The Psychological Causes of Erectile Dysfunction

Whilst erectile dysfunction (ED) is rarely a condition that’s entirely ‘all in the head’, there are a number of psychological factors that may be contributors. We explore these, and propose methods of overcoming ED.

Published: Wednesday 19 May 2021



Most men will have experienced some form of sexual dysfunction due to not being in a conducive mindset for sex at the time. Perhaps you’ve had a lot on at work and are feeling stressed, or perhaps you experienced relationship issues that have lowered your arousal levels. If erectile dysfunction has been an issue on numerous occasions, it’s worth exploring the psychological factors that might be contributing to ED. Despite only accounting for about 10% of all ED cases, psychological factors are likely to be the main cause of erectile dysfunction in younger men, and could also be a contributing factor in older men.

This article explores how emotional and behavioural factors can cause ED, and the best methods of addressing these issues to help get your mojo back.

Which Psychological Factors can Cause ED?

Depression

Depression is an increasingly common mental health condition, affecting individuals of all ages. The pandemic only worsened this, with the depression rate in June 2020 being double that of the pre-lockdown rates. Additionally, those affected by depression during the pandemic were twice as likely to report their relationship being impacted compared to adults with no or only mild depressive symptoms[1]. Depression is different from temporary mood fluctuations, rather it’s characterised by longer term feelings of dejection that can deeply affect your personal wellbeing, work life, and relationships. Activities that were once enjoyable may no longer bring pleasure and so are withdrawn from, including sex. Depression is likely to lower the libido, making impulses to have sex few and far between. This can result in the inability to achieve an erection when faced with stimulation that would normally cause arousal.

On top of this, common anti-depression medications like SSRIs and SNRIs are known to have libido-lowering effects, and so may be directly contributing to erectile dysfunction.

Stress

When people have a lot on their plates, sex is often one of the first things to take a back seat. Not only are those suffering from stress usually occupied with other events occurring in their lives, stress can also disrupt hormone levels and narrow the arteries, restricting proper blood flow to the penis. Post-traumatic stress can have an even more significant impact on sex, with one study of veterans with PTSD finding the disorder to increase their risk of sexual dysfunction more than threefold[2]. Personal and professional stress is one of the main causes of erectile dysfunction in middle-aged men, with job problems, relationship issues, financial burdens or changes in health often playing a part.

Low Self-esteem

Those with low self-esteem view themselves as having low self-worth, sometimes due to having a negative perception of their body image, or perhaps as a result of comparing themselves too harshly with their friends or in social settings. You may have experienced a particular scarring relationship or been bullied, which has damaged your sense of self-worth. This produces low confidence, and can take a significant emotional toll on your wellbeing. Low self-esteem might carry over to the bedroom, where fear and anxiety about your sexual performance, if you’ll be “good enough”, can lead to the inability to remain relaxed, prompting erection problems. Not approving of what you see in the mirror can also make you want to avoid having sex altogether to avoid any anticipated embarassment or because you expect your sexual partner to not desire you. Prolonged self-esteem issues can often lead to depression and anxiety, and self-medication, which are all associated with low libido.

Performance Anxiety

Nervousness or anxiousness about how you will perform in the bedroom can happen to men of all ages, but you are most likely to experience this as a teenager or young adult when you are first starting to have sex. It is not uncommon for this to continue or to resurface later in life, especially if you haven’t been sexually active for a while. Low self-esteem and general anxiety can feed into performance anxiety, and a 2015 study found a close connection between performance anxiety and depression[3]. The difficulty with this issue in particular is that the pattern can often become cyclical, with the initial occurrence/s only knocking your confidence more, and increasing your fear of sexual dysfunction going into your next intimate encounter, causing repeating erection problems.

Relationship Problems

Any issues in a relationship have the potential to cause your desire to engage in sexual activity with that person to decrease. For example, sexual interactions with a long term partner may decrease in frequency if you are more preoccupied; perhaps you become more embedded in the company you work at and in your career, and have taken on additional responsibilities like caring for children or aging parents/relatives, which may cause stress. Less time spent with each other may start to break down communication in the relationship. Alternatively, you may be a fairly recent couple that is starting to get into arguments, and this makes you less interested in sexual activity with them. Whatever your situation, damaging the connection you have with your partner is likely to decrease your arousal when with them, and increase the likelihood of experiencing erectile dysfunction.

Pornography Addiction

Pornography can be a useful tool for you and your partner to explore your sexuality with eachother and venture into new sexual territories, but the immediate and free nature of porn in this day and age means it’s never been easier to consume too much. The aim of the pornographic director / studio / actors is to get the viewer to watch as much of their content as possible, resulting in the content of porn having become more extreme and more overtly sexual than it was a few decades ago in order to gain attention in a crowded market. When watching porn frequently, the brain becomes trained to expect and need that level of stimulation to achieve arousal, having set unrealistic expectations about sex or sexual partners based on porn.

A study of 28,000 Italian men found that men who watched large quantities of porn from an early age would often become desensitised to it, and were more likely to lose interest in real life sexual encounters, something they coined “sexual anorexia”[4].

A likely consequence of this over stimulation and desensitation is the inability to become or remain aroused by a partner during sex, leading to a diagnosis of pornography induced erectile dysfunction (PIED).

How to Treat Erectile Dysfunction

Erectile Dysfunction Treatments

Whilst it is vital to address the root causes of any psychological factors causing your erectile dysfunction, a combination of behavioural and medicinal treatments is ideal. There are several affordable erectile dysfunction treatments that have been clinically proven to increase sexual functioning.

Popular oral medication includes:

Alternative treatments include:


Change your medication

If you are taking medication for depression and are experiencing erectile dysfunction or lack of libido, ask your doctor to outline your alternative options. SSRIs and SNRIs are known to reduce libido, but NRDIs like Wellbutrin don’t have this effect. Your doctor will advise you on whether it’s best to adjust your dose or to switch medication.


Therapy

Often an outside perspective can offer a much needed insight into the workings of your mind, help to identify patterns of behaviour, and help to break a negative cycle using structured steps.

Types of therapy include:

Counseling - A therapist will work with you to identify and address your stressors and your triggers for anxiety or depression, and show you ways to manage these.

Psychodynamic therapy - This type of therapy digs into the subconscious to identify any deep internal conflict that is the root cause of ED.

Sex therapy - This aims to reduce stress and anxiety around sex by focusing on the sensational pleasure, rather than arousal and sexual activity, to build a secure and reliable sex life.

Sexual anxiety therapy - The focus here is on reducing anxiety from improving your understanding of ED, going into depth on the causes, potentially underlying emotional issues, and solutions.


Stress management techniques

There are numerous techniques to identify your stress triggers and control the negative feelings that typically proceed. Experts have identified slow tempo, instrumental songs (of whatever genre is your favourite) as the best music to listen to to unwind and decompress[5]. Exercise is vital for stress relief, with the release of stress-reducing endorphins creating positive emotions and combating stress, anxiety or depression. Meditation is another proven stress-reducer where you can clear your mind and refresh. Guided imagery is a type of meditation used to increase libido, whereby you write a script vividly detailing a successful sex session with a partner, record yourself speaking it aloud, and then play it back whilst you visualise the experience.

You can learn more about stress-relieving techniques which can be applied to help reduce the impact of ED in our detailed blog on How to Stress Less.

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