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Psychological Causes of Erectile Dysfunction

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Updated February 09, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Most research into the causes of erectile dysfunction focus on physical factors; understanding how erections work, and what might be physiologically or anatomically getting in the way of them working the way we want. This makes sense in part because research suggests that physical causes are more common. But erections are much more than a simple physical event, and psychological causes of erectile dysfunction, while more difficult to isolate and study, are equally important to consider if you're experiencing erectile dysfunction and trying to understand what's causing it.

Psychological causes of erectile dysfunction, clinically referred to as psychogenic erectile dysfunction, include thoughts, feelings, and the kinds of interactions we have in our sexual relationships. Sometimes they are tied to the moment of having sex, other times they relate to our overall psychological health and happiness, or even to events from our past, including our childhood. There are countless ways that our interpersonal and psychological experiences can result in erectile dysfunction, and if you're experiencing erectile dysfunction and have seen a physician to rule out physical factors, talking with a qualified therapist may be another helpful step in figuring out the cause. Below are some of the more common psychological causes of erectile dysfunction.

Depression
People who experience depression often report a lower libido, feeling sexy less and feeling less like they want to have sex with other people. Not wanting to have sex, not being able to focus on pleasurable feelings and physical stimulation, as well as general thoughts of low self-worth and low desirability can all have a negative impact on erectile functioning. Depression can also be an indirect cause of erectile dysfunction as many medications used to treat depression are known to cause erectile dysfunction.

Stress
Stress, whatever its cause, can contribute to erectile dysfunction in a few ways. Psychologically, stress can make it more difficult to relax, to focus, to connect with others, all of which can lead to erectile difficulties. We can also experience stress about our ability to get an erection and this can turn an occasional occurrence into an ongoing dysfunction. Finally, stress can lead us to engage in activities like drinking, smoking, and overeating, which can themselves lead to erectile dysfunction.

Sexual Performance Anxiety
Sexual performance anxiety refers to the very common experience of worry or having distressing thoughts and/or feelings prior to and during sexual activities. In many cases sexual performance anxiety takes the form of negative thoughts and self talk about not being "good enough" as a sexual partner, not being able to "perform," or otherwise being sexually "inadequate." All men will occasionally experience erectile difficulties. Unfortunately sexual performance anxiety, when it becomes intense and one doesn't have tools to deal with it, can result in difficulties turning to dysfunction.

Relationship Difficulties
Sexual relationships are impossible to completely remove from personal and romantic relationships or partnerships. If you are having problems in a relationship, even if those problems have nothing to do with sex, they can get played out in the sexual realm. As all men know, erections are not completely under their conscious control, and harboring ill feelings (bitterness, anger, pain, etc…) can translate into an inability to get an erection.

The Vicious Cycle
Erectile dysfunction isn't always a matter of a single cause. Sometimes a man will have difficulty getting an erection, which might be caused by physical or psychological factors, or a combination of both. And once he has that experience a few times, he can begin to worry about performing, and experience stress and even depression. The occasional inability to get an erection can become an erectile dysfunction because of the vicious circle of anxiety and its effects. This is one of many reasons why talking with both your partner and health care professionals about erectile difficulties and dysfunction is important. While it's possible to stop the cycle, the longer one is in it, the trickier it is to get out.

Even if you suspect that your erectile dysfunction is psychological, it's recommended that you start by getting a physical exam from a doctor. The information you get can help even with treatment of psychological causes, but as important, erectile dysfunction can be an early warning sign of other health problems, so getting checked out by your doctor is a good idea. Once you have a picture of what, if any, physical factors there are, getting a referral to a therapist, particularly a sex therapist, is a good place to start working on psychological causes of erectile dysfunction.

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