What is psychological erectile dysfunction?

When most people think of erectile dysfunction (ED), they might think of an older man who has high blood pressure, heart disease or medical conditions. Not someone who is, by all accounts, fit and healthy.

But psychological erectile dysfunction can occur at any time for a man. And the number of young, healthy men (and people assigned male at birth) experiencing ED is increasing[1]. ED can happen even when you are interested in sex or having sex.

If you feel psychological erectile dysfunction is the culprit for you, don’t worry. In this article, we’ll explain some common causes and treatment options to help you return to your regular self.

Article summary

It’s easy to lose hope and confidence in yourself when you experience psychological erectile dysfunction.

Luckily, there are treatments to help you feel yourself again, which target the root cause (with some ED medication help).

Now that you know how to beat psychological erectile dysfunction, you can be back to enjoying sex alone with your partner in no time.

What is psychological erectile dysfunction?

Psychological erectile dysfunction is when a person can't get or keep an erection for sex due to negative thoughts, stress and anxiety, or emotional issues.

How do you know if ED is physical or psychological?

See your doctor to check if a medical issue causes your erectile dysfunction. They will usually perform a few tests (blood pressure, cholesterol, etc.) and discuss your overall health.

If you are physically healthy but still feel stuck, it may be your emotions. This is especially true if you have gone through a difficult or upsetting situation.

It is very difficult to measure how many men experience psychological ED, with estimates ranging from 10-90%[2]. So, you’re not alone.

The mind is a powerful thing and can easily show its concerns, like depression and anxiety, as physical problems like ED.

One occasion of being unable to become or stay erect for sex can feed into a negative self-reinforcing cycle of fear of it happening again, which then causes the same issue.

Causes of psychological erectile dysfunction

Realising that your erectile dysfunction has a psychological cause might cause a sigh of relief or ignite worry. 

On the one hand, psychological erectile dysfunction doesn’t point to a physical health problem. But, on the other hand, the effect on your mind and body doesn’t make it any less real or painful.

That said, it’s important to realise that it can be addressed and doesn’t have to last forever.

So, what are the five most common psychological factors for erectile dysfunction?

Depression and erectile dysfunction

Up to 10% of the population[3] will experience a depressive episode in their lives. Depression can come in waves, ranging from mild to severe, with symptoms including low mood and a disinterest in activities.

It’s normal to experience low libido and a loss of desire and pleasure to initiate/participate in sex when you’re feeling low yourself.

There can be many reasons why you might experience depressive episodes, including overwhelming stress, at work or home, or genetic influences.

And, when you suddenly find you can’t enjoy sex, that can worsen your low mood as it taps into your self-confidence.

For many people, a common treatment for depression is anti-depressant medication.  However, sexual desire and function can be affected while taking them, particularly with SSRIs[4].

If you take anti-depressant medication and feel like it might be the cause of your erectile dysfunction, talk with your GP before making any medication change.

Anxiety, stress and erectile dysfunction

Though many people group anxiety and stress, their triggers are different.

Anxiety is a constant, heightened level of stress regardless of the activity. Stress is usually caused by a specific activity and doesn’t last as long.

When you’re anxious or stressed, the hormone cortisol is released, quickening your heart rate and making you more alert. All in preparation for your fight-or-flight response. 

This response is important from a survival point of view. But sometimes, the mind doesn’t recognise how to tell the difference between a life-and-death situation accurately, resulting in anxiety or chronic stress in your everyday life. 

A 2023 study on the effect of stress on erectile dysfunction[5] has shown that cortisol can affect an otherwise healthy male’s sexual function.

Do not downplay the effect that emotional and mental strain can have on your body. For example, long periods of stress[6] can cause nausea, chest pain, and make you more likely to get colds and infections.

Unfortunately, sometimes erectile dysfunction and performance anxiety can go hand-in-hand. If you worry about how you’ll perform, those anxious thoughts can affect your ability to achieve an erection.

This results in a negative loop that can be difficult to break without help.

Relationship problems

An often underrated influence on psychological erectile dysfunction is your relationship with your partner.

If there are issues, like a failure to communicate or an emotional distance, it can trigger erectile dysfunction by tapping into your stress responses. (Your mind is registering ‘danger’ and is reacting.)

Many men and those AMAB, can believe issues in relationships are a failure of themselves, which can compound itself into anxious and depressive thoughts. 

Combining those feelings of not being good enough with performance anxiety can lead to psychological erectile dysfunction.

It is also common to experience ED in a new relationship, especially after a difficult breakup or the death of a partner.

History of sexual trauma

The effects of sexual trauma or negative sexual experiences, from childhood or a previous relationship, can be life-lasting. 

It might prevent you from growing emotionally attached to your partner. Or maybe to see your erection, arousal or sexual desires in a shameful way. 

Roughly half of men[7] who report sexual assault have experienced, and still do experience, long term sexual function issues with their partners. 

Pornography and erectile dysfunction

Although the findings are new and need further research, a recent study[8] reviewing the impact of pornography on sexual dysfunction has shown that there may be a link. 

Watching too much porn can cause men to become numbed to sex with their partner. Even causing some men to need more drastic, ‘kinkier’ sex to achieve and maintain an erection.

Alongside that, comparing performance or body image with that of a porn actor can lead to performance anxiety and self-esteem issues.

Will psychological erectile dysfunction go away?

Yes, it is possible to beat this type of erectile dysfunction.

Once you have an idea of what the root cause is, the next step is to figure out what the best treatment option(s) are for you.

Treatments for psychological erectile dysfunction

Though the following treatments might seem like a difficult mountain to climb, it’s important to remind yourself that you deserve to feel and be your best.

Each of these treatments might be enough to help your psychological erectile dysfunction, but there’s nothing wrong if you need a combination either.

1. Talk with a mental health professional

The stigma surrounding men going to therapy is changing for the better[9].

Speaking with a mental health professional is the best first step toward fixing your psychological erectile dysfunction. They provide a safe space to help unearth the root cause of your ED.

Different types of therapies are available, so it might take some experimenting to find the one that best suits you. Talk to your doctor for a referral or find a service privately.

For example, cognitive behavioural therapy (CBT) teaches you to change hurtful, negative behaviours and habits into healthy ones.

2. Talk with your partner

Confiding in your partner about your stresses, concerns, and anxieties can strengthen your relationship. Often, ED causes strain within a relationship as the partner believes they are the reason.

But opening up to your partner can create a healthy environment for you both to release any pent-up worry.

If you or your partner aren’t comfortable discussing your relationship or relationship issues alone, consider seeking guidance from a couple’s counsellor.

3. Consider erectile dysfunction medication

Looking after your mental health and learning new, healthy ways to deal with negative feelings can take time.

But, if you want to address the physical issue of ED, then using erectile dysfunction medication alongside the above treatments is probably the way to go.

Two of the medications we recommend to start with are Tadalafil (Cialis) and Sildenafil (the active agent in Viagra). These medicines only work alongside sexual stimulation.

Choosing the right erectile dysfunction medicine might be overwhelming. We want to make sure you only take what you need when you need it and only for as long as you need.

If you need help understanding which treatment might be the one for you, let us help you by using our secure online query form.

Having the help of prescription medication can relieve some stress on your mind. It’s important to note that these treatments only help when you’re already sexually aroused (turned on). So, make sure you’re addressing the psychological reasons behind your ED as well.

Knowing that medications are available to support your mental health journey can be a sigh of relief. But can be followed quickly by the dreaded thought of talking about it with your GP.

For some, that can be enough of a barrier.

And that’s where we come in.

Over 21,000 customers trust our team of UK-registered doctors and pharmacists, where we value patient safety above all else.

Reach out to us today for secure, patient-first advice.

FAQs

Does stress cause erectile dysfunction?

Yes, stress can cause psychological erectile dysfunction. By tapping into the nervous system, stress ignites the fight-or-flight hormone cortisol, leading to symptoms such as digestion issues, being irritable or grumpy, and erectile dysfunction.

Does grief cause erectile dysfunction?

Similar to anxiety and depression affecting your sexual desire, grief affects the mind in a similar way, which can manifest itself as ED.

Grieving is natural and should never be rushed or ignored. But, if you’ve noticed you’ve been intensely grieving for an extended period, it could be a sign of complicated grief[10]. If this is the case, reach out to your GP or therapist for support.  

Can a break-up cause erectile dysfunction?

Yes, a break-up can cause psychological ED. Though not the same as grief, you’ve still suffered a loss even if you suggested the breakup. 

It’s normal for a person’s mood to dip after a break-up. It’s not a surprise if the ability to achieve and maintain an erection can be a knock-on effect of that.

Can a new relationship cause erectile dysfunction?

Entering a new relationship is exciting and nerve-wracking, especially when you’re ready to be intimate. 

However, the pressure you might put yourself under to perform a certain way, especially with the desire to satisfy your partner, can lead to performance anxiety and erectile dysfunction.

Just remember, your partner is likely feeling the same way. So, consider discussing your concerns beforehand, which might help you overcome any first-time awkwardness.

References

1. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017;6: 79–90. 
2. Kuno H, Godschalk M, Mulligan T. 51 - Male Sexual Behavior during Aging. In: Hof PR, Mobbs CV, editors. Functional Neurobiology of Aging. San Diego: Academic Press; 2001. pp. 739–747. 
3. The most common diagnosed mental health problems: statistics. In: Mental Health Foundation [Internet]. [cited 2 May 2024].
4. Higgins A, Nash M, Lynch AM. Antidepressant-associated sexual dysfunction: impact, effects, and treatment. Drug Healthc Patient Saf. 2010;2: 141–150.
5. Rahardjo HE, Becker AJ, Märker V, Kuczyk MA, Ückert S. Is cortisol an endogenous mediator of erectile dysfunction in the adult male? Transl Androl Urol. 2023;12: 684–689.
6. Stress Symptoms. In: WebMD [Internet]. [cited 2 May 2024].
7. Kamnerdsiri WA, Fox C, Weiss P. Impact of Childhood Sexual Assault on Sexual Function in the Czech Male Population. Sex Med Today. 2020;8: 446–453.
8. Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, et al. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci . 2016;6.
9. Men’s Health Week: Men's changing attitude to mental health and therapy. [cited 2 May 2024].
10. Complicated grief. In: Mayo Clinic [Internet]. 13 Dec 2022 [cited 2 May 2024].