Erectile Dysfunction (ED) is a common issue that affects millions of men worldwide. While there are various causes of ED, including physical factors like diabetes and cardiovascular problems, psychological factors can also play a significant role. Psychological ED is characterized by difficulties achieving or maintaining an erection due to emotional or mental factors rather than physical ones. Fortunately, it is a treatable condition, and with the right strategies, you can overcome it.
This article explains the concept of erections and the impact psychological factors have on it. It also provides information on treatment options to help overcome psychological ED.
How Do Erections Occur?
Getting an erection is a complex process. It involves a combination of
- brain psychological impulses,
- adequate testosterone levels,
- a properly functioning nervous system, and
- a healthy vascular system.
An erection is the result of nerve impulses and blood flow to the penis during sexual arousal. The muscles in the corpora cavernosa relax, allowing blood to fill the area, resulting in expansion and an erection.
There are three types of erections:
- nocturnal erections during sleep,
- reflexive erections from physical stimulation, and
- psychogenic erections caused by visual or mental stimulation.
All three types depend on the proper functioning of hormones, muscles, blood vessels, the nervous system, and emotional regulation.
A physical examination and laboratory tests can rule out physiological causes. However, psychological factors also play a significant role in the ability to achieve and maintain an erection.
What is Psychological Erectile Dysfunction?
Erectile dysfunction is a condition that affects a man’s ability to achieve or maintain an erection. There are three types of erections, as we covered above: reflexive, psychogenic, and nocturnal. They are associated with physical stimulation, and visual or mental images, and occur during sleep, respectively.
Men may experience erectile dysfunction because of psychological factors like anxiety, stress, depression, guilt, or body image issues. Relationship problems, mental health, sleep disorders, and other stressors can also contribute to ED. This type of ED is known as psychological impotence.
On the other hand, physical impotence can develop due to underlying medical conditions that affect blood flow to the genitals. This could include age-related changes or diseases of the circulatory and respiratory systems.
Psychological impotence can’t be fixed just with medicine, but it can be treated by addressing the cause.
What Causes Psychological Impotence?
Erectile dysfunction can have both physical and psychological causes. When it is caused by psychological factors, it is referred to as psychological ED or impotence. There is no single psychological cause of ED, but rather a variety of issues. These triggers often overlap and can occur simultaneously.
Let’s take a closer look at each cause to understand how it can play a role in the development of psychological ED.
1. Stress
Many people are familiar with the feeling of stress, but some experience it more frequently than others. Stress can come from various sources, such as work, loss, or financial issues, and can lead to feelings of worry, stress, or depression. These emotions can contribute to a sense of powerlessness.
When experiencing stress, the last thing on your mind and body may be sex. The release of stress hormones in the bloodstream can make it impossible to achieve an erection.
Stress can play a key role in the development of erectile dysfunction (ED). When left unaddressed, stress can lead to anxiety. This creates a cycle of stress that can negatively impact mental health and sexual performance. It’s important to address stress and anxiety because they are closely linked and have physical effects.
Research supports the connection between anxiety, stress, and ED. A 2015 study looked at the records of 64 men with ED or premature ejaculation (PE) and found a strong correlation between ED and anxiety or depression. Out of the 64 participants, 8 had comorbid depressive disorders, and 15 had anxiety disorders. Most of the participants’ disorders began before the onset of sexual dysfunction. This indicates that they may have played a role in the development of ED.
2. Performance Anxiety
Performance anxiety and ED have a complex relationship. Feeling stressed or anxious about sex can lead to sexual problems for anyone, regardless of gender. When a person feels unable to meet their partner’s expectations, they may feel inadequate or incapable. These feelings of low self-worth can lead to physical symptoms such as ED. Studies show that psychological factors, including a person’s state of mind, can play a role in ED.
Feeling anxious about performance can become a self-fulfilling prophecy. This fear of not satisfying a partner can make someone nervous during sex. The nervousness can then cause erectile dysfunction (ED). This anxiety can often stem from negative self-talk, such as worries about achieving an erection, satisfying a partner, or PE. If you’ve had trouble getting an erection before, it might stay on your mind. This could make it hard to relax during sex.
Performance anxiety can stem from negative thoughts. These feelings can be influenced by factors like
- body image,
- penis size,
- gender roles,
- relationship issues, and
- the use of internet porn.
External stressors such as money or work can also cause performance anxiety.
3. Depression
Depression can negatively impact sexual function, including erectile dysfunction. This mental health condition is often caused by an imbalance in brain chemicals, but it can be difficult for men to recognize and seek help.
Unless you have personally dealt with depression, it may be difficult to understand its complexity. Clinically, it is a much more serious condition than just feeling sad. It can have a negative impact on various aspects of one’s life, both mental and physical. It can be difficult for men to identify and acknowledge that they may be experiencing depression. Many men may not be familiar with the symptoms or may be hesitant to seek help, as reported by the National Institute of Mental Health.
Some of the most common signs of depression include:
- a persistent sad or empty mood,
- feelings of hopelessness,
- reduced interest in activities and hobbies,
- feelings of worthlessness or guilt,
- changes in appetite and weight,
- difficulty sleeping or oversleeping,
- difficulty focusing or making decisions,
- physical pains or aches with no clear cause, and
- suicidal thoughts or behavior
These symptoms can greatly affect one’s ability to enjoy activities, including sexual activities.
Research conducted in 1998 found a correlation between depression and ED in middle-aged men. The information came from a study in Massachusetts. It showed that depression and ED are linked and not influenced by age or demographics. With proper treatment, however, most men are able to regain healthy sexual interest and resolve ED issues.
4. Relationship Problems
Maintaining a healthy relationship is a challenge that requires effort and understanding. The negative effects of conflicts and poor communication in a relationship can extend to the sexual aspect. This can cause issues such as decreased sexual desire and erectile dysfunction. When problems arise in a relationship, it can affect sexual desire and performance.
In some cases, the ED itself may be the cause of relationship issues. If you’re struggling to communicate with your partner, it can be hard to address the psychological causes of ED. Seeking counseling can help you understand each other’s needs and strengthen your connection.
5. Guilt
Intense feelings of guilt can disrupt the communication between the brain and the body, leading to ED. Erectile dysfunction can lead to feelings of guilt and shame, exacerbating the problem and contributing to a cycle of ongoing ED. This may occur as a form of subconscious retaliation for feeling guilty. Men who hold religious or cultural beliefs that view sex as shameful may also experience impotence due to feelings of guilt. This is considered a psychological cause of ED.
Many times, these emotions are linked to mental health problems like depression. This can make it hard for men to ask for help or find the right treatment.
6. Low Self-Esteem
If you lack confidence in your sexual abilities or appearance, it can lead to difficulties in sexual performance. This can create a negative feedback loop, where low self-esteem leads to sexual performance issues, reinforcing feelings of low self-worth.
Erectile dysfunction and low self-esteem can feed into each other, creating a vicious cycle. Research has shown that a significant proportion of men with ED also experience low self-esteem.
A study published in the BMJ discovered that erectile dysfunction can lead to significant emotional turmoil for men. It can negatively impact their self-worth and the quality of their relationships. The connection between erectile function, depression, anxiety, and self-esteem is complicated, but it exists.
7. Pornography Addiction
While watching porn isn’t inherently bad or harmful, excessive use of it may have a negative impact on your erectile function and sexual health. Research shows that watching too much porn can make people have unrealistic expectations about sex and partners. This can, in turn, cause erectile dysfunction. This phenomenon is known as pornography-induced erectile dysfunction (PIED). It occurs when the brain becomes accustomed to the type of stimulation provided by pornography. Thus it is difficult to achieve arousal through other means.
While there isn’t much research, consuming too much porn might harm your sexual health and ability to get an erection. It may cause you to develop unrealistic expectations about sex and may also lead to a lack of sensitivity known as “death grip” syndrome. This can affect your ability to achieve and enjoy sexual activity in real-life situations.
8. Substance Use
Drug and alcohol use can negatively impact your ability to achieve and maintain an erection. They can also interfere with the body’s natural process of getting an erection. Studies have also found a connection between substance abuse and low testosterone levels, which play a crucial role in erections. If you think substance use may be causing your ED, seeking help from a local clinic or Alcoholics Anonymous may be a good starting point.
How Do You Know if Your ED is Psychological?
If you are concerned that you may have psychological ED, the first step is to speak with your healthcare provider. After a physical examination and review of your medical history, your healthcare provider may ask you a series of questions. They may also perform tests to eliminate any potential medical causes for your erectile dysfunction.
These tests include
- measuring your testosterone levels,
- checking for cardiovascular disease,
- assessing for diabetes,
- measuring blood pressure,
- evaluating kidney function, and
- analyzing any physical damage to your penis or surrounding area.
These tests can help identify any hormonal or physical issues that may be contributing to your ED.
Your healthcare provider may also conduct a self-assessment by asking about
- your sexual desire,
- ability to achieve and maintain an erection,
- ability to orgasm,
- satisfaction during intercourse, and
- overall sexual satisfaction.
These self-reported assessments, along with laboratory tests, may lead your healthcare provider to recommend a psychological evaluation. This will help them determine the underlying cause of your ED.
To find out if your erectile dysfunction is caused by your mind, ask yourself these questions:
- Are you having trouble performing despite your interest in and attraction to your partner?
- Are you able to get an erection when masturbating?
- Do you have morning erections?
- Are you experiencing a lot of stress or anxiety?
- Are you worried about satisfying your partner?
Answering yes to these questions doesn’t necessarily mean your ED is psychological. However, it may suggest that psychological factors play a role in your symptoms. If you suspect a mental health issue such as anxiety or depression may be involved, speak with a healthcare professional.
ED and Mental Health
ED can have a negative impact on a person’s well-being, including mental health, relationships, and social life. Studies have shown that there are links between ED and mental health issues such as anxiety, depression, stress, low self-confidence, self-esteem, relationship difficulties, and sleep issues.
These factors can contribute to performance anxiety and can also be a result of it. If a person experiences erections in the morning but not during sexual activity, there may be an emotional or psychological cause. Counseling and psychological treatment, such as cognitive behavioral therapy, may help address these concerns and improve ED.
How to Overcome Psychological ED: Treatment Options
Mental health concerns can have a major impact on your sexual function. If you’re experiencing ED in addition to these issues, speak with your doctor. You and your healthcare provider can find the cause and develop a treatment for psychological ED. This will help restore your sexual well-being.
Similar to how physical health problems can lead to erectile dysfunction, psychological ED can also be treated. However, it is not as straightforward as taking medication such as sildenafil before sexual activity.
These medications help with ED, but they don’t fix emotional or psychological problems. They do not have any effect on one’s moods, feelings, or thoughts.
To effectively treat psychological ED, it is important to address the underlying cause. It could be a mental illness or negative feelings toward sex. One of the most common and effective treatments is cognitive-behavioral therapy (CBT). It is a form of therapy that helps to identify and change negative thought patterns and behaviors that may be contributing to ED. This therapy is facilitated by a therapist and has been found to be useful in treating depression, anxiety, and ED.
This treatment focuses on addressing the individual’s reaction to the situation rather than the situation itself (in this case, difficulty in achieving or maintaining an erection). Through understanding and recognizing negative thought patterns, it is possible to change them in a positive way to resolve the issues.
Another treatment option is psychosexual therapy or sex therapy. It is a specialized form of counseling that helps individuals and their partners overcome sexual issues. For those who are not comfortable talking to a therapist, alternative therapies can be tried at home, such as:
- Meditation: Although there’s no direct research on the effects of meditation on erectile dysfunction, studies have found that it may improve depression and anxiety.
- Relaxation techniques: Techniques such as rhythmic breathing and guided imagery may help to reduce stress and improve sexual function.
Talking about ED with your healthcare provider and partner is a crucial step in the healing process. Acknowledging the issue and being open with your partner can help ease stress and anxiety.
Give your partner a chance to ask questions and understand the issue. They can also offer support by giving tips to enhance your sexual desire or help with erection problems.
Takeaway
Erectile dysfunction can have various causes, both physical and psychological. If you suspect that your ED is psychological, speak with your healthcare provider for proper diagnosis and treatment. They may suggest medication and/or therapy as appropriate.
We offer FDA-approved ED medications online, learn more about them here.
References
- Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013 Jan 12;381(9861):153-65. doi: 10.1016/S0140-6736(12)60520-0. Epub 2012 Oct 5. PMID: 23040455. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60520-0/fulltext
- Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry. 2015 Jul;60:114-8. doi: 10.1016/j.comppsych.2015.03.001. Epub 2015 Mar 19. PMID: 25818906. https://www.sciencedirect.com/science/article/abs/pii/S0010440X15000346?via%3Dihub
- Simopoulos EF, Trinidad AC. Male erectile dysfunction: integrating psychopharmacology and psychotherapy. Gen Hosp Psychiatry. 2013 Jan-Feb;35(1):33-8. doi: 10.1016/j.genhosppsych.2012.08.008. Epub 2012 Oct 6. PMID: 23044247. https://www.sciencedirect.com/science/article/abs/pii/S016383431200271X
- Araujo, Andre B. BA; Durante, Richard PhD; Feldman, Henry A. PhD; Goldstein, Irwin MD; McKinlay, John B. PhD. The Relationship Between Depressive Symptoms and Male Erectile Dysfunction: Cross-Sectional Results From the Massachusetts Male Aging Study. Psychosomatic Medicine 60(4):p 458-465, July/August 1998. https://journals.lww.com/psychosomaticmedicine/Abstract/1998/07000/The_Relationship_Between_Depressive_Symptoms_and.11.aspx
- Tomlinson J, Wright D. Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study. BMJ. 2004 May 1;328(7447):1037. doi: 10.1136/bmj.38044.662176.EE. Epub 2004 Mar 29. PMID: 15051618; PMCID: PMC403839. https://www.bmj.com/content/328/7447/1037
- Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel). 2016 Aug 5;6(3):17. doi: 10.3390/bs6030017. Erratum in: Behav Sci (Basel). 2018 Jun 01;8(6): PMID: 27527226; PMCID: PMC5039517. https://www.mdpi.com/2076-328X/6/3/17
- Duca Y, Aversa A, Condorelli RA, Calogero AE, La Vignera S. Substance Abuse and Male Hypogonadism. J Clin Med. 2019 May 22;8(5):732. doi: 10.3390/jcm8050732. PMID: 31121993; PMCID: PMC6571549. https://www.mdpi.com/2077-0383/8/5/732
- McCabe MP, Althof SE. A systematic review of the psychosocial outcomes associated with erectile dysfunction: does the impact of erectile dysfunction extend beyond a man’s inability to have sex? J Sex Med. 2014 Feb;11(2):347-63. doi: 10.1111/jsm.12374. Epub 2013 Nov 20. PMID: 24251371. https://onlinelibrary.wiley.com/doi/full/10.1111/jsm.12374
- Khan S, Amjad A, Rowland D. Cognitive behavioral therapy as an adjunct treatment for Pakistani men with ED. Int J Impot Res. 2017 Sep;29(5):202-206. doi: 10.1038/ijir.2017.23. Epub 2017 Jul 13. PMID: 28701798. https://www.nature.com/articles/ijir201723
- Meditation and Mindfulness: What You Need To Know https://www.nccih.nih.gov/health/meditation-and-mindfulness-what-you-need-to-know
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