Erectile dysfunction and Mental health

Jenny Constable writes a very real article about the link between erectile dysfunction and depression, as seen first hand as a Men’s Health Physiotherapist

Jenny is seeing more and more young men with problems achieving and maintaining erections. This feeling of a lack of control can cause anxiety and depression which, unfortunately, only exacerbates the issue.

There are many reasons why men have episodes of erectile dysfunction (ED). We often hear about the older generation (the over 60s) but little is understood why more and more of the younger generation (18-40) are having problems. One cause can be due to dysfunctional pelvic floor muscles. These muscles can be tight, weak and have tender points. These problems are generally all seen together and can impact the pelvic floor muscles’ function.

Why does this happen?

There are two possible causes; the first being that the pelvic floor muscles are just like any other muscles in the body, if they aren’t looked after they can get weak. The pelvic floor muscles are key in helping maintain blood inside the penis by contracting against the blood vessels which prevents backflow of blood to keep it erect. So, if they are weak then this function will be reduced and you may lose your erection sooner than you like.

The second could be caused by tightness. Our pelvic floor muscles (PFM) are like our own bodyguard system. If they sense danger, tension or worry they tighten up and close down the hatches. Busy stressful jobs mean the PFM are constantly in protection mode. Unfortunately, most people would be unaware that the PFM is in a state of contraction and over time this causes tightening and weakness due to reduced movement of the muscles. Quite often men will research the subject of ED online and find the advice readily given is to strengthen the PFM using ‘Kegel’ exercises, however, this often results in an over-strengthening of the PFM without tackling the real issue of reducing the tension within the muscles first. The result of progressive over-strengthening of the PFM can make the ED worse, thus perpetuating the cycle.

It is believed that younger people are more susceptible to this scenario due to high stress jobs, over-working in the gym and general tiredness as a result of lifestyle. Plus, younger people often lack the confidence to get help when it comes to their performance in the bedroom. Therefore, more men turn to the internet for help and frequently find themselves in this situation; making matters worse by exercising the wrong muscles or over doing it with already-tight muscles.

So, what can you do? 

Firstly it is a good idea to check you are doing the PFM exercises correctly.

  • Stand in front of the mirror with no underwear on.
  • Breathe in. As you breathe out, try to lift your testicles up inside you (without your hands). Or, try to stop yourself passing wind; You are aiming to see your testicles and penis lift up slightly. As you let go you should see everything drop back down again.
  • Repeat this again, but try to hold it for up to 10 seconds while still breathing in and out. Could you keep your testicles lifted or did they slowly drop down after a few seconds? You are aiming to hold for the whole 10 seconds. Stop as soon as you feel the muscles relax.
  • Repeat this exercise 10 times in a row 3 times a day. Make sure you fully relax in-between each squeeze. Don’t worry, you don’t have to be standing in front of the mirror for these. You want to try doing the exercises in a variety of positions (laying down, sitting and standing).

If, after attempting this exercise, you can’t see anything move or you just can’t feel the squeeze or let go, your muscles may be too tight. It might be worth coming to see a Men’s health physiotherapist who can check what’s going on. They can provide you with exercise and techniques to release these muscles and help you regain proper function or ascertain what or if you have any other issues.

You can find a specialist physiotherapist by looking at the squeezy app which has a directory of pelvic health physiotherapists.(

Also watch out for a new internet based self help program on ED in the younger male “@Mojo.Men or”. This will have information from doctors, psychologists, real life stories and myself. It will be a safe place to show you tips and ideas on how to improve your erectile function. 

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