Psychological Erectile Dysfunction: What Is It?

Erectile dysfunction¹ is a sex-related condition involving difficulty getting and maintaining an erection. This condition could be due to lifestyle, medications, and psychological factors. 

Psychological erectile dysfunction is when depression, anxiety, stress, and body image affect your ability to get or maintain an erection. Often, psychological erectile dysfunction goes hand-in-hand with issues like diagnosed mental health disorders or a low sex drive. It can also be associated with relationship difficulties. 

Psychological erectile dysfunction is different from other types of erectile dysfunction. For example, it tends to come and go and can be worse in certain situations. This condition can also start quite suddenly. 

Symptoms of psychological erectile dysfunction

The main symptom of erectile dysfunction is the inability to get or maintain an erection to allow for satisfactory sexual intercourse. This defines the condition. 

Psychological erectile dysfunction has different symptoms than other types of erectile dysfunction. For example, it might come on quite suddenly. This is especially true if you are experiencing significant stress or traumatic events and relationship difficulties. 

Other types of erectile dysfunction, like those caused by medicines, are likely to be more gradual. 

Psychological erectile dysfunction might not affect you all the time. On some days, or in some situations, you may not have a problem with erectile function. Increased stress, poor mental health, and relationship difficulties could cause your condition to be worse. 

Often with psychological erectile dysfunction, you might develop an erection, but you might not be able to maintain it for long enough. This is the most common issue reported. 

Also, you will probably experience normal erections while you sleep and in the morning when you wake up. 

You might experience symptoms of mental health conditions that go hand-in-hand with psychological erectile dysfunction. These can include signs of anxiety and depression such as: 

• Low mood

• Disinterest

• A feeling of panic

• A rapid heartbeat

• Other factors 

Causes of psychological erectile dysfunction 

Psychological erectile dysfunction is a complex condition with various factors possibly contributing to it. 

The exact cause of the condition is often unknown and can be hard to determine. Possible causes include: 

• Performance anxiety

• Depression

• Relationship concerns

• Feelings of guilt

• Low self-esteem

• Cultural or religious beliefs

Performance anxiety 

Performance anxiety is a feeling of concern about how you will perform sexually. This can include worries about whether you will please your partner and fear about maintaining an erection. As a result, erectile dysfunction might occur. 

This issue can affect your sex life and well-being, possibly leading to avoiding sex, poor self-image, and even mental health issues like depression. 

Performance anxiety is complex because it can lead to erectile dysfunction. However, erectile dysfunction can also make men feel a sense of performance anxiety. This leads to a vicious cycle.

Depression 

Studies² have shown that depression (significant feelings of low mood and disinterest) is linked to erectile dysfunction. The chance of erectile dysfunction is increased by 39% in men with depression. This also works the other way around. Men with erectile dysfunction are three times more likely to have or develop depression. 

This shows that depression can cause or contribute to erectile dysfunction, but also that erectile dysfunction can cause mental health issues like depression. 

Relationship concerns 

Relationship concerns, meaning any problems affecting the connection and intimacy in your relationship, can cause erectile dysfunction. Common issues reported are conflict with your partner or concerns about the quality of the relationship. 

Feelings of guilt 

Erectile dysfunction can cause many negative feelings, including a sense of guilt. You may feel guilty because you cannot perform or please your partner. This is very common. Feelings of guilt can contribute to the issue of erectile dysfunction. 

Low self-esteem 

Low self-esteem is very common and can be associated with mental health issues like depression. Feelings of low self-esteem can both contribute to erectile dysfunction and be caused by the condition, possibly creating a cycle. 

Cultural or religious beliefs 

Discussing sex and pleasure can be taboo or negatively portrayed in some religions or cultures. Therefore, sex and sexual issues are sometimes thought of as shameful. This could be a psychological contributor to erectile dysfunction. 

Gender expectations of men also have a role to play. Men are expected to be strong and sexually dominant in many cultures and religions. This could add to the shame and pressure felt by men who experience erectile dysfunction or other sexual issues. 

How is psychological erectile dysfunction diagnosed? 

Erectile dysfunction is a complex condition with various causes. Therefore, to get a diagnosis, your doctor will: 

• Ask some questions 

• Examine you 

• Run some tests 

Firstly, your doctor will ensure they have your complete medical history, including any medications you are on and medical conditions that could contribute to your erectile dysfunction. 

They will also ask for your sexual history, including previous and current partners and your experiences with erectile dysfunction. Your doctor needs to understand when it started and if it has gotten worse over time. They will also ask some questions about your mental health and stress levels. 

Your doctor will do a general examination, which includes assessing your heart rate and blood pressure and getting a general view of your body. They will also examine your penis, testes, and prostate to ensure no obvious physical causes of erectile dysfunction. This helps rule out other diseases and conditions. 

They will do some blood tests to ensure you do not have certain heart conditions or diabetes, which can contribute to erectile dysfunction. The blood tests will also check your hormone levels. The hormone testosterone can sometimes affect erectile dysfunction. 

Some scans can also be done, but these are not regularly used unless your doctor thinks there might be some non-psychological issues causing your erectile dysfunction. 

If the results of your physical examinations and blood tests are normal, your doctor can diagnose psychological erectile dysfunction based on your answers to their questions. Based on this, your doctor can recommend some treatments or techniques to try. 

How common is psychological erectile dysfunction? 

Erectile dysfunction is very common, affecting 12 million men in the US.³ It is a complex condition, and it can be challenging to determine its exact causes due to various contributing factors. 

For these reasons, there is not much information about how many men experience psychological erectile dysfunction. However, the information available suggests this is a common problem. 

One study⁴ found that more than 10% of erectile dysfunction patients reported that they believed their erectile dysfunction was caused primarily by psychological factors. Another study⁵ said that 13% of cases of erectile dysfunction in men under 40 had psychological causes. 

How do I know if my erectile dysfunction is psychological? 

It is important to visit your doctor to determine if your erectile dysfunction is psychological. They can run tests to ensure all your erectile structures are working properly and you do not have any underlying conditions causing the condition. 

Some signs could show that your erectile dysfunction is psychological. These include: 

• Normal erections while you are sleeping/when you first wake up

• Sudden onset of erectile dysfunction

• Erectile dysfunction that comes and goes

• High-stress levels

• Mental health or relationship issues 

It is important to note that erectile dysfunction does not always have a clear cause. Often, many different factors can contribute. For example, you might have physical issues or an underlying condition made worse by psychological factors, including depression and anxiety. 

How to treat psychological erectile dysfunction 

Luckily, there are various treatments and techniques that can help with your erectile dysfunction. These include, but are not limited to: 

• Psychotherapy 

• Couples counseling 

• Relaxation techniques 

• Medication 

Talk to your doctor about what approaches might suit you. 

Psychotherapy 

Psychotherapy involves regular appointments with a psychologist to discuss erectile dysfunction, sexual issues, and mental health issues. This intervention could be individual (one-on-one with the therapist) or in a group setting. 

Studies⁶ have found this intervention effective but even more so when combined with medications. 

Couples counseling 

If you are experiencing relationship issues, this could be a contributing factor to erectile dysfunction. Both individual and couples counseling can be helpful for men experiencing erectile dysfunction. Couples counselors can also suggest some sexual therapies that couples can try to implement at home.

Relaxation techniques

Relaxation techniques, such as mindfulness and sensate focus, may help people manage erectile dysfunction caused by psychological factors.

Mindfulness can be used to improve sexual dysfunction. However, it’s not known for sure if there is a direct link between mindfulness and treating erectile dysfunction. The practice of mindfulness involves a focus on breathing and an awareness of the present moment. 

Another technique called sensate focus can be used with couples. This form of sex therapy involves eliminating the focus on achieving orgasm for either person and concentrating on your experience of sensations. 

Sensate focus is helpful for performance anxiety and other stresses that men with erectile dysfunction may experience. 

Medication 

Medications generally work very well for men with psychological erectile dysfunction. Your doctor might suggest prescribing medications after you have tried other techniques. 

The most common medications are called phosphodiesterase type 5 (PDE5) inhibitors. These include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra). PDE5 inhibitors are usually taken before sexual intercourse to help cause and maintain an erection. 

Sometimes, medications for certain mental health conditions can contribute to erectile dysfunction, so your doctor might need to review your medications if you feel this is the case. 

When to visit a doctor

If you are experiencing erectile dysfunction, visit a doctor. Not all erectile dysfunction is psychological; sometimes, it can be a sign of other conditions that need immediate treatment. Your doctor can help with your symptoms, including psychological distress and sex-related problems. 

If your doctor diagnoses you with psychological erectile dysfunction, you might not need treatment immediately. Try making small changes first, like relaxation techniques. 

The lowdown 

Erectile dysfunction is the persistent inability to get or maintain an erection. Psychological factors like depression, anxiety, and low self-esteem are key causes of erectile dysfunction in some men. 

Psychological erectile dysfunction is different from other forms of the condition. It may happen suddenly, goes on and off, and is associated with mental health symptoms like low mood and a feeling of panic. If your erectile dysfunction is psychological, you will experience normal erections while you sleep and when you wake up in the morning. 

If you are experiencing erectile dysfunction, visit a doctor. This is important because erectile dysfunction can signify other underlying conditions.