Behind the doors of a sex therapist, clients seek understanding, acceptance, and answers.  But how can mental health professionals help their clients achieve these goals?  Dr. Stephanie Buehler, a licensed psychologist, sex therapist and a recognized author, invites you to “Step Into My Office” with monthly sidebars taken from her own experience.

While the prevalence of ED varies according to study, about 20% of men over the age of 30 have had some experience with this disorder, defined as the inability to attain or maintain an erection as desired (Albersen, Orabi, & Lue, 2012; Dandona & Rosenberg, 2010). The older a man is, the more at risk for developing problems with erections. In order to be diagnosed, ED must be associated with personal distress.


Mitchell, a medical student who had just turned 26, visited several physicians to figure out why he could no longer perform sexually with his girlfriend, of whom he was very fond. When no physical cause could be determined, he was referred to me for assessment. Mitchell denied any anxiety, and indeed, he appeared to be a self-controlled, confident man—which also made him fairly well defended. After three sessions I uncovered the fact that he had tried to have sex while recovering from bronchitis. When his body hadn’t performed as expected, he became even more tired and felt “bad all over.” It seems he had developed symptoms of depression that he did not recognize. Once we created a timeline of symptoms and sexual problems, things began to make sense. Mitchell came to session four to thank me; no additional treatment was needed.

Like Mitchell, many men don’t recognize symptoms of depression in themselves. Because they are socialized to hold in their feelings, they do not experience sadness or report it to others. Thus, they may not connect grief, loss, ending of a relationship, or other stress with ED (Gambescia, 2009). ED may obscure a man’s underlying relationship problems, such as high levels of conflict and lack of intimacy, feeling undesired, or a partner’s lack of response to romantic or sexual Printovertures. ED may also be a response to a partner’s sexual dysfunction (Metz & McCarthy, 2004). Issues concerning pregnancy and disagreements about starting or adding to a family can erode a man’s desire for intercourse.

For a full list of activities to help overcome a situation like this, as well as tips for improving erectile function and sexual confidence, check out Stephanie Buehler’s book What Every Mental Health Professional Needs to Know About Sex.