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Your Problems in Bed Might Be Psychological Erectile Dysfunction


written by Carrie Borzillo - Jan 17, 2022
medically reviewed by Dr. Christine Bishara, MD - Mar 22, 2022

Photo Credit: by Fernando Cferdo, Unsplash.com
Photo Credit: by Fernando Cferdo, Unsplash.com

Most men have been there at one point in their life. You have the right partner, the mood is set, you’re both ready to have some fun, and then for some reason you can’t quite rise to the occasion. Or perhaps you do, but then it’s over before you can say, “Sorry, I don’t know what’s wrong.” Before you think you’re broken, consider this: approximately 20 percent of men suffer from what is known as psychological erectile dysfunction, which is also referred to as psychogenic erectile dysfunction.

This is actually really good news because, unlike with some other causes of erectile dysfunction (such as an injury, blood vessel issues, or pre-existing medical conditions), psychological ED doesn’t require needles, pumps, or medical procedures to overcome. “Psychological ED can be caused by a range of emotional, cognitive, or social causes and conditions. Chronic mental health conditions, including depression and anxiety, for example, can affect sexual function. Meanwhile, acute emotional difficulties such as stress can affect your sexual desire – and, as a result, can impact your sex life too,” says Dr. Earim Chaudry, Medical Director of men’s mental health platform Manual.

Symptoms of Psychological Erectile Dysfunction

One aspect of psychological erectile dysfunction that is the same with ED caused by a medical reason is the symptoms, which are…

● Difficulty in achieving an erection.

● Unable to get an erection at all (impotence).

● Trouble keeping an erection.

● Premature ejaculation.

● Taking too long to ejaculate.

● Decrease in sexual desire.

If any or all these symptoms have happened to you, don’t worry just yet. Consider this: The Cleveland Clinic reports that it is “normal” to have trouble getting an erection, or keeping one, for 20 percent of your sexual encounters. But, if you have trouble getting an erection more than 50 percent of the time, it could indicate a medical issue and warrant a trip to your general doctor, who may then refer you to a urologist.

The Mayo Clinic is a bit broader on their advice. They say to contact a doctor if you have concerns about your erections or you're experiencing other sexual problems such as premature or delayed ejaculation, if you have diabetes, heart disease, or another known health condition that might be linked to erectile dysfunction, or if you have other symptoms along with erectile dysfunction.

Don’t forget: You are not alone. While erectile dysfunction statistics vary greatly, a 2019 report by Cleveland Clinic states that 1 in 10 men have had ED at some point in his lifetime with the U.S. being the country with the most cases and Spain being the country with the lowest cases. Additionally, University of Wisconsin Health reported that ED affects approximately 10 percent of men per decade of life — meaning 50 percent of men in their 50s are affected by ED.

That said, erectile dysfunction is not ageist as it affects younger men as well. The Journal of Sexual Medicine published a study that found that ED affected about 26 percent of men under the age of 40. And the problem is growing each year. According to the International Journal of Impotence Research, an estimated 322 million men are expected to have ED by 2025.

Causes of Psychological Erectile Dysfunction

The difference between psychological erectile dysfunction and non-psychological ED is quite significant. But before one can learn if your sexual woes are truly a psychological problem, your doctor needs to assess if there’s an underlying medical condition causing it first.

In brief, ED happens when not enough blood flows to the penis. Contributing factors to this are widespread and include diabetes, cardiovascular disease, hypertension, high cholesterol, obesity, kidney disease, low testosterone levels, Parkinson’s disease, multiple sclerosis, Peyronie’s disease (in which scar tissue develops on the penis resulting in a bent penis), and/or injury to the pelvic area.

If You’re having ED, your doctor will do an evaluation to determine if the cause is organic or psychological. They will probably check testosterone levels in addition to other tests. A telltale sign in differentiating psychological ED from an organic cause is the presence of morning erections which more likely points to a psychological factor as the cause of your erectile dysfunction. If your doctor rules all of that out of the equation, then we’re most likely talking about psychological erectile dysfunction caused by mental health or emotional issues, including depression, anxiety, and/or stress.

“Depression is a common medical condition that can cause low mood, a lack of interest, and an aversion to activity. Often associated with sadness, anger, low self-esteem, and other negative emotions, the psychological condition can affect many parts of your life – including your sexual activity. According to one study, 72% of men with depression experienced a decrease in sexual desire and libido, while a reduced ability to feel pleasure is a common symptom too. Understandably, these can combine to reduce your ability to achieve an erection,” explains Dr. Chaudry.

Anxiety and stress are also key contributors. “Anxiety and stress are different medical issues,” explains Dr. Chaudry. “While stress is usually acute and is a response to external events, anxiety can be chronic and may not have a specific cause. However, the symptoms are similar and are caused by similar chemical changes in your body. For example, when stressed or anxious, your body releases cortisol, the hormone that speeds your heart rate and boosts energy.”

It’s common for men with ED to experience sex itself as stressful, which is referred to as performance anxiety that can make ED worse. “Performance anxiety is often triggered by worries about being able to achieve an erection, pleasing a partner, or ejaculating too early. One of the particular difficulties with psychological ED is that it can be self-reinforcing. If you experience ED once, it can knock your self-esteem and make you anxious about future sexual experiences. This way, it can contribute to performance anxiety, and may make future erectile problems more likely,” adds Dr. Chaudry.

Treatment for Psychological Erectile Dysfunction

Treatment for psychological erectile dysfunction is less invasive than some treatments for ED related to medical issues. After your medical doctor clears you of any underlying health issues, he or she may refer you to a mental health professional. The key is to find the underlying emotional or mental health issues that might be contributing to your sex life.

Here are Dr. Chaudry’s three steps to help you get through psychological ED:

1. Talk to Someone: “If you’re in a relationship, talking with your partner about how you feel is vital. Keeping your struggle to yourself may make any feelings of stress or dissatisfaction worse – and may compound your relationship issues,” he says.

2. Seek Professional Help: “It sounds like a big step, but it shouldn’t be. Seeking help for psychological problems should be as normal as going to a doctor about any physical health condition or complaint. A psychologist, counselor, or psychiatrist can help you dig deep into the base causes of your condition – and they will be able to guide you toward a solution too. For example, they can help you gain greater control over your emotions through techniques like cognitive behavioral therapy (or CBT),” he says.

3. Try Erectile Dysfunction Medications: “ED treatments, such as Viagra, Sildenafil (the active agent in Viagra), and Tadalafil (Cialis), are not only effective with the physical causes of erectile problems. Medication like these can help to reduce your performance anxiety – and to boost your confidence long-term. If you are suffering from low libido or reduced desire, however, Viagra may not be effective. You will need to be aroused for these drugs to do their work,” he says.

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