Is it Erectile Dysfunction or a Mental-Health Challenge? Insights From Psychologists.

Psychologists in Tanzania conceptualize ED as strongly intertwined with mental-health conditions, particularly depression, performance anxiety, chronic stress, and low self-worth.

• Twelve psychologists working in public and private facilities were purposively sampled based on direct experience with clients presenting ED alongside mental-health concerns.
• A qualitative phenomenological design was employed to capture practitioners' lived experiences and interpretive frameworks.
• Data were analyzed thematically following Braun and Clarke's approach.
• Participants consistently identified psychological distress as both a precipitant and consequence of erectile difficulties.

Psychologists described a bidirectional cycle in which psychological distress precipitates erectile difficulties while ED simultaneously intensifies emotional suffering and relationship strain.

• This bidirectional relationship was a central theme reported across participant accounts.
• The cycle was described as self-reinforcing, with ED worsening the mental-health conditions that initially contributed to it.
• Relationship strain was identified as a key component of this cycle alongside individual emotional suffering.

Cultural scripts of masculinity, expectations of male sexual competence, and stigma surrounding emotional vulnerability were found to shape help-seeking behavior and therapeutic engagement among Tanzanian men with ED.

• Psychologists emphasized that sociocultural factors were significant in how ED presented and was managed in the Tanzanian context.
• Stigma surrounding emotional vulnerability was identified as a barrier to care-seeking.
• These findings highlight the sub-Saharan African cultural context as distinct from contexts in which most prior ED and mental-health research has been conducted.
• Masculinity-related stigma was identified as a critical factor to address for improving men's sexual and psychological wellbeing.

Psychologists reported employing biopsychosocial formulations, psychosexual assessment, cognitive-behavioral interventions, couple therapy, and psychoeducation as central components of care for ED.

• These therapeutic approaches were reported across practitioners working in both public and private facilities.
• The use of biopsychosocial formulations reflects an integrative approach that accounts for psychological, relational, and sociocultural processes alongside biological factors.
• Couple therapy was specifically noted as a component, highlighting the relational dimension of ED management.

The study identified a need to strengthen psychosexual services, embed mental-health screening in sexual health settings, and address masculinity-related stigma to improve men's sexual and psychological wellbeing in Tanzania.

• These recommendations emerged from practitioners' reported experiences managing ED as a masked mental-health presentation.
• Embedding mental-health screening in sexual health settings was identified as a structural response to the co-presentation of ED and mental-health concerns.
• Limited evidence existed prior to this study on how ED and mental health dynamics are understood within sub-Saharan African contexts, highlighting a research gap this study sought to address.