Erectile Dysfunction Psychological Causes: Stress, Depression, and More

Erectile Dysfunction Psychological Causes: Stress, Depression, and More

For example, men who start out with a low self-esteem may see themselves as unsexy or inadequate. What the commercials don't show you: Masters and Johnson on Sex and Human Loving. Chemicals help brain cells communicate to stimulate blood flow to the penis. Estimation of ten-year risk of fatal cardiovascular disease in Europe: Other people also read: An intimate connection of psyche and soma—Neglected area of psychosomatics?

Here are seven other surprising factors that may raise your risk of developing ED. J Adolesc Health 2020;55: Hormone-induced ED.

Pharmacological treatment of T deficiency in the young essentially relies on the site of origin of the dysfunction: Many men like to talk about sex, but like women, they may find it harder to talk about sex when it is not going well. The couple can stop communicating altogether -- not only in the bedroom, but in all aspects of their relationship. These mechanical or physically invasive approaches have largely been superseded, however, by the drug sildenafil citrate (trade name Viagra), which is taken in pill form. Stress and anxiety about performing sexually or pleasing a partner can cause sexual dysfunction in both men and women. Non-invasive treatments are often tried first. Most patients will recognise the worsening cycle of ED and anxiety as soon as it is pointed out and will appreciate that it is understood and is a common situation.

In a more recent RCT, the use of vardenafil 10 mg oral dispersible tablets has been compared to the use of the drug itself in association with cognitive behavioral sexual therapy (CBST) for 10 weeks in 30 couples with ED male partners, randomly assigned to one study arm (96).


Lifelong premature ejaculation. They will be able to provide advice, or if appropriate, suggest a short-term treatment which can help to get you through a difficult period and restore confidence. The majority of women do not have an orgasm during penetrative sex; and this is perfectly okay. In part, that’s because they enjoy renewed sexual confidence. Fortunately, however, there are a number of effective ways of dealing with erectile dysfunction. Heaton JP, Morales A, Adams MA, et al.

Erectile dysfunction impacts their partners, too. Decreased blood flow to the penis is one of the primary causes of ED. Disagreements are a part of any normal relationship. Communication is the first step in resolving this particular cause for psychological ED but it is also one of the most difficult steps to take. Sexual dysfunctions among young men:

“I never had this problem before I dated you. While little blue pills do work, they require a certain amount of preplanning. Erectile dysfunction is then likely to reoccur, and thus anxiety rises again. Guides, the testicles and prostate should be checked manually for enlargement and/or abnormalities. This drug works by enhancing the effects of nitric oxide, a chemical that, upon sexual stimulation, is normally released to widen the blood vessels supplying the penis. There is no point in worrying and not doing anything about it. Testosterone replacement therapy—perceptions of recipients and partners.


In fact, it is universally recognized that a low calorie diet or bariatric surgery can induce a significant increase in T plasma levels, reaching 10 nmol/L with the most invasive surgical procedures (62). Guilt is a painful and gut-wrenching emotion. The most common side effects are: In the 8th century, men of Ancient Rome and Greece wore talismans of rooster and goat genitalia, believing these talismans would serve as an aphrodisiac and promote sexual function. But for some men, psychological issues are the root of the problem. Office & school supplies, the brain naturally produces this component but many people often fall deficient of it. Identification of late-onset hypogonadism in middle-aged and elderly men. This group represents the first tertile of age of a sample of patients (n=619) consulting the Sexual Medicine and Andrology Unit of the University of Florence for erectile dysfunction and followed-up for a mean of 4.

This creates a vacuum that causes the blood to fill your penis, making it erect. 3. types of study designs used in this review, 5% would seek help from medical doctors, 55. For men, however, depression isn’t always an easy diagnosis. A reduction in flaccid acceleration, which can be used by clinicians to objectively verify the arteriogenic origin of ED and to characterize the extent of a self-reported symptom, has been also associated with a future risk of CV events, with the association being significant in younger but not in older men (37). The diagnosis of depression begins with a physical exam and interview by a health care professional. Surgery for erectile dysfunction is usually only recommended if all other treatment methods have failed. It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis. In some cases, treating the underlying cause may also resolve the problem. Some of the most common are depression, relationship problems, stressful circumstances and a history of negative sexual experiences.

For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide. Some of the historical causes stem from childhood and can be a result of sexual abuse or trauma or even early sexual abuse or trauma experiences in a relationship. To learn more about this highly effective ED treatment, make an appointment with a GAINSWave certified provider. Frequency of sexual dysfunction in "normal" couples. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts). Secondary erectile dysfunction, the much more common type, is when a man has had erections before but now fails to have one more than 25% of the time.

Rastrelli G, Maggi M.

Considering The Emotional Impact Of Erectile Dysfunction

The painful distress a woman can experience when her man suffers with erectile dysfunction (ED). Parazzini F, Menchini Fabris F, Bortolotti A, et al. Rho-kinase inhibitors, if nitrites/nitrates were harmful, then we would see vegetarians having a higher incidence of cancer and cardiovascular disease. Young patients are often reassured without any further medical investigations, including physical exam.

Some medications for treating depression can have sexual side effects. Troubles in your emotional relationship can affect your sexual relationship. Having said that, morning erections do become less frequent as you grow older. The different CV risk associated with ED in different age bands has been confirmed by the meta-analysis of the available longitudinal studies (33).

Diabetes is often associated with erectile dysfunction.

Surgical Treatment

The most common side effects of IU alprostadil are a burning feeling in the penis. Bitterness and resentment — even outright anger — might persist as well. The first such drug to appear on the market was Viagra (sildenafil). McCullough agrees: He suggests talking about whether there are things in your life that you can change - this could be eating better, stopping smoking, exercising more or reducing stress levels. Direct risk factors for erectile dysfunction may include the following: Relationship problems.

  • However, reported frequency of spontaneous erection and sexual thoughts were significantly decreased as a function of T decline even in younger subjects (50).
  • But, when your brain and body are focused on surviving a threat, getting an erection is simply not the sort of physical response that is prioritized!
  • Researchers asked 478 men with ED to complete the Self-Esteem and Relationship (SEARS) questionnaire, once before starting ED medication and again about three months later.
  • The most effective ED treatments can't be expected to do much against a tide of constant fatigue, inadequate sleep and the effects these issues have in a relationship.
  • An erection is the result of an interaction between the blood circulation system, the nervous system, the hormonal balance and a number of psychological factors.
  • These instances may often only be temporary, and pass without the need for intervention.


Men who are taking medications that contain nitrates, such as nitroglycerin, should NOT use these medications. About 7 out of 10 men do well and have better erections. Without treatment, symptoms of depression may last indefinitely. Hormonal problems — Abnormal levels of certain hormones can interfere with erections and sex drive. A meta-analysis of the available prospective studies has shown the role of depression as a significant risk factor for development of ED (71).

The role of anxiety on sexual arousal.

The treatment for ED starts with taking care of your heart and vascular health. The prescribed medicines of Viagra, Cialis and Levitra can be effective but do present some side effects, so consultation with a GP or specialist andrologist is recommended. So, don’t stress if you’re not getting them as often! Many hormonal conditions can be treated using injections of synthetic (man-made) hormones to restore normal hormone levels. The risk of erectile dysfunction increases with age.

Vascular (blood vessel) disease — Erections happen when blood collects in the shaft of the penis. A common cause of ED, depression affects a person physically and psychologically. Get the facts, you should consult with a physician who knows your medical history and current medical conditions before using Tri-Mix or any erectile dysfunction treatments. Can a 'first-line' treatment be used? I have even had a case where an individual was involved in a car accident. In fact, the first thing a woman thinks when a man can't get an erection is that it's her fault, and nothing could be further from the truth," says Andrew McCullough, MD, director of sexual health and male infertility at NYU Medical Center in New York City. "You'll still need a prescription to get these medicines. Couples with bad frequency set themselves up to be nervous, because they may feel that each person has to "knock it out of the park. "This was not directly related to anything except his own level of vulnerability of being human.

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Are early and current erectile problems associated with anxiety and depression in young men? The ENIGMA study. Health care providers can recommend antidepressants that are appropriate for men with ED. Do you get morning erections? Spontaneity suffers. In particular, ED has been reported in subjects using serotonin selective re-uptake inhibitors (SSRI), lithium and benzodiazepines (83). Cortisol, which the body produces as a response to stress, can cause sexual problems; and during periods of stress, levels of testosterone (a hormone the male body needs to produce erections) may drop. It may be the case that sex is not as fulfilling due to over familiarity, or concerns about the relationship.

It's of great value to have the first shot in the doctor's office before doing this on your own. If you are trying to access this site from the United States and believe you have received this message in error, please reach out to [email protected] BJU Int 2020;100: Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. In 1982, he received FDA approval to market the product as the ErecAid®. Conflicts within the family and within the couple as contextual factors in the determinism of male sexual dysfunction. Sure, this condition might be common – but isn’t erectile dysfunction a problem that only middle and senior-aged men get?

However, there may also be psychological reasons, such as depression and anxiety. By then you are committed to taking prescriptions and "timing" when we are sexual for the rest of your sexual relationship. Men who qualify for NHS prescriptions for erectile dysfunction treatments may be able to get a vacuum pump on the NHS (see above for more details). Sex therapy and counselling is a specialised area and access to properly trained counsellors in this field is very limited, or even absent, via the NHS. What are some of the psychological causes of erectile dysfunction? Erectile function can be impaired in several endocrine disorders and treating these conditions can improve ED (43). These kinds of situations are ones skilled psychological therapists are able to understand and treat.

When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the base of the penis to maintain it.

Other Tests

Many of the psychological difficulties that maintain ED are self-induced. Psychological causes include anxiety over performance, hostility or other negative feelings toward the sexual partner, and stress, anxiety, depression, or other emotional conflicts outside of the relationship. Nerve damage — Nerves must be working normally for a man to get and keep an erection. J Sex Med 2020;6: In secondary hypogonadism, patient needs dictate the therapy. Causes of performance anxiety Performance anxiety is typically caused by negative thoughts about one’s ability to perform well during sexual activity. You can learn more about porn induced erectile dysfunction here.

Some authors recommend the use of sildenafil by mouth to replace the injectable drugs in cases of contraindications, although the efficacy of such medication is controversial. Many advances have occurred in both diagnosis and treatment of erectile dysfunction. Questions about ed, but lifestyle changes, while basically free, can be difficult to make and may take months to take effect. Masters WH, Johnson VE:

How Sexual Health Clinics Can Help With Erection Problems

Working through your psychological issues or relationship problems with a mental health professional can help to eliminate the effects those issues have on your sexual performance. Slow down and take a moment to get yourself aroused and ready for sex. Sexual dysfunctions are common side effects of several psychotropic drugs that can disrupt sexual health by several different mechanisms (83). Nowadays, erectile Dysfunction is a common problem faced by men. Fur-friendly 'wearable for pets' and their humans, if you smoke, quit. For an issue that is so common it is perhaps peculiar that it is not the subject of much conversation. Penile implants are a type of surgery that may be considered. These links may appear obvious to a physician or counsellor but not necessarily to a patient.

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A prospective, randomized, double-blind, placebo-controlled trial. For men to break the cycle, they first need to recognize that it exists. You may need more arousal, you may need more closeness in the relationship, and you may need to look at what you say to yourself during sex. Work through it together. Vascular age of a subjects with a specific CV risk profile corresponds to the chronological age of a subjects who has the same estimated risk but only due to chronological age, because of the absence of the other modifiable risk factors (i. )In some cases, treatment can involve inserting prostaglandin pellets into the urethra, injecting smooth muscle relaxants and vasodilators into the penis, a penile implant, a penis pump, or vascular reconstructive surgery. In any case, you should talk to your doctor if you are encountering sexual problems. Even though ED can be embarrassing to talk about, experts say that it’s essential for a healthy relationship for couples to address the issue together.

Men most often start having sex with their penile implants by eight weeks after surgery. Psychotherapy, marital counseling, or sex therapy may be helpful in treating cases of impotence that have psychological or emotional causes. Anxiety and erectile dysfunction: However, the true number may be even higher than 20%. Prevalence of erectile dysfunction and related health concerns in the general population. J Urol 1992, 147: A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men.

Impotence (erectile dysfunction):

“Couples need to take the emphasis off intercourse and concentrate on giving and receiving pleasure. Clinical correlates of T deficiency show different figures according to patient’s age. It’s almost as if the unconscious mind punishes you by denying you pleasure in response to the guilt that you feel. The psychological origins of erectile dysfunction are varied. The ability to get an erection is connected a man’s masculinity. Specific treatment for erectile dysfunction will be determined by your doctor based on: Alcoholism, endocrine disease, and neurological disorders are typical physical causes.

Research shows that 75% of people with depression also have problems in the bedroom.

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Unusual characteristics of the penis itself could suggest the basis of the impotence. Attempts to treat ED date back well over 1,000 years. The researchers, who surveyed more than 3,000 men ages 57 to 85, found that a man whose female partner got too close to his friends was 92 percent more likely to experience difficulty getting or maintaining an erection than one whose partner didn't. Both men and women can – and do - have problems that affect their sex lives. However, embarrassment or "performance anxiety" can make a physical problem worse. With sildenafil, vardenafil and avanafil, you should be able to have sex from one to 10 hours after taking the medicine. Prior to looking at psychological effects or causes the common medical causes include Diabetes, history of smoking or alcohol use, certain medications (particularly SSRI antidepressants), aging, testosterone levels and vascular disease.

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It could be something as simple as a run away script or learning how to better use E-utilities, http: A new cardiovascular risk factor for male subjects with sexual dysfunction. In contexts different than Sexual Medicine and Andrology, the assessment of conventional risk factors is certainly more convenient. This primes us, physically and mentally, to evade danger.

A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. Only then can men start to change maladaptive ideas about sexuality that are not entirely helpful. Alprostadil can cause some side effects including: Erectile dysfunction (ED) is the inability to get or keep an erection firm enough for sexual function. In the body, this could produce various symptoms, such as premature ejaculation, inability to orgasm, or loss of interest in sex. Some experience guilt due to behavior that they have participated in.

Long-Term Testosterone Therapy Improves Urinary, Sexual Function and Quality of Life

Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected or inadequate. “Most identify themselves with their penis. This can build up to include penetrative sex. The FDA has issued consumer warnings and alerts. The role of ED as a risk factor for female dysfunction, including impairment in arousal, orgasm, sexual satisfaction and sexual pain, has been also confirmed in a study involving 632 sexually active couples, whose male partner age ranged 18–80 years (90).

A high level of psychological differentiation (being able to be strong enough to stand up for yourself and tolerate uncomfortableness while people are standing up for themselves) is required for good erection to occur in a sexual relationship.

What are the different types (and causes) of ED?

Relaxation techniques, for example, can be beneficial for many of the causes of psychological ED including stress, anxiety, and depression. Not only is this not true, experts say this approach can make things worse. Because there is a triad relationship between depression, ED and cardiovascular disease, men with depression should be fully evaluated for medical illness as well as psychological factors. Surgical re-vascularization, acne can hike premiums. When this happens, your brain becomes “trained” to not only expect but, in a way, to need that kind of experience in order to achieve arousal and climax. Therefore, instead of wasting money, risking one’s physical health and worsening one’s erectile function, men with psychological impotence should opt for treatment strategies that truly address the root of the trouble. Sexual dysfunction, depression, and the impact of antidepressants. This can lead to a feeling of being not confident in that zone or area or not feeling confident enough to be a “penetrator” if penetration of the activity desired.

Are you interested in sex and attracted to your partner but have trouble performing? In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. Some of these areas also affect your sex drive and ability to have an erection. Among these men, the impairment of erection during masturbation was associated with family and personal history of CVD (35), as well as with impaired response to the test with the intracavernous injection (ICI) of prostaglandin E 1 , which suggests an arteriogenic damage of penile arteries and predicts forthcoming MACE (36). It's also available from chemists. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. 3 years for the occurrence of MACE. For some men, depression can accompany the condition of erectile dysfunction (ED).

The most common of them (i. )Association between erectile dysfunction and coronary artery disease. Morales A, Heaton JP, Johnston B, et al. An erection problem is the inability to sustain an erection which is good enough for a man to achieve penetration or orgasm, explains Dr Anand Patel, GP and specialist in sexual function. In line with this cognitive explanation, a recent study conducted on 367 military personnel younger than 40 years showed that a deteriorated genital self-image is associated with sexual anxiety which, in turn, is associated with a higher probability of sexual dysfunction (82). We always recommend contacting your primary care physician first for a thorough assessment in determining the extent to which a man’s ED is physical or psychological. 3. medication changes, data collected from 1,195 randomly selected, community-dwelling men as part of the Florey Adelaide Male Ageing Study showed that with increasing age diabetes appears to be independently associated with moderate-to-severe ED [37]. If on one hand, depression and anxiety can lead to ED, drugs commonly used for their treatment can cause ED, as well.