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Can stress and anxiety cause ED?

Erectile dysfunction (ED) affects nearly 20% of men in the U.S., but the link between stress, anxiety, and sexual health isn’t often addressed. Psychological inputs allow the body to achieve erections at a desired time—mental distractions affect that ability.

The sexual response cycle has four main phases: desire, arousal, orgasm, and relaxation. Erectile dysfunction specifically relates to arousal. Feeling anxious or stressed can make it hard to feel or sustain sexual pleasure. There are a lot of misconceptions that erectile dysfunction has something to do with desire, ejaculation, or even climax,” says Ryan Berglund, MD, a urologist at the Glickman Urological & Kidney Institute at Cleveland Clinic. “It is purely the inability to obtain and maintain an erection sufficient for intercourse.” 

Can stress or anxiety cause erectile dysfunction?

“Anything that can lead to anxiety can inhibit the ability to get an erection,” says Dr. Berglund. That includes daily stressors, mental health conditions, and performance anxiety.

Psychogenic erectile dysfunction

When outside stressors and other psychological factors are behind ED, it’s categorized as psychogenic erectile dysfunction. It generally happens in two ways. Anxiety causes a mental distraction, making it challenging to focus on sex. Or, stress can cause an increase in sympathetic nerve activity (think: the fight-or-flight response). 

“Interestingly, the part of the autonomic nervous system that stimulates an erection is the parasympathetic nervous system, which is what is at work when you’re resting or sleeping,” explains Dr. Berglund. Your body’s stress response counteracts the parasympathetic system, which works when you’re at rest. Meaning, it’s nearly impossible to stay aroused when you’re seized with fear and panic. 

Depression and anxiety disorders

There is also an association between depression, anxiety, and erectile dysfunction—likely due to general life dissatisfaction, reduction in sexual desire, or medication side effects, notes Yooni Yi, MD, assistant professor, Department of Urology at Michigan Medicine.

Performance anxiety

Performance anxiety occurs when your attention is focused on negative thoughts or worries about pleasing your partner—rather than the erotic stimulation that causes arousal. It’s a specific type of sexual stress that affects 14% to 25% of men, according to Dr. Yi. Over time, performance anxiety can diminish self-esteem, sexual confidence, and partner communication—and even lead to relationship conflict or resentment. 

RELATED: The ultimate guide to erectile dysfunction

How do you treat erectile dysfunction from stress or anxiety?

Alleviating psychogenic erectile dysfunction or performance anxiety is a process, not a quick-fix. “It is important for the patient to accept this at the start of treatment,” Dr. Yi says. If possible, it is also beneficial for your partner to be involved throughout the process. 

1. Determine the cause.

Often, the cause of erectile dysfunction is multifactorial. In other words, there can often be multiple causes, including changes in blood flow to the penis, altered nerve function, hormones, medications, prior surgery, and psychological factors, says Dr. Yi. 

Situational erectile dysfunction (like being able to get an erection via masturbation, but not with a partner) is a key symptom of psychogenic erectile dysfunction. If the cause is medical in nature, your physician will get a detailed history and perform a physical, possibly including blood work. Morning erections noted at the time of waking up, while one is still having issues with ED with a partner, also point toward psychogenic erectile dysfunction. 

RELATED: Diagnosing erectile dysfunction

2. Reduce triggers.

If you recognize a particular stressor is contributing to performance anxiety or erectile dysfunction, try to avoid those situations. Discussions with your partner—including expectations of erection duration, nervousness about the refractory period, or body insecurities—may help alleviate some of these triggers of stress and ED.

3. Consider medication. 

PDE5 inhibitors (like Viagra, Levitra, and Cialis) can enhance your sexual response, even if you’re experiencing stress or performance anxiety—but they may not get to the root of the issue. “A lot of times when we treat erectile dysfunction, we actually just empirically put the patient on PDE5 inhibitors without necessarily addressing the primary problem,” says Dr. Berglund. “These medications help the ability to obtain and maintain an erection, but it doesn’t address other underlying problems like relationship issues or diminished libido or desire.”

If you’re in a prolonged state of anxiety, a better solution may be to address the underlying psychological problem, with a visit to a mental health professional. In some cases, anxiety-induced ED is treatable with medication. However, certain medications used to treat depression, anxiety, or high blood pressure can also make it difficult to get an erection. Talk to your doctor about your concerns to find the right treatment plan.

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4. Consult a therapist.

If these steps haven’t alleviated the issue, your physician may refer you to a mental health professional or sex therapist. “These sessions can work on exploring barriers, communication techniques, anxiety reduction techniques and adjuncts that will help in overcoming the psychological aspects of erectile dysfunction,” says Dr. Yi.

It can take time to completely eliminate anxiety’s effect in the bedroom, but don’t give up. With the right treatment (and a little persistence), your sex life can return to normal.