Erectile dysfunction can result from physical or psychological causes – and often a combination of the two. When physical causes begin to trigger ED, men often worry about their ability to have an erection… and this performance anxiety makes the problem worse.
Psychological, or psychogenic erectile dysfunction, can also be caused by:
- Fear of sexual failure (performance anxiety)
- Stress
- Anxiety Disorders
- Depression and other mood disorders
- PTSD
- Relationship issues
(See our article on Causes of Erectile Dysfunction for more information.)
Remember that there are many causes for erectile dysfunction, both physical and psychological, and sometimes ED is a symptom of a serious underlying medical problem. To determine if your ED is primarily due to physical or psychological factors, you’ll need to see a doctor. However, there are a few indicators that help to narrow down the cause.
| Physical | Psychological | |
| Do you have nighttime and morning erections? (See our article on the stamp test for nighttime erections) | No | Yes |
| Did your ED come on suddenly or gradually? | Gradual | Sudden |
| Is you ED occasional or consistent? | Consistent | Occasional |
| Are you experiencing general feelings of stress or depression in you daily life? (Take our online depression assessment.) | No | Yes |
| Do you have feelings of stress or anxiety during sexual encounters? | No | Yes |
| Are you able to achieve and maintain an erection while masturbating? | No | Yes |
Bear in mind that your answers to these questions will give only a general indication. For a full diagnosis of your condition, consult your doctor.
If your doctor determines that there are psychological causes for your erectile dysfunction, counseling can help.
More About Psychological Causes of Erectile Dysfunction
Relationship Issues
Relationship issues often affect your sex life. But sexual issues such as erectile dysfunction can also affect relationships. Often it’s hard to separate the “cause” from the “effect.”
Resolving relationship issues requires trust and good communication. Sometimes just acknowledging the issues and talking with your partner can help. In other cases, counseling may be needed.
Stress and Anxiety
Stress and anxiety – including “performance anxiety” – are common causes of erectile problems. Anxiety is distracting, and it can block the mental processes that are necessary for arousal. Stress and anxiety can also increase production of adrenaline, which diverts blood from the penis.
Studies1 2 3 show a clear relationship between anxiety and erectile dysfunction.
Stress and anxiety issues often require help from a counselor or coach specializing in sexual issues to resolve.
Depression
Depression is a medical condition that affects all aspects of your life. It reduces your energy and makes it difficult to focus or take pleasure in anything, including sex. Studies4 5 have shown a clear link between depression and erectile dysfunction.
There is an online test that can help to determine if you’re experiencing depression.
Resolving depression usually requires medical help, which make include psychotherapy or medication.
PTSD
Men who are suffering from PTSD have significantly higher rates of erectile dysfunction6. PTSD generally requires medical care; it’s important for patients to discuss erectile dysfunction with their doctor or therapist.
Dealing with Psychological Erectile Dysfunction
ED that is caused by psychological issues can be difficult to treat, in part because most doctors and therapists don’t have training or experience to deal with these issues. You may need to consult a counselor or coach who specializes in sexual issues.
Your doctor may also prescribe PDE5 inhibitors – pills like Viagra, Cialis, or their generic equivalents. These pills can sometimes give you the boost you need to get past psychological blocks and rebuild confidence.
References
- Rajkumar, Ravi Philip; Kumaran, Arun Kumar. “Depression and anxiety in men with sexual dysfunction: a retrospective study.” Comprehensive Psychiatry. Jul 2015; 60:114-8.
<https://pubmed.ncbi.nlm.nih.gov/25818906/> - Velurajah, Rajalaxmi; Brunckhorst, Oliver; Waqar, Muhammad; McMullen, Isabel; Ahmed, Kamran. “Erectile dysfunction in patients with anxiety disorders: a systematic review.” International Journal of Impotence Research. Feb 2021.
<https://www.nature.com/articles/s41443-020-00405-4> - Pyke, Robert E. “Sexual Performance Anxiety.” Sexual Medicine Reviews. Apr 2020;8(2):183-190.
<https://pubmed.ncbi.nlm.nih.gov/31447414/> - Liu, Quin; Zhang, Youpeng; Wang, Jin; Li, Sen; Cheng, Yongbiao; Guo, Jialun; Tang, Yong; Zeng, Hanqing; Zhu, Zhaohui. “Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis.” The Journal of Sexual Medicine. Aug 2018; Volume 15, Issue 8, Pages 1073-1082.
<https://www.jsm.jsexmed.org/article/S1743-6095(18)31007-5/fulltext> - Araujo, Andre B; Durante, Richard; Feldman, Henry A; Goldstein, Irwin; McKinlay, John B. “The Relationship Between Depressive Symptoms and Male Erectile Dysfunction – Cross-Sectional Results From the Massachusetts Male Aging Study.” Psychosomatic Medicine. Aug 1998; Volume 60 – Issue 4 – p 458-465.
<https://journals.lww.com/psychosomaticmedicine/Abstract/1998/07000/The_Relationship_Between_Depressive_Symptoms_and.11.aspx> - Cosgrove, Daniel J; Gordon, Zachary; Bernie, Jonathan E; Hami, Shadha; Montoya, Daniel; Stein, Murray B; Monga, Manoj. “Sexual dysfunction in combat veterans with post-traumatic stress disorder.” Urology. Nov 2002;60(5):881-4.
<https://pubmed.ncbi.nlm.nih.gov/12429320/>