Table of ContentsView AllTable of ContentsStress and SexualityPsychological ED CausesMental and Sexual HealthSeeking TreatmentFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Stress and Sexuality
Psychological ED Causes
Mental and Sexual Health
Seeking Treatment
Frequently Asked Questions
Erectile dysfunction(ED), also known as impotence, is the inability to achieve and maintain an erection long enough for satisfactory sexual activity. Worldwide, ED affects up to 52% of men.However, all men usually experience ED at some point in their lifetime.
Stress can interfere with sexual function and cause ED.This article discusses how stress impacts a person’s physical, mental, and sexual health, along with strategies for managing stress to improve quality of life.
Verywell / Ellen Lindner
The Relationship Between Stress and Sexuality
Stress is part of our biological survival mechanisms.
The stress response, as it is known, is how we respond to real or perceived threats.Two main hormones play a role in the fight or flight response: adrenaline and cortisol.
Prolonged, chronic stress means the hormones designed to keep us from danger begin causing stress-related issues, such ashigh blood pressure, heart disease, and ED.One study highlighted the benefit of stress management for improving ED and how an action plan for managing stress should be part of ED treatment.
Psychological Erectile Dysfunction Causes
Beyond stress, ED has been linked to other mental health disorders.
Anxiety
Anxiety triggers the stress response and can raise heart rates, increase blood pressure, and cause rapid breathing.
Up to 37% of people with ED have also reported anxiety disorders. Researchers think that anxiety alters the functioning of the sympathetic nervous system, which is responsible for the initiation and maintenance of erections.
Abuse, Sexual Trauma, or PTSD
People who have experienced a history of abuse, trauma, orpost-traumatic stress disorder(PTSD) are at a higher risk of experiencing ED.This can make for a greater challenge, because people who have experienced abuse may feel a stigma or shame about disclosing a history of abuse and/or trauma.
While this makes seeking necessary help difficult, it’s important to find a trusted healthcare provider or mental health professional to assist in overcoming the abuse.
Work and Financial Stress
Work or financial problems also cause significant psychological stress. Involuntary job loss and financial distress are significant risk factors for ED. It’s been proven that sexual desire can decrease when a person loses their job or their job is threatened.
Depression
Depressionoccurs from a chemical imbalance of neurotransmitters, such asserotoninanddopamine, in the brain. Several studies have reported an association between erectile dysfunction and elevated levels of depressive symptoms.
While women are twice as likely to be diagnosed with depression, men are four times as likely to die from suicide, which indicates that many men have undiagnosed depression.
Men’s depressive symptoms are different. Their depression is expressed outwardly and may include aggression, irritability, and violent or risky behaviors, resulting in a greater impact on their family. Men who are depressed are less likely to connect positively with their partner and children, and are more likely to be negative and withdrawn.
Help Is AvailableIf you or someone you know are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor.
Help Is Available
If you or someone you know are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor.
A problem with treating depression in people with ED is that the common prescription treatments for depression,selective serotonin reuptake inhibitors (SSRI), can cause low libido or delay in ejaculation. Therefore, men need to let their healthcare provider or mental health counselor know about issues with ED so they can try to prescribe a medication with fewer sexual side effects.
Relationship Issues
When resentment or frustration builds over time in a relationship, these underlying emotions can impact ED.
If you are experiencing relationship challenges, this type of stress does contribute to ED, but it doesn’t mean that ED is your fault or your partner’s fault. It may just mean that the two of you need to find new ways of building connections together.
With sensitive topics like ED, sometimes one or both partners may shut down for fear that talking about it will make it worse. Avoiding the problem might seem like it’s protecting the relationship, but it actually can make the divide worse.
Consider seeking help from a mental health professional or sex therapist for ways to improve your connection.
Sexual Performance Anxiety
Once an episode of ED occurs, it may create a fear that it will happen again. This can cause performance anxiety and pressure to perform.
The brain may perceive ED as a failure. When a man attempts another sexual encounter, both the body and the subconscious mind will limit the man’s arousal and prevent an erection, which causes a cycle of ED.
Many men suffer from sexual performance anxiety when they compare their performance with that of what is seen in adult films (pornography). The desire to emulate what is seen in highly-produced and augmented adult filmsmay lead to performance anxiety and sexual dysfunction.
Tips for Managing Mental and Sexual Health
Stress Reduction
Because chronic stress can cause ED, taking steps to manage and reduce stress can help improve sexual function.
In one study, participants were involved in an eight-week stress management program that included diaphragmatic breathing exercises, progressive muscle relaxation, and supportive meetings with others. The findings showed significant improvement in perceived stress and erectile function scores.
Talk to Your Partner
Talking to your partner is an important part of managing the stress of ED. A trusted partner is ready to help and support you. Discussing it may even help the two of you become closer as you face the challenge as a team.
Sensual vs. Sexual Connection
When it comes to physical intimacy, sexual intercourse is only one part of the experience. Other physical acts, such as touching, caressing, and kissing, can help our brains release oxytocin, the bonding and attachment hormone.
Some options to consider include:
The Mind and Body
Taking care of your mind and body can help improve ED. Consider taking part in exercise, movement, and other engaging activities to keep you active. A healthy heart and blood vessels are directly linked to better erections.
Recreational drug and alcohol use can make ED worse.Limiting your intake of alcohol, nicotine, marijuana, andcaffeinecan help improve ED and stress.
Men are typically taught the importance of self-sufficiency and strength. This can make seeking help especially difficult. However, not getting the help needed for treatable issues such as stress and ED prolongs suffering for both men and their partners.
It’s also important to let your healthcare provider know if you are having ED issues because ED can reveal other medical issues, including cardiovascular problems.
Therapy
Talking to a counselor or therapist is an important part of ED treatment, and has been shown to be more effective when combined with medication than medication alone.
There are many types of mental health professionals, from marriage and family therapists to sex therapists. Consider working with a professional, possibly alongside your partner.
The Different Types of Psychotherapists
Deciding to Get on Medication
When it comes to medication, the focus of treatment may be on the mental health disorder, erectile dysfunction, or both. This is why it’s important to be open with your healthcare provider about all the issues you are facing.
A class of medications calledselective serotonin reuptake inhibitors(SSRIs) are commonly used to treat depression and anxiety. These medications could help treat the anxiety or stress that is causing sexual dysfunction. However, this same type of medication can cause other issues with sexual function, like low libido or delayed ejaculation.
Often, dual therapy may be needed to treat both the mental health disorder and erectile dysfunction. Combination therapy with ED medications, includingPDE-5 inhibitors, such as sildenafil or tadafil, can be beneficial.
Alternative TreatmentsYou may also consider alternative treatments for ED that can help relieve stress. These may include:YogaBreathing exercisesMeditationAcupunctureHerbal supplements
Alternative Treatments
You may also consider alternative treatments for ED that can help relieve stress. These may include:YogaBreathing exercisesMeditationAcupunctureHerbal supplements
You may also consider alternative treatments for ED that can help relieve stress. These may include:
A Word From Verywell
Although talking to your healthcare provider about ED may be uncomfortable at first, it’s an important conversation to have. They can help treat your ED and provide guidance on ways you can reduce stress associated with ED. With treatment, most people can enjoy a healthy and fulfilling sex life as they age.
Sensate focus continues to be one of the best ways to overcome sexual performance anxiety. Sensate focus is about slowing down the experience of sex and moving very slowly with your partner. The focus is on being in the moment, having a sensual experience instead of focusing entirely on orgasm and sexual intercourse. It’s designed to reduce the cycle of performance anxiety.
The most common treatments for stress and sexuality include individual and couples-based cognitive behavioral sex therapy (CBST). Other treatments that may be helpful include group therapy and mindfulness. Several studies found that combining CBST with medications improved ED as well as anxiety, compared to just CBST alone or just the medication alone.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mourikis I, Antoniou M, Matsouka E, et al.Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation.Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-yHarvard Health.Understanding the stress response.Herman JP, McKlveen JM, Ghosal S, et al.Regulation of the hypothalamic-pituitary-adrenocortical stress response.Compr Physiol. 2016;6(2):603-621. doi:10.1002/cphy.c150015Zaman Huri H, Mat Sanusi N, Razack AHA, Mark R.Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction.Patient Prefer Adherence. 2016;(10):807-823. doi:10.2147/PPA.S99544Kalaitzidou I, Venetikou MS, Konstadinidis K, Artemiadis AK, Chrousos G, Darviri C.Stress management and erectile dysfunction: a pilot comparative study.Andrologia. 2014;46(6):698-702. doi:10.1111/and.12129Velurajah R, Brunckhorst O, Waqar M, et al.Erectile dysfunction in patients with anxiety disorders: a systematic review.Int J Impot Res.2021. doi:10.1038/s41443-020-00405-4Gewirtz-Meydan A, Opuda E.The impact of child sexual abuse on men’s sexual function: a systematic review.Trauma Violence Abuse. 2020:1524838020939134. doi:10.1177/1524838020939134Dadomo H, Ponzi D, Nicolini Y, et al.Loss of socio-economic condition and psychogenic erectile dysfunction: the role of temperament and depression.Adaptive Human Behavior and Physiology. 2020;6(1):57-74. doi:10.1007/s40750-019-00125-0Call JB, Shafer K.Gendered manifestations of depression and help seeking among men.Am J Mens Health. 2018;12(1):41-51. doi:10.1177/1557988315623993Adaikan PG. AB022.The psyche of male sexual difficulties related to related to the partner.Transl Androl Urol. 2015;4(Suppl 1):AB022. doi:10.3978/j.issn.2223-4683.2015.s022Park B, Wilson G, Berger J, et al.Is internet pornography causing sexual dysfunctions? A review with clinical reports.Behavioral Sciences. 2016;6(3):17. doi:10.3390/bs6030017Magon N, Kalra S.The orgasmic history of oxytocin: Love, lust, and labor.Indian J Endocr Metab. 2011;15 (Suppl 3):S156-S161. doi:10.4103/2230-8210.84851Avery-Clark C, Weiner L, Adams-Clark AA.Sensate focus for sexual concerns: an updated, critical literature review.Curr Sex Health Rep. 2019;11(2):84-94. doi:10.1007/s11930-019-00197-9Ostfeld RJ, Allen KE, Aspry K, et al.Vasculogenic erectile dysfunction: the impact of diet and lifestyle.Am J Med. 2021;134(3):310-316. doi:10.1016/j.amjmed.2020.09.033Cleveland Clinic.Erectile dysfunction.Burnett AL, Nehra A, Breau RH.Erectile dysfunction: AUA guideline.J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J.Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.Sex Med. 2014;11(6):1376-1391. doi:10.1111/jsm.12520Montejo AL, Montejo L, Baldwin DS.The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management.World Psychiatry. 2018;17(1):3-11. doi:10.1002/wps.20509Atallah S, Haydar A, Jabbour T, Kfoury P, Sader G.The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5inhibitors, for the treatment of erectile dysfunction: a systematic review.Arab Journal of Urology. 2021;19(3):310-322. doi:10.1080/2090598X.2021.1926763
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Mourikis I, Antoniou M, Matsouka E, et al.Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation.Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-yHarvard Health.Understanding the stress response.Herman JP, McKlveen JM, Ghosal S, et al.Regulation of the hypothalamic-pituitary-adrenocortical stress response.Compr Physiol. 2016;6(2):603-621. doi:10.1002/cphy.c150015Zaman Huri H, Mat Sanusi N, Razack AHA, Mark R.Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction.Patient Prefer Adherence. 2016;(10):807-823. doi:10.2147/PPA.S99544Kalaitzidou I, Venetikou MS, Konstadinidis K, Artemiadis AK, Chrousos G, Darviri C.Stress management and erectile dysfunction: a pilot comparative study.Andrologia. 2014;46(6):698-702. doi:10.1111/and.12129Velurajah R, Brunckhorst O, Waqar M, et al.Erectile dysfunction in patients with anxiety disorders: a systematic review.Int J Impot Res.2021. doi:10.1038/s41443-020-00405-4Gewirtz-Meydan A, Opuda E.The impact of child sexual abuse on men’s sexual function: a systematic review.Trauma Violence Abuse. 2020:1524838020939134. doi:10.1177/1524838020939134Dadomo H, Ponzi D, Nicolini Y, et al.Loss of socio-economic condition and psychogenic erectile dysfunction: the role of temperament and depression.Adaptive Human Behavior and Physiology. 2020;6(1):57-74. doi:10.1007/s40750-019-00125-0Call JB, Shafer K.Gendered manifestations of depression and help seeking among men.Am J Mens Health. 2018;12(1):41-51. doi:10.1177/1557988315623993Adaikan PG. AB022.The psyche of male sexual difficulties related to related to the partner.Transl Androl Urol. 2015;4(Suppl 1):AB022. doi:10.3978/j.issn.2223-4683.2015.s022Park B, Wilson G, Berger J, et al.Is internet pornography causing sexual dysfunctions? A review with clinical reports.Behavioral Sciences. 2016;6(3):17. doi:10.3390/bs6030017Magon N, Kalra S.The orgasmic history of oxytocin: Love, lust, and labor.Indian J Endocr Metab. 2011;15 (Suppl 3):S156-S161. doi:10.4103/2230-8210.84851Avery-Clark C, Weiner L, Adams-Clark AA.Sensate focus for sexual concerns: an updated, critical literature review.Curr Sex Health Rep. 2019;11(2):84-94. doi:10.1007/s11930-019-00197-9Ostfeld RJ, Allen KE, Aspry K, et al.Vasculogenic erectile dysfunction: the impact of diet and lifestyle.Am J Med. 2021;134(3):310-316. doi:10.1016/j.amjmed.2020.09.033Cleveland Clinic.Erectile dysfunction.Burnett AL, Nehra A, Breau RH.Erectile dysfunction: AUA guideline.J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J.Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.Sex Med. 2014;11(6):1376-1391. doi:10.1111/jsm.12520Montejo AL, Montejo L, Baldwin DS.The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management.World Psychiatry. 2018;17(1):3-11. doi:10.1002/wps.20509Atallah S, Haydar A, Jabbour T, Kfoury P, Sader G.The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5inhibitors, for the treatment of erectile dysfunction: a systematic review.Arab Journal of Urology. 2021;19(3):310-322. doi:10.1080/2090598X.2021.1926763
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mourikis I, Antoniou M, Matsouka E, et al.Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation.Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-yHarvard Health.Understanding the stress response.Herman JP, McKlveen JM, Ghosal S, et al.Regulation of the hypothalamic-pituitary-adrenocortical stress response.Compr Physiol. 2016;6(2):603-621. doi:10.1002/cphy.c150015Zaman Huri H, Mat Sanusi N, Razack AHA, Mark R.Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction.Patient Prefer Adherence. 2016;(10):807-823. doi:10.2147/PPA.S99544Kalaitzidou I, Venetikou MS, Konstadinidis K, Artemiadis AK, Chrousos G, Darviri C.Stress management and erectile dysfunction: a pilot comparative study.Andrologia. 2014;46(6):698-702. doi:10.1111/and.12129Velurajah R, Brunckhorst O, Waqar M, et al.Erectile dysfunction in patients with anxiety disorders: a systematic review.Int J Impot Res.2021. doi:10.1038/s41443-020-00405-4Gewirtz-Meydan A, Opuda E.The impact of child sexual abuse on men’s sexual function: a systematic review.Trauma Violence Abuse. 2020:1524838020939134. doi:10.1177/1524838020939134Dadomo H, Ponzi D, Nicolini Y, et al.Loss of socio-economic condition and psychogenic erectile dysfunction: the role of temperament and depression.Adaptive Human Behavior and Physiology. 2020;6(1):57-74. doi:10.1007/s40750-019-00125-0Call JB, Shafer K.Gendered manifestations of depression and help seeking among men.Am J Mens Health. 2018;12(1):41-51. doi:10.1177/1557988315623993Adaikan PG. AB022.The psyche of male sexual difficulties related to related to the partner.Transl Androl Urol. 2015;4(Suppl 1):AB022. doi:10.3978/j.issn.2223-4683.2015.s022Park B, Wilson G, Berger J, et al.Is internet pornography causing sexual dysfunctions? A review with clinical reports.Behavioral Sciences. 2016;6(3):17. doi:10.3390/bs6030017Magon N, Kalra S.The orgasmic history of oxytocin: Love, lust, and labor.Indian J Endocr Metab. 2011;15 (Suppl 3):S156-S161. doi:10.4103/2230-8210.84851Avery-Clark C, Weiner L, Adams-Clark AA.Sensate focus for sexual concerns: an updated, critical literature review.Curr Sex Health Rep. 2019;11(2):84-94. doi:10.1007/s11930-019-00197-9Ostfeld RJ, Allen KE, Aspry K, et al.Vasculogenic erectile dysfunction: the impact of diet and lifestyle.Am J Med. 2021;134(3):310-316. doi:10.1016/j.amjmed.2020.09.033Cleveland Clinic.Erectile dysfunction.Burnett AL, Nehra A, Breau RH.Erectile dysfunction: AUA guideline.J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J.Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.Sex Med. 2014;11(6):1376-1391. doi:10.1111/jsm.12520Montejo AL, Montejo L, Baldwin DS.The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management.World Psychiatry. 2018;17(1):3-11. doi:10.1002/wps.20509Atallah S, Haydar A, Jabbour T, Kfoury P, Sader G.The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5inhibitors, for the treatment of erectile dysfunction: a systematic review.Arab Journal of Urology. 2021;19(3):310-322. doi:10.1080/2090598X.2021.1926763
Mourikis I, Antoniou M, Matsouka E, et al.Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation.Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-y
Harvard Health.Understanding the stress response.
Herman JP, McKlveen JM, Ghosal S, et al.Regulation of the hypothalamic-pituitary-adrenocortical stress response.Compr Physiol. 2016;6(2):603-621. doi:10.1002/cphy.c150015
Zaman Huri H, Mat Sanusi N, Razack AHA, Mark R.Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction.Patient Prefer Adherence. 2016;(10):807-823. doi:10.2147/PPA.S99544
Kalaitzidou I, Venetikou MS, Konstadinidis K, Artemiadis AK, Chrousos G, Darviri C.Stress management and erectile dysfunction: a pilot comparative study.Andrologia. 2014;46(6):698-702. doi:10.1111/and.12129
Velurajah R, Brunckhorst O, Waqar M, et al.Erectile dysfunction in patients with anxiety disorders: a systematic review.Int J Impot Res.2021. doi:10.1038/s41443-020-00405-4
Gewirtz-Meydan A, Opuda E.The impact of child sexual abuse on men’s sexual function: a systematic review.Trauma Violence Abuse. 2020:1524838020939134. doi:10.1177/1524838020939134
Dadomo H, Ponzi D, Nicolini Y, et al.Loss of socio-economic condition and psychogenic erectile dysfunction: the role of temperament and depression.Adaptive Human Behavior and Physiology. 2020;6(1):57-74. doi:10.1007/s40750-019-00125-0
Call JB, Shafer K.Gendered manifestations of depression and help seeking among men.Am J Mens Health. 2018;12(1):41-51. doi:10.1177/1557988315623993
Adaikan PG. AB022.The psyche of male sexual difficulties related to related to the partner.Transl Androl Urol. 2015;4(Suppl 1):AB022. doi:10.3978/j.issn.2223-4683.2015.s022
Park B, Wilson G, Berger J, et al.Is internet pornography causing sexual dysfunctions? A review with clinical reports.Behavioral Sciences. 2016;6(3):17. doi:10.3390/bs6030017
Magon N, Kalra S.The orgasmic history of oxytocin: Love, lust, and labor.Indian J Endocr Metab. 2011;15 (Suppl 3):S156-S161. doi:10.4103/2230-8210.84851
Avery-Clark C, Weiner L, Adams-Clark AA.Sensate focus for sexual concerns: an updated, critical literature review.Curr Sex Health Rep. 2019;11(2):84-94. doi:10.1007/s11930-019-00197-9
Ostfeld RJ, Allen KE, Aspry K, et al.Vasculogenic erectile dysfunction: the impact of diet and lifestyle.Am J Med. 2021;134(3):310-316. doi:10.1016/j.amjmed.2020.09.033
Cleveland Clinic.Erectile dysfunction.
Burnett AL, Nehra A, Breau RH.Erectile dysfunction: AUA guideline.J Urol. 2018;200(3):633-641. doi:10.1016/j.juro.2018.05.004.
Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J.Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.Sex Med. 2014;11(6):1376-1391. doi:10.1111/jsm.12520
Montejo AL, Montejo L, Baldwin DS.The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management.World Psychiatry. 2018;17(1):3-11. doi:10.1002/wps.20509
Atallah S, Haydar A, Jabbour T, Kfoury P, Sader G.The effectiveness of psychological interventions alone, or in combination with phosphodiesterase-5inhibitors, for the treatment of erectile dysfunction: a systematic review.Arab Journal of Urology. 2021;19(3):310-322. doi:10.1080/2090598X.2021.1926763
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
