Erectile Dysfunction: Could Stress, Anxiety, or Insecurity Be the Cause?

Medical Reviewer

Erectile dysfunction (sometimes called impotence) refers to difficulties in getting or keeping an erection. It’s also the general terminology sometimes used to describe reduced sexual desire. Sometimes, erectile dysfunction can have psychological causes.

First, it’s important to know that the inability to achieve an erection is not at all uncommon. Anyone who has experienced a period of stress, illness, or fatigue knows this. Remove the cause and the problem is often solved. Second, if erectile dysfunction becomes a longer-term issue, then it’s time to speak to a doctor. Before psychological causes are ruled in, physical causes and risk factors need to be ruled out.

Physical vs. psychological causes: Not just a case of ‘either or’

It’s not uncommon to find information online that categorizes erectile dysfunction as either physical or psychological in origin, but the boundaries can be more blurred than that. For example, one clear physical cause of erectile dysfunction is nerve damage caused by a spinal injury. But, in the case of depression for example, the issue becomes more circular. Depression is well known as a cause of reduced sexual desire, but then again, erectile dysfunction is also known as a potential cause of depression. Mood states do develop because of physical problems, but physical problems also develop due to mood states.

Psychological causes of erectile dysfunction

Our earliest experiences can have profound effects on our later development. Negative emotions such as guilt, shame, or inadequacy are easily learned from adults, who may also physically or psychologically punish children over perceived wrongdoing. Once embedded, such beliefs can interfere with normal adult intimacy and sexual performance.

Sexual dysfunction can also occur in couples where little or no attempt at physically relating is made to improve the situation. Within relationships, sexual dysfunction can develop for any number of reasons. What starts as a normal, loving, and intimate bond, can start to erode due to jealousy, clashes over finance, how to raise the children, or anything else that causes unresolved tensions.

The Sexual Advice Association provides a useful list of possible psychological causes for erectile dysfunction. One of the causes listed is uncertainty over sexual identity. This is also an issue the British Society of Sexual Medicine identified via a report by urologist Dr. Geoff Hackett. Dr. Hackett suggests that urologists need to start asking sensitive questions to men who experience erectile dysfunction as to their possible sexual orientation. In the UK alone, Hackett estimates that upwards of 100,000 men experience erectile dysfunction because they are confused or conflicted over their sexual orientation.

Questions your doctor may ask

To fully understand the root cause of your erectile dysfunction, your doctor or other health care professional will likely ask you questions about your symptoms. For example, it’s important to know whether the issue is long-standing or more recent, and whether it affects some or all situations. A long-standing problem may, for example, indicate early-life trauma, or, some form of faulty learning. More recent problems might be due to stress, worry, alcohol, or drug misuse.

You should also pay attention to whether the dysfunction only occurs during attempts at sexual intercourse with a particular person, as opposed to say masturbation leading to ejaculation. This can help determine whether the issue is relationship-based.

Getting help from a sex therapist

Once physical causes for erectile dysfunction have been discounted, the next step is to get help via psychosexual counseling — more commonly known as sex therapy. A trained therapist will listen, ask questions, and ultimately aim to illuminate possible causes of erectile dysfunction and help in their resolution.

See more helpful articles:

Who Should Be on Your Erectile Dysfunction Health Care Team?

How to talk to your partner about erectile dysfunction

Do you know the facts behind erectile dysfunction?