erection, and in many cases sex therapy support can increase erectile rigidity through pleasure education, use of aids and/or psychological and relational support.
When to see a doctor
It doesn't hurt to undergo a general health screening for circulatory, hormonal or other physical causes for erection concerns, however speaking to a sex therapist should be considered a complementary treatment protocol.
GPs may note that all bloods and physical markers are 'normal', and prescribe Viagra or Cialis, which can certainly be a helpful first line of support but treats the symptom and not the cause of the issue, and for many is not a long-term solution.
How we approach this at Good Vibes Clinic
An initial session includes a holistic review of your situation, identifies possible causes, and builds a plan of evidence-based treatment, typically sex therapy support over anywhere from two to many sessions, to address the situational, psychological, neurological or relational factors involved.
We take a multidisciplinary approach where needed, which might include couples therapy (available in-clinic) or referral to a Pelvic Floor Physiotherapist, Urologist, GP or other allied health practitioner, decided together with your sex therapist after your initial assessment.
Meet our ED specialised therapists
Taylor Neal (she/they)
Somatic Sexologist
Taylor’s approach is trauma informed, somatic, and rooted in acceptance and equity.
Ally Moore (she/her)
Sex Therapist
Ally’s style is warm, collaborative, and grounded in emotional safety, inviting clients to bring curiosity and vulnerability into the therapeutic space.
Grace Crawford (she/her)
Sex Therapist and Counsellor
Grace draws from a range of modalities, including person-centred, narrative therapy, CBT/ACT and somatic practices.
Common myths about erectile dysfunction
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Myth. The truth is: Incidence in under-40s has risen sharply. See the stats above.
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Myth. If an erection issue has any situational, relational or psychological roots, Viagra or Cialis can treat the symptoms but not the cause. Viagra can be a great short-term solution to reduce anxiety in specific sexual situations, but addressing the underlying causes will reduce the need for medical intervention in the long term.
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Myth. Physical, hormonal and neurological causes are common too and worth ruling out (see Physical causes above).
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MYTH! Difficult or missing erections in partnered sex typically relate to performance anxiety more than being in the 'wrong' relationship. When you're alone there's no one to perform for, whereas sex with others can create stress around getting erect and 'lasting long enough,' which actually then contributes to the lack of erection.
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Myth. It’s true that porn can contribute to unrealistic expectations around performance and duration, but it's not a universal or guaranteed cause.
Frequently asked questions
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You're welcome to come straight to therapy, especially if you suspect that your concern is situational, psychological or relational in nature. We will always recommend connecting with a GP if our assessment identifies there may be any physical factors at play.
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Yes, and the research is showing that it's becoming more and more common to experience erection issues as a young adult.
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Yes, this is known as performance anxiety. In folks under 50, anxiety is the most common cause of erection issues and can be treated very successfully with sex therapy support.
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Only if you want them to be. Sexual functioning concerns that happen in a couple's sexual relationship are a couple's sexual issue, not something wrong with you.
Even if it's your body experiencing the concern, there is almost always a complex interplay of relational factors that contribute to it showing up in partnered sex.
All individual sessions are completely confidential and there is no requirement for your partner to attend, but we do find faster success if the partner is open to attending or engaging in activities needed to support overcoming the concern.
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No, we don't. However, if we think medication would be supportive we will certainly discuss this with you and can provide relevant referrals as required.
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Absolutely. All our sessions, regardless of what you share, are required by law to remain confidential. If we receive your explicit consent to contact other relevant treating parties we're happy to do this, but it's not essential if it doesn't feel comfortable for you.
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Yes, our sessions can be completed online or in person in Surry Hills.
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Yes, although it depends on the therapist. Get in touch with the clinic and we can talk you through what applies to your situation.