The Most Common Causes and How To Treat It – Promescent

According to research, over 150 million men from different places, with various
lifestyles, and of all ages experience erectile dysfunction. The number of men affected by erectile dysfunction,
including those under 40, is increasing rapidly.

The causes of erectile dysfunction (ED) aren’t just physical, such as illness or injury.
Mental health plays a key role in everyone’s sexual health, too.

Quick FAQs

Psychogenic erectile dysfunction, or psychological ED, is when a man can’t achieve
or maintain an erection during sexual activity due to psychological reasons that range from stress and anxiety to
relationship worries.

Causes of Psychological ED

By 2025, studies estimate that 322 million men will struggle with erectile dysfunction, with
nearly 20 percent of those being under 40.

In men under 40, over 85% of ED cases are due to psychological erectile dysfunction. Various psychological
issues can contribute to ED, including:

• anxiety about sexual performance
• stress and anxiety
• depression
• issues in the relationship
• lingering guilt
• low self-esteem
• overuse of pornography

Performance Anxiety

Sexual
performance anxiety (SPA) is a real and common sexual complaint among both men and women.

It affects up to 25% of men and can contribute to erectile dysfunction and premature ejaculation.

While SPA has a lot to do with a person’s negative thoughts about their performance, it isn’t the only factor that
can influence those feelings.

Body image, penis size, and ideas of gender roles can add additional anxiety that can spiral into erectile
dysfunction.

Stress

The human body is built to feel and react to stress. But, when it becomes an ongoing problem, stress can negatively impact all the systems of the body. It can cause issues that
lead to ED.

Anxiety happens when there’s too much stress over time, which then causes more stress, and you become stuck in a
cycle of negative thoughts.

The body releases adrenaline and cortisol into the brain when there’s stress and anxiety. It causes the heart to
beat faster and sometimes decreases blood flow to the arteries of the penis, making it hard to get an erection.

Prolonged stress requires attention, because it can also lead to high blood pressure, heart attacks, or strokes.
These are all known risk factors of erectile dysfunction.

Additionally, some treat stress and anxiety by excessively drinking, smoking, or doing drugs, which can only worsen
the ED.

Depression

Depression often comes with the inability to take joy or pleasure in anything, much less sex.

According to research, men who experience depression are more likely to struggle with erectile
dysfunction. Doctor-prescribed antidepressants, such as fluoxetine (Prozac) and sertraline
(Zoloft), have shown promise when treating men with depression that also deal with erectile dysfunction.

Another study found that depression-related ED can happen to men of all ages, backgrounds, and lifestyles.

Relationship Problems

Relationship problems can be stressful. As noted before, stress can cause other physical issues that lead to ED.

But beyond the physical issues, relationship problems may cause men to be less interested in sex with their
partner. Underlying issues may lead to depression or anxiety that could cause difficulties obtaining an erection.

Erectile dysfunction doesn’t only affect the person that is struggling with sexual dysfunction.

The person’s partner may experience confusion, feel unwanted, and even have suspicion an affair is occuring,
especially when there is a total communication breakdown.

Improving communication and pursuing therapy can be helpful to addressing relationship problems, decrease overall
stress, and help treat psychogenic ED.

Low Self-Esteem

Studies show that men that struggle with erectile dysfunction are more likely to
experience low self-esteem.

This low self-esteem may contribute to men experiencing performance anxiety, and potentially make erectile
dysfunction more likely to happen.

A study concluded that prevention of ED can help improve the self-esteem of men. With
boosted confidence, there’s less likelihood for a man’s erection to be hindered by performance anxiety.

Guilt

The guilt of underperforming is only one form that can cause erectile dysfunction. A man cheating on their significant other may experience ED while stepping out or when
returning to their partner.

The feeling of guilt causes tension, and that inability to relax is what causes erectile dysfunction.

Pornography Over Use

Some men experience ED with no identifiable cause. One of the most controversial theories is that the
overconsumption of online pornography may cause erectile dysfunction in some men.

Some studies suggest too much porn leads to poor sexual health. However, there is plenty
of research that finds that there is no correlation between pornography and erectile
dysfunction.

Something else to consider is that viewing pornography, especially hardcore, can give rise to feelings of guilt,
which may increase the odds of ED. Hardcore porn may also desensitize sexual responses or change how a person views their real-life partner.

Psychological Trauma

Post-traumatic stress disorder is proven as a cause of erectile dysfunction. Research shows that people with PTSD struggle with ED at a higher rate than their
peers. It establishes a correlation between psychological trauma and sexual dysfunction.

Some studies suggest that erectile dysfunction caused by PTSD isn’t dependent on the type
of trauma. Men that have experienced combat, sexual or physical abuse, or serious accidents can experience
psychological trauma that causes erectile dysfunction.

OCD

Based on clinical research, men diagnosed with obsessive-compulsive disorder (OCD) report a
higher prevalence of sexual dysfunction and decreased sexual satisfaction.

OCD can cause feelings of dissatisfaction with your partner, fear of intercourse, or disgust when thinking about
sexual activity.

Fears of contamination and pregnancy obsessions are common in people with OCD and can lead to psychological
impotence in men.

Talk therapy and doctor-prescribed medications are proven treatments for OCD and can help alleviate the intrusive
thoughts that keep you from engaging in sexual activity.

Schizophrenia

Schizophrenia is
a complicated diagnosis that often overlaps with other psychological issues like anxiety and depression.

It’s estimated that half of those with schizophrenia have coexisting behavioral or mental health disorders, which
increases the risk for erectile dysfunction.

How do I Know if ED is Psychological?

Only a doctor can determine whether or not erectile dysfunction is psychological. But, there are red flags you can
look for to determine if your ED is physical or psychological.

• Do you have issues performing even though you’re attracted to your partner and are interested in sexual
  activity?
• When you masturbate, can you achieve and maintain an erection?
• Are you experiencing normal morning erections?
• Has a life event caused massive stress in your life?
• Are you nervous that you’re not pleasing your partner?

The first thing your personal physician will do is run tests to rule out physical causes, including any current
medication. They may review the following:

• Sexual history
• Physical exam
• Ultrasound of the penis
• Blood tests
• Urine analysis
• Injection test
• Overnight erection test

A medical professional will then look for the mental causes of erectile dysfunction once they have a complete
medical history and rule out underlying conditions as the cause of the ED.

Signs of psychological erectile dysfunction include:

• Inability to get an erection
• Unable to maintain an erection
• Premature ejaculation
• Delayed orgasm
• Loss of interest in sex
• Difficulty performing

Determining the exact cause of psychological ED is unknown and complicated to diagnose. In some cases, the cause of
erectile dysfunction is both physical and psychological.

How do You Treat Psychological ED

Psychological erectile dysfunction is as treatable as the physical variety. The approaches to treating
psychological ED include medication, therapy, and changes in lifestyle.

Medication

Doctors regularly prescribe medication such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil
(Cialis) to treat symptoms of erectile dysfunction.

If a physician determines that the case of ED is psychological, they may prescribe an antidepressant. Fluoxetine (Prozac) or sertraline (Zoloft) are common SSRIs that treat depression
and anxiety and cause the lowest incidence of erectile dysfunction.

Some men may experience erectile dysfunction due to their antidepressant or anxiety medication. Do not stop taking
medication prescribed by a doctor unless you consult with them first.

Alternative medications

You and your doctor can discuss alternative treatments if you suspect the antidepressant is causing erectile
dysfunction.

Vitamin regimes that include folate, B12, and other B vitamins have shown promise
when treating symptoms of mental disorders.

Magnesium deficiency can cause anxiety, confusion, and symptoms of depression.

Supplements that contain magnesium may not only help with major depression but also might treat sexual dysfunction in some men.

Always consult with a medical professional before you begin any supplement or alternative treatment to avoid
adverse reactions.

Healthy habits

There are a variety of habits that can help improve overall mental health, and as a result, potentially treat
erectile dysfunction.

• Relaxation techniques: Yoga, meditation, and other relaxation techniques cost nothing and can help reduce
  stress and anxiety.
• Diet and exercise: According to research, changing your diet and exercising can boost your mental health.
• Sleep: People who had 6 hours of sleep
  or less per night on average were 2.5 times more likely to report frequent mental distress than those who averaged
  6 hours of sleep more.
• Practice Gratitude: A study reported in a University of Utah Health article found that gratitude can
  lessen stress, anxiety, and depression.

Therapy

Cognitive behavior therapy (CBT) is a common type of talk therapy that helps identify and change unhealthy thought
patterns that lead to anxiety and depression.

While it’s not easy to talk about erectile dysfunction, research shows that CBT can better help you understand what thoughts lead to ED and
how to change them in a positive way.

Takeaways

Psychological erectile dysfunction doesn’t care how old you are. Approximately 20 percent of all cases occur in men under 40.

Stress, anxiety about sexual performance, relationship issues, and low esteem can all lead to the inability to get
and maintain an erection.

Only a doctor can diagnose psychological ED, but there are symptoms that you can be on the lookout for. An abnormal
amount of stress, still having the ability to get a morning erection, and trouble performing are potential signs
that your ED is physiologically related.

Common doctor-prescribed medications like Viagra and Cialis can help treat erectile dysfunction. However, in some
cases, a doctor will treat ED with an SSRI, though some antidepressants cause further issues with sexual
dysfunction.

If side effects of medication concern you, there are alternative methods to treating psychological ED. CBT therapy,
lifestyle changes, and magnesium supplements are natural treatments for erectile dysfunction.

Related Articles