When people experience erectile dysfunction, a Viagra prescription seems like the next logical step. But did you know that pills like Viagra and Cialis work best when what causes ED is something physical, like heart disease or diabetes? If the causes of ED are something mental (like stress, anxiety or relationship issues), you might be dealing with something called psychological erectile dysfunction.
With physical ED, the issue is a lack of blood flow to the penis. ED medication relaxes your blood vessels, so enough blood can get to where you need it most. On the other hand, psychological ED means you’re physically capable of having an erection, but something mental is keeping it from happening. This could be your mental health, worries about performing sexually or issues with your relationship. Below, we’ll share the most common mental causes of impotence and what you (and your partner) can do to turn things around.
The best way is to see your doctor. They’ll be able to run some tests and make sure everything is physically working as it should. In 80% of cases, erectile dysfunction has a physical cause.[1]
But if you’ve already been to the doctor and there’s no physical reason for why you can’t get an erection, you’re most likely dealing with psychological ED.
There are many reasons why erectile dysfunction can happen. The most common causes of psychological ED are things that affect your mood and emotions, like life stress, performance anxiety or issues in your relationship. An erection is both a physical and mental response — while your body supplies blood to your penis, your mind is in charge of arousal. Negative thoughts, fears and worries can all interfere with the brain signals that trigger an erectile response.
Psychological ED (also called psychogenic ED) is when a mental block causes erectile dysfunction. Unlike physical ED, where you might need medication like Viagra to get an erection, psychological ED is treated by addressing the underlying emotional issues. Psychological and physical ED can also happen in tandem, so you should always talk to your doctor first to rule out physical causes.
Psychologically induced ED is common and has many treatment options. You’re not alone, and help is available.
If you’re wondering whether stress can cause erectile dysfunction, the answer is yes. Stress can be distracting; it’s hard for your body (and mind) to be in the mood for sex if you’re worried about work or another issue.
Anxiety and erectile dysfunction are also linked: being anxious can make it more difficult to get an erection, and erection difficulties can make you more anxious.[2] The good news is that treating the underlying cause of the stress and anxiety in your life should also treat your ED.
Performance anxiety happens when worries about your ability to do something are so powerful, they impact your life. Performance anxiety isn’t always sexual. You can have performance anxiety about your job, a literal performance like a speech or presentation or when trying something for the first time. It’s common for someone in a new relationship to experience erectile dysfunction occasionally.
When it comes to sex, performance anxiety usually means worries about your body (including penis size) or about your ability to please a partner. However, something like work stress can make it harder for you to get an erection, which can then cause performance anxiety, which can make it even harder to get an erection. It’s an anxiety ouroboros.
“Performance anxiety not only affects new relationships, but couples that have been together for a while,” says Craig Marsh, Pharmacist Prescriber for EveAdam UK. “Life stress such as stress at work or in your personal life can cause performance ED. Sometimes a weekend break away together can help you re-connect, reduce stress and help with performance ED.”
So talk to your partner about your worries. By addressing the problem head on, you’ll feel less anxious about performing — and you’ll grow intimacy in your relationship.
If you’re experiencing both depression and erectile dysfunction, you’re not alone. It’s a very common cause of psychological ED. Oftentimes, people who are depressed feel like they’re always too tired, lose interest in things they used to enjoy and notice a dip in their sex drive. Depression can keep you from being “in the moment,” impact your self-esteem or body image and add stress to your relationship. All of these things can contribute to ED.
If the depression is acute (a response to something specific that happened), it’s possible that your erectile dysfunction will resolve itself once time has passed. If the depression is chronic, however, you could keep experiencing ED indefinitely if you don’t seek treatment. In either case, it’s important to get help for your depression. That, in turn, can help treat erectile dysfunction.
You’ve talked to your doctor, see a therapist regularly and take a daily antidepressant. You’re doing everything right but your ED isn’t any better. In fact, it seems worse. What gives?
Unfortunately, some antidepressants can cause erectile dysfunction or other sexual issues, like making it really difficult to orgasm or burning your sex drive to the ground. These are not side effects you should live with, and you should talk to your prescriber if you experience any of them. They might be temporary and go away on their own as your body gets used to the medication but if they don’t, it might be time to adjust the dose or find a different antidepressant.
Psychological erectile dysfunction doesn’t have to be permanent — but it won’t always go away without treatment. That doesn’t mean you need medication or multiple visits to the doctor. The best thing to do is to pinpoint a possible cause like life stress, new relationship anxiety or mental health issues like depression. Once you’ve got the cause identified, you’re on your way to curing ED.
Focus on what you can control, like lifestyle changes to avoid stress or increasing communication with your partner to feel more comfortable when you’re having sex. It’s possible you might need help. Don’t be afraid of trying talk therapy or couples counseling. We’ll discuss all the ways to treat psychological ED later on in this article, so keep reading.
When you’re having problems in your relationship, this can lead to problems in the bedroom. Which can then make the relationship even worse. It’s a vicious cycle.
If you think your erectile dysfunction is the result of a problem in your relationship, it’s important to figure out why. Is something that your partner is doing making you feel uncomfortable, or lowering your self esteem? Or is there a negative past experience that you’re bringing to your current relationship, like insecurity or body image issues?
Talk to your partner about what’s bothering you. It’s possible that reassurance from them will help you feel more ‘in the moment’ during sex or remove any pressure you’re feeling about needing an erection to please your partner. On the flip side, couples therapy is an option if you think relationship problems are the cause of your ED but you want some help with opening up communication between you and your partner.
Can porn cause erectile dysfunction? Possibly. Porn-induced erectile dysfunction (PIED) is a recently identified condition but it’s not fully understood how it works. Theories about porn-induced ED focus on how porn can change how a person perceives sex in real life, from overexposure to “unrealistic” bodies and reactions to porn’s impact on dopamine levels.[3]
If you watch a lot of pornography and experience erectile dysfunction, or if you find yourself often choosing porn over sex with your partner, it might be time to take a break.
“Masturbation-induced ED” is a bit of a misnomer. The physical act of masturbation can’t directly cause erectile dysfunction, although you’ll experience a refractory period after orgasming during which you won’t be able to get another erection. However, erectile dysfunction and masturbation do have some links. For example, watching a lot of pornography might change the way you think about sex with your partner and make it more difficult to become physically aroused.
It’s also possible to get used to masturbating in a specific way, whether by using a specific type of visual stimulation or a technique (like a really firm grip) that doesn’t translate well to partnered sex.
Some men choose to masturbate a few hours before sex to help them last longer, but this could ultimately make it more difficult to orgasm depending on how long their refractory period is.
You can have physical or psychological erectile dysfunction no matter what age you are, but there are often mental reasons for erectile dysfunction before age 30. That’s because many of the physical causes of ED (like cardiovascular issues or diabetes) are more common in older men. At the same time, psychological issues like performance anxiety in a new relationship can be more likely to cause erectile dysfunction in your 20s.
If you’re in your 20s or 30s and experiencing erectile dysfunction, it’s important to see your doctor to rule out physical causes, because ED can be a sign of undetected cardiovascular disease.[4] If you’ve gotten checked out and are physically healthy but still having trouble getting an erection, you probably have psychological ED. Below, we’ll explore how you can treat it.
There are many different ways to overcome psychological erectile dysfunction — and not all of them involve going to the doctor. Talk therapy, particularly cognitive behavioral therapy (CBT), is well-known for helping men deal with ED. Couples therapy or sex therapy with your partner can be more productive than handling the issue alone, so don’t be afraid to communicate with your partner.
There are also a few DIY tricks to cure erectile dysfunction and, of course, medication might be an option. You should also speak with your primary care physician and make sure you’ve ruled out any possible physical causes for your ED.
Your thoughts, feelings and physical experiences are all connected. CBT, or cognitive behavioral therapy, is a talking therapy that helps you overcome problems by changing the way you think.
During a CBT session, you’ll learn how mental things like negative thinking, unrealistic expectations around sex or feeling a pressure to perform can cause physical reactions like ED. Working with a licensed therapist, you’ll get access to coping strategies and communication skills that you can use to regain control over your thoughts and body.
Erectile dysfunction shouldn’t be something you feel you have to solve by yourself, and it can be really helpful to involve your partner in your treatment. (In fact, studies show that stress-related ED goes away 50-70% of the time when the partner is involved in therapy.[5]) Couples experiencing erectile dysfunction can benefit from either talk therapy or sex therapy.
A couples talk therapy appointment would address the thoughts of both partners, and help you learn how to communicate your needs and fears. Because psychological ED is often caused by performance anxiety, knowing you have the support and understanding of your partner can be a really helpful tool in overcoming ED.
Unlike a talk therapist who can help address underlying issues of depression, anxiety and other emotional issues that contribute to erectile dysfunction, a sex therapist will approach the issue even more directly. You’ll work on your sexual communication skills as well as learn exercises you can do with your partner at home, which will build sexual intimacy while taking away the pressure to perform (and maintain an erection).
Before you start looking for a therapist, it’s worth trying a few things at home to cure ED. There are a few DIY solutions for erectile dysfunction which are basically lifestyle changes — they address the different things that could be causing your ED, and might make a big difference.
One of the biggest causes of mental erectile dysfunction is stress, so of course it’s best to try and remove stress from your life. But that’s much easier said than done. If the stress is coming from something outside of your control, like a big project at work, focus on what you can control — like getting enough sleep,[6] exercising and eating healthy. Long-term stress isn’t good for you, though, and if the issue isn’t something like a big project (which will soon be over) but your entire job, we really recommend trying to address the stressors themselves.
Take this same approach with causes like performance anxiety, dependence on pornography, relationship issues or fatigue. First, focus on what you can control. Talk to your partner. Limit the amount of pornography you watch, or try something new like reading erotica. Talk to your partner. Make time for rest and relaxation. Did we mention talking to your partner? With a little effort and a lot of communication, you might find your psychological ED goes away on its own.
It’s possible that medication can help psychological ED, but not necessarily in the way you think. Viagra, Cialis and other ED pills make it possible to physically have an erection, which isn’t a problem for people with psychological erectile dysfunction. However, taking medication known for “causing” erections might help you regain your confidence, especially if you’re experiencing performance anxiety.
Being anxious about not getting an erection and then not getting an erection can create an anxiety cycle that feels impossible to break. ED pills like Viagra can be great at getting you out of that headspace and breaking the cycle. Further good news: studies have shown that men with psychological ED have a strong response to placebo treatment.[7]
ED medication won’t necessarily help you address the root cause of psychological erectile dysfunction, though. If it’s the result of depression, you’d be better off talking to a therapist or asking your doctor about antidepressant medication. And if you’re experiencing ED because of changes in your libido or inability to feel “in the moment” due to stress, Viagra won’t be as beneficial as addressing the stressors in your life.
“ED affects most men at some point in their lives,” says Dr. Daniel Atkinson, the Clinical Lead at EveAdam UK. “It’s really common in men who are in a new relationship and are anxious about sexual performance. Sexual arousal starts in the mind: when men feel turned on, this usually leads to an erection — but all sorts of psychological issues can affect how this works.”
At EveAdam, we offer many types of medical treatment for erectile dysfunction. Viagra and other ED pills aren’t usually prescribed for psychological erectile dysfunction as they address physical ED, but they might be the confidence boost you need if you feel like you’ve exhausted other options.
“Feelings of worry or low mood are really common for everyone,” says Dr. Daniel. “Addressing these psychological issues will usually sort out any ED problems and no ED medication will be required, but medications like Viagra and Cialis can be helpful in the short term.”
Talk to an expert and find out if ED medication is right for you.
[1] Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
[2] McCabe, M.P. and Althof, S.E. (2014). 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? The Journal of Sexual Medicine, 11(2), pp.347–363.
[3] Park, B., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., Klam, W. and Doan, A. (2016). Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behavioral Sciences, 6(3), p.17.
[4] Simopoulos, E.F. and Trinidad, A.C. (2013). Male erectile dysfunction: integrating psychopharmacology and psychotherapy. General Hospital Psychiatry, 35(1), pp.33–38.
[5] Kaplan H.S. (1980) The New Sex Therapy. In: Marmor J., Woods S.M. (eds) The Interface Between the Psychodynamic and Behavioral Therapies. Critical Issues in Psychiatry (An Educational Series for Residents and Clinicians). Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3000-4_25
[6] Cho, J.W. and Duffy, J.F. (2019). Sleep, Sleep Disorders, and Sexual Dysfunction. The World Journal of Men’s Health, 37(3), p.261.
[7] Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.
