Psychological factors are responsible for about 10%-20% of all cases of erectile dysfunction, or ED. It is often a secondary reaction to an underlying physical cause. In some cases, the psychological effects of ED may stem from childhood abuse or sexual trauma. However, the most common psychological causes of ED include:
- Stress : Stress can be job-related, money-related, or the result of marital problems, among other factors.
- Anxiety : Once a man experiences ED, he may become overly worried that the problem will happen again. This can lead to “performance anxiety,” or a fear of sexual failure, and consistently lead to ED.
- Guilt: A man may feel guilty that he is not satisfying his partner.
- Depression : A common cause of ED, depression affects a person physically and psychologically. Depression can cause ED even when a man is completely comfortable in sexual situations. Drugs used to treat depression may also cause ED.
- Low self-esteem: This can be due to prior episodes of ED (thus a feeling of inadequacy) or can be the result of other issues unrelated to sexual performance.
- Indifference: This may come as a result of age and a subsequent loss of interest in sex, be the result of medications or stemming from problems in a couple’s relationship.
All men at one time or another will experience ED. Only if the problem becomes persistent — occurs more than half the time — or becomes a source of distress for you or your partner should you be concerned and consider seeking medical advice and treatment. For men whose erectile dysfunction is caused by psychological problems, therapy may be needed.
- Stress-Induced Erectile Dysfunction: Can Stress Cause ED?
- Stress-Induced Erectile Dysfunction
- How Stress Affects Your Body
- The Dangers of Chronic Stress
- Psychological Causes of ED – Is It All in Your Head?
- Impotence (Erectile Dysfunction)
- What Is It?
- What Causes Erectile Dysfunction?
- Mayo Clinic Q and A: What causes erectile dysfunction and should it be checked?
- Situational Erectile Dysfunction: Should You Worry?
- Diagnosing Situational Erectile Dysfunction
- Causes of Short-Term ED
- Treatment of Situational Erectile Dysfunction
Stress-Induced Erectile Dysfunction: Can Stress Cause ED?
Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Stress-Induced Erectile Dysfunction
Stress is your body’s natural response to changes in your environment. And it’s a good thing—in limited doses. But constant stress can damage blood vessels, and cause serious conditions like high blood pressure, heart disease, obesity, diabetes, and even stress-induced erectile dysfunction.
How Stress Affects Your Body
When you get “stressed out” your body makes adrenaline increases your heart rate to move more oxygenated blood to your muscles, lungs, and brains to make you faster, stronger, and even able to think more clearly. In a very real way, stress can turn you into a part-time superhero. At least for a few minutes.
Most people call this shakey, reaction to stress the “fight-or-flight” response because it keys you up to either flee or defend yourself. But your body isn’t built to handle this heightened state for very long. And problems happen when your body has to process constant stress.
The Dangers of Chronic Stress
Chronic stress is different than a sudden burst of adrenaline due to immediate danger like a fire or car crash. A steady stream of adrenaline wears on your body. But adrenaline is particularly tough on your arteries.
Your arteries are like a fire hose. They can handle enormous amounts of pressure during stressful times when your heart pumps hard and fast, especially when you need more oxygenated blood during an emergency. But there’s a reason your heart doesn’t beat 250 times a minute all day long. You can’t handle that constant pressure.
Chronic stress is like using a fire hose to water your garden. For 10 hours in a row. That blast of high-pressure water will not only ruin your garden, it’ll destroy the fire hose if left on too long. In your body, your blood vessels are that fire hose. They can handle the pressure long enough to put out the occasional fire, but can’t handle that kind of pressure all day every day.
Remember, erections are largely about adequate blood flow. A chronic high-stress environment will eventually damage the way your blood vessels function, severely limiting your ability to get and maintain an erection.
Stress-induced erectile dysfunction can be caused by any number of factors including:
- Workplace stress
- The loss of a loved one
- Changes in your health
- and financial problems
Life is stressful. But it’s important for your overall health (and your sexual health) to learn how to manage your stress. If you’re experiencing stress-induced erectile dysfunction, don’t be ashamed to talk to a doctor. They can help you treat and possibly even reverse the damage that stress is doing to your body and your erections.
Psychological Causes of ED – Is It All in Your Head?
Cognitive behavioral therapy (CBT) is a common and highly effective treatment for psychological issues in general, but also for ED. Facilitated by a therapist, this type of treatment helps you to identify and change unhealthy patterns of thought and action which may be contributing to your erectile issues. This kind of treatment is based on the idea that the situation itself (your inability to achieve or maintain an erection) is not the core problem, but rather your reaction to it. If you can learn to better understand yourself and your thought patterns, you can change them in a positive way to resolve your issues.
If you aren’t quite ready to talk to a therapist about your psychological impotence, there are some alternative therapies you can try at home. Relaxation techniques, for example, can be beneficial for many of the causes of psychological ED including stress, anxiety, and depression. Here are a few ideas you can try on your own:
- Rhythmic breathing – Concentrating on your breathing while taking long, slow breaths can help you take a step back from your stress and anxiety to live in the moment. Try inhaling slowly and deeply over a count of 5 then hold your breath for 5 seconds before exhaling slowly over another count of 5.
- Meditation – Just ten to fifteen minutes of meditation a day can drastically reduce your stress and anxiety. There are many different ways to practice meditation, so try a few options to see what works best for you.
- Guided imagery – This practice involves calming your mind and slowing your breathing while creating peaceful imagery in your head. It may also involve positive self-talk, giving yourself affirmations and dispelling negative thoughts.
If you suffer from psychological impotence, you probably have a lot on your mind and the thought of sharing your problems with your doctor, let alone anyone else, can be overwhelming. It is important to realize, however, that discussing your problem with your partner is an important part of the healing process.
You may find that the simple act of acknowledging your issues and being honest with your partner takes some of the weight off your shoulders. Give your partner the opportunity to ask questions to help them understand – you may even be able to give them some tips on how to help you when you are experiencing difficulties.
Once you have talked to your partner about your issues, you may want to consider taking things one step further with psychosexual therapy. This is a form of therapy in which both you and your partner see a therapist together. The therapist will help you and your partner break out of the cycle of stress and disappointment that has been coloring your sex life and contributing to your ED. Going to a therapist with your partner may also help you work out any relationship issues that have been affecting your sex life so the both of you will be more satisfied.
While erectile dysfunction is a deeply personal issue, it is not something you should suffer through alone. Psychological ED can be particularly damaging to your confidence but opening up to someone about your issues can help. Today is the day to take the first step toward seeking help and finding the right treatment program.
Impotence (Erectile Dysfunction)
What Is It?
Published: December, 2018
Impotence means that a man’s penis doesn’t get hard enough to have sexual intercourse. The man cannot get or maintain an erection. The medical term is erectile dysfunction (ED).
ED is not the same as premature ejaculation.
The major causes of ED include:
- Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. Vascular disease can limit the amount of blood flowing to or staying in the penis. Both can result in problems with erections.
- Vascular disease is the most common medical cause of impotence.
- Nerve damage — Nerves must be working normally for a man to get and keep an erection. Nerves can be damaged by diabetes, multiple sclerosis, prostate surgery or damage to the spinal cord.
- Psychological factors — Psychological issues such as depression, anxiety, guilt or fear can sometimes cause sexual problems. At one time, these factors were thought to be the major cause of impotence. Doctors now know that physical factors cause impotence in most men with the problem. However, embarrassment or “performance anxiety” can make a physical problem worse.
- Medications — Many medications cause problems with sexual function. These include drugs for high blood pressure, depression, heart disease and prostate cancer.
- Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. Hormonal problems, such as a low testosterone level, are an uncommon cause of impotence.
A man with impotence has either a problem getting an erection or difficulty maintaining one. This usually interferes with sexual activity.
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What Causes Erectile Dysfunction?
As recently as two decades ago, doctors tended to blame erectile dysfunction on psychological problems or, with older men, on the normal aging process. Today, the pendulum of medical opinion has swung away from both notions. While arousal takes longer as a man ages, chronic erectile dysfunction warrants medical attention. Moreover, the difficulty is often not psychological in origin. Today, urologists believe that physical factors underlie the majority of cases of persistent erectile dysfunction in men over age 50.
Erectile dysfunction in older men. Because erections primarily involve the blood vessels, it is not surprising that the most common causes in older men are conditions that block blood flow to the penis, such as atherosclerosis or diabetes. Another vascular cause may be a faulty vein, which lets blood drain too quickly from the penis. Other physical disorders, as well as hormonal imbalances and certain operations, may also result in erectile dysfunction.
The vascular processes that produce an erection are controlled by the nervous system and certain prescription medications may have the side effect of interfering with necessary nerve signals. Among the possible culprits are a variety of stimulants, sedatives, diuretics, antihistamines, and drugs to treat high blood pressure, cancer, or depression. But never stop a medication unless your doctor tells you to. In addition, alcohol, tobacco, and illegal drugs, such as marijuana, may contribute to the dysfunction.
Erectile dysfunction in younger men. With younger men, psychological problems are the likeliest reason for erectile dysfunction. Tension and anxiety may arise from poor communication with the sexual partner or a difference in sexual preferences. The sexual difficulties may also be linked to these factors:
- Feelings of inadequacy
- Personal sexual fears
- Rejection by parents or peers
- Sexual abuse in childhood
Mayo Clinic Q and A: What causes erectile dysfunction and should it be checked?
DEAR MAYO CLINIC: Is it easy to determine a direct cause of erectile dysfunction? My husband is 51 and refuses to see his doctor even though I know it’s bothering him. Does erectile dysfunction ever go away on its own, or is treatment always necessary?
ANSWER: Finding the specific cause of erectile dysfunction isn’t always simple. A number of underlying medical conditions can trigger erectile dysfunction, and other factors such as stress, depression or anxiety can make it worse. But it’s important to have erectile dysfunction evaluated. It could be an early warning sign of other potential health problems. And erectile dysfunction is unlikely to resolve without some treatment or lifestyle changes. Your husband definitely should see his health care provider about erectile dysfunction.
Erectile dysfunction is the inability to get or keep an erection firm enough for sex. It’s a common problem. Studies of men 40 to 70 have found that about 52 percent have some degree of erectile dysfunction.
Having erection trouble from time to time isn’t necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect self-confidence and contribute to relationship problems. Perhaps most important, though, problems getting or keeping an erection can be a sign of an underlying health condition that needs treatment, such as vascular disease, which can lead to a heart attack or stroke.
The reason for the connection between erectile dysfunction and conditions such as heart disease often stems from problems with the inner lining of blood vessels, called the endothelium, and smooth muscle. Endothelial dysfunction causes inadequate blood supply to the heart and impaired blood flow to the penis. It also contributes to the development of plaque buildup in the arteries, which is a risk factor for heart disease called atherosclerosis.
Erectile dysfunction doesn’t always signal an underlying heart problem. However, research suggests that the earlier a man experiences erectile dysfunction that is not due to psychological factors, the more likely he is to have hidden — sometimes called occult — endothelial dysfunction, and the more likely he is to experience something like a heart attack in the future.
Many of the health problems associated with heart disease and stroke also are associated with erectile dysfunction, including high blood pressure, high cholesterol and diabetes. Your husband should see his health care provider to be screened for these and other similar conditions as a first step in identifying the possible cause of erectile dysfunction.
If an underlying medical condition is found, treatment for it may help resolve erectile dysfunction. In some cases, lifestyle changes also can be helpful in combating erectile dysfunction, as well as lowering the risk for other health concerns.
For example, several studies have demonstrated the benefits of exercise on improving erectile function. One study found that when men increased their level of exercise to 120 minutes or more a week of cardiovascular activity, such as running, biking, swimming or jogging, it had an effect nearly as strong as taking an erectile dysfunction medication. Quitting smoking, losing excess weight and eating a healthy diet all can have a positive effect, too.
In men who have no other health concerns and in whom a specific cause of erectile dysfunction cannot be identified, medication such as sildenafil, tadalafil, vardenafil or avanafil, often can treat erectile dysfunction successfully. These medications enhance the effects of nitric oxide — a natural chemical in the body that relaxes muscles in the penis, increasing blood flow. When these medications no longer are effective, other erectile dysfunction treatments are available.
Encourage your husband to make an appointment to see his health care provider. Evaluating and treating erectile dysfunction is important not only for his sexual health, but also it may benefit his long-term health overall. — Dr. Landon Trost, Urology, Mayo Clinic, Rochester, Minnesota
Situational Erectile Dysfunction: Should You Worry?
Based solely on the profusion of ads on TV, you’d think erectile dysfunction is an all-too-common problem affecting huge numbers of otherwise healthy middle-aged men. And while it’s true that the National Institutes of Health estimates up to 30 million men in the United States have ED, that number can be misleading. The risk of developing long-term ED, the type caused by a medical condition that interferes with either the nerves that control an erection or the blood supply needed to maintain one, increases with age. Thus for men in their 50s, the chances of having long-term ED are only about 4 percent — compared with a 25 percent chance for 65-year-olds.
In addition to long-term ED, many more men suffer from situational erectile dysfunction, or short-term ED. Situational ED also results in the inability to get or maintain an erection, but only in certain situations. “This type of ED is usually temporary and can be caused by stress, fatigue, or too much alcohol,” says Drogo Montague, MD, a urology professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. “It is so common that every man experiences it sooner or later.”
Although an erection malfunction can be rattling to the nerves, often there’s no serious cause for concern. “If a man can have a good erection most of the time and a satisfactory sexual experience, I would not consider that to be erectile dysfunction,” says John S. Wheeler, MD, a urology professor at Loyola University Medical Center in Maywood, Ill. “If you can have sex in some situations and not in others, the cause is probably psychological and not physical.”
Diagnosing Situational Erectile Dysfunction
If a man has problems getting or maintaining an erection up to 20 percent of the time he has sex, that’s considered normal. If problems occur more often than that, it’s best to seek medical help. A doctor can usually diagnose situational erectile dysfunction by checking a patient for physical problems and going over his health history. A monitor that measures the penis for erections while the patient sleeps can also be prescribed.
Not having or desiring sex as often as you did when you were younger is not a sign of a sexual problem. “For many older guys, having sex a few times a month may be enough, and is perfectly normal,” says Dr. Wheeler.
Causes of Short-Term ED
There are many potential causes of situational ED. “Occasional erectile dysfunction is common in younger men who still have lots of anxiety about first encounters,” notes Montague. And older men “may find that fatigue affects their ability to have an erection more than when they were young,” he continues.
Situational factors that can hamper sexual performance include:
- Stress. Stress causes the release of brain chemicals that can keep an erection from even getting started. The classic example is performance anxiety. “One erection failure can lead to fear and anxiety that can produce a temporary problem with erectile dysfunction,” says Montague.
- Fatigue. Sometimes you may just be too tired to tango. “Fatigue can decrease the desire for sex, and trying to have sex when you are fatigued is a common cause of ED,” Montague notes. This may be especially true if you usually have sex in the evening.
- Alcohol. Alcohol is a common culprit in cases of short-term ED. Although a drink or two may dispel stress and anxiety, too much alcohol depresses your sexual response. “Older men may find that alcohol interferes with sex more than it did when they were younger, but any man who is inebriated is unlikely to have a good experience,” warns Wheeler.
- Drugs. Many common medications, including over-the-counter medications, can cause short-term ED. Cold medications with antihistamines, some blood pressure drugs, prescription pain relievers, sleep aids, and pills for depression or anxiety are all possible triggers. “A common drug given for prostate enlargement called tamsulosin (Flomax) may also cause erectile dysfunction,” notes Wheeler.
- Condom problems. Unfamiliarity with how to use a condom, or having to interrupt the flow of sex to put on a condom, can cause an erection deflation and temporary erectile dysfunction, especially for younger men. “For older men, condoms can be a cause of erectile dysfunction because they cut down on the stimulation needed to maintain an erection, or to achieve orgasm,” says Montague.
- Relationship troubles. “Relationships change over time, and it takes two people interested in sex to have a good sexual experience,” notes Montague. Poor communication, unresolved anger, and other relationship issues can result in situational erectile dysfunction.
Treatment of Situational Erectile Dysfunction
“Most short-term ED problems can be avoided by making healthy lifestyle choices,” says Montague. “A good rule of thumb is that if you do what is good for your heart, you will be doing what’s good for your erection.”
Follow these prescriptions:
- Try positive lifestyle changes: Quit smoking, limit alcohol to two drinks a day, get plenty of exercise, and eat a healthy diet.
- Plan sexual activity for a time when you have both energy and time for sex. “Try having sex in the morning instead of at the end of a busy day,” Montague suggests. “Take a vacation to recharge your relationship.”
- Avoid over-the-counter medications that may cause ED, and ask your doctor whether any of your prescription medications could be causing a problem.
- Talk to your partner about any anxiety you have about ED. For good communication, try talking openly about what arouses each of you, and keep in mind that intimacy can relieve performance anxiety.
- If you feel you need help to improve your psychological outlook, or to work on your relationship, consult a mental health professional — individual therapy and couples therapy are two options.
The most important thing to remember about avoiding situational erectile dysfunction is to get it out in the open, where you can deal with it. “The longer you wait, the more anxiety you have, and the worse it gets,” says Montague.