Psychosexual Therapy for Erectile Dysfunction

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Key takeaways

• Psychosexual therapy addresses psychological causes of ED such as anxiety, stress, and relationship issues.
• It typically involves six to twelve sessions and may be used alone or alongside medication.
• Therapy is available on the NHS, though waiting times vary; private options are also available.
• Combining therapy with ED tablets can be effective when both physical and psychological factors are present.
• There are no physical side effects, but the process can be emotionally challenging and requires commitment.

What is psychosexual therapy for erectile dysfunction?

Psychosexual therapy is a form of counselling that focuses on the psychological, emotional, and relationship aspects of sexual difficulties. It is delivered by a trained therapist—often a psychosexual therapist, counsellor, or clinical psychologist with specialist training in sexual health [2].

The therapy typically involves talking sessions, either individually or with a partner, to explore thoughts, feelings, and behaviours around sex. The therapist may help identify underlying causes such as performance anxiety, low self-esteem, depression, stress, past sexual trauma, or relationship conflict [1].

Sessions are confidential and non-judgemental. The therapist may set exercises or 'homework' to try at home, such as sensate focus techniques (gradual, non-pressured touching exercises) that help rebuild intimacy and reduce anxiety around sexual performance [2]. The aim is to address the root psychological causes rather than just the physical symptom of ED.

Who may benefit from psychosexual therapy?

Psychosexual therapy may be particularly helpful if your erectile dysfunction is primarily psychological in origin—sometimes called psychogenic ED. This is more common in younger men, though it can affect any age group [10].

You may benefit if you experience erections during sleep or masturbation but have difficulty during partnered sex, which suggests a psychological rather than purely physical cause. Therapy is also valuable if ED began suddenly after a stressful life event, bereavement, relationship breakdown, or traumatic experience [1].

Men with performance anxiety—worrying about achieving or maintaining an erection—often find therapy helpful, as the anxiety itself can perpetuate the problem. Relationship issues, communication difficulties with a partner, or a history of sexual abuse or trauma are other situations where psychosexual therapy can be effective [2].

Even when ED has a physical cause (such as diabetes or cardiovascular disease), there is often a psychological component that develops over time. Therapy can be used alongside medical treatments like tablets to address both aspects [1].

When to consider therapy over tablets

If you have tried ED tablets and they have not worked, or if you experience side effects that make them unsuitable, psychosexual therapy offers an alternative approach. It is also worth considering if you prefer not to take medication, or if your ED is linked to specific situations or partners rather than being a constant problem [2].

How effective is psychosexual therapy for erectile dysfunction?

Research shows that psychosexual therapy can be effective, particularly when psychological factors are the main cause of ED. Studies suggest that cognitive-behavioural therapy (CBT) and other talking therapies can improve erectile function, sexual satisfaction, and reduce anxiety around sex [8].

Success rates vary depending on the underlying cause, the quality of the therapeutic relationship, and whether a partner is involved in the sessions. Therapy tends to work best when both partners attend, as relationship dynamics and communication are often key factors [2].

Unlike tablets, which work within hours, psychosexual therapy requires time and commitment. Most courses involve six to twelve sessions over several weeks or months. Improvements may be gradual, and some men find that combining therapy with medication offers the best outcome [1].

It is important to have realistic expectations. Therapy is not a quick fix, and it requires active participation and honesty. However, for men whose ED is rooted in anxiety, stress, or relationship issues, the benefits can be long-lasting and address the underlying problem rather than just the symptom [2].

Are there any side effects or risks?

Psychosexual therapy does not have physical side effects in the way that medication does. However, the process can be emotionally challenging. Discussing intimate issues, past trauma, or relationship problems may bring up difficult feelings, and some men find the sessions uncomfortable or distressing at first [2].

It is normal to feel vulnerable or anxious when starting therapy. A good therapist will work at a pace that feels manageable and will provide support throughout. If you have a history of mental health difficulties, such as depression or post-traumatic stress disorder, it is important to let the therapist know so they can tailor the approach appropriately [1].

There are no medical contraindications to psychosexual therapy, and it can be used safely alongside other treatments for ED, including tablets, injections, or vacuum devices. In fact, combining therapy with medication is often recommended when both physical and psychological factors are present [2].

What to expect during sessions

Sessions typically last 50 to 60 minutes and take place weekly or fortnightly. The therapist will ask questions about your sexual history, current difficulties, relationship, and general wellbeing. You may be given exercises to practise at home, and progress is reviewed in subsequent sessions. Confidentiality is maintained throughout, and you can stop therapy at any time [2].

Is psychosexual therapy available on the NHS?

Psychosexual therapy is available on the NHS, but access varies widely depending on where you live. Some areas have specialist sexual health clinics or psychosexual therapy services within NHS trusts, while others have long waiting lists or limited provision [1].

Your GP can refer you to an NHS psychosexual therapist if one is available locally. Alternatively, some sexual health clinics (also called GUM clinics) offer psychosexual counselling as part of their service. Waiting times can range from a few weeks to several months [2].

If NHS provision is limited or waiting times are long, you may choose to see a private psychosexual therapist. Private therapy is not usually covered by the NHS, and costs vary but typically range from £50 to £150 per session. The College of Sexual and Relationship Therapists (COSRT) maintains a register of accredited therapists in the UK [2].

Some men find that a combination of NHS-prescribed medication and private therapy works well, allowing them to address both the physical and psychological aspects of ED without long delays [1].

How does psychosexual therapy compare with ED tablets?

ED tablets such as sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Spedra) work by increasing blood flow to the penis when you are sexually aroused. They are highly effective for many men—clinical trials show success rates of around 60-80%—and they work within 15 minutes to an hour, depending on the medicine [9].

Tablets are a good first-line treatment when ED has a physical cause, such as diabetes, high blood pressure, or reduced blood flow. They are also helpful when psychological factors are present, as successfully achieving an erection can reduce performance anxiety and restore confidence [1].

However, tablets do not address the underlying psychological or relationship issues that may be contributing to ED. If anxiety, stress, or relationship conflict is the main cause, tablets alone may not be enough, and some men find that the problem returns when they stop taking the medication [2].

Psychosexual therapy, by contrast, aims to resolve the root cause. It takes longer to work and requires active engagement, but the benefits can be more enduring. Many men find that a combination of therapy and tablets offers the best outcome: the tablets provide immediate support while therapy addresses the underlying issues [1].

Combining therapy with medication

Using both approaches together is often recommended, particularly when ED has both physical and psychological components. The medication can help restore erectile function and reduce anxiety, while therapy addresses communication, relationship dynamics, and emotional wellbeing. Your GP or a specialist can advise on the best combination for your situation [2].

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately
• Sudden loss of vision or hearing after taking ED medication – seek urgent medical help
• Chest pain during sexual activity – stop and call 999 if pain does not resolve quickly
• Severe distress, suicidal thoughts, or mental health crisis – contact your GP urgently, call 111, or go to A&E

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.