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Anxiety not only can cause impotence in the first place, but it can undoubtedly worsen the condition once it exists.  For instance, a man who's cheating on his wife may not be able to have an erection when he's with his mistress, as subconsciously he's feeling guilty.  A man who has come out of a relationship where he was emotionally scarred may suffer from impotence because he no longer trusts women.  It's a complete fallacy that men can have sex at the drop of a hat, anytime, anywhere and with whomever.  Men have just as many tender feelings as women but society has never allowed them to be expressed.

After impotence has occurred a few times, even the most confident guy is going to start worrying.  The longer this goes on, the worse it gets — yet the problem may be quite solvable.

For reasons of pride, ego, embarrassment, fear, men often don't seek help immediately, sometimes preferring to suffer in silence, even feigning other excuses for not wanting sex.  This can leave their partners bewildered and unhappy.  Worry and anxiety only compound an already difficult situation.  Worry is concern over an existing problem and anxiety is an overall state of discomfort, often irrational.  Neither serves any worthwhile purpose whatsoever, other than pinpointing a problem that needs to be dealt with.

What psychological condition can cause impotence, what are the underlying factors and what does it tell us about the belief systems of the sufferer?

Impotence sufferers often are the first child of a family.  They are commonly overachievers, workaholics, overly-focused on duty and responsibility, too hard on themselves, leaders and very controlled.  With a profile like that, nothing but the best is tolerated in any area of life.  As perfection requires effort and is not achievable anyway, something has to give, and sexual dysfunction is one way in which the body can 'break down', signalling that it's under too much strain.  I have seen this pattern time and again in clients who have consulted me regarding impotence.  What is required is a relaxing of efforts in their lives generally so that some breathing space is created and balance can be restored.

Anxiety and all other negative emotions can be very destructive.  They are part of an overall belief system that is learned over many years so it can take a while for these patterns to shift.  If they are the cause of impotence, counselling may be required to remove the power of doubt and fear, for they are the real enemies.  Sex problems are very often other behavioural problems in disguise and they don't disappear overnight or by themselves.  Nor do they benefit from overworking.  It's like the sore that never heals because you won't stop picking at it.  If you allow yourself to become anxious every time you want to make love because you don't think you're going to be able to 'perform,' you're doing yourself a real disservice.  You are actually creating a new problem which exaggerates the first.

If you feel that you are even starting to become dysfunctional, look at your overall lifestyle — diet, sleeping, exercise, work habits, relationships, emotional balance, smoking, alcohol intake, etc. — then figure out what needs changing.  Self-help is always best and, if done right, should reduce the need for medical intervention.

However, if you are convinced that there's something else wrong, then check with your doctor and look at your other options.

If you are by nature an anxious person, you might want to enrol in a positive thinking/assertiveness course, or read some books on these subjects.  Take up yoga or tai chi, learn to relax more, take your time with things, for example, enjoy a bath before love-making.  Experience the journey instead of being in a hurry to proceed to the destination.

One of the worse things you can do if you're concerned about erection is to avoid sexual contact.  Out of embarrassment, men will simply stop making love in order to get out of having to explain impotence, even in a marriage.  Single men will either stop going out, or lose their confidence about going to bed with a woman.  This creates a failure complex and pushes the problem further into the forefront of the mind. This is really about self-esteem and self-image.  If you see yourself as being valuable only when you're doing well in bed, then sexual dysfunction can be emotionally crippling and immobilising.

The quality of a man's relationship is also a crucial factor, if he's married or seeing someone regularly.  If he doesn't feel able to share his fears and anxieties honestly with his partner, he's more inclined to hide or play down the problem.  Women often ask me how best to help their partners in these situations and I say that large doses of patience and tact are needed, along with a positive attitude.  Most importantly, there needs to be a de-emphasising of intercourse as being the only worthwhile sexual pursuit.  An impotent man can still perform oral sex, touch and stroke his partner, bring her to orgasm with his hands or mouth, use a vibrator, communicate with her, love her, and so on.  There are also specific measures he can take to restore his erection and these we'll look at in a moment.

One other possible cause of impotence needs to be covered, and that is something called 'distraction'.  Researchers have found that a man is more likely to be impotent when he is 'distracted' from sexual thoughts and feelings.  So, if he's preoccupied with work problems, feels stressed, worrying about money or whatever, he's less likely to be interested in sex.  The body obediently follows suit and fails to perform.  If a man had to masturbate while someone was reading a dry scientific journal to him, he would find it a lot harder to reach climax than if, instead, it were an erotic novel.

what can be done?
Apart from the suggestions I've already mentioned, a specialist can be consulted who may want to test the patient in laboratory conditions.  For example, a device can be placed on the penis to measure erectile activity during sleep.  This is known as the 'nocturnal penile tumescence test' and it helps distinguish organic from psychogenic impotence. Normal male responses during sleep include several erections over a seven to eight-hour period, so an overnight stay in hospital can identify the cause of the problem.  If none exists in the physical area, psychological reasons can then be examined.

Another important clue is whether a man has more difficulty becoming erect when he's on his own or when he's with a partner.  That tells us a bit more about his mental state and helps pinpoint what needs to be worked on.  It's a process of elimination essentially as, piece by piece, the picture becomes clearer.

Sometimes doctors give prostaglandin injections in the penis which bring on erections, again to determine if the cause is physical.  If it definitely is, and the impotence appears to be irreversible, penile implants are an option.  These consist of silicone rods that are inserted into the penis and attached to a pump implanted in the scrotum.

Another type is a mechanical device, which can be either a cylinder inserted into the penis by a pump at the head, or one that has a spring mechanism.  A third way to go is an inflatable prosthesis which operates on an inbuilt hydraulic system.  It comprises silicone rods, a pump in the scrotum and a reservoir of saline fluid stored elsewhere in the body, all connected by tubes.

If you suffer from impotence, the important thing is to identity the particular cause in your case and to do something quickly to alleviate the symptoms — including anxiety.  Some deep breathing before intercourse will help relax you, and having the right attitude about yourself, and sex in general, will also make all the difference.

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