What Is Psychogenic Erectile Dysfunction?

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Psychogenic erectile dysfunction is the inability to achieve or maintain an erection during sex due to psychological factors. These factors can include stress and anxiety, depression, guilt, low self-esteem, or relationship concerns. About 40% of erectile dysfunction (ED) cases are considered psychogenic. While erectile dysfunction can affect men at any age, many psychogenic ED cases occur in young men.

This article will discuss the symptoms, causes, diagnosis, and treatment of psychogenic erectile dysfunction.

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Failing to get an erection on occasion is not uncommon or a major cause for concern. But when a person struggles to achieve and maintain an erection during sex at least half of the time, it may be erectile dysfunction.

Symptoms of erectile dysfunction may include:

  • Inability to have an erection
  • Trouble achieving an erection
  • Loss of erection before sex is over
  • Premature or delayed ejaculation
  • Interest in sex, but difficulty performing

It's important to keep in mind that symptoms may vary from person to person. Having awareness of symptoms and how erectile dysfunction impacts sexual performance can help facilitate conversations with a healthcare provider.


Erectile dysfunction can be caused by an underlying medical condition. To determine if erectile dysfunction is psychogenic, a healthcare provider will seek to explore and rule out any medical conditions that could be causing the problem.

After ruling out medical conditions, a physician or mental health professional may want to discuss and evaluate psychological factors that may be impacting a person's sexual function.

Psychological causes that may contribute to erectile dysfunction include:

  • Stress and anxiety: When an individual is anxious or stressed, becoming aroused can be challenging.
  • Performance anxiety: Worries about sexual performance or being able to satisfy a partner can lead to anxiety, which impacts the ability to have and keep an erection.
  • Depression: Depression can cause a lack of interest in activities, which can include sex. Experiencing depression can make it hard to connect with others, including in sexual relationships.
  • Relationship concerns: Conflict in relationships can lead to emotional stress and create distance between partners, which can hinder sexual performance.
  • Feelings of guilt: Whether it's related to past performance, emotional stress, or other issues, guilt can lead to depression and anxiety and ultimately ED.
  • Low self-esteem: This can be related to performance during previous sexual activity and can lead to feelings of inadequacy or shame.
  • Cultural or religious beliefs: A person's attitude towards sex may be influenced by their religious or cultural beliefs.
  • Trauma: A history of sexual abuse or trauma can cause an emotional response during sex and in sexual relationships. Addressing these with a mental health professional is crucial to healing.

Psychological reasons causing a person’s inability to have and maintain an erection during sex are as real and valid as any other medical reason for ED. Working with a healthcare provider or mental health professional can help uncover what psychological factors are at play and how they may be worsening ED.

The Cycle of Psychogenic ED

Psychogenic erectile dysfunction can work in a vicious cycle. Anxiety or depression may precede erectile dysfunction and create problems when a person engages in sexual activity. Or, a person experiencing ED may develop symptoms of anxiety or depression as a result of their dysfunction.


To determine the root cause of any type of ED, speak with a healthcare provider. They will conduct a thorough evaluation, reviewing the person's medical and sexual history, past substance use, and overall health and vital signs.

Healthcare providers may utilize a variety of tests and tools to investigate the cause of ED, including but not limited to:

  • Blood tests: Help identify potential underlying causes that may be contributing to ED, such as heart problems, anemia, or hormonal abnormalities, including testosterone, which is a foundation for erectile dysfunction. These can also check kidney and liver function.
  • Nocturnal penile tumescence (NPT) test: Measures erectile function during sleep.
  • Urine tests: Can look for the presence of diabetes as an underlying condition.
  • Thyroid tests: The thyroid helps regulate sex hormones. A thyroid deficiency could be causing ED.

Once any other medical explanation is ruled out, a mental health professional can be brought in to determine if psychological factors at play. There may be a combination of things causing the ED.

A mental health professional will conduct a psychological evaluation to determine if there is a psychological reason causing or connected to the person's ED.


Psychogenic ED is treated by addressing the psychological factors involved.

The main treatment methods for psychogenic ED include:

  • Psychotherapy: Therapy can help patients identify their thoughts and feelings related to sexual activity and impotence. Through therapy, patients can develop balanced thoughts about themselves, their relationships, and sexual performance.
  • Couples counseling: This can create an opportunity for partners to improve communication about intimacy and sex, examine their sexual relationship, and gain insight and understanding of each other’s sexual functioning.
  • Relaxation techniques: Implementing breathing strategies, meditation, or visualization may promote calm and relaxation.
  • Medication: A healthcare provider may prescribe medication to physically help a patient achieve an erection (e.g., Viagra), or medication for managing psychological symptoms, including antidepressants or anti-anxiety medication.

Treating the Body and Mind

If an individual's ED is caused by both physiological and psychological factors, a healthcare provider may recommend a combination of medication, lifestyle changes, and mental health care to treat ED.

A Word From Verywell

Sexual health and function is an important part of a person's life. ED—whether it's due to psychological factors or not—is a very personal condition. Don't be afraid to seek help and to share your concerns with a healthcare provider. Doing so can help you identify the cause of your ED and create a tailored treatment plan to improve your psychological and sexual well-being.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Cleveland Clinic. Erectile dysfunction.

  3. Rew KT, Heidelbaugh JJ. Erectile dysfunctionAm Fam Physician. 94(10):820-827.

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  5. UpToDate. Patient education: sexual problems in men (beyond the basics).

By Geralyn Dexter, LMHC
Geralyn is passionate about empathetic and evidence-based counseling and developing wellness-related content that empowers and equips others to live authentically and healthily.