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Erectile difficulties and the role
of counselling
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IECLS00190d Date of Preparation: March 2012
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What is Erectile Dysfunction?
Erectile Dysfunction (ED), also sometimes known as
impotence, is the persistent or recurrent inability to get
and/or keep an erection sufficient for satisfactory sexual
intercourse. This happens when not enough blood can get
into the penis or stay long enough to allow an erection.
Many men live with ED for years without seeking medical
advice, because of embarrassment or a belief that
ED cannot be treated. However there are a number of
treatment options available. In addition, ED may be an
early warning sign of other conditions. So it makes sense
not to allow embarrassment get in your way - if you are
worried about ED, go to your doctor without delay to get it
checked out and treated.
Erectile Dysfunction is a common condition and over 50%
of men aged over 40 will experience some degree of ED at
some stage in their lives. 1
If you are worried you may
have ED, talk to your doctor
and get it checked out.
Many men find talking about such intimate matters very
difficult but rest assured that your doctor is used to
dealing with such subjects. Talking about your ED can
be an important part of treating it and your doctor may
refer you to a counsellor to discuss the issue further. A
counsellor will have a lot of experience dealing with sexual
dysfunction and will be able to put you at ease. For more
information on the role of counselling please turn overleaf.
Make an appointment today to see your doctor to get
help and advice.
What causes ED?
In many cases, ED is caused by a combination of both
physical and psychological factors. A proper medical
assessment is important as ED could be caused by an
underlying physical illness, medication side effects, or
be related to psychological issues - some examples
include: Physical Causes: Diabetes, Heart disease, High
blood pressure, Kidney failure, Post-operative effects:
Following prostate surgery, Psychological causes:
Stress, Other conditions: Prostate cancer, Nerve
problems, e.g. multiple sclerosis and Parkinson’s disease,
Trauma, Medication side effects: ED may be caused by
a side effect of medication that you are taking.

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Counselling
A counsellor is a qualified health care professional to
whom you can talk about ED, how it is affecting you, what
may be causing it and what you can do about it. Men with
sexual dysfunction generally benefit from counselling.
Your doctor may provide counselling for you as part of
your overall treatment. If your doctor considers that you
will benefit from seeing a specialist sexual & relationship
counsellor, he or she will be able to recommend one.
What you can expect from
sexual and relationship
counselling
The counsellor will be able to teach you about techniques
that work well for managing ED symptoms. These
techniques can be especially effective if you are very
anxious about being able to get or keep an erection.
After the first session you might see your counsellor every
week, but with this kind of counselling the appointments
may become more spread out to give you time to try out
any techniques or exercises.
To get the most out of sexual & relationship counselling,
it is important to participate fully in your sessions and
make time between sessions to think about what you have
discussed and try out any techniques that your counsellor
has recommended.
A sexual & relationship counsellor is trained to assess and
treat sexual difficulties including ED in a supportive and
non-judgemental manner. As with any type of counselling,
confidentiality is assured, so anything you discuss will
be kept between you and your counsellor. You will not
undergo any medical examination or need to take your
clothes off. The counsellor will explain that you do not
have to answer any questions or do any exercises that you
don’t feel comfortable with.
Sexual & relationship counsellors work with men on their
own as well as couples, so you can choose to go alone or
with your partner if you prefer.
Sessions typically last for 50 minutes. Your first session
may be longer so that the counsellor can make an initial
assessment.
ED is often linked to what is going on in the rest of your life
such as stress, family matters, and physical difficulties, so
the counsellor may discuss these with you. They will be
skilled at helping to put you at ease so that you can speak
openly.

Act
Act
Assessment
If you think you may have ED, there are some questions on
the next page and a questionnaire on the reverse which
may help you to tell your doctor about the problems you
are experiencing and also help him/her to assess you.
The questions on the reverse are taken from the Sexual
Health Inventory For Men Questionnaire. 2
This is a validated questionnaire used by doctors. It asks
basic questions about your erectile function over the past
6 months. Each question has several responses, and
you should choose the one that best describes your own
situation.
Once completed, tear this page off and make an
appointment to see your GP. Act today!
For more information, visit
www.manmatters.ie
Questionnaire
What is your age?
When did you first start experiencing erection problems?
Since you started experiencing erection problems,
have they gradually got worse over time?
❏ Y ❏ N
Do you suffer from any of these conditions?
❏ Diabetes
❏ Heart disease
❏ High blood pressure
❏ Kidney problems
❏ Prostate surgery
❏ Spinal cord injury
❏ Nerve damage
❏ Depression or anxiety
❏ None of the above
References:
ACT!
1. Feldman, H. et al. Impotence and its Medical and Psychosocial Correlates: results
of the Massachusetts Male Aging Study. Journal of Urology, 1994;151: 54-61.
2. Rosen RR et al. Research Instruments For The Diagnosis And Treatment Of
Patients With Erectile Dysfunction. Urology 2006; 68 (supplement 3A): 6-16
IECLS00190d
Date of Preparation: March 2012
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Over the past 6 months:
Sexual Health Inventory for Men Questionnaire 2
Choose one response from each question based on the past 6 months and write the corresponding number in the box next to the question.
Adapted from Rosen RR et al. Urol 2006; 68 (supplement 3A):6-16
1. How do you rate your confidence that
you could get and keep an erection?
1 Very low
2 Low
3 Moderate
4 High
5 Very high
2. When you had erections with sexual
stimulation, how often were your
erections hard enough for
penetration?
0 No Sexual
Activity
1 (Almost never/
never)
2 (A few times,
ie, much less
than half the
time)
3 (Sometimes,
ie, about half
the time)
4 (Most times.
ie, much more
than half the
time)
5 (Almost
always/
always)
3. During sexual intercourse, how
often were you able to maintain your
erection after you had penetrated
(entered) your partner?
0 (Did not
attempt
intercourse)
1 (Almost never/
never)
2 (A few times,
ie, much less
than half the
time)
3 (Sometimes,
ie, about half
the time)
4 (Most times,
ie, much more
than half the
time)
5 (Almost
always/
always)
4. During sexual intercourse, how
difficult was it to maintain your
erection to completion of intercourse?
0 (Did not
attempt
intercourse)
1 (Extremely
difficult)
2 (Very difficult)
3 (Difficult)
4 (Slightly
difficult)
5 (Not difficult)
5. When you attempted sexual
intercourse, how often was it
satisfactory for you?
0 (Did not
attempt
intercourse)
1 (Almost never/
never)
2 (A few times,
ie, much less
than half the
time)
3 (Sometimes,
ie, about half
the time)
4 (Most times,
ie, much more
than half the
time)
5 (Almost
always/
always)
Total Score*
* Add the numbers corresponding to questions 1-5. If your score is 21 or less, you may be showing signs of erectile dysfunction and may want to speak to your doctor.