Negli ultimi anni si parla sempre più apertamente di sessualità, e quindi anche nei nostri studi professionali sono sempre più frequenti richieste legate alla sfera sessuale. Ci sono vari disturbi che possono compromettere una vita sessuale soddisfacente, e tra questi i più comuni sono i disturbi dell’eccitazione e i disturbi da dolore sessuale. Iniziamo quindi questa nuova rubrica dedicata alla sessualità parlando del deficit di erezione (o disfunzione erettile).
Cosa s’intende per “deficit di erezione”?
Il deficit di erezione viene definito come una difficoltà a raggiungere o mantenere l’erezione fino al completamento dell’attività sessuale. I disturbi dell’erezione sono molto frequenti; si parla di un 10% circa di diffusione nella popolazione generale, che può salire fino ad oltre il 50% con l’aumentare dell’età (70 anni).
Quali sono le cause della difficoltà di erezione?
Le cause di questo problema sessuale possono essere fisiche e psichiche, legate alla storia personale e/o alla relazione di coppia. Spesso fattori di entrambi i tipi concorrono a causare e mantenere la difficoltà di erezione. Tra i fattori organici spesso si tratta di problemi vascolari (di circolazione) o neurologici. È importante quindi, prima di tutto, condurre un attento esame medico, allo scopo di appurare la presenza di cause organiche, per poi passare agli aspetti psicologici, che nella grande maggioranza dei casi incidono significativamente. La presenza di erezioni spontanee notturne ed al risveglio, nonché la capacità di raggiungere e mantenere l’erezione durante la masturbazione, sono prove del fatto che non vi siano cause organiche di disfunzione erettile, ma che il problema sia di natura psicologica.
Quali sono i fattori psicologici delle difficoltà di erezione?
Ansia, depressione e stress cronico sono i tre nemici dell’erezione più importanti dal punto di vista psichico. Le difficoltà di erezione, inoltre, sono spesso associate ad ansia sessuale, al timore di fallimento, alle preoccupazioni sulla prestazione sessuale e ad una ridotta sensazione soggettiva di eccitazione sessuale e di piacere. Spesso capita che, quando l’uomo inizia a notare un ritardo nella comparsa dell’erezione, la donna inizia a diventare incerta sul proprio corpo e l’uomo inizia a spaventarsi. Ma questo crea un circolo vizioso da cui è difficile uscire, poiché la paura di non avere l’erezione genera un allarme che fa perdere l’erezione!
È vero che avviene un cambiamento fisiologico dell’erezione con l’aumentare dell’età?
Assolutamente sì. Da giovani è più facile eccitarsi, e quindi avere un’erezione attraverso semplici stimoli psichici, quindi un’immagine, un pensiero, un odore…; con il passare degli anni, invece, questo non è più sufficiente ma è necessaria una stimolazione manuale per raggiungere l’erezione. L’erezione ha anche un’altra caratteristica, cioè oscilla, non rimane stabile per tutta la durata del rapporto. Da giovani, tuttavia le fluttuazioni sono talmente minime da risultare impercettibili, mentre con l’età aumentano di intensità e possono essere fonte di preoccupazione. In realtà non bisogna allarmarsi: essendo una risposta del tutto naturale del nostro corpo, è utile imparare a prendere confidenza con il proprio corpo e quello del partner, e invece di controllare il livello di eccitazione, concentrarsi sul piacere.
Come si cura la disfunzione erettile?
Il trattamento della disfunzione erettile richiede un percorso che passa attraverso una fase di accurata valutazione del problema, allo scopo di escludere le possibili cause mediche, per arrivare al trattamento cognitivo-comportamentale (o mansionale), terapia psicologica che ha dimostrato una buona efficacia nella cura di questi disturbi. L’esperienza clinica mostra che nella gran parte dei pazienti la genesi del deficit erettivo è multifattoriale; l’efficacia della terapia dipende quindi dalla capacità di riconoscere i diversi fattori e di modificarli. È quindi essenziale la collaborazione stretta tra i diversi componenti del gruppo di lavoro (l’andrologo, il sessuologo, lo psicologo) che si occupano del deficit erettivo e della sua cura.
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