Psychological ED: Definition, Causes, & Treatment

What Is Psychological Erectile Dysfunction (ED)?

Psychological erectile dysfunction (ED) is erectile dysfunction caused by a psychological factor, such as mood, trauma history, or interpersonal relationship concerns with one’s partner. Psychological ED accounts for about 40% of ED cases.² ED is often associated with men of an older age; however, research has indicated that about 26% of new ED cases occur in men under the age of 40.³

Aside from psychological or health concerns, environmental factors or other distractions may impact one’s success at achieving and maintaining an erection. Failing to achieve or maintain an erection is a common experience. It is important to understand that an incidental occurrence of difficulty achieving or maintaining an erection does not necessarily indicate the presence of ED.

Symptoms of erectile dysfunction may include:

• Inability to achieve an erection
• Trouble maintaining an erection once achieved
• Loss of erection before achieving orgasm
• Premature ejaculation
• Delayed ejaculation

The Cycle of Psychogenic ED

The psychological components of ED can be cyclical in nature. For instance, anxiety or guilt may be the root cause of the psychological ED. Experiencing ED during sexual activity will likely cause said emotions to reoccur due to poor performance or embarrassment. Overcoming psychological concerns can be a difficult process; however, not addressing underlying psychological concerns will only perpetuate the symptoms of psychological ED.

Psychological ED Causes

Psychological ED can be caused by a variety of emotional factors and lifestyle habits, including stress, anxiety, and trauma. It’s possible that an afflicted individual may be dealing with more than one factor as the cause. Whether there is one or multiple causes for the individual’s ED, it’s important that the root concern is evaluated and addressed to overcome the ED.

Common causes for psychological ED include:

Stress

Stress can lead to psychological ED due to the emotional strain placed on one’s mind and body. Stress will oftentimes lead to the individual feeling distracted by external factors or events, limiting their ability to stay focused on sexual activity and maintain their erection. Stress-induced ED can also be cyclical, with the difficulties associated with ED only making the individual more stressed.

Anxiety

Anxiety can lead to psychological ED due to the heightened emotional state distracting from one’s ability to become and stay aroused. Anxiety-induced ED will oftentimes be caused by sexual performance anxiety, which regards feeling concerned about one’s ability to sexually satisfy their partner. This emotional concern can impact one’s ability to maintain an erection throughout sexual activity.

Low Self-Esteem

Low self-esteem can also lead to symptoms of psychological ED. Low self-esteem may be related to one’s personal body dysmorphia or muscle dysmorphia, leading to assumptions that they are unattractive or non-sexual beings. Low self-esteem can also be related to performance difficulties during previous sexual activity, which may lead to feeling shame or embarrassment.

Depression

Depression can lead to psychological ED due to an impact on one’s desire or ability to engage in a variety of behaviors. An overall low level of desire to engage in activities associated with depression will also affect one’s willingness or desire to engage in sexual activity when depressed. This low motivation and desire will have a negative impact on one’s libido and ability to obtain and maintain an erection.

Pornography

Excessive porn consumption can sometimes lead to porn-induced erectile dysfunction. Research has suggested that excessive consumption of pornographic material can create unrealistic expectations of sex and one’s sexual partners.⁴ Such unrealistic expectations can lead to sexual dysfunction and psychological ED when the individual in question engages in sexual activity.

Interpersonal Relationship Concerns

Conflict in one’s relationship may also lead to psychological ED. Interpersonal relationship concerns with one’s partner can lead to varying levels of emotional distress and create a lack of emotional intimacy. Said emotions can breed feelings of resentment and disinterest in sexual activity with one’s partner, resulting in a dead bedroom. With such emotional tension between partners, it may become difficult to forge a sexual connection and perform appropriately.

Sexual Trauma

Some causes of psychological ED are rooted in the experience of sexual trauma. A history of sexual abuse or trauma can give rise to intense emotional responses during sexual activity, creating a reluctance or inability to perform “appropriately.” Having a partner who has experienced sexual abuse may also cause psychological ED, as concern for the partner’s emotional well-being and an unwillingness to potentially trigger them may distract from sexual activity.

Post-Traumatic Stress Disorder

Individuals suffering from post-traumatic stress disorder (PTSD) may also experience difficulty with psychological ED. A 2021 study indicated that those suffering from PTSD have a higher chance of developing psychological ED as opposed to their peers of similar backgrounds, ages, and ethnic origins.⁵ Individuals with PTSD have difficulty focusing on sexual activity when their bodies enter heightened states of arousal, as symptoms of PTSD take over during said arousal period.⁶

How Do You Know If Your ED Is Psychological?

To determine the cause(s) of one’s specific case of ED, it may be beneficial to speak with a healthcare provider. A review of one’s medical and sexual history, as well as blood tests, urine tests, or other exams, may reveal indicators for experiencing ED. Based off the results, a doctor can determine whether the ED is psychological, related to a medical concern, lifestyle choices, or a combination.

If medical explanations for ED are ruled out, the afflicted individual may benefit from an evaluation by a mental health professional. Engaging in psychotherapy may not be an individual’s preferred method of treatment, however, it may be necessary depending on the individual. The mental health provider will assist the individual with identifying any psychological cause(s) for one’s ED.

Some signs your ED may be psychological include:

• You’re interested in sex and feel attracted to your partner but have trouble performing
• You can achieve an erection while masturbating
• You have difficulty focusing on sexual activity
• Cultural or religious beliefs are affecting your perspective of sex and/or sexual activity
• Your relationship with your partner may be strained, affecting sexual intimacy and desire
• Your ED cannot be otherwise explained by a medical condition

Treatment Options for Psychogenic ED

Just as with ED caused by medical concerns, psychological ED is entirely treatable. A mental health professional can help to identify whether the individual’s psychological ED is caused by an undiagnosed mental health disorder or by an intrapersonal or interpersonal emotional concern. If the ED is caused by both medical and psychological factors, healthcare providers may recommend various treatment methodologies to address the ED.

Treatment options for ED include:

Therapy

There are a variety of different therapy modalities to assist individuals struggling with psychological ED. Each modality approaches the individual and associated concerns from a different lens. Depending on the individual’s comfort level in openly discussing the psychological ED in front of others, individual counseling or couples counseling may be utilized.

• Cognitive behavioral therapy (CBT): CBT is an option to treat generalized stress, anxiety, depression, as well as other mental health conditions. Addressing such concerns may assist with preventing the recurrence of psychological ED.
• Sex therapy: Sex therapy is a type of talk therapy specifically related to sex and sexuality concerns. In sex therapy, one may talk about their past sexual history, their sexual health, and any issues they are experiencing during sexual activities. Identifying and addressing triggers related to sexual behavior may assist with overcoming psychological ED.
• Couples therapy: Couples therapy may be beneficial for individuals struggling with ED due to interpersonal concerns with a partner. Through couples counseling, the individual and their partner will ideally identify items of concern in their relationship and work toward overcoming said issues, increasing intimacy during sex and, thus, the psychological ED.

Medication

In some cases, individuals struggling with ED may utilize medications to assist with overcoming their inability to obtain and/or maintain an erection. There are several ED medications approved by the FDA. Said medications are called PDE-5 inhibitors, which work by opening up one’s blood vessels and increasing blood flow to one’s penis. This improved blood flow makes it easier to obtain and maintain an erection when aroused.⁸

Lead-in sentence: Common medications used to treat psychological ED include:

• Viagra (sildenafil): Viagra will alleviate symptoms of ED for 4-6 hours.
• Cialis (tadalafil): Cialis will alleviate symptoms of ED for up to 36 hours.
• Levitra (vardenafil): Levitra will alleviate symptoms of ED for 4-6 hours.
• Stendra (avanafil): Stendra should be taken 15 to 30 minutes before intercourse.

Lifestyle Changes

Talking to a healthcare or mental health professional about one’s struggles with ED may be difficult for some. Discussion of sex and sexual functioning is still a taboo subject for many people, especially when discussing with someone the individual does not have a personal relationship with. Although professional evaluation is encouraged for assistance, there are ways in which one can attempt to improve their psychological ED at home.

Some alternative therapies for psychological ED treatment include:

• Meditation: Meditation has not been directly correlated with combating psychological ED. However, meditations targeted for anxiety can lessen an individual’s overall level of anxiety, which may be a factor in some cases of psychological ED.
• Relaxation techniques: Relaxation exercises for anxiety, such as breathing techniques to regulate oneself, may keep one’s mind at a less heightened state. This may inadvertently assist with factors causing one’s psychological ED.
• Improve cardiovascular health: Poor cardiovascular health may be a factor in causing ED. Routine exercise may assist with addressing cardiovascular health.
• Regulate sleep patterns: Regulating one’s sleep patterns and obtaining appropriate rest may leave one’s physical body in better shape for “appropriate” sexual functioning.
• Open communication with a partner: Discussing one’s struggles with ED may be difficult with a healthcare professional; however, speaking candidly with one’s partner may assist with identifying the root cause of the concern.
• At-home testing: In order to identify whether one is still physically capable of achieving erection, the Nocturnal Penile Tumescence (NPT) Stamp Test may be used. This specific test is outdated; however, it can still be safely conducted at home to ensure one’s penis is still capable of becoming erect.⁷

Where to Find Professional Help for Psychological ED

Dealing with psychological ED can be a stressful process for many people. Experiencing feelings of shame, guilt, and anxiety, amongst other complex emotions, may leave afflicted individuals in a negative headspace. An online therapist directory is a useful tool for finding a sex therapist in one’s local community to help with their concerns. There are also online therapy options available if one cannot or does not desire to receive in-person service.

In My Experience

Sex-related disorders can be hazardous to one’s confidence in regard to sex and overall self-image. Sex-related topics can be uncomfortable to talk about for many people; however, seeking services from a healthcare professional, mental health professional, or both is paramount to overcoming said concerns. Leaving these issues unaddressed may lead to longer-lasting symptoms and more significant emotional concerns due to poor sexual performance and satisfaction.