Psychological ED: A Q&A Overview

Medically reviewed by Mr Craig Marsh
Written by Sonya Neville
Last reviewed 24/11/2021
4 minute read
Medically reviewed by Mr Craig Marsh
Written by Sonya Neville
Last reviewed 24/11/2021
4 minute read
Man looking up

Is a mental block giving me ED?

When people experience erectile dysfunction, a Viagra prescription seems like the next logical step. But pills like Viagra and Cialis work best when the cause of ED is physical, like heart disease or diabetes.

If the causes of ED are something mental (like stress, anxiety or relationship issues), you might be dealing with something called psychological erectile dysfunction.

How do I know if my ED is psychological?

The best way is to see your doctor. In 80% of cases, erectile dysfunction has a physical cause.[1] But if you’ve already been to the doctor and there’s no physical reason for why you can’t get an erection, you’re most likely dealing with psychological ED.

What causes psychological erectile dysfunction?

The most common causes of psychological ED are things that affect your mood and emotions, like life stress, performance anxiety or issues in your relationship. Unlike physical ED, where you might need medication like Viagra to get an erection, psychological ED is treated by addressing the underlying emotional issues.

1. Stress, depression and ED

Stress can be distracting; it’s hard for your body (and mind) to be in the mood for sex if you’re worried about work or another issue. Being anxious can make it more difficult to get an erection, and erection difficulties can make you more anxious.[2] And depression can keep you from being “in the moment,” impact your self-esteem or body image and add stress to your relationship.

2. Are temporary ED and psychological ED the same thing?

Sometimes. Temporary ED is erectile dysfunction that only lasts for a short time. This is usually because it’s caused by lifestyle factors that are possible to control, like a bad diet or chronic stress. Temporary ED can be either physical or psychological. 

3. ED and relationship problems

Talk to your partner about what’s bothering you. It’s possible that reassurance from them will help you feel more ‘in the moment’ during sex or remove any pressure you’re feeling about needing an erection to please your partner. Couples therapy is an option if you want some help with opening up communication between you and your partner.

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4. Can too much pornography cause ED?

Theories about porn-induced ED focus on how porn can change how a person perceives sex in real life, from overexposure to “unrealistic” bodies and reactions to porn’s impact on dopamine levels.[3] If you watch a lot of pornography and experience erectile dysfunction, or if you find yourself often choosing porn over sex with your partner, it might be time to take a break.

5. Can too much sex cause erectile dysfunction?

More sex is actually likely to improve your confidence and reduce the risk of performance anxiety. After sex, however, you’ll experience something called a “refractory period,” which is a short time during which it’s difficult or impossible to become physically aroused.

Is ED in younger men always psychological?

You can have physical or psychological erectile dysfunction no matter what age you are. If you’re in your 20s or 30s and experiencing erectile dysfunction, it’s important to see your doctor to rule out physical causes, because ED can be a sign of undetected cardiovascular disease.[4]

Treatment for psychological ED

Pills falling out of a jar
There are many different ways to overcome psychological erectile dysfunction — and not all of them involve going to the doctor. 
  • Talk therapy is a general type of psychotherapy where you talk through your issues with a licensed professional.
  • CBT, or cognitive behavioral therapy, is a talking therapy that helps you overcome problems by changing the way you think.
  • Try DIY solutions for erectile dysfunction like getting enough sleep,[5] exercising and eating healthy. 
  • Couples experiencing erectile dysfunction can benefit from either talk therapy or sex therapy. Stress-related ED goes away 50-70% of the time when the partner is involved in therapy.[6]
ED pills like Viagra can be great at getting you out of that headspace and breaking the cycle. Studies have shown that men with psychological ED have a strong response to placebo treatment.[7]

Erectile dysfunction: how we can help

At EveAdam, we offer many types of medical treatment for erectile dysfunction. Viagra and other ED pills aren’t usually prescribed for psychological erectile dysfunction as they address physical ED, but they might be the confidence boost you need if you feel like you’ve exhausted other options.

 

“Feelings of worry or low mood are really common for everyone,” says Dr. Daniel. “Addressing these psychological issues will usually sort out any ED problems and no ED medication will be required, but medications like Viagra and Cialis can be helpful in the short term.”

Talk to an expert and find out if ED medication is right for you.

References

[1] Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017. 

[2] ​​McCabe, M.P. and Althof, S.E. (2014). A Systematic Review of the Psychosocial Outcomes Associated with Erectile Dysfunction: Does the Impact of Erectile Dysfunction Extend Beyond a Man’s Inability to Have Sex? The Journal of Sexual Medicine, 11(2), pp.347–363.

[3] Park, B., Wilson, G., Berger, J., Christman, M., Reina, B., Bishop, F., Klam, W. and Doan, A. (2016). Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behavioral Sciences, 6(3), p.17.

[4] Simopoulos, E.F. and Trinidad, A.C. (2013). Male erectile dysfunction: integrating psychopharmacology and psychotherapy. General Hospital Psychiatry, 35(1), pp.33–38.

[5] Kaplan H.S. (1980) The New Sex Therapy. In: Marmor J., Woods S.M. (eds) The Interface Between the Psychodynamic and Behavioral Therapies. Critical Issues in Psychiatry (An Educational Series for Residents and Clinicians). Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3000-4_25

[6] Cho, J.W. and Duffy, J.F. (2019). Sleep, Sleep Disorders, and Sexual Dysfunction. The World Journal of Men’s Health, 37(3), p.261.

[7] Chowdhury SH, Cozma AI, Chowdhury JH. Erectile Dysfunction. Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I. 2nd edition. Wolters Kluwer. Hong Kong. 2017.

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