Every man can expect to experience problems with erection at some time. Problems with achieving or maintaining an erection are called erectile disorders (ED). The term impotence is no longer used since it carries misleading connotations about a man's masculinity.

If ED occurs in all situations (that is, with all partners) it is said to be global. If the man cannot achieve an erection with his regular partner but an erection occurs with other women or during masturbation, the ED is said to be situational.

So what are the things that can prevent a man from achieving an erection? The four enemies of sexual prowess are emotional stressors, fear of failure in sexual relations, spectatoring and unresolved personal conflicts. These can be addressed by increasing individual awareness, seeking the help of a counsellor and a strong commitment to create a healthy relationship.

1. Emotional factors

Stress, fatigue and emotional crises are common causes of erectile failure. Most men are surprised that they are unable to achieve an erection or easily lose it during periods of unemployment or bereavement. This is because the vasocongestion of the penis is not just a mechanical process but depends on many psychological inputs. This type of ED is situational. Relaxation, rest and addressing psychological issues will relieve this problem.

2. Performance anxiety

Men who measure their sexual experiences like final examinations, that is, they are unhappy unless their partners have multiple orgasms, place enormous pressure on themselves. This also occurs when men compare themselves with previous or imaginary sexual competitors. This condition is called performance anxiety. It is the fear of failure during sexual relations and it is guaranteed to ruin your sex life.

3. Spectatoring

The fear of failure in achieving an erection or maintaining one produces anxiety in the man. Each time he has sex he worries about his erection. This results in spectatoring - observing and evaluating his responses rather than experiencing the pleasures. Spectatoring eventually leads to loss of intimacy and a likely loss in erection. Soon the man is caught in a vicious cycle of ED, performance anxiety, spectatoring and a chronic psychological problem.

4. Interpersonal conflicts

Conflicts within the relationship will manifest as ED in men and women. Financial, job or family related issues often cause conflict or resentment in relationships resulting in poor erections and little or no desire for sex. Many men are unaware of the significance of these problems and instead worry that they are impotent. Trying to solve the problem by popping pills, such as Viagra, is only a temporary measure and not always successful. Instead, men in committed relationships should seek to develop effective coping strategies to address problems in the relationship. Counselling may be helpful to resolve severe sexual difficulties.

Erectile dysfunction is a psychological catastrophe for most men. They feel ashamed to share the problem with others. These men seek quick fixes in pills or casual encounters. A healthy solution involves sensate focus exercises. This technique helps men to relax and relearn how to experience pleasure rather than reducing sexual relations to an Olympic event.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.