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Is Erectile Dysfunction Psychological? Impotence Causes Sexual Anxiety

Impotence Causes Sexual Anxiety In Men Which Can Be Mental, Stress And Performance Problems. Overcome Conditions With Erection Induced Sexual Performance Symptoms.
Shahrokh Shariat, MD
Senior Editor & Writer

Prof. Shariat has published over 1400 scientific papers in peer-reviewed journals. In 2014 he received the Matula Award from the European Society of Urology (EAU), and in 2017 the Gold Cystoscope Award from the American Society of Urology, probably the most important urologist award worldwide.

We’re going to speak of the reasons that are more than physical; they are a psychological part of who we are, our personalities, what we grew up with, or what we are living through now or situational instances. What is our situation is keeping us from being able to climax or for men to have an erection?

Why You Should Trust Me

I spent 30 years as a healthcare provider, seeing ED patients with relationship problems and I have given sex therapy to thousands of men and women about the elements of the intimate relationship and what works for them, and what doesn’t. One of the things that I spend a lot of time listening to people talk about is his issues around having an erectile problem for a fulfilling sexual activity or sex life.

There are a lot of psychological causes that contribute to erectile dysfunction. It is important to differentiate from physical conditions of sexual dysfunction and erectile dysfunction causes and ED symptoms of cardiovascular disease (heart disease), vascular disease, blood pressure, and blood flow.

But today, we will talk a little about ED treatment option for those things that help adjust erectile dysfunction. But, if I can frame this topic in a broader focus than just psychological ED.

People get into relationships, and over time they fall in lust, then they fall in love. When you’re young, and you meet somebody it’s like “I can do this one, that one, and I can do her over there and this one over here!”, You can’t necessarily do it, but you fantasize.

You attend to someone, and that someone energizes you, and you desire someone, and then relationships get habituated, and life intrudes. You have children, or you have house payments, or you have overtime at work, or you have grocery shopping, or you have an argument, and there are so many social blocks, religious blocks, or whatever it may be to having conversations about sexual matters.

I talked to so many people who think that it’s supposed to work, it’s meant to happen, why didn’t it work and why aren’t we both satisfied? How can he or she do this, that or the other?

At some point in those conversations, what I start to hear is people say “Well, I can’t, it doesn’t happen for me, I don’t get an erection, or I can’t keep an erection and I don’t know why.”

The Psychology Of Why This Happens…

We will discuss matters and issues that we are aware of why it happens. And we’re not just going to tell you to eat some wheat bread or something, and you will solve this problem. That’s not what’s involved…

It’s like appetite and people come into a relationship with two different kinds of cravings. Just like everything else, you have to have a compromise, and there has to be an overlap. It’s like the knuckles on a train, where box carts join together- they flex and adapt so you’re able to go over different terrain without breaking apart.

Relationships are like that, and there are examples of siblings who say “Oh, I love all my brothers and sisters equally,” well that’s crap! You don’t!

Sometimes you have a favorite, and over time that preference will change. Just say you’ve got two brothers and Tom’s your favorite, and you don’t like Joel as much. Then all of a sudden you like Joel a lot and Tom ticks you off. So basically, what I’m saying is that the relationship flexes.

The same thing happens with the husband and wife; there are times when you like them and others not so much. From a therapy point of view, one of the worst things you can hear is “I really love you, but I just don’t like you.” I’d rather hear that you like me and you’re hoping that you’ll fall in love with me or stay in love with me because liking is a critical component.

We get busy; we get distracted, we get upset and especially if there’s an imbalance in desire because we don’t have those tools for talking about the fact that there’s an imbalance of desire. You don’t want it as much as I do, you don’t want it as often, you don’t want it in the same way, etc.

There’s a whole lot of literature about arousal and foreplay, invitation and stimulation, and bringing the mind into play which is your most sexual organ into the intimate conversation. The problem is that nobody talks to each other about what they want or what they don’t want!

We expect our partners just to get it. I may be at work thinking about what I want to do tonight, and you’re just supposed to get it? Automatically? We must have been signaling…

It Doesn’t Work Like That!

But, nobody’s taught that and movies tell us different things and our parents don’t talk to us about it (or they do, and we don’t want to hear it from them) and everything seems to confuse us. But, say we have the desire, or we have it bad (women can fake this but men can’t), but with ED a lot of things contribute to that including mental health.

Let’s just say the man gets depressed and doesn’t feel good about himself. It may be chemical depression and may not be related to hormones. It may be in their chemistry in the brain, and it may not even be related to relationship issues. It often is, but other things also cause depression.

Depression in and of itself can be a contributor to sexual satisfaction, sexual arousal, desire, and for men – erectile problems. One of the complications of that is that a lot of antidepressants further inhibit sexual arousal and erectile functioning. It seems like you have to make a choice “do I want erectile dysfunction or do I want to be depressed?”.

Many antidepressants come with this component about the loss of sexual desire and responsiveness, it can happen a couple of different ways, and generally, from my experience, physicians don’t tell you this.

If you’re taking an antidepressant for some time, you may discover that you don’t think about having sex, you don’t get horny, and you don’t become aroused independently. Now, if your partner approaches you, you may be responsive it’s like “oh yeah, I forgot about that, but we can do that!”.

Although, at times in the middle of being responsive, all of a sudden, the chemical switch throws and it’s over. And your partner is going to think your erectile function issue is about them, that they’re not doing it right; they are not doing it the way you want; you don’t love them, they’re not attractive; their overweight; I didn’t get my hair done; should I have fixed steak for dinner, etc.

In their heads, they extrapolate all these possibilities and make it a psychological cause, but they don’t talk to you about it. So when I do marriage counseling, and I know that antidepressants are a component of their lives, I must explain that if this happens, then they need to talk to each other because it’s not a rejection of your partner., it’s psychological ED.

This isn’t about you; it’s about medicine. So, let’s start over, or let’s wait 24 hours and try it again. But, the person who is taking the antidepressant is not likely to be the initiator of the sexual encounter.

Often men give up the antidepressant sexual medicine because it’s ruining their sexual functioning. This leads to them being stressed out even more and with further depressive symptoms and they become hard to live with. There’s no joy in Loversville.

If it is the male that is using the antidepressants, there are ways that we can get around that such as by using erectile dysfunction medication like VigRX Plus, Male Extra, ExtenZe, or ProSolution Plus Pills just to name a few. Or by using prescription sexual medicine such as Viagra or Cialis (but, stay away from these as they come with dangerous side effects). Vacuum pumps are also an option such as the BathMate or Penomet.

This Is A Segue Into Another Issue…

For some men, erectile difficulty occurs because of performance anxiety. I talked to some men, especially younger men who articulate a fantasy about a sexually aggressive woman. “I’m walking down the highway, and a carload of nymphomaniacs stop me and demand that I satisfy all of them and it’s great.” They are trying to find a solution to their erection problem that they don’t have the sexual function and social skills to fulfill… So they fantasize!

In my experience with women who are much more sexually liberated and free with themselves (more than a lot of women are) will come in and say, “I am sexually demanding. Aggressive in asking for or seeking what I want and I find that men are afraid of me and veer away from me, they don’t want that!” So, in reality, they don’t want that they just say they want it. The fantasy is what they wanted.

Sometimes, in situations where you have performance demands or performance expectations, you shut off, it’s a psychological issue. Once a man starts to worry about whether or not he has a penile erection or if his penis is firm enough to be functional then this opportunity is lost because it’s not going to be there.

Don’t Think About It… It’ll Just Happen!

The more you think about it, the more you will get caught in this paradigm where you become your own worst enemy because you thought about it. That’s a whole… Relax… Trust… Be safe mindset, it’s not always a psychogenic ED medical condition.

One of the complementary responses that couples can make is to talk about having an erection, having Vaginal penetration, having orgasms. It’s not the be-all and end-all of sex or intimacy. There are many other ways to have an intimate encounter and achieve sexual satisfaction without premature ejaculation at least that she says “I love you, I cherish you, I want you, I want you to feel good about my loving,” it doesn’t necessarily hang on the hook of an erection.

If couples can embrace that concept and participate in that kind of sharing, the issue of performance anxiety of sexual intercourse will deteriorate. Then the performance will be there. People who have had ED symptoms and sexual dysfunction issues have had their emotional balances so far off that their bodies have forgotten how to love each other because of their hateful, avoidant, and non-responsive behavior.

Now you need to learn to let our bodies learn to care about each other and to be safe with each other. Go home and stop everything, spend 45 minutes paying attention to each other (turn off the TV, shut the door, don’t answer the phone, and don’t worry about dinner being cooked). Spend this time in the physical space of one another, look in their eyes, breathe with them, touch their skin, feel the texture and hug them but DO NOT be sexual!

Don’t sexually touch her, or any places where she may find it arousing, just be in that safe space again physically.

How Does That Work?

Well, most of the time the clients will come in and say that they’ve not been able to manage to do this exercise. They will make excuses and say that they forgot or the children make them busy etc. we keep working with them until they try it, and then they’ll come in, and they will be sheepish and chagrined, “well we tried it, but we ended up having sex.” Uh Oh!

Isn’t that so so sad! We all laugh about it and then discuss what’s the message…

What’s The Lesson Learned…

So much of that is about safety, trust, and intentional intimacy that men, in particular, have to learn. It’s not about “sex as the orgasm.” It’s not about scoring or getting off; it’s about being with this woman in this zone where the focus is on the global experience and not the particular experience.