Erectile dysfunction (ED) is a condition where men and people with penises are unable to keep a firm enough erection to complete intercourse. ED is the most common sexual problem among men. Really, we’re not blowing smoke and platitudes at you. ED is one of those universal experiences that most men will have at least once in their life.
Symptoms of Erectile Dysfunction
- Reduced libido or sex drive
- Difficulty or inability to become erect
- Difficulty maintaining an erection long enough to complete sexual activity
ED affects approximately 30 to 50 million men in the United States and 150 million men globally. And while ED has been known to increase alongside age, it is not confined to older demographics. Men can develop ED at any point in their life. In fact, according to The Journal of Sexual Medicine, nearly 20% of new ED cases are among men younger than 40 years old. The statistics make you wonder, is it something in the water? Or is it all in your head?
Nearly 40% of ED cases are psychogenic, meaning the problem isn’t physical; it’s psychological or situational. Psychogenic ED is common among young men, so, without further ado, here are the most common psychological factors that contribute to erectile dysfunction.
Common Psychological Causes of Erectile Dysfunction
Depression is a complex and severe mood disorder characterized by persistent or chronic negative emotions that color the way you perceive, feel, and behave. It was thought that depression resulted from chemical imbalances in the brain, but new research suggests depression is much more complicated than chemical imbalances.
Many things and circumstances can result in a person experiencing depression. These may include physical, emotional, or sexual abuse, conflict or disputes with loved ones, genetics, death or loss of a loved one, substance misuse, certain medications, serious illnesses, and more. Depression may manifest as fatigue, loss of interest in work, hobbies, or sex, sleeping difficulties, changes in appetite, thoughts of suicide or suicide attempts, or physical aches or pains.
According to the National Institute of Mental Health, the depressive symptoms of men may manifest differently than women’s, including erectile dysfunction. Depression may cause an imbalance in your brain chemicals, which are the messengers responsible for getting you aroused in the first place. A chemical imbalance may cause you to lose interest in sex or struggle to become erect. Some antidepressant medications may also contribute to ED.
Anxiety is the experience of fear or apprehension about the future. Anxiety is a natural biological response that can stem from factors including genetics, environment, and brain chemistry. Some common triggers of anxiety include financial problems, conflicts (e.g., arguments or disagreements), certain prescription drugs, social events, and for some people, sex.
Sexual performance anxiety is a type of anxiety that involves fear of poor sexual performance or the fear of disappointing your partner sexually. While it’s normal to be a little anxious before sexual encounters, extreme internalization of these fears can manifest in the body as erectile dysfunction. Like stress, anxiety can affect how your brain sends signals to the penis, making it harder for you to achieve or maintain an erection. Performance anxiety affects between 9-25% of men and is a known contributor to psychological ED.
Symptoms of sexual performance anxiety include:
- Premature ejaculation
- Inability to become or maintain an erection
- Difficulty reaching climax during sexual activity
- Lack of interest in sex or low sex drive
While anxiety and performance anxiety are normal experiences, suffering from feelings of anxiety for six months or longer may indicate a chronic condition. Extreme feelings of anxiety can be the hallmark of an anxiety disorder, which requires a medical diagnosis.
Stress is one of the body’s most common biological and psychological responses to danger, perceived or real. It can register as an overwhelming feeling of physical, mental, or emotional tension coming from thoughts, events, or life circumstances. People who are stressed may experience or struggle with fatigue, changes in appetite, sleeping difficulties, acne, headaches, frequent sickness, pains, rapid heartbeat, sweating, changes in libido, and depression.
Stress activates your sympathetic nervous system, aka that fight or flight imperative we so often hear referenced. Your body mobilizes its resources and prepares to expend energy. Stress increases the production of stress hormones, like cortisol and adrenaline, to prepare your body for ‘battle.’ When those hormones are coursing through your body, they lower testosterone levels because if you were in actual danger, you wouldn’t be trying to ‘get it on.’ Because testosterone plays a huge role in sex drive, reduced levels mean you may have trouble with arousal or becoming erect. And stress, being the sneaky fiend it is, can interrupt how your brain sends signals that allow blood to flow into the penis and cause an erection.
Self-esteem is more than liking yourself. It’s an inherent belief system that informs how we move through the world and interact with others. Our self-esteem is reflective of how we value ourselves. Poor self-esteem can look like negative self-talk, feeling unattractive, or masquerade as imposter syndrome, making us feel inadequate in our relationships or careers. Low self-esteem can hold us back from living our best lives.
It’s common for those who experience low self-esteem to harbor fear of failure or disappointment, loss of motivation, or loss of interest in many things, including sex. Some possible causes of low self-esteem include an unsupportive environment, abuse, trauma, unrealistic expectations, bullying, mood disorders, and more.
The link between low self-esteem and ED can be cyclic. If you feel poorly about yourself or your life, those feelings might follow you into the bedroom and manifest as sexual dysfunction.
As with most emotional experiences, guilt is hard to define, and its reaches are insidious. Guilt is the experience of feeling like you deserve blame or reproach for something you may have done or said, something not done or said, or something you imagined. Alternatively, these feelings can arise from a sense of inadequacy. However, guilt isn’t all bad. It does function as a moral compass and guide for people. However, anything in excess is probably not beneficial to your health.
Some people may feel guilty about not meeting their partner's sexual expectations, real or imagined, or even feel guilty about experiencing physical pleasure in the first place, which can also affect their sexual function and performance. Prior relationship issues, such as infidelity, can also contribute to guilt and sexual functioning, meaning it may result in – you guessed it – ED.
To complicate the concept of guilt even more, culture and religion can compound guilt too. Sometimes the ideology or practices of specific cultures and religious beliefs can clash with positive sexuality and instill strong feelings of guilt in a person making it difficult to experience pleasure or arousal.
Trauma is a multi-dimensional biological response to an impactful event, and it’s far more nuanced than just a feeling. An event is classified as trauma if it is so profound that you can’t cope, make sense of the world, and are rendered helpless. Trauma can affect people in complex ways for many years regardless of when the event occurred or the severity.
What makes trauma so insidious is that it rewires your brain, creating new neural pathways that web out over every facet of your life. Trauma is not always confined to a single occurrence or one-time feeling; it can be ubiquitous, unconscious, and self-perpetuating.
Sexual abuse is a trauma that can externalize itself as sexual dysfunction, which makes sense if the correlation is negative. And yes, men can be victims and survivors of sexual trauma. Men who have gone through trauma may be diagnosed with post-traumatic stress disorder (PTSD), which increases the risk of experiencing erectile dysfunction because they’re more likely to suffer from fear, sadness, depression, anxiety, low self-esteem, and isolation.
Psychogenic Erectile Dysfunction Treatments
Many of the causes of psychogenic ED are self-perpetuating. For example, if you’re stressed from work, and it affects your ability to get or maintain an erection, you may experience anxiety or depression. Therefore, treating psychogenic ED can require a multi-faceted systemic approach, as well as patience and self-compassion.
The first step in treating your sexual health is to visit your healthcare provider or therapist for a proper diagnosis and treatment plan appropriate to your situation. That treatment plan may include cognitive behavior therapy, oral medications, relaxation techniques, meditation or other mindfulness techniques, or vibrators that help alleviate erectile dysfunction, like Tenuto.
Cock rings can help treat ED because they restrict blood in the penis when it’s hard to help maintain a firm erection. Sometimes a simple cock ring is not enough, which is why Tenuto introduced vibrations to the basic principle of a cock ring for enhanced stimulation.
If you are experiencing ED, don’t feel discouraged. You are in good company, and numerous treatment options exist from medications to natural ED options. You can still lead a healthy and active sex life with ED.