It is a well-known fact that erectile dysfunction (ED) is more common among older men. According to the Massachusetts Male Aging Study [1], the prevalence triples between ages 40 and 70 years old. However, this is a condition that can affect men of all ages. In fact, studies [2] have found that one in four men seeking medical help for new-onset erectile dysfunction is younger than 40, and those erection problems are severe in almost half the young men. Psychological causes of ED should be considered.
In older men, underlying health conditions such as diabetes and high blood pressure are known causes of erectile dysfunction. But what causes ED in younger men who are in perfect physical health?
Psychological factors are a major contributing factor in many men with ED. In fact, they may be the culprit in up to 20 percent of men [3] experiencing trouble with erections. The psychological reasons for erectile dysfunction can be wide-ranging and may not be obviously apparent to the man and/or his partner.
Common subconscious and emotional causes of ED include stress, depression, loss of interest, and performance anxiety. In addition, the recreational use of ED drugs can lead to sexual dysfunction. Fortunately, erectile dysfunction caused by psychological issues is reversible and can often be treated by addressing the underlying cause. Here’s a guide to the common psychological causes of erectile dysfunction and what can be done to overcome them.
Stress or Anxiety
The fast-paced, technology-driven lifestyle most people lead nowadays can cause a great deal of stress and anxiety. Financial strain, problems in the workplace, and relationship issues can all affect a man’s ability to achieve and maintain an erection. This is because, during periods of stress, the brain becomes focused on essential functions for survival such as blood flow and heart rate rather than non-essential functions such as libido and arousal.
In addition, stress impacts a mans basic mood for sex. The underlying problems causing stress take up all the mind space and distract him from enjoying sex and pleasing his partner. Hormones also play a role in sexual dysfunction. During a stressful period, the levels of cortisol, the main stress hormone, are high, whereas the levels of testosterone, the male hormone, may drop.
This can lead to problems with penile erection, orgasm, libido, and sexual satisfaction. Techniques to counter chronic stress can help prevent ED. These include relaxation through deep breathing, meditation, yoga, and Tai-Chi, engaging in physical activity, and relying on social support.
Another cause of ED is the pressure to perform during sex, commonly referred to as performance anxiety. It is not unusual for a man to be a little nervous about sex when the relationship is new. However, this anxiety usually abates as the couple becomes familiar with each other. If it persists, performance anxiety can become a self-perpetuating cause of erectile dysfunction.
For example, a single episode of premature ejaculation or trouble achieving and/or maintaining an erection may lead to anxiety about sexual performance at the next encounter. Overthinking and worrying about achieving an erection feed the fear of sexual failure. In addition, some men develop feelings of guilt about not being able to pleasure and satisfy their partner.
All this focus on performance impacts the psyche and distracts a man from being able to relax and enjoy the experience. The more anxious a man is, the less he is able to perform, the more anxious he becomes, leading to a vicious cycle of worrying and being unable to perform.
Depression or Low Self-Esteem
Depression manifests in many ways: fatigue, change in appetite, erratic sleep patterns, hopelessness, apathy, and loss of self-esteem. In addition to these
well-known symptoms, depression is commonly found in men with sexual disorders such as erectile dysfunction and premature ejaculation.
Studies [4] show that in the majority of men, depression and anxiety pre-date the onset of erection problems, suggesting that the psychological issues could be contributing to the sexual dysfunction. The relationship between depression and ED is complex but is known to be independent of other factors [5].
This means that depression can cause erectile dysfunction in men of all ages regardless of their lifestyle habits, the medications they are on, and their hormone levels.
The inability to perform in the bedroom can affect a man’s confidence, leading to low self-esteem. But the reverse is also true. Low self-esteem, which is a common symptom of depression, can become the driving force in causing erection problems. Feelings of inadequacy can create a negative view of one’s worth and abilities, which in turn can create a concern for sexual failure.
Once a man becomes caught up in a poor perception of himself, he may begin to project it onto his partner. For instance, loss of confidence and low self-worth may lead a man to believe he cannot satisfy his partner, which could have an effect on sexual performance.
Another potential link between the two conditions is that some of the medications used to treat depression can lead to erectile dysfunction. A number of psychiatric medications are known offenders in causing ED, failed ejaculation, and decreased libido. Men who are suffering from ED and depression both should talk to a health care provider about appropriate antidepressants that do not cause worsening of sexual dysfunction.
Indifference or Loss of Interest
Loss of interest, indifference, or loss of sexual desire is one of the most common psychological causes of erectile dysfunction. Men who are not interested in sex are more likely to have ED. Men who have ED are more prone to experience low libido. What causes ED due to loss of interest in sex?
Age: As men get older, their sex drive decreases due to a natural reduction in testosterone levels.
Relationship problems: Erectile dysfunction can cause problems in a relationship, but conversely, relationship problems can easily spill over into sex life.
Over-familiarity: In longstanding relationships, sex can begin to feel boring or routine.
Depression or stress: Loss of sex drive can occur as a result of chronic stress and/or depression.
Medication side effects: Sometimes the loss of libido may be caused by a physical cause, for example, as a side effect of certain prescription medications.
Good communication is essential to cultivate and maintain a healthy interpersonal and sexual relationship. Trying new things and stepping out of the comfort zone can help ignite sexual desire and lead to more fulfilling sex. Getting treatment for depression can sometimes restore desire and reduce the likelihood of ED. Speaking to a doctor is important to identify whether any medications may be causing reduced sexual desire and/or inability to orgasm.
Unrealistic Expectations
A number of factors affect a couple’s ability to have healthy, fulfilling sex. Reading cues correctly, establishing a connection, and mixing things up to avoid falling into a routine are all important. Having sex often is another key factor. A reduced frequency of sexual intercourse can set up an expectation that sex when it happens, must be riveting [6]. More frequent sex helps a couple understand how to handle occasional failures, discuss anxiety, and learn to be intimate in more ways than one.
Another lesser-known cause of ED is masturbation. Some men masturbate with rough strokes and become accustomed to being aroused with that level of stimulation. When this cannot be duplicated with a partner, they are unable to achieve an erection. Similarly, masturbating to unrealistic scenarios or watching material that cannot be recreated in real life can set a man up for disappointment when attempting to have intercourse with a partner [7]. Limiting the amount of masturbation may help. Sometimes, looking at images rather than videos can lead to desensitization with better arousal and erectile function during sex with a partner.
Pornography addiction is another potential cause of erectile dysfunction that many men fail to consider. The availability of free-streaming high-definition porn has made this problem worse, especially among young men. When a man spends a considerable amount of time watching pornography, he gets used to being aroused by something that is not always rooted in reality.
This can train the brain to expect and need that kind of experience to achieve arousal and climax. In addition, it can lead to a loss of desire for romantic-sexual interactions. Men who are compulsive viewers of porn become accustomed to being fully in control of the experience without having to deal with a partner, who is a real, complicated human being with their own needs and insecurities. All of this can set up a man for failure during real-world sexual intercourse with a partner [8].
Reliance on ED treatment
Medications such as Viagra and Cialis are a viable treatment option for men who are experiencing erectile dysfunction as a result of short-term anxiety or stress. These drugs can help overcome the problem and restore confidence until the troublesome period is over. However, there is a danger that the use of these medications can lead to an over-reliance on drugs to achieve an erection.
Based on new research [9], experts caution that the recreational use of ED drugs can lead to psychogenic erectile dysfunction in healthy young men. It is believed that regular use of these medications leads to reduced confidence in achieving and maintaining erections unaided. Also, ED medication users may become over-sensitive and develop unreasonable standards of erectile performance.
If the problem with obtaining and sustaining erections is persistent (occurs more than half the time) and is a source of distress for you or your partner, it’s important to seek medical advice and treatment. The best practice is to always determine what is causing erectile dysfunction before doing something about it.
If performance anxiety, stress, or other psychological issues are the cause, short-term treatment with PDE5 inhibitors such as Viagra may be recommended to provide a confidence boost without leading to dependence. If it is determined that physical causes such as poor blood flow to the penis are the underlying reason, regular and continued use these medications may be indicated.
However, some men experience side effects with these drugs, and vacuum erection devices (VEDs) or penis pumps offer a simple, inexpensive, and safe alternative.