Erectile dysfunction (ED) can be a brutal enemy to tackle.
We commonly associate this type of sexual dysfunction with older adults.
However, a great deal of younger patients also suffers from sudden ED symptoms.
Moreover, when their levels of confidence are compromised, they start having symptoms of performance anxiety. So, one episode can make young males more likely to have another one.
We can also have erectile dysfunction after prostate surgery, even when it was performed carefully. Some of these patients regain their erections after a while, which would not happen if there was a biological cause.
For this reason, everything points out that erectile dysfunction has psychological factors, too. But is it normal to experience difficulties in achieving a lasting erection after a hard day at work?
In this article, we are going to answer this question with medical evidence. We’re also giving you tips and recommendations you can use for those critical moments. Others are meant to be applied as a part of your lifestyle. And, some treatments we’re also going to mention do require medical assistance.
Stress, anxiety, and erectile dysfunction
Erectile disfunction is deeply tied to emotions. Arousal before sexual intercourse is not an automatic function that we can turn on and off. It has a vital psychological component to it. That’s what doctors consider one type of non-organic erectile dysfunction. It is also known as psychogenic erectile dysfunction.
This particular problem has psychological causes, as the name implies. It is also known as adrenaline-mediated erectile dysfunction. This alternative name gives further clues to what is happening, and we’re covering that in the next section.
Having a hard day at work and worrying too much about something can kill erections.
The same happens if you just had a frightening experience. This sexual problem is common in older and younger patients, regardless of their age. It should not be confused with organic causes and has a few distinct features (1).
For example, in erectile dysfunction caused by stress and anxiety, we usually find this (1):
- Erectile dysfunction appears suddenly and without notice. You can fail to have an erection after having a pleasant sexual experience last week. In contrast, organic causes of erectile dysfunction are usually gradual. They appear progressively over a long period of time.
- The sexual function is intermittent in cases of psychogenic erectile dysfunction. You can have a variable erection, and the dysfunction is situational. After having a bad experience, you can have a very hard erection after a few days. In contrast, organic causes of erection are often progressive. They rarely improve by themselves.
- In psychogenic causes, patients often achieve an erection. However, their sustaining capability is reduced. In other words, they can’t maintain a hard erection for a long time. When the cause is organic, the erection response is always inadequate.
- If you have psychogenic causes of erection, you may still have erections at night. This is called penile tumescence, and it is common in males. It happens a few times every night, and it is not altered when the cause is related to perceived stress.
- In psychogenic erectile dysfunction, you have the same problem regardless of your position. If you have an organic erectile dysfunction, the standing position favors you. The problem usually appears when you’re lying down, primarily if the cause is associated with a venous leak.
How do stress and anxiety cause erectile dysfunction?
What’s the relationship between stress and ED? Psychogenic erectile dysfunction is also known as adrenaline-mediated erectile dysfunction.
That’s because adrenaline and noradrenaline can inhibit erection almost immediately. They are both potent electrolytic neurotransmitters. In other words, they destroy erections, and they do it through chemical signals.
In the erectile tissue of the penis, there are many receptors. Some of them are adrenal receptors, which receive adrenaline and noradrenaline. We have many of them, and studies show hoy they contract erectile tissue. That’s why we immediately lose an erection after being frightened or disturbed. But even if we’re not especially frightened, this causes an increase in the release of adrenal and stress hormones. They have the same effect, to a lesser degree, and trigger erectile dysfunction (2).
There is also another cause of psychogenic erectile dysfunction that is tied to all of this. It is known as sexual performance anxiety, and it is a common cause of ED in young people. This problem was recognized more than 50 years ago.
However, it is still difficult to treat, and there are not many studies about it. In some cases, it is considered a symptom instead of being a medical problem. It is not a self-perpetuating and destructive problem as it is often portraited. However, it requires our attention and sometimes needs psychotherapy to get better.
The leading cause is distracting thoughts. These are often associated with a constant worry about pleasing or hurting your sexual partner. Body image problems may also play an important role and insecurities about your relationship with your partner.
Additionally, having a sexual dysfunction experienced in the past can trigger another episode, especially if you worry too much about it. This problem can sometimes be difficult to handle because it is difficult not to worry about worrying, contributing to sexual performance anxiety (3).
Health conditions that can cause ED, stress, and anxiety
In some cases, even young men have erectile dysfunction due to organic causes or health conditions. They are usually not very severe but cause or potentiate sexual performance anxiety.
We can name and explain several health conditions that may add up to the psychological background and worsen erectile dysfunction (4):
- A subclinical dysfunction of the endothelium: In some cases, we won’t find any significant vascular problem. Instead, there is a mild dysfunction of the endothelium. This is the arterial lining, which usually synthesizes a lot of substances. For example, it creates nitric oxide, which expands the blood vessels. This substance is crucial for normal erection.
- Peyronie’s disease: This is a structural abnormality of the penis. It is caused by plaques that build in the penis and create a curvature. It is more common in older adults but can be seen in young men as well. It can cause a veno-occlusive dysfunction that leads to erectile function problems. It is also a cause of psychological issues and insecurities. In all cases, Peyronie’s disease is a potential cause of erectile dysfunction.
- Thyroid problems: An excessive or defective thyroid function can cause erectile dysfunction. The exact reason is currently unknown. However, in a study, 70% of men with hypothyroidism and 63% of men with hypothyroidism had erectile dysfunction. In the case of hypothyroidism, it may cause lower levels of testosterone. In the case of hyperthyroidism, it may block the effects of nitric oxide in the corpus cavernosum.
- Diabetes Mellitus: There’s a strong association between diabetes and erectile dysfunction. In some studies, 75% of men with diabetes also report erectile dysfunction. In others, the prevalence is lower but still significant. Diabetes impairs blood circulation. Since erections are based on the blood filling the corpora cavernosa of the penis, and impaired circulation is a direct cause of erectile dysfunction.
- Klinefelter syndrome and other hypogonadism problems: For obvious reasons, hypogonadism problems cause erectile dysfunction. Testosterone plays a significant role when it comes to sexual activity. In Klinefelter syndrome and other causes of hypogonadism, low testosterone is a direct cause of erectile problems. The same happens as men grow older, and their testosterone levels start to decrease. Even cryptorchidism, which is much more common than Klinefelter, can lead to low testosterone and erectile dysfunction levels.
- High soy diets: Some studies link very high soy consumption with an excess of phytoestrogens. Soy contains a substance called daidzein. This substance behaves similar to estrogens in the body. In the penis, it reduces the elasticity and increases collagen production. In the long term, according to animal models, it may cause erectile dysfunction. However, it has been observed in very few cases in humans. In these cases, it is associated with substantial consumption of soy every day.
- Neurogenic health problems: Anything that affects the neurons that reach the penis can lead to erectile dysfunction. For example, multiple sclerosis men are twice as likely to have ED as compared to healthy individuals. Some patients with epilepsy may have sexual dysfunction as well. And it may also affect patients with a spinal condition.
- Side effects of certain medications: A variety of drugs can cause erectile dysfunction. For instance, many antidepressants, some neuroleptics and antiepileptics, and finasteride. Even some non-steroidal anti-inflammatory drugs can be blamed.
- Diagnosed cases of depression and anxiety: Occasional psychological stress and anxiety are likely causes of erectile dysfunction. But if you have major depression or an anxiety disorder, the chances are even higher.
- Relational issues: This is not a health condition, but should also be included as a risk factor of erectile dysfunction. Having relation issues with your sexual partner causes a deterioration of sexual satisfaction, sexual arousal, and orgasm. It may also increase sexual pain and lead to severe cases of erectile dysfunction.
Easing stress and anxiety to treat erectile dysfunction
There’s a lot we can do to cope with chronic stress and anxiety. If they are causing erectile dysfunction, there are a few additional tips we should also consider.
Firstly, if you’re having stress and anxiety problems, try the following recommendations:
- Work with your expectations: Anxious people usually have very high expectations. Not having control of everything causes severe stress. So, if you lower your expectations and learn to let it go, that may work to ease tension.
- Ask for help: We usually think that asking for help is the same as bothering someone else. But in reality, people are generally more available and willing to help than we judge.
- Look for solutions to the problem: The first stage of panicking in front of the stressor is normal. But you shouldn’t stay there. Get back to the basics and evaluate what the problem is and how to solve it.
- Reduce your aggressiveness: Being combative and angry causes an increase in your heartbeat, awkward feeling in your chest, and a surge of adrenaline. We know that adrenaline kills erections, so being aggressive is not helping you.
- Create a supportive network: Build on relationships that help you when you’re in trouble. Having a supportive network enables you to cope with problems and job stress faster.
- Challenge your belief system: Sometimes, we have deep beliefs that are not adaptive and do not help us in any way. Is one of them causing stress or anxiety? Are they indispensable?
- Relax and exercise: Take time to meditate or practice deep breathing to relax, and other stress management techniques. Live a more active lifestyle and exercise as regularly as you can.
But what about sexual performance anxiety? What if your anxiety levels start to rise when sex is around? You may even begin to adopt avoidant behaviors, which are not contributing to solving the problem. What to do, then?
- Break the cycle: Sexual performance anxiety has a vicious cycle. You have an episode. The disappointing experience cause concern for the next time. This increases sexual performance anxiety and makes it more likely to happen. You can break this cycle by not thinking about the future and stop worrying too much about you. Just enjoy the experience. And, if you have a negative outcome, be reassured that it happens to the best of us.
- Engage in the sensory experience: The problem here is worrying too much about what your partner is thinking. Instead of focusing on the mind, focus on the sensory experience. Stay in the now and feel with your skin what is happening.
Even with these recommendations, stress and anxiety can still cause erectile dysfunction. When to look for medical help?
- If your relationship is being affected by erectile dysfunction
- If you try and do not find solutions for yourself
- When there’s a marked decline in job or academic performance
- When stress and anxiety trigger substance abuse
- If you start having irrational fears or obsessive preoccupations
- If you engage or think about engaging in self-destructive, antisocial, or dangerous behavior
- When all of this is markedly affecting your quality of life
Treatments for Erectile Dysfunction
Treating erectile dysfunction is not difficult if you know where it comes from. After making a diagnosis, a specialist will choose the correct treatment, which may be one of these or a combination (1, 3):
- Lifestyle modifications: This type of treatment is very useful in younger patients. Professionals would research their medical records, medication use, diet, exercise, and other risk factors. They may suggest very concrete lifestyle modifications such as stop smoking, weight loss, or changing the individual’s diet or medications.
- Psychotherapy: We can use a variety of techniques, including mindfulness-based interventions and cognitive behavior therapy. They are especially useful for those who have sexual arousal problems. Psychosexual counseling is sometimes all we need to solve the problem.
- Medications: We typically use oral phosphodiesterase inhibitors (pde5 inhibitors). Viagra or sildenafil is the most widely known. They relax the smooth muscles and promote erection. We should be cautious with these medications if we have chest pain, heart disease, or a previous heart problem. Other drugs come in a suppository or as penile injections.
- Vacuum erection devices: These are cylindrical mechanisms that create negative pressure and pump the penis. They mechanically draw blood into the penis and cause an erection. They can be used with a constriction band, which is placed in the base of the penis. Some of them can cause bruising on the penis and other adverse effects.
- Surgical interventions: There are a variety of surgical procedures. For example, we can use penile implants with inflatable devices. In some cases, patients may recover their sexual function with penile vascularization if they have vascular disease. However, these procedures are reserved for organic causes of erectile dysfunction.
Stress and anxiety are common causes of erectile dysfunction, whether they are occasional or a significant mental health problem. They should be evaluated as a potential cause before considering medical causes. If you have sudden and intermittent episodes of erectile dysfunction, it is more likely due to stress and anxiety.
Sexual performance anxiety is a critical problem, especially in younger men. It is rooted in feelings of insecurity and constant worries about your performance and what your partner is thinking. It has a vicious cycle to it, but you can break it by enjoying your senses and letting it go when you have an unpleasant experience.
In some cases, medical therapy will be required, especially when there’s a medical condition involved in erectile dysfunction.