Could ED Be Psychological?

Erectile dysfunction (ED) is a common sexual problem among men across the globe. Various causes can weaken erectile function and make it difficult for you to have enjoyable intercourse. 

Men are often told erectile dysfunction is in their head, i.e., that psychological factors have a lot to do with it. Can erectile dysfunction be psychological? The answer is – yes, it can. 

In fact, the term psychogenic erectile dysfunction refers to the persistent inability to achieve or maintain an erection satisfactory for sexual performance due to predominantly psychological or interpersonal reasons. 

What’s more, psychogenic and organic ED (physical causes) have some differences. You see, psychogenic ED has a sudden onset and intermittent function.

On the other hand, organic ED has a gradual onset and tends to be progressive. In men with organic ED, the erection is better in a standing position than lying down. 

Throughout this post, we are going to focus on the psychological causes of ED and how to overcome them. Keep reading to find out more.

Psychological causes

Your psychological health and wellbeing have a major impact on erectile function. In fact, there are multiple causes for psychological erectile dysfunction. The most prevalent triggers are:

  • Stress

  • Anxiety

  • Depression

  • Guilt

  • Unrealistic sexual expectations

Because of poor mental health, ED patients can experience a serious erectile problem. The longer these stressors last, the more vulnerable people are at having low sexual desire, trouble with sexual initiation, achieving an orgasm, and more. But, before you can treat the problem, you need to learn precisely what’s causing it. Let’s take a look at each psychological cause of ED. 


  • Over 440,000 people in the UK complained about stress at work. In fact, almost 9.9 million workdays were lost as a consequence in 2015. 

  • Reports indicate that among 740 per 1,000 workers, work stress is a typical problem in public service institutions. 

Stress is a normal human reaction, and it happens to everyone. That’s how our body reacts to negative situations and stimuli. Stress appears as emotional or physical tension. It depletes our energy levels, may cause headache, and it can harm our physical and psychological health in many ways. 

Plus, stress and poor mental health are more common than people think. Scientists evaluated 10,000 people in Yazd, Iran, to investigate the prevalence of anxiety. Exactly 34.8% of the volunteers suffered from stress. Around 18.2% had moderate, 20.2% severe, and 23.4% very extreme stress. 

But, what does it have to do with intimate dysfunction? Well, in men, stress can contribute to ED. Evidence shows that stress has a negative or debilitating effect on sexual health, especially in men. 

The impact of stress on male sexual health can get to the point of manifesting ED or male impotence. This sexual dysfunction causes more distress and thereby worsens the condition. The vicious cycle continues if stress is left untreated. 

The way this psychological issue is causing erectile dysfunction could be linked to neural oscillations, also known as brain waves. Stress can affect how the brain signals the body’s physical response. Simply put, stress could interrupt how the brain sends messages to the reproductive organ to encourage blood flow. 

Erections happen when blood rushes down to penile tissues and fills up chambers to give you engorgement. Stress may interrupt this process. This could explain why many men struggle to achieve an erection when they’re dealing with work-related stress, money-related stress, and other causes of stress they may experience.

Based on a recent cross-sectional study, burnout and occupational stress are a serious trigger for intimate dysfunction. Whenever men are stressed at work, they are more likely to have trouble achieving arousal, physical pleasure, orgasm, and desire. 

To study the impact of occupational stress and burnout, scientists evaluated 251 residents. They analyzed their job stress measure and their impact on sexual intimacy. Exactly 57% of the volunteers were men in their 30s. According to the results, personal burnout, alcohol, and hypertension were linked with erectile dysfunction. 

In women, however, the impact of stress was a little bit different. Stress at work had a negative impact on natural lubrication. This also affected their ability to achieve an orgasm. Overall, personal burnout was associated with intimate dysfunction in men, whereas job stress was linked with female sexual problems. 


Studies show sexual performance anxiety affects 9% to 25% of men and contributes to premature ejaculation and psychogenic ED.

Anxiety disorders, just like stress, can contribute to ED by affecting how the brain sends signals to the penis. Anxiety is the feeling of intense, excessive, persistent worry and fear about everyday situations. 

Contrary to popular belief, anxiety is not a single disease. Instead, it’s a term that refers to several conditions that share these feelings of fear, nervousness, among others. But, when we’re talking about anxiety, it’s also important to mention a major contributor to ED – performance anxiety. 

Performance anxiety is the fear of doing something wrong in front of a group of people. Another name for that problem is “stage fright.” In a sexual setting, performance anxiety is the fear of not living up to expectations. Whether you’re trying to meet your expectations or someone else’s, you can experience anxiousness, nervousness, and fear of failing. It’s difficult to achieve an erection under these circumstances. 

The root cause of performance anxiety lies in a man’s negative thoughts about the ability to perform during sexual intercourse. Some of the most common factors that lead to performance anxiety include:

  • Penis size

  • Body image

  • Sexual inexperience 

  • Relationship problems

  • Unsatisfactory sexual intercourse in the past 

  • Other sources of stress and anxiety that may make you doubt your performance


When paired with stress and anxiety, depression can heighten any psychological erection problem you might have. But, what most people don’t realize is that depression can affect a patient both physically and mentally. 

If a person doesn’t get treatment for depression, they are prone to intimate dysfunction. Regardless of how comfortable they may feel in a sexual situation. While serious depression can hinder your sexual arousal and make it tricky for men to maintain an erection during or before intercourse. 

Although depression may affect men differently, the depressive symptoms with ED are very easy to recognize. Men can experience premature ejaculation, delayed orgasm, lose of interest in sex, or feelings of worthlessness. 

Eventually, these psychological disturbances can trigger distress in their romantic relationship. When you don’t manage it, depression can turn into a vicious cycle and intimate dysfunction. 


Guilt and low self-esteem go hand in hand. Those who can’t satisfy their partner tend to feel guilty. This intensifies their anxiety and interferes with their sexual function. If the psychological impotence persists, the guilt turns into an actual side effect, triggering an ongoing ED cycle. 

Therefore, feelings such as shame and low self-esteem can lead to serious depressive disorder. Without proper behavioral and mental health management techniques, getting this psychological cause under control becomes difficult. 

But, there is also another problem. It is not uncommon for men to feel a sense of guilt after masturbating, which can affect their sexual behaviors. Scientists studied over 4,200 men to analyze their sense of guilt. 

Although masturbation is normal, 8.4% of the volunteers reported feeling guilty after masturbating. Emotions such as these could drastically affect their quality of life and romantic relationships. 

Unrealistic Sexual Expectation

Sometimes, sexual dysfunction is embedded in people’s expectations. Take pornography, for example. Pornographic materials can set up unrealistic expectations in inexperienced men, experts explain. 

The moment they try real-world intercourse, they realize that it doesn’t live up to their sexual fantasies. This could cause crippling anxiety that saps their libido. In the long-run, emotions such as these could have a drastic impact on their desire to have any sexual activity.  

Based on a 2020 study, the presence of pornographic materials has drastically increased. Well over 43% of young adults and adolescents use pornography. Due to the easy access, anyone can watch it. 

But, the longer people use pornography, the easier it becomes to develop unrealistic fantasies about sex. They may not get a psychogenic erection because of it. This type of impotence can affect their performance in bed. 

According to research, the best way to solve this problem would be for partners to tune in to their intimate interest and get a realistic perspective on what their partner can and can’t do. Sometimes, however, it’s best to consult with a mental health professional or get counseling, especially if that individual is addicted to porn. 

How to Recognize Psychological ED?

Some men might believe that their intimate dysfunction is just a normal part of the aging process. Luckily, modern treatment can help you change that attitude. The main step of figuring out whether you have psychological ED is to ask for a thorough medical examination.

Consult with your doctor or contact a urologist. They can help run some tests and find out if you need ED therapy. With proper medication, mental health treatment, or sex therapy, you can get your penile erection back on track.

Do have in mind that certain medical conditions could make you prone to erectile dysfunction, such as obesity, vascular disease, blood pressure fluctuations, heart disease, hormonal problems, alcoholism, and diabetes. 

Also, radiation or surgery for prostate cancer might damage the nerves in the organ and cause erectile dysfunction. So, you may need to rule out these health issues by doing tests. 

The following tests can tell you if your ED is the result of mental health problems. These tests include:

  • Psychological exam – this is used to screen for anxiety, depression, or any other psychological issue that might cause intimate dysfunction. 

  • Urine tests – the doctor may do a urinalysis to look for signs of a metabolic or other underlying cause of ED.

  • Blood sample – this is a method meant to check for signs of cardiovascular disease, metabolic condition, coronary artery disease, or other health issues. 

  • Physical exam – the doctor could do a physical exam of the testicle and penis health. The goal of the exam is to check the nerves, including how they react to sensations. 

  • Ultrasound – In case of blood vessel problems, the doctor could do an ultrasound and identify the dysfunction’s risk factor. 

Once the doctor identifies the problem, you can start with adequate treatment if necessary. 

Treatments for Psychological Causes of Erectile Dysfunction (ED)

Although each psychological symptom for erectile dysfunction may be complicated to manage, you can still treat them compared to a medical health issue. But, solving the psychological ED symptoms is not as simple as taking Viagra

Instead, you will need to deal with the triggers from the inside. You can try multiple options. The most practical choices are:

  • CBT (Cognitive Behavioral Therapy)

  • Relaxation techniques

  • Medication

  • Penile implant

Here is how each treatment opportunity can help you revamp your sex life and overcome erectile dysfunction

CBT (Cognitive Behavioral Therapy)

CBT is the go-to choice of ED treatment for alleviating mental stressors. This short-term therapy is designed to change your thinking patterns. The treatment helps patients take a goal-oriented and problem-solving approach by focusing on their current behaviors, thoughts, and issues. 

This is a collaborative form of therapy, which requires both a counselor and the patient to work together. With it, people can lessen the stress, learn to cope with their complex relationships, and overcome numerous intimate challenges. 

With the CBT treatment package, men will mix behavioral and cognitive techniques with sex therapy. This is an excellent strategy for managing psychological and physical distress. For example, cognitive techniques will help restructure peoples’ stimulations and regain control. At the same time, sex therapy will focus on helping them train their sexual skills. The treatment will challenge all dysfunctional sexual beliefs and change their negative outlook on intercourse. 

Relaxation Techniques

Learning a couple of relaxing techniques could help with the dysfunction. According to research, relaxation has been linked to varying levels of success when dealing with this kind of problem. When you try to relax, you can lessen the effect of depression, anxiety, and stress. To achieve that, here are a couple of options that may prove useful:

  • Meditation Meditation can reduce heart rate, manage blood circulation, and help reduce stress. Research shows that in females, meditation helped boost their desire, arousal, and sexual satisfaction. With regular meditation, women can decrease intimate dysfunction. Although more research is necessary on males, it seems that meditation and mindfulness could be practical therapy for men. 

  • Guided imagery – Positive and inspiring self-talk can go a long way. By practicing guided imagery, people can calm their minds and dispel negative emotions. This may come in handy when the ED is the result of stress from work. 

  • Rhythmic breathing – Taking slow and concentrated breaths can temporarily ease the stress. Based on reports, when you breathe deeply, you send a calming message to the brain. That way, you can balance out the heart rate and blood pressure. 


When dealing with severe depression and anxiety, people pair CBT (psychotherapy) with medication. This combination seems to have the highest rates of improving complex, chronic, and severe forms of mental distress. 

In cases such as these, doctors may suggest antidepressants. They are meant to stabilize the psychological distress and help the mind function normally. Options like SNRIs can be used for major forms of anxiety or depression. Products like desvenlafaxine, venlafaxine, and duloxetine are quite popular. 

Other than that, people might have to use TCAs, which are tricyclic antidepressants. They have a three-ring chemical structure that could prove useful for numerous mental issues. 

The idea of these products is to control the serotonin level, stabilize mood, and help people control their emotions. Not only is this necessary when dealing with psychological stressors, but it is also critical for serious cases of mental instability. 

However, antidepressants may take 2 to 4 weeks for the effects to kick in, which means that some people might feel discouraged after starting their treatment. But, to achieve the desired results, you would need to give them time. 

If you are worried about the antidepressants affecting your current health state, consult with a healthcare provider. They will let you know if you need to make any changes to your doses, including practical ways on how to manage anxiety and depression along the way. 

But, this is not something you can take on your own. Only a doctor should prescribe your medications. So, consult with a specialist before taking any steps to control the dysfunction. 

Penile Implant

Implants are devices that help men achieve an erection. The doctor may recommend an implant if all the other options fail. These devices, however, are used only in severe cases of scarring. In other words, they are not recommended for everyone. 

You may be advised to stay away from this option if you have:

  • Situational ED, like a temporary sexual problem that is reversible

  • A metabolic condition that you don’t manage

  • An infection that’s affecting the reproductive organ

The devices help men maintain an erection. But, they don’t boost their intimate sensations or desire. Sometimes, the surgery could cause an infection, implant problems, or adhesion. Since this is risky surgery, you should talk to your urologist and discuss your expectations and possible complications. 


Erectile dysfunction can be a debilitating problem. But, when caused by a mental stressor, it can be even harder to deal with. It will damage your confidence and ego. If you are suffering from this kind of impotence, know that you are not alone. There are many men out there experiencing the same kind of erectile dysfunction.

The good thing is, there are ways that can help you fix that inability to enjoy sex. All you have to do is consult with a specialist and pick the best approach that’s tailored to your needs. Now that you know everything about psychological erectile dysfunction, you can get it under control. 

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