Erectile dysfunction can silently shake the foundation of a loving relationship, leaving behind feelings of shame, frustration, and distance. For many men, it’s more than a physical challenge – it feels like losing a part of who they are, especially in the deeply personal space of intimacy.
The quiet pain lingers, creating unspoken tension that can leave both partners feeling isolated. What once was a place of closeness and vulnerability now feels fragile, as doubt and insecurity creep in. It’s a deeply emotional struggle, often hidden behind brave faces, but it takes a toll on the heart and the mind.
At its core, this isn’t just about performance – it’s about connection and self-worth.
Potential causes
Thulisa Dyantyi, a sexual and reproductive health nurse from Cape Town, says medical conditions that lead to erectile dysfunction include heart disease, high blood pressure, diabetes, atherosclerosis (a condition caused by clogged blood vessels), obesity, and tobacco use.
“These conditions affect blood flow in the body to the organs,” she explains.
“They are the cause of inadequate blood flow to the penis veins, which can lead to erectile dysfunction.”
Thulisa Dyantyi
Dyantyi also notes other conditions, including prostate cancer or an enlarged prostate, sleep disorders, low testosterone levels in the body, and antidepressants.
“Prostate cancer reduces sexual desire and the frequency of sexual intercourse, as there is also pain in the prostate and pain when urinating.”
She adds that antidepressants can also play a role, stating, “Antidepressants act on the serotonin levels in the body. Serotonin helps the body feel less depressed, but too much serotonin inhibits sexual desire.
“There are over-the-counter medications to boost libido in men, but it’s also best to seek medical attention so that the underlying cause can be addressed,” Dyantyi says, adding that medication will be prescribed under medical supervision.
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Traditional treatments
Madoda Mditshwa, a heritage activist and traditional healer from Mbizana in the Eastern Cape, explains that factors contributing to weak erections vary from person to person.
“We use herbs to help men facing these challenges, and these are safe herbs without added chemicals.”
Madoda Mditshwa
Mditshwa notes that for men, maintaining control over their bodies, especially their manhood, is crucial. When erectile dysfunction occurs, it often leads to a loss of self-confidence and a feeling of not being fully in control.
“This is common, and one contributing factor is poor blood flow. As traditional healers, we mix several herbs – such as phakama and ivuka, among others – as our first approach to help men balance their erectile function.” He also says that while there are quick fixes available from herbal pharmacies, these can be risky.
Mditshwa explains that erectile dysfunction is a challenge that requires attention and time to heal.
Mental toll of erectile dysfunction
Thabo van Wyk, a clinical psychologist with Tshwane District Health Services from Atteridgeville, Tshwane in Gauteng, says from a psychological standpoint, prolonged erectile dysfunction can lead to feelings of sadness, and men with erectile dysfunction often isolate themselves due to the shame associated with the disorder.
“Erectile dysfunction, which is the inability or difficulty to achieve or sustain a penile erection, is the most prevalent sex-related stressor for males.”
Thabo van Wyk
He adds, “Men over 40 are more likely to have it, and the prevalence rises with comorbidities or age. It is estimated that between 14% and 48% of people have erectile dysfunction.”
Van Wyk notes that these men can feel overwhelmed, leading to performance anxiety, which may make getting an erection more difficult.
Van Wyk notes that increased communication between spouses is typically the main goal of psychotherapy.
He says, “Communication draws attention to sexual intimacy and how it might be addressed by emphasising other erogenous zones, such as physical touch and kissing.
“In order to address any negative ideas that can emerge due to erectile dysfunction, reassurance is also advised.”
Van Wyk says the following therapeutic interventions are available:
- Cognitive behavioural therapy targets the pessimistic ideas linked to erectile dysfunction that cause anxiety or depression.
- Men can also benefit from mindfulness when it comes to meditation and relaxation. Reducing tension can enhance the sexual experience.
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