Psychological Erectile Dysfunction Causes

Psychological ED - is your mind getting in the way of sex?

Erectile dysfunction caused by a psychological or mental factor is not quite as common as physical ED but still impacts a lot of men’s sex lives.

Psychological ED means you’re physically capable of having an erection, but something mental is keeping it from happening.

This could be your mental health, worries about performing sexually or issues with your relationship. Below, we’ll share the most common mental causes of impotence and what you can do to improve things.

Medically reviewed by

Daniel Atkinson, Clinical Reviewer

Stress, anxiety and ED

If you’re wondering whether stress can cause erectile dysfunction, the answer is yes. 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.

Anxiety and erectile dysfunction are also linked: being anxious can make it more difficult to get an erection, and erection difficulties can make you more anxious. The good news is that treating the underlying cause of the stress and anxiety in your life should also treat your ED.

What is performance anxiety?

Performance anxiety happens when worries about your ability to do something are so powerful, they impact your life.

When it comes to sex, performance anxiety usually means worries about your body (including penis size) or about your ability to please a partner. So try talking to your partner about your worries. By addressing the problem head on, you should feel less anxious about performing.

Depression and erectile dysfunction

If you’re experiencing both depression and erectile dysfunction, you’re not alone. It’s a very common cause of psychological ED. Oftentimes, people who are depressed feel like they’re always too tired, lose interest in things they used to enjoy and notice a dip in their sex drive. Depression can keep you from being “in the moment,” impact your self-esteem or body image and add stress to your relationship. All of these things can contribute to ED.

If the depression is acute (a response to something specific that happened), it’s possible that your erectile dysfunction will resolve itself once time has passed. If the depression is chronic, however, you could keep experiencing ED indefinitely if you don’t seek treatment. In either case, it’s important to get help for your depression. That, in turn, can help treat erectile dysfunction.

Can antidepressants cause erectile dysfunction?

You’ve talked to your doctor, see a therapist regularly and take a daily antidepressant. You’re doing everything right but your ED isn’t any better. In fact, it seems worse. What gives?

Unfortunately, some antidepressants can cause erectile dysfunction or other sexual issues, like making it really difficult to orgasm or burning your sex drive to the ground. These are not side effects you should live with, and you should talk to your prescriber if you experience any of them. They might be temporary and go away on their own as your body gets used to the medication but if they don’t, it might be time to adjust the dose or find a different antidepressant.

Are temporary ED and psychological ED the same thing?

Temporary ED and psychological ED can sometimes be the same thing. Temporary ED is exactly what it sounds like: 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.

Is psychological ED permanent?

Psychological erectile dysfunction doesn’t have to be permanent — but it won’t always go away without treatment. That doesn’t mean you need medication or multiple visits to the doctor. The best thing to do is to pinpoint a possible cause like life stress, new relationship anxiety or mental health issues like depression. Once you’ve got the cause identified, you’re on your way to curing ED.

Focus on what you can control, like lifestyle changes to avoid stress or increasing communication with your partner to feel more comfortable when you’re having sex. It’s possible you might need help. Don’t be afraid of trying talk therapy or couples counseling. We’ll discuss all the ways to treat psychological ED later on in this health guide, so keep reading.

ED and relationship problems

Can porn cause erectile dysfunction? Possibly. Porn-induced erectile dysfunction (PIED) is a recently identified condition but it’s not fully understood how it works. 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.

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.

Does masturbation cause ED?

“Masturbation-induced ED” is a bit of a misnomer. The physical act of masturbation can’t directly cause erectile dysfunction, although you’ll experience a refractory period after orgasming during which you won’t be able to get another erection. However, erectile dysfunction and masturbation do have some links. For example, watching a lot of pornography might change the way you think about sex with your partner and make it more difficult to become physically aroused.

It’s also possible to get used to masturbating in a specific way, whether by using a specific type of visual stimulation or a technique (like a really firm grip) that doesn’t translate well to partnered sex.

Some men choose to masturbate a few hours before sex to help them last longer, but this could ultimately make it more difficult to orgasm depending on how long their refractory period is.

Can too much sex cause erectile dysfunction?

Not directly. In fact, more sex is 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. This is perfectly normal and isn’t the same thing as erectile dysfunction.

Talk therapy for erectile dysfunction

Talk therapy is a general type of psychotherapy where you talk through your issues with a licensed professional. Together with your therapist, you’ll learn how things in your life (like stress or thoughts) can contribute to ED, and practice management techniques. There are different types of talk therapy — a popular one is cognitive behavioral therapy, which places extra attention on how your thoughts impact your life.

CBT for erectile dysfunction

Your thoughts, feelings and physical experiences are all connected. CBT, or cognitive behavioral therapy, is a talking therapy that helps you overcome problems by changing the way you think.

During a CBT session, you’ll learn how mental things like negative thinking, unrealistic expectations around sex or feeling a pressure to perform can cause physical reactions like ED. Working with a licensed therapist, you’ll get access to coping strategies and communication skills that you can use to regain control over your thoughts and body.

Do I need couples therapy for ED?

Erectile dysfunction shouldn’t be something you feel you have to solve by yourself, and it can be really helpful to involve your partner in your treatment. (In fact, studies show that stress-related ED goes away 50-70% of the time when the partner is involved in therapy. ) Couples experiencing erectile dysfunction can benefit from either talk therapy or sex therapy.

A couples talk therapy appointment would address the thoughts of both partners, and help you learn how to communicate your needs and fears. Because psychological ED is often caused by performance anxiety, knowing you have the support and understanding of your partner can be a really helpful tool in overcoming ED.

Unlike a talk therapist who can help address underlying issues of depression, anxiety and other emotional issues that contribute to erectile dysfunction, a sex therapist will approach the issue even more directly. You’ll work on your sexual communication skills as well as learn exercises you can do with your partner at home, which will build sexual intimacy while taking away the pressure to perform (and maintain an erection).

Self help for erectile dysfunction

Before you start looking for a therapist, it’s worth trying a few things at home to cure ED. There are a few DIY solutions for erectile dysfunction which are basically lifestyle changes — they address the different things that could be causing your ED, and might make a big difference.

One of the biggest causes of mental erectile dysfunction is stress, so of course it’s best to try and remove stress from your life. But that’s much easier said than done. If the stress is coming from something outside of your control, like a big project at work, focus on what you can control — like getting enough sleep, exercising and eating healthy. Long-term stress isn’t good for you, though, and if the issue isn’t something like a big project (which will soon be over) but your entire job, we really recommend trying to address the stressors themselves.

Take this same approach with causes like performance anxiety, dependence on pornography, relationship issues or fatigue. First, focus on what you can control. Talk to your partner. Limit the amount of pornography you watch, or try something new like reading erotica. Talk to your partner. Make time for rest and relaxation. Did we mention talking to your partner? With a little effort and a lot of communication, you might find your psychological ED goes away on its own.

Can medication help with psychological ED?

It’s possible that medication can help psychological ED, but not necessarily in the way you think. Viagra and other ED pills make it possible to physically have an erection, which isn’t a problem for people with psychological erectile dysfunction. However, taking medication known for “causing” erections might help you regain your confidence, especially if you’re experiencing performance anxiety.

Being anxious about not getting an erection and then not getting an erection can create an anxiety cycle that feels impossible to break. ED pills like Viagra can be great at getting you out of that headspace and breaking the cycle. Further good news: studies have shown that men with psychological ED have a strong response to placebo treatment.

ED medication won’t necessarily help you address the root cause of psychological erectile dysfunction, though. If it’s the result of depression, you’d be better off talking to a therapist or asking your doctor about antidepressant medication. And if you’re experiencing ED because of changes in your libido or inability to feel “in the moment” due to stress, Viagra won’t be as beneficial as addressing the stressors in your life.