Psychological Causes of Poor Sexual Performance

It Really Might be All in Your Head


The psychological factors in erectile dysfunction

The good news about what’s sometimes referred to as psychological erectile dysfunction is that it’s treatable. The other side of that coin is far too many men would rather suffer with ED than follow through with treatment plans. Embarrassment may be a factor – but the only thing that’s actually odd about ED is how common it really is.

In 2007, a Johns Hopkins Bloomberg School of Public Health study reported that 18 million men in the United States alone faced difficulties having or maintaining an erection. And as many as 20% of all cases of ED each year are psychologically-based.

Psychological impotence defined

The first things to rule out when diagnosing ED are physical problems. Heart conditions, obesity, diabetes, and medications are known to cause impotence. For those who are otherwise healthy but having trouble with erectile function, psychological factors need to be considered.

While self-diagnosis is never a great idea, arming yourself with a self-assessment before seeking help can give your doctor a head start. If you’re able to have an erection while alone or you have consistent morning erections, then it’s unlikely the problem is “mechanical.”

Causes of psychological ED

Psychological impotence isn’t necessarily rooted in one issue. While experiences such as sexual abuse or trauma are more readily identified as culprits, other common causes may be more subtle.

  • Depression makes life bland and tiresome. If sex is even of interest, becoming aroused enough to produce an erection may be challenging. One study concluded that, “the relationship between depressive symptoms and MED (male erectile dysfunction) in middle-aged men is robust and independent of important aging and para-aging confounders…”
  • The hormones associated with stress shift your sympathetic nervous system into fight or flight mode. When you’re stressed, sex might be the furthest thing from your mind, thereby making an erection difficult.
  • Performance anxiety. This is tied to stress, of course. Being worried about delivering a respectable performance is sometimes a self-fulfilling prophecy. Whether it’s based on negative past experiences or just trying to impress a new partner, the fear of failure can make men too self-conscious to perform.
  • Relationship problems, pornography addiction, and all of the previously listed causes can make having sex seem uninteresting. Sex drive is certainly a physical response – but the mental aspects directly impact the physical ones, and they are powerful in their own right.

Treatment options

When ED becomes persistent enough to prevent an erection on a consistent basis, doctors typically recommend treatment. Treatment is also advisable when erectile difficulties cause relationship problems.

For men experiencing psychological ED, popular pharmaceuticals such as Viagra and Cialis typically aren’t effective. The mind is the key:

  • Sometimes, talking about your problem is the best way to address it. Therapists can help men understand relationship problems, anxiety, and other psychological factors behind ED.
  • Guided imagery. One form of psychological therapy involves visualization. Treatment involves patients, either with the help of a therapist or audio recordings, relaxing with their eyes closed while they engage in positive visualization exercises.
  • Sweeping ED under the rug is a sure-fire way to compound the psychological factors behind it. Talk with your partner about your problem. Communication will help them understand this issue and perhaps alleviate some of the stress that might be working against an erection. Also, do not hesitate to communicate with your doctor.

When it’s time to play detective

Erectile dysfunction can be complicated. It’s not always as simple as psychological versus physiological. Things such as poor sleeping habits, diet – even how well you clean your teeth – can contribute to ED. And once a physical issue tanks performance, it can lead to anxiety and other psychological problems.

If you’d like to learn more about some of the hidden causes of ED, check out our blog: “Headaches, Biking, Snoring, and Other Surprising Causes of ED”.

Alvaro Ocampo M.D.

Dr. Ocampo is an expert physician specializing in anti-aging, hormone therapy, pathology and environmental medicine. He received his medical degree from Columbia State Medical School in Montreal, Canada. Dr. Ocampo’s comprehensive medical experience includes working as medical officer for the U.S. Public Health Service and C.D.C, National Institute for Occupational Health, medical director for the U.S. Public Health Service, and as a Principal Investigator for American Pharmaceutical Companies.