Psychogenic Erectile Dysfunction: An Overview

Psychogenic Erectile Dysfunction (PED) differs from typical ED in that it’s caused only by psychological factors. 

In this article, we discuss the psychological causes and treatment plans that differ from those for organic erectile dysfunction, how PED is diagnosed and managed, and when it is time to see your doctor.

What is psychogenic erectile dysfunction?

Psychogenic erectile dysfunction (PED) is the inability to obtain and maintain an erection satisfactory for sexual performance due to psychological factors. 

This condition is very common, especially in young men. One study¹ reported that as many as 85.2% of men under 40 struggle with PED. PED not only affects sexual health but can impact interpersonal relationships, mood, and quality of life.

What are the symptoms of psychogenic erectile dysfunction?

PED disrupts sexual performance with the following symptoms:

• Inability to obtain an erection

• Inability to maintain an erection

• Premature or delayed ejaculation

• Decreased sexual desire.

What causes psychogenic erectile dysfunction?

The erection process requires coordination between blood vessels and psychological and neurological factors. Any changes in the components of erectile response can disrupt sexual performance and can be caused by:

• Emotional stress -External pressures such as work-related stress, family problems, and relationship issues can cause emotional stress that impedes your ability to engage in sex.

• Anxiety - Feelings of anxiety can occur based on fear of appearance, self-confidence, sexual performance, or external pressures.

• Depression - The relationship between ED and depression is likely bidirectional, meaning depression can be both the cause and effect of PED.

• Partner conflicts - Conflicts can cause stress or emotional trauma that impedes your ability to engage in sexual activity with your partner. Feeling pressured into sex may cause PED.

In this case, open discussions with your partner and your doctor can help you and your partner reach a mutual understanding of your feelings around sex. Power struggles, physical and emotional attraction loss, and extramarital affairs may also cause PED.

Psychogenic erectile dysfunction diagnosis

Your doctor can diagnose PED after a physical examination and assessment of your clinical history. If the primary triggers for your experience with ED symptoms are situational, you may be diagnosed with PED. 

You may also be experiencing ED as a side effect of a medication or a pre-existing health condition, such as diabetes mellitus or high blood pressure (hypertension). To identify whether the cause of your ED is organic or psychogenic, your doctor may perform blood tests to assess glucose levels, blood count, testosterone levels, and lipid (fat) levels.

These can help identify underlying health conditions that can cause organic ED. 

Your doctor may also perform a urine test and nocturnal penile tumescence (NPT) test to investigate the physical causes of ED. During a nocturnal penile tumescence test, a device is attached to the penis that measures erection frequency throughout the night and again when you’re awake.

This reflects your ability to obtain an erection without psychological pressures or stress. 

Psychogenic erectile dysfunction treatment

Various treatment methods are available to suit the wide range of PED triggers.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) has emerged as a potential and promising treatment choice for younger men. This treatment may introduce new stimulation techniques such as physical or audiovisual stimulation to increase sexual desire. However, more research is still needed to identify the effectiveness of CBT for older men or men of all ages. 

Couples counseling 

Counseling provides a facilitated, safe space for couples to communicate about sexual and emotional issues, aiming to increase intimacy and improve communication. This has increased sexual satisfaction, and erectile dysfunction is a common issue.

Anxiety reduction

Tackling root causes of external stress such as low self-confidence and work-related, family, or relationship stress may reduce and prevent PED.

Medication

Various over-the-counter and prescription medications are available that may aid in restoring erectile function. 

When ED coexists with depression or anxiety, treatment of the mood disorder may be the most appropriate first step. Selective serotonin reuptake inhibitors (SSRIs), commonly known as antidepressants, can be taken to manage the depression and anxiety symptoms that can lead to PED. 

Sildenafil citrate (Viagra) is an over-the-counter pill that has been shown to improve erectile function in men with depression and can be used in combination with treatments for mood disorders such as SSRIs.

Is there a cure for psychogenic erectile dysfunction?

Few studies reflect the effects of long-term treatment outcomes of sex therapy treatments. However, improved sexual performance has been reported in both medicinal and behavioral treatments. 

Can psychogenic erectile dysfunction be prevented?

High-quality sex therapy may relieve PED by reducing anticipatory sexual anxiety, distraction, and performance anxiety. Pleasure-orientated reinforcement for future sexual encounters can also be incorporated.

When to visit your doctor

If you or your relationship are affected by an inability to obtain or maintain an erection, it may be time to seek medical attention from a healthcare professional. 

If left untreated, PED can have long-term effects on your mental health and relationships with yourself and others, but there are multiple ways to approach the issue. 

PED is nothing to be ashamed of and should be discussed openly and honestly with your healthcare professional and your partner to find the right treatment plan for you. 

The lowdown

ED from psychogenic causes can be treated and prevented, reducing strain on your mental health and relationships. Having an open and honest conversation with your doctor will ensure the correct treatment plan is identified for you.