Psychological ED: Causes & Treatment Options

Though erectile dysfunction (ED) is linked to various physical health issues — like hypertension (high blood pressure) and low testosterone — mental health issues can also contribute to what’s known as psychological ED.

Psychological ED is when you have a hard time achieving or maintaining an erection due to psychological factors like depression, stress, or performance anxiety.

Luckily, there are as many effective ED treatments as potential causes. So, take a deep breath.

We’ll explain how mental health can negatively impact erectile function and what you can do to treat psychological ED and enjoy a fulfilling, satisfying sex life.

When erectile dysfunction is related to a psychological problem, it’s referred to as psychological ED or psychogenic ED.

An estimated 30 million men in the U.S. are affected by ED, making it an extremely common issue. Statistics show ED affects guys of all ages — some research suggests that roughly 26 percent of new ED cases occur in men under age 40.

Younger men are typically understood to be in better physical health. So, what gives?

Well, it’s not just about physical health. In fact, erectile dysfunction issues are common symptoms of mental health issues like anxiety, depression, and plenty of others.

In the same way you may not be able to get an erection if you’re being intimate with someone you’re not sexually attracted to, there are plenty of other mental blocks that can stand in the way of your sexual satisfaction.

But what are they? Let’s dig in.

As with physical ED, there’s no single psychological cause that can trigger erectile dysfunction in men. Instead, a variety of issues can all cause or contribute to psychological ED, such as:

• Performance anxiety

• Stress and anxiety

• Relationship problems

• Depression or PTSD

• Guilt and low self-esteem

• Pornography use

• Certain masturbation practices

Some medications used to treat psychological issues, like antidepressants, can also play a role in the development of erectile dysfunction due to their side effects.

Many of these mental ED triggers are closely linked, so it’s entirely possible you could be affected by more than one at a time.

Let’s take a closer look at each potential cause to understand how it can play a role in the development of psychological ED.

1. Performance Anxiety

In many ways, bedroom performance anxiety can become a self-fulfilling prophecy. You feel nervous about being able to satisfy your partner, so when it’s time for action, you panic and wind up not being able to perform.

In some cases, sexual performance anxiety is triggered by negative self-talk — like if you’ve convinced yourself that you won’t be able to achieve an erection, please your partner, or avoid ejaculating too early.

If you’ve found it difficult to get an erection in the past, these experiences may also stick in your mind and affect your ability to relax in the bedroom.

Studies show sexual performance anxiety affects nine to 25 percent of men, contributing to sexual dysfunctions like premature ejaculation (PE) and psychogenic erectile dysfunction.

2. Stress and Anxiety

Stress and anxiety are two different things, but they’re closely related when it comes to erectile dysfunction.

Stress is often an underlying factor in erectile dysfunction. Over time, though, stress can cause anxiety, which, in turn, triggers more stress, creating a vicious cycle that can cause mental erectile dysfunction.

Studies suggest that chronic stress (even the kind that originates at work) contributes to elevated cortisol levels and increased sympathetic nervous system activity, which can disrupt erectile function.

Our guide to stress versus anxiety breaks down the similarities and differences between the two.

3. Relationship Problems

Contributing factors to ED can also be psychosocial and come from (or lead to) relationship problems.

Studies show that men with ED report lower levels of relationship satisfaction and more conflict in their romantic partnerships than men without ED.

Erectile dysfunction can also create problems in the relationship — another example of how the ED cycle can affect many aspects of your life.

Communication is the first step in resolving this particular cause of psychological ED, but it can also be one of the hardest steps to take.

Couples counseling is a safe space for two people who love each other to get help learning to listen and find the magic again.

4. Depression or PTSD

Some of depression’s most common symptoms go beyond a persistent sad, empty mood — they can make it challenging to take pleasure in much of anything. Yes, including sex.

According to research from 2018, patients with depression had a 39 percent higher risk of erectile dysfunction than those without depression. And it goes both ways — having ED seemed to increase the risk of depression by a whopping 192 percent.

Depression is far from the only mental health condition that can affect libido (sex drive).

There’s also a close relationship between post-traumatic stress disorder (PTSD) and erectile dysfunction. According to one 2021 study, men with PTSD had a higher risk of developing ED than men in a non-PTSD group.

5. Guilt or Low Self-Esteem

Many men who suffer from erectile dysfunction feel guilty about not being able to satisfy their partner. If the problem persists, the guilt may become more than a minor issue — it could contribute to the ongoing cycle of mental ED as well.

Similarly, low self-esteem may keep you down in more ways than one. If you don’t feel confident about sexual performance or body image, it can negatively impact your sexual experiences and overall well-being.

Like many other aspects of psychological erectile dysfunction, low self-esteem and sexual performance issues often make each other worse.

One study found that erectile dysfunction can cause serious distress in men. The researchers also noted that this distress can have a real impact on self-esteem and the quality of relationships.

6. Pornography Use

While watching porn isn’t inherently bad or harmful, excessive use of pornography may contribute to both depression and sexual performance issues such as ED.

Research also suggests that if you spend a lot of time watching — and masturbating to — pornography, you may develop unrealistic expectations about real-life sex or your sexual partners.

When this causes mental blocks for getting or staying hard, it’s referred to as porn-induced erectile dysfunction.

Our guide to pornography consumption and depression is worth reading if you’re unsure about your own relationship with porn at the moment.

7. Certain Masturbation Practices

This one has some psychological components and some physical components.

Although research is limited, masturbating too often may reduce your level of sexual satisfaction through something called death grip syndrome. Death grip syndrome is being able to reach orgasm during masturbation but not during partnered sex or penetrative sex. It doesn’t have a formal medical meaning, and its potential causes are manifold.

In short, you get used to orgasming one way, so stimulation any other way doesn’t quite do it for you. You may also have a decrease in penile sensitivity due to how you masturbate.

The combination of porn-induced ED and death grip syndrome can affect sexual function and enjoyment from real-life sex.

If you’re physically healthy and feel worried you may have psychological ED, the first step is to talk to a healthcare professional.

After discussing your medical history, your provider may do a physical exam, ask you some questions, and run tests to rule out medical causes for your ED.

To rule out medical conditions as a contributor to erectile dysfunction, your healthcare provider might request these assessments:

• Complete blood count (CBC)

• Fasting glucose or glycated hemoglobin (A1C)

• Comprehensive metabolic profile

• Thyroid-stimulating hormone

• Lipid profile

• Serum total testosterone

Besides laboratory tests, your medical provider may ask questions about your sexual desire, ability to get and maintain an erection, ability to reach orgasm, level of satisfaction from sexual intercourse, and general sexual satisfaction.

Based on your answers and the results of your lab tests, your healthcare provider may recommend a psychological evaluation to further explore the potential cause of ED.

Whether you’ve talked to a healthcare professional or not, a few signs may suggest that your erectile dysfunction is psychological in nature. Ask yourself these questions:

• Are you able to achieve an erection while masturbating?

• Do you experience morning erections?

• Are you under a lot of stress or experiencing an abnormal amount of anxiety?

• Do you get nervous about pleasing your partner?

Answering “yes” to any of these questions doesn’t always mean your ED is psychological. However, it could be a sign that one or several psychological factors play a role in your symptoms.

It’s especially crucial to talk to a healthcare provider if you think your ED symptoms may have something to do with a clinical mental health issue such as anxiety or major depression.

Just like erectile dysfunction caused by physical health issues, psychological ED is almost always treatable.

How to beat psychological erectile dysfunction, then, is to address the root of the problem, whether it’s a mental illness or simply feelings of guilt about sex.

Treatment of erectile dysfunction is categorized into three groups:

• Medication

• Therapy

• Lifestyle changes

Let’s look at your options in more detail.

ED Medication

Treating psychological ED isn’t always as simple as taking a tablet of sildenafil (the active ingredient in Viagra^®) before sex.

Although medications like Viagra, tadalafil (Cialis^®), vardenafil (Levitra^®), and avanafil (Stendra^®) are effective at treating ED for many men, they’re not magical cures that create libido or sexual interest. They only work when you’re actually in the mood.

Most ED medications are phosphodiesterase type 5 inhibitors (PDE5 inhibitors) that work by widening blood vessels and increasing blood flow to soft tissues in the penis.

These drugs are designed to help with the physiological causes of ED, such as poor blood flow or nerve damage. They might give you a little more confidence, but they won’t get rid of anxiety or other psychological causes of ED.

Therapy for ED

Several types of therapy can help with performance problems in the bedroom.

Cognitive behavioral therapy (CBT) and psychosexual therapy are approaches where a therapy professional can help you uncover the root causes of your ED symptoms and devise strategies to get your sex life back on track.

Cognitive Behavioral Therapy for ED

CBT is a common depression and anxiety treatment in which a therapy provider helps identify and change unhealthy patterns of thinking and behavior. Research shows it’s useful as a form of treatment for men with ED.

CBT operates under the understanding that your inability to achieve or maintain an erection isn’t the core problem — it’s that you’re thinking about intimacy in a way that’s causing issues.

When you better understand your thought patterns, you may be able to change them in a positive way to resolve your issues.

Psychosexual Therapy (Sex Therapy)

Another option is psychosexual therapy (aka sex therapy). This specialized form of counseling is designed to help you (and, in many cases, your partner) overcome sexual issues such as erectile dysfunction.

Lifestyle Techniques for ED

There are also numerous alternative therapies you can try at home. These include:

• Meditation. Though there’s no direct research on the effects of meditation on erectile dysfunction, studies have found that some forms of meditation may improve depression and anxiety.

• Relaxation techniques. Other techniques for promoting relaxation and reducing stress — such as rhythmic breathing and guided imagery — might help you overcome psychogenic ED and improve sexual function.

If you suffer from psychological ED, you probably have a lot on your mind. So the thought of sharing your problems with a healthcare provider might feel a little overwhelming.

It’s important to realize, however, that discussing ED with a healthcare professional (and your partner) is a critical part of the healing process. You may find that acknowledging the issue and being honest with your partner takes some weight off your shoulders.

Give your partner the opportunity to ask questions to help them understand what’s going on. You might even be able to give them tips on how to get you in the mood for sex or help you when you start to experience difficulties getting or maintaining an erection.

For years, men believed that ED was a normal part of growing older — and pretty exclusively related to physical causes. But hopefully, your sexual health education has now been updated to include mental causes of erectile dysfunction.

If you’ve Googled “ED mental illness” or “mental block erectile dysfunction,” you’re not alone. Your erectile dysfunction could very well be psychological in nature or possibly both physical and mental.

Here’s a recap of your roadmap for dealing with psychological ED:

• Don’t dismiss sexual problems just because you’re young and healthy. Young men experience relationship issues and sexual problems just like older men — often due to stress, anxiety, depression, and other mental health issues.

• Seek medical advice to rule out underlying causes. This can include things like high blood pressure, heart disease, high cholesterol, obesity, low testosterone, problems with the nervous system, and urology-related triggers for ED.

• If you think ED could be psychological in nature, talk to someone. A healthcare professional can help you pinpoint the cause and suggest medical treatments, such as prescription medication. They can also recommend things like psychotherapy or other mental health treatments.

If you’re ready to tackle psychological ED, get advice from a healthcare provider today who’ll determine if a prescription is appropriate.