Is Erectile Dysfunction Psychological?

All in Your Head! Is Erectile Dysfunction Psychological?

Performance lacking in the bedroom? Is it a physical problem, or are you suffering from performance anxiety?

At one moment or another, almost all men have wondered if their sexual performance is up to par or if they satisfy their partner sexually. 

Despite what popular culture would have you believe, these thoughts are completely normal, but when fears and anxiety creep into your sex life, sexual performance anxiety can happen. 

Performance anxiety refers to negative thoughts and preoccupations with one’s inability to perform sexually or satisfy one’s partner. It can lead to a self-fulfilling prophecy in which a man’s worry regarding his sexual performance becomes true, leading to psychological erectile dysfunction. 

Up to 25% of men admit to persistent sexually related anxieties lasting several months. Research also shows that anxiety, depression, and emotional and life stressors are common causes of erectile dysfunction (ED).

The problem is that experiencing performance anxiety will cause most men to spiral down a path of negative thinking and excessive worrying. 

So how can you tell if erectile dysfunction is due to performance anxiety or whether another physical or psychological factor causes it?

To help you answer this question, we’ve enlisted the help of Dr. Michael Stokes, a mental health counselor and an AASECT-certified sex therapist. 

How can you tell if sexual dysfunction is due to performance anxiety?

Men who regularly get morning erections but have difficulty achieving or maintaining an erection with their sexual partners are likelier to have psychological ED. 

The same goes for masturbation—if you can have a strong erection when you masturbate but not with your sexual partner, your erectile problems are probably due to performance anxiety.

Another clue to performance anxiety is if you notice that ED only occurs in certain situations— for example, with a new partner you want to impress. 

Or, if ED comes and goes, popping up when you are dealing with stressful life situations but disappearing when life is going well, it may be psychological. 

On the other hand, organic ED, caused by an underlying medical problem, persists regardless of the situation. 

Why does performance anxiety cause erectile dysfunction?

The link between performance anxiety and erectile dysfunction is physiological. For our ancestors, stumbling upon a lion triggered the “fight or flight,” which is supposed to prepare them for a life-threatening situation. The stress hormones— cortisol and adrenaline— shot up and sparked the sympathetic nervous system, that part of our hard wiring that accelerates our heart and breathing rate to provide much-needed energy to escape with our lives. 

Anxiety triggers the same hormone spikes, but unfortunately, when the stressor is our perceived inability to please our sexual partners, the results are disastrous. 

As stress hormones trigger blood flow to the heart and muscles, it diverts blood away from the penis, making it difficult to get an erection.  This cycle can perpetuate itself. Studies show that panic disorder can closely resemble and trigger sexual performance anxiety.

anxiety cause erectile dysfunction?

Since sexual activity increases heart and breathing rate, it can mimic a life-threatening stressor, causing anxiety or panic in predisposed individuals. 

What causes performance anxiety? 

Typically, performance anxiety stems from negative self-talk. Negative thoughts like, “will I ejaculate too early?”,” Will I be able to get or keep an erection?”, “What if she doesn’t have an orgasm?” What if she’ll leave me or doesn’t want to see me again?” are common in men with performance anxiety. 

When our minds are working overtime, we can’t fully tune into the pleasurable sensations, which are so integral to stimulating our sexual response and for having an erection. 

Of course, it is entirely normal to have difficulty getting an erection occasionally. This can happen once every four times in a man without any psychological or medical problems. 

However, when the stresses of daily life— such as career, relationships, or finances— weigh heavily on your mind, it can be challenging to focus on sexual pleasure or being in the moment. 

It is often enough to experience performance anxiety once to get into the sexual performance anxiety cycle. A single failure to achieve an erection can make some men become preoccupied with thoughts about whether this will happen to them again. This leads to more anxiety and more occurrences of erectile dysfunction.

Sometimes embarrassment around performance anxiety can give men the sense that they alone deal with these issues. This can be especially true when societal norms, locker room talk, or excess porn watching give an unrealistic expectation of “normal” sex. 

How can men overcome sexual performance anxiety?

Luckily, several different solutions can help most men overcome sexual performance anxiety and regain their erectile function:

Talk about it with your partner

While men may feel shame around performance anxiety and not want to talk about it, the silence around unmet expectations only worsens the situation.

overcome sexual performance anxiety

Like the proverbial elephant in the room, embarrassment and anger about performance anxiety can claim important space in your relationship. 

Setting up a time (outside of sex) when you and your partner are willing and able to talk about your sexual relationship can help bring some understanding and space to decrease unnecessarily high expectations.  

Focus on the senses

Another helpful option is to focus on the pleasurable sensations during intimacy rather than the specific goals of achieving or maintaining an erection. 

Focusing on sensual experiences makes it more intuitive for the body to take over and for an erection to occur. Considering experience rather than goals can help men get out of their heads and focus on the pleasures of intimate connection. 

Mindfulness and meditation

Research indicates that meditative practices and mindfulness exercises can be helpful for men dealing with performance anxiety and erectile dysfunction.

Mindfulness and meditation

Clearing your mind of limiting thoughts and visualizing success can help to assuage anxieties. It may be helpful to involve a committed partner in this practice or give yourself time before the sexual activity to use these techniques.  

Talk to a therapist

Finally, some men feeling overwhelmed with performance anxiety may benefit from sexual psychotherapy. 

A therapist can provide resources to help break the cycle of negative self-talk and formalize steps you can take on your own or with your partner to manage the anxiety and get back to enjoying your sexual relationships.

Does Viagra work for performance anxiety?  

Some men may wonder if it is a good idea to take Viagra, Cialis, or other erectile dysfunction medicines for sexual performance anxiety. 

While these medications have been used in psychogenic ED, for example, in men with depression, there is a potential for dependence on the medications for sexual intimacy. 

These medicines directly increase blood flow to the penis, minimizing the effect of performance anxiety, but still require enough sexual stimulation to work. This means that for some men with severe anxiety, Viagra and other medicines may not be enough.  

These medicines have significant side effects and should not be taken without a medical health professional’s guidance.  

What can you do if your partner has performance anxiety? 

Sexual performance anxiety can be challenging for the man’s sexual partners. Shame and secrecy can take a toll on the relationship, and the repercussions often spill outside the bedroom. 

First, understanding whether your partner has performance anxiety versus an underlying medical condition causing ED is important, as the treatments are quite different.  As men who have morning erections or erections when masturbating are more likely to have performance anxiety, this is an important clue. 

As performance anxiety can be wrapped up in a man’s self-esteem and sense of masculinity, it’s essential to have compassion and create an open and non-judgemental space when communicating. 

Refrain from having the conversation during sex and encourage your partner that erections are simply one part of sexual intimacy and highlight other ways or methods that your intimacy needs can be met. With openness, compassion, and patience, sexual performance anxiety can be overcome.  

Is it ED or Performance Anxiety?

Performance anxiety can seem like an insurmountable mountain. Fear of failure is accurate, and when the fear is related to something as fundamental as your ability to get an erection, it can be marred with feelings of shame and hopelessness. 

Yet, sexual performance anxiety is quite common, and there are tried and true methods to not only deal with it but to surmount it. Take action now to rid yourself of performance anxiety!

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