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The causes of erectile dysfunction (ED) aren’t just physical, such as illness or injury. Mental health plays a key role in everyone’s sexual health, too.
Quick FAQs
Some of the causes of psychological ED include sexual performance anxiety, stress, and relationship issues.
The best way to know if ED is psychological is consulting with a doctor. But experiencing morning erections and being able to get an erection when masturbating may be signs of psychological ED.
Psychological ED can be treated in various ways such as taking medication, adopting healthier habits, and seeking therapy.
Psychogenic erectile dysfunction, or psychological ED, is when a man can’t achieve or maintain an erection during sexual activity due to psychological reasons that range from stress and anxiety to relationship worries.
Causes of Psychological ED
By 2025, studies estimate that 322 million men will struggle with erectile dysfunction, with nearly 20 percent of those being under 40.
In men under 40, over 85% of ED cases are due to psychological erectile dysfunction. Various psychological issues can contribute to ED, including:
- anxiety about sexual performance
- stress and anxiety
- depression
- issues in the relationship
- lingering guilt
- low self-esteem
- overuse of pornography
Performance Anxiety
Sexual performance anxiety (SPA) is a real and common sexual complaint among both men and women.
It affects up to 25% of men and can contribute to erectile dysfunction and premature ejaculation.
While SPA has a lot to do with a person’s negative thoughts about their performance, it isn’t the only factor that can influence those feelings.
Body image, penis size, and ideas of gender roles can add additional anxiety that can spiral into erectile dysfunction.
Stress
The human body is built to feel and react to stress. But, when it becomes an ongoing problem, stress can negatively impact all the systems of the body. It can cause issues that lead to ED.
Anxiety happens when there’s too much stress over time, which then causes more stress, and you become stuck in a cycle of negative thoughts.
The body releases adrenaline and cortisol into the brain when there’s stress and anxiety. It causes the heart to beat faster and sometimes decreases blood flow to the arteries of the penis, making it hard to get an erection.
Prolonged stress requires attention, because it can also lead to high blood pressure, heart attacks, or strokes. These are all known risk factors of erectile dysfunction.
Additionally, some treat stress and anxiety by excessively drinking, smoking, or doing drugs, which can only worsen the ED.
Depression
Depression often comes with the inability to take joy or pleasure in anything, much less sex.
According to research, men who experience depression are more likely to struggle with erectile dysfunction. Doctor-prescribed antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft), have shown promise when treating men with depression that also deal with erectile dysfunction.
Another study found that depression-related ED can happen to men of all ages, backgrounds, and lifestyles.
Relationship Problems
Relationship problems can be stressful. As noted before, stress can cause other physical issues that lead to ED.
But beyond the physical issues, relationship problems may cause men to be less interested in sex with their partner. Underlying issues may lead to depression or anxiety that could cause difficulties obtaining an erection.
Erectile dysfunction doesn’t only affect the person that is struggling with sexual dysfunction.
The person’s partner may experience confusion, feel unwanted, and even have suspicion an affair is occuring, especially when there is a total communication breakdown.
Improving communication and pursuing therapy can be helpful to addressing relationship problems, decrease overall stress, and help treat psychogenic ED.
Low Self-Esteem
Studies show that men that struggle with erectile dysfunction are more likely to experience low self-esteem.
This low self-esteem may contribute to men experiencing performance anxiety, and potentially make erectile dysfunction more likely to happen.
A study concluded that prevention of ED can help improve the self-esteem of men. With boosted confidence, there’s less likelihood for a man’s erection to be hindered by performance anxiety.
Guilt
The guilt of underperforming is only one form that can cause erectile dysfunction. A man cheating on their significant other may experience ED while stepping out or when returning to their partner.
The feeling of guilt causes tension, and that inability to relax is what causes erectile dysfunction.
Pornography Over Use
Some men experience ED with no identifiable cause. One of the most controversial theories is that the overconsumption of online pornography may cause erectile dysfunction in some men.
Some studies suggest too much porn leads to poor sexual health. However, there is plenty of research that finds that there is no correlation between pornography and erectile dysfunction.
Something else to consider is that viewing pornography, especially hardcore, can give rise to feelings of guilt, which may increase the odds of ED. Hardcore porn may also desensitize sexual responses or change how a person views their real-life partner.
Psychological Trauma
Post-traumatic stress disorder is proven as a cause of erectile dysfunction. Research shows that people with PTSD struggle with ED at a higher rate than their peers. It establishes a correlation between psychological trauma and sexual dysfunction.
Some studies suggest that erectile dysfunction caused by PTSD isn’t dependent on the type of trauma. Men that have experienced combat, sexual or physical abuse, or serious accidents can experience psychological trauma that causes erectile dysfunction.
OCD
Based on clinical research, men diagnosed with obsessive-compulsive disorder (OCD) report a higher prevalence of sexual dysfunction and decreased sexual satisfaction.
OCD can cause feelings of dissatisfaction with your partner, fear of intercourse, or disgust when thinking about sexual activity.
Fears of contamination and pregnancy obsessions are common in people with OCD and can lead to psychological impotence in men.
Talk therapy and doctor-prescribed medications are proven treatments for OCD and can help alleviate the intrusive thoughts that keep you from engaging in sexual activity.
Schizophrenia
Schizophrenia is a complicated diagnosis that often overlaps with other psychological issues like anxiety and depression.
It’s estimated that half of those with schizophrenia have coexisting behavioral or mental health disorders, which increases the risk for erectile dysfunction.
How do I Know if ED is Psychological?
Only a doctor can determine whether or not erectile dysfunction is psychological. But, there are red flags you can look for to determine if your ED is physical or psychological.
- Do you have issues performing even though you’re attracted to your partner and are interested in sexual activity?
- When you masturbate, can you achieve and maintain an erection?
- Are you experiencing normal morning erections?
- Has a life event caused massive stress in your life?
- Are you nervous that you’re not pleasing your partner?
The first thing your personal physician will do is run tests to rule out physical causes, including any current medication. They may review the following:
- Sexual history
- Physical exam
- Ultrasound of the penis
- Blood tests
- Urine analysis
- Injection test
- Overnight erection test
A medical professional will then look for the mental causes of erectile dysfunction once they have a complete medical history and rule out underlying conditions as the cause of the ED.
Signs of psychological erectile dysfunction include:
- Inability to get an erection
- Unable to maintain an erection
- Premature ejaculation
- Delayed orgasm
- Loss of interest in sex
- Difficulty performing
Determining the exact cause of psychological ED is unknown and complicated to diagnose. In some cases, the cause of erectile dysfunction is both physical and psychological.
How do You Treat Psychological ED
Psychological erectile dysfunction is as treatable as the physical variety. The approaches to treating psychological ED include medication, therapy, and changes in lifestyle.
Medication
Doctors regularly prescribe medication such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis) to treat symptoms of erectile dysfunction.
If a physician determines that the case of ED is psychological, they may prescribe an antidepressant. Fluoxetine (Prozac) or sertraline (Zoloft) are common SSRIs that treat depression and anxiety and cause the lowest incidence of erectile dysfunction.
Some men may experience erectile dysfunction due to their antidepressant or anxiety medication. Do not stop taking medication prescribed by a doctor unless you consult with them first.
Alternative medications
You and your doctor can discuss alternative treatments if you suspect the antidepressant is causing erectile dysfunction.
Vitamin regimes that include folate, B12, and other B vitamins have shown promise when treating symptoms of mental disorders.
Magnesium deficiency can cause anxiety, confusion, and symptoms of depression.
Supplements that contain magnesium may not only help with major depression but also might treat sexual dysfunction in some men.
Always consult with a medical professional before you begin any supplement or alternative treatment to avoid adverse reactions.
Healthy habits
There are a variety of habits that can help improve overall mental health, and as a result, potentially treat erectile dysfunction.
- Relaxation techniques: Yoga, meditation, and other relaxation techniques cost nothing and can help reduce stress and anxiety.
- Diet and exercise: According to research, changing your diet and exercising can boost your mental health.
- Sleep: People who had 6 hours of sleep or less per night on average were 2.5 times more likely to report frequent mental distress than those who averaged 6 hours of sleep more.
- Practice Gratitude: A study reported in a University of Utah Health article found that gratitude can lessen stress, anxiety, and depression.
Therapy
Cognitive behavior therapy (CBT) is a common type of talk therapy that helps identify and change unhealthy thought patterns that lead to anxiety and depression.
While it’s not easy to talk about erectile dysfunction, research shows that CBT can better help you understand what thoughts lead to ED and how to change them in a positive way.
Takeaways
Psychological erectile dysfunction doesn’t care how old you are. Approximately 20 percent of all cases occur in men under 40.
Stress, anxiety about sexual performance, relationship issues, and low esteem can all lead to the inability to get and maintain an erection.
Only a doctor can diagnose psychological ED, but there are symptoms that you can be on the lookout for. An abnormal amount of stress, still having the ability to get a morning erection, and trouble performing are potential signs that your ED is physiologically related.
Common doctor-prescribed medications like Viagra and Cialis can help treat erectile dysfunction. However, in some cases, a doctor will treat ED with an SSRI, though some antidepressants cause further issues with sexual dysfunction.
If side effects of medication concern you, there are alternative methods to treating psychological ED. CBT therapy, lifestyle changes, and magnesium supplements are natural treatments for erectile dysfunction.
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