Most men will experience erectile problems at least once in their lives. But the severity and frequency with which men get them can vary.

There are several possible causes of erectile dysfunction, and this can have a bearing on how often or for how long a man encounters it. 

Poor blood flow is an oft-cited reason, which is why the condition is more prevalent in older men, who are more susceptible to such illnesses as high blood pressure and diabetes, which impede circulation.

Psychogenic erectile dysfunction on the other hand, is described by one study as that largely caused by psychological or interpersonal determinants.

circular chart showing psychological causes of ED

Five of which we will discuss here: 

  1. Performance anxiety 
  2. General stress
  3. Depression
  4. Loss of interest
  5. Reliance on ED treatment

These can be wide-ranging, and not even apparent to some until problems have arisen during intercourse.

These instances may often only be temporary, and pass without the need for intervention.

But cases where these problems persist should definitely be addressed. Talking about them with your partner, or seeking treatment from a doctor are important steps in tackling the issue.

Here is our guide to the psychological causes of erectile dysfunction, and what you can do to overcome them:

1. Performance Anxiety and ED

This is primarily defined as pressure to perform during sex.

It is not uncommon in new relationships, where a man might be nervous about a sexual encounter and eager to impress their partner. For this reason, erectile dysfunction in young men may often be attributable to performance anxiety, because they’re new to sex and experiencing self-imposed pressure to prove their ‘ability’ to their partner, but also to themselves. 

Again, the problem is often not one which persists, and may pass as partners become more accustomed to each other and comfortable in a sexual relationship.

However, performance anxiety, thought to be among the most common psychological causes of impotence, is considered to be a major component in persistent psychogenic ED due to its self-perpetuating nature.

Explained; the more anxious a man gets anxious about being able to perform, the less able they are to get an erection, and the more anxious they get, and so on, causing a spiral of deterioration.

In such cases, it is important to talk about the problem sooner rather than later. The longer the issue is left unaddressed, the more of an obstacle it may become.

Sometimes a conversation with your partner may be all it takes to relieve worries and ease feelings of tension.

But if this doesn’t sufficiently solve the problem, it may be wise to approach your GP. They will be able to provide advice, or if appropriate, suggest a short-term course of treatment (such as with a PDE5i medicine like Sildenafil) to help to get you through a difficult period and restore confidence.

2. General Stress and ED

Psychological causes of ED aren’t always related to sex itself.

Sometimes issues at work, periods of financial strain, or stress related to just about any area of your life can have a significant effect on sexual performance too.

There are a number of reasons why.

Experts think that during times of stress, activity in less essential sections of the brain, including in those which manage arousal, starts to decrease.

Another more simple reason is distraction.

When the brain is dealing with stress, it becomes much harder to remain focused on intercourse.

Hormone behaviour during stress is thought to play a role too. 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.

Tackling the issue at its root can help to alleviate stress. This might be talking to your employer to ease your workload if you’re feeling pressure in your job; or getting advice and help on any financial problems which are causing you to worry.

3. Depression and ED

Loss of self-esteem, overall fatigue and disturbed eating and sleeping habits are well-known signs of depression.

But one of the less talked about albeit common symptoms of depression is erectile dysfunction.

In fact, the two issues can sometimes fuel each other and make the other one worse.

One study has shown that prescription treatments like Viagra can improve cases of ED in depressed males and, to some extent, alleviate depressive symptoms.

But treatment for depression has to begin with talking to your doctor. They will be able to assist you by pointing you in the direction of a therapist.

For some, prescription anti-depressants may be recommended. However some of these can exacerbate impotence.

Let your doctor or therapist know if your symptoms get worse, so that they can make any necessary adjustments to your treatment.

4. Loss of Interest in Sex and ED

One pattern you may be noticing among most of the psychological causes of ED is that they are largely self-perpetuating.

Loss of sexual desire, or libido, is another example of this.

Men are more prone to erectile problems if they aren’t as interested in sex; and are more prone to loss of libido if they have erectile problems.

Relationship issues can be a cause of libido problems.

It may be the case that sex is not as fulfilling due to over familiarity, or concerns about the relationship. Talking to your partner about the issue, or seeking advice and support from organisations such as Relate can help.

It is advisable however, particularly if you feel that there aren’t any underlying issues in your relationship, to speak to your GP. Sometimes loss of libido can have a medical cause, or be a side effect resulting from prescription treatment.

Let’s also not forget that loss of sex drive can often be a consequence of the other factors on this list, such as depression or stress. Taking measures to address these may also assist in restoring desire; and in turn reducing the likelihood of erectile dysfunction.

Another related issue that has come to prominence in recent years is porn-induced erectile dysfunction which stems from habitually watching pornography. Psychologically, this can create a perception of sex that is idealistic and unattainable. When coming to engage in the real thing, they might find that it doesn’t live up to these heightened (and often unrealistic) expectations, and experience problems becoming aroused (leading to ED).

Someone can remedy this by reducing the amount of porn they watch, or if they think they might be experiencing porn addiction, seeking help from a therapist.

5. Reliance on ED Treatment

Medication for erectile dysfunction is a route many men with decreased blood flow take.

It can also provide a viable short-term treatment option for those men experiencing impotence related to anxiety, by helping them to overcome a troublesome period and restoring confidence.

But some experts do posit, and this theory is supported by one study in the Journal of Sexual Medicine, that medications of this kind can cause reliance on their use when used recreationally; and subsequently the user may come to feel that erections are unachievable without them.

Perhaps the best way of avoiding this prospect then, is to determine the issue causing erectile dysfunction before taking measures to treat it.

Those physical cases caused by poor blood flow may necessitate more regular or continued use of ED medication. Daily options like Cialis are available in smaller doses, and are often specified for men with chronic ED problems.

However, in those cases where performance anxiety is the cause, prescription treatment might be better considered as a short-term solution, to provide a confidence boost.

In any case, you should talk to your doctor if you are encountering sexual problems. Because the potential causes are so wide-ranging, they will be able to help you identify the issue at the source, and the best possible course of treatment.

Page last reviewed:  11/05/2021