Erectile dysfunction or the inability to get the penis hard and keep it firm long enough for sexual satisfaction is common among men from 40 to 70. As men age, they require more stimulation to achieve an erection and more recovery time in between erections.
But, erectile dysfunction (ED) can also be caused by several health conditions, medications, and lifestyle habits, affecting men at any age. Yet, beyond the physically-related causes of ED are the psychogenic causes. Data reveals nearly 40% of ED cases are due to psychological factors. If a guy continues to have an erection during sleep or in the morning upon waking up, the cause of ED is likely emotional or psychological.
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Erectile dysfunction diagnosis
Erectile dysfunction is estimated to affect about a third of men. The global prevalence of ED reportedly reaches up to 76.5%. In the US alone, the estimate is about 30 million men experience ED.
It is a common health condition and varies in severity. For some men, it happens case-to-case, while others are affected over a longer period, often accompanied by pain. The physical causes are often taken into consideration first including medical history, prescription medications taken, and the presence of certain habits.
To check the physical symptoms of ED, the healthcare provider will require a physical exam, blood tests, urine tests, and an ultrasound. However, if ED is most likely psychological, your doctor may ask questions to screen for possible psychological causes of the condition.
Common psychological causes of erectile dysfunction
Since some 40% of cases of ED are psychologically-related, it is wise to look into the different issues affecting erection in men. Also, there is no single cause that triggers ED. There are, instead, various contributing factors to psychological impotence.
Anxiety
Around 90% of teenagers and young men are affected by psychological ED, mainly due to anxiety and nervousness. General anxiety as well as sex-related anxiety, more specifically sexual performance anxiety (SPA) can lead to sexual difficulties. The anxiety may be caused by poor body image, low self-esteem, unrealistic expectations, disconnect and conflict in the relationship, past negative sexual experiences, or trauma.
Also, a few anti-anxiety medications are linked to erectile dysfunction. These are paroxetine (Paxil), fluoxetine (Prozac), venlafaxine (Effexor), sertraline (Zoloft), and similar selective serotonin reuptake inhibitors (SSRI). Anxiolytics like lorazepam and amitriptyline may also cause problems that reduce sexual desire or libido needed to achieve and maintain a strong erection.
Stress
Stress at work, at home, in the relationship, and personal stress is a primary contributing factor to ED in middle-aged men. Increased stress can put you at risk of developing physical conditions linked to ED including:
- Heart disease
- High cholesterol
- Obesity
- High blood pressure
- Substance abuse
Your weight and your vascular health are especially important in the erection process. Furthermore, stress can alter how your brain signals the body to respond to sex. Stress may interrupt brain signals to the penis responsible for blood flow for an erection. Anxiety can also cause unnecessary stress, and vice versa, starting a cycle of ongoing sexual dysfunction.
Depression
Being diagnosed with clinical depression can place men at risk of ED. Depressed men may lack interest in pleasurable activities or any daily activities due to a persistent sad, hopeless, and pessimistic mood. Depression also alters weight, sleep, and appetite. Further, it can cause slower movements, unexplained pains, and aches.
Antidepressants also come with sexual side effects, such as dysfunction, decreased libido, delayed orgasm, and ejaculation issues. Antidepressant-induced sexual dysfunction may be caused by taking common medications to treat depression including sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa). If medications are the problem, you can talk with your doctor about changing your prescribed medications with lower risks of sexual side effects like vortioxetine (Trintellix), mirtazapine (Remeron), and vilazodone (Viibryd).
Sexual Indifferences
When men feel boredom or conflict in the relationship, it can lead to them feeling sexually indifferent. They may not take a particular interest in sexual activities with their partner. When men become sexually indifferent, even the thought of sex or attempts of stimulation may not come with a burst of dopamine. Hence, he is unlikely to feel excited, motivated, or any pleasure in engaging in sexual activity.
Problems with a sexual partner
Connection and intimacy accompany real-life sexual experiences. Feeling disconnected or having difficulties with your relationship can bleed over into men’s sex lives. On the other hand, when you can’t get hard for your partner or can’t achieve a satisfying sexual experience, this can also create problems in the relationship. Communication is essential to resolve this cause of psychologically-induced ED.
How to know if erectile dysfunction is psychological?
It is wise to consult your doctor to first rule out medical causes linked to erectile dysfunction. These may include heart disease, diabetes, hormonal disorders, alcoholism, substance use, high cholesterol, high blood, obesity, injury or surgery in the penis and surrounding area, and low testosterone or low-t levels.
Your doctor may also inquire about your libido or sexual desire, erection issues, orgasm issues, and level of sexual satisfaction–in your personal and sexual life. Thereafter, your doctor may recommend a psychological evaluation to explore the other causes of ED.
Before you go to the doctor, you may also ask yourself whether you have the signs of psychological ED such as:
- Experiencing morning and nocturnal erections, but not during sex
- Have trouble performing sexually even though you are attracted to your partner
- Erection difficulties despite being interested in sex
- Can achieve an erection while masturbating
- Feel nervous about pleasing your sexual partner
- Under a lot of stress or anxiety
- Experiencing problems in the relationship causing emotional distance
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Psychological ED treatment options
The treatment of psychological ED is dependent on the underlying contributing factors. ED medications are not foremost as a necessary treatment for psychological erectile dysfunction. This is because the problem may not be due to poor blood flow into the penis or damage to the nerves responsible for causing an erection. Moreover, ED medications may not directly impact feelings, thoughts, and mood. Even injectables and implants may not deal with issues like depression, anxiety, and low self-esteem.
First, address the root of the problem whether it is a feeling of indifference or a mental health condition. It can be especially beneficial to talk with a therapist to identify and alter unhealthy patterns of behavior and thinking that are causing issues to your erection.
On this note, a common treatment for psychological issues is cognitive-behavioral therapy (CBT). It can help treat ED by first treating anxiety and other psychological issues without drugs or any medication.
Sex therapy or psychosexual therapy is another specialized form of counseling that can help in overcoming sexual dysfunction. It can help to involve your partner when going through therapy or counseling.
