What You Can Do About Stress and Erectile Dysfunction

Confronting the psychological causes of ED

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.

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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.

Adrenaline, also known as epinephrine, is produced by the adrenal glands and acts immediately so that we're ready to react to danger. After adrenaline peaks, cortisol is released for several hours. Cortisol keeps us in a less acute but still stressed state until the threat has passed.

Prolonged, chronic stress means the hormones designed to keep us from danger begin causing stress-related issues, such as high 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 men 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.

Chronic anxiety that leads to ED can be compounded by a loss of sexual confidence that can trigger secondary depression.

Abuse, Sexual Trauma, or PTSD

Men who have experienced a history of abuse, trauma, or post-traumatic stress disorder (PTSD) are at a higher risk of experiencing ED. This can make for a greater challenge, because men 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

Depression occurs from a chemical imbalance of neurotransmitters, such as serotonin and dopamine, 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 Available

If you are experiencing thoughts of suicide or self-harm, call 911 immediately or contact the National Suicide Prevention Lifeline at 800-273-8255.

For more mental health resources, see our National Helpline Database.

A problem with treating depression in men with ED is that the common prescription treatments for depression 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 films may lead to performance anxiety and sexual dysfunction.

Tips for Managing Mental and Sexual Health 

ED can affect a man's quality of life by causing issues with confidence and self-image as well as depression. It's important to find what works for you to manage mental health, which may also improve your sexual health. There are strategies you can take advantage of to help improve both.

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:

  • Sensual time: Thinking about sex a little differently may take the pressure off. Sensual things to do together can include taking a shower, incorporating mutual masturbation, or adding sex toys to your sensual experience. Overall, it may help to keep an open mind and explore new ways to be physically intimate.
  • Sensate focus: This sexual technique can help reduce sexual performance anxiety. Sensate focus emphasizes intimacy through touching and communication while taking the pressure off a specific sexual outcome.

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, and caffeine can help improve ED and stress.

Seeking Treatment

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.

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 called selective 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.

Another option would be to focus only on the ED by starting oral medications, such as PDE-5 inhibitors. One study indicated that men with erectile dysfunction and depressive symptoms who were not treated for depression when they began taking a PDE-5 inhibitor noticed a reduction in depressive symptoms, and their relationships improved.

Often, dual therapy may be needed to treat both the mental health disorder and erectile dysfunction. Combination therapy with ED medications, including PDE-5 inhibitors, such as sildenafil or tadafil, can be beneficial.

Alternative Treatments

You may also consider alternative treatments for ED that can help relieve stress. These may include:

  • Yoga
  • Breathing exercises
  • Meditation
  • Acupuncture
  • Herbal supplements

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 men can enjoy a healthy and fulfilling sex life as they age.

Frequently Asked Questions

  • Why is stress a physiological cause of erectile dysfunction?

    Stress seems to inhibit sexual function. This happens because stress works by decreasing levels of sex steroids, reducing sexual motivation and/or desire, and impairing erectile function. In studies, ED is connected to participants' self-reports of high levels of both physical and emotional stress.

  • How do you overcome sexual performance anxiety with ED?

    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.

  • How do therapists help with stress and sexuality?

    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.

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