ADVERTISEMENTS FOR anti-impotence drugs are everywhere. The brand name Viagra—the “little blue pill”—has quickly become a household word and for understandable reasons. Studies show that more than 50 percent of American men ages 40 to 70 experience at least occasional erectile difficulties, episodes that increase with age. Yet a little-acknowledged statistic is that pharmaceuticals fail to help from 25 to 33 percent of men with erectile dysfunction.

Are millions of males, and their partners, simply out of luck? Not necessarily. A variety of psychological treatments can overcome the mental triggers that often cause the sexual disorder.

Emotional Blocks

Every erection begins in the brain—the most important sexual organ. The brain stem emits nerve impulses that control erectile function. Yet parts of the limbic system that are responsible for learning and emotions also affect the signals. The nerve impulses make their way through the erection center of the spinal column to the erectile tissue of the penis, where they trigger a chain reaction in the membranes of vascular muscle cells. This chain reaction depends on a messenger molecule called cyclic guanosine monophosphate, or cGMP.

But the engine of desire works in reverse, too: an erection softens as soon as the enzyme phosphodiesterase begins to degrade the cGMP molecules. Viagra, and competing drugs such as Levitra and Cialis, inhibits phosphodiesterase to help maintain the erection. An erection first needs to be triggered psychologically, however; without this impetus, the potency pills are of little help.

Although urologists often attribute erectile dysfunction to organic causes, in many cases the problem is in the mind. Failure to achieve an erection can result from an array of psychological causes. Even a man in peak health can experience emotional blocks in bed. These kinds of incidents can in turn lead to a vicious circle. Fear that a husband cannot satisfy his wife’s sexual desires, for example, can ruin all sense of play in lovemaking, creating an even greater chance of physical problems.

Pressure for sexual performance and potency is itself a large contributor to impotence, and this theme is pushed continually. Advertising is rife with sexually charged images and symbols, selling men everything from automobiles to razor blades and beer. Talk about “good” or “better” sex is also ubiquitous in the media, as if bad sex (whatever that means) were the best one could hope for without special effort.

The net outcome is that unrealistic sexual myths become anchored in adolescent psyches and self-perpetuate into adulthood: men end up scoring their sexuality by how often they can “do it” and for how long. There is no place for sensuality, much less weakness or fear.

As studies by the late sexual psychologist and popular author Bernie Zilbergeld demonstrated, most men with potency problems believe in such myths. Men also often overestimate the level of women’s sexual demands. As a result, as soon as sex is in the offing, a man is most likely to observe and assess the situation as if he were an outsider, rating what is expected and what he can deliver. Zilbergeld called this phenomenon “spectatoring.”

Another psychological cause of impotence is stress, but not as the media typically portrays it. The image of the overworked executive who goes soft in bed is a bad cliché. If a man who is exasperated at his job has trouble achieving an erection—say, the night before a very important business meeting—the problem is seldom the work stress itself. Instead he is usually transferring to his sex life the pressure to perform that he feels generally in his business life. This turns the love act from a dance of desire into a grueling job that must be completed—and completed well.

Relieving the Pressure

Sexuality is multidimensional, involving anticipation, desire, love and attachment. Psychological treatment strategies therefore vary with each person. Most therapists will begin with conversation to get to know an individual’s life circumstances, needs, hopes and worries. A treatment regimen might include 10 to 20 therapy sessions, along with partner exercises at home. These may involve massage or stroking in which both partners take turns, as well as simple guidance from the therapist about how they can unwind together. By doing these exercises, the partners begin to unlearn fear and to take pleasure in natural body contact.

Most treatments are not based on long-term therapeutic intervention. Some regimens are as short as one week, during which patients relearn how to relax and how to stay worry-free during sex. Exercise and other physical interventions short of drugs can also play a part; some plans may include deep-relaxation procedures and, as in hypnosis, may synchronize a subject’s breathing with words voiced by the therapist.

Other counselors will prescribe exercise sessions with machines that strengthen the pelvic musculature. A recently published study by urologist Frank Sommer of the University Medical Center in Cologne, Germany, showed that regular, targeted exercise improved the sexual potency of 80 percent of the men who tried it, compared with 74 percent of men treated with Viagra. Many men feel better simply because they have some kind of handle on the situation.

The success of sex therapy cannot be measured simply by whether a man regains his sexual potency—even though that is why most men seek treatment. A man who learns to live in harmony with his partner and not race through life pursuing a self-image as a sex machine has already taken a giant step toward a more satisfying sexual life.