In the anxious individual, there can be overactivity of the sympathetic system leading to increased smooth muscle tone. Alternatively, signals from the brain of an individual with a psychogenic issue can override the erectogenic parasym-pathetic output from the sacral spinal cord. Psychosexual therapy can help the individual to deal with issues such as performance anxiety, reduced attraction to his partner (which may or may not be linked to a relationship problem), past sexual trauma, misconceptions about normal sexual function, suppressed feelings about sexuality, fear of sexually transmitted diseases or pregnancy. By enquiring about early morning and spontaneous erections, which all healthy men get, one can eliminate a physical cause for ED. Asking about the sort of situations in which the ED manifests itself can also help. For instance, if he is able to masturbate with an erection while alone, but is unable to perform with a partner suggests a "situational" response. There may be more than one partner with whom the man has sexual contact. Gay and bisexual men in "straight" relationships may have difficulty achieving an erection with a female partner due to feelings of guilt about their true sexual preference.
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