Erectile Dysfunction and Low Libido – Causes and Treatments

Exploring the connection between low libido and erectile dysfunction, and reviewing recommended treatments

Man who suffers from both low libido and erectile dysfunction, sitting on the bed, looking concerned

Erectile dysfunction and low libido are two common sexual issues that are highly connected. Erectile dysfunction, and concerns about erections, are a direct and significant risk factor for low libido.  Likewise, it is estimated that about 1 in 4 men with low libido also has erectile dysfunction.

In this article, we’ll explore the connection between low libido and erectile dysfunction, and recommend a few treatment options based on your specific case.

Can low libido cause erectile dysfunction?

Yes, low libido can cause erectile dysfunction. Libido, or desire, is the initial stage in the sexual response cycle. Therefore, if you have low libido, it is very likely that you will experience erectile dysfunction when attempting to have sex without the matching desire.

One model of the typical male sexual response process consists of four stages:

  • Desire— Before achieving a physical erection, psychological or physical stimulation triggers excitement, making men open to sex.
  • Excitement or arousal— Physical erection occurs, reaching its peak (or plateau). Men may notice an increased heart rate, blood pressure, and breathing.
  • Orgasm— This marks the peak of sexual pleasure and often includes ejaculation (though not always).
  • Resolution— The body and penis return to their normal state. Men also experience a normal refractory period, making it impossible to achieve another erection immediately.

A disruption at any stage can lead to sudden erectile dysfunction. In cases of low libido, the process is stopped at the first stage, making it challenging or impossible to achieve an erection.

It’s important to note that having low desire doesn’t necessarily mean a complete lack of interest in sex. In many cases, an erection can still occur when the man does have the desire to have sex.

Does erectile dysfunction cause low libido?

The frustration of experiencing erectile dysfunction can eventually lead to low libido in men. If you’ve experienced erectile dysfunction, you know how frustrating this can be. It’s no wonder that men with ED sometimes lose the desire to have sex.

Research shows that men with a lack of confidence in their ability to have an erection are much more likely to have low libidos.

A vicious cycle in which ED causes low libido, which in turn worsens ED can often be created.

Issues that cause both low libido and erectile dysfunction

There are a few issues that can contribute to both erectile dysfunction and low libido. If you’re experiencing both of these conditions simultaneously, these factors may be worth considering.

  1. Stress: Specifically, work-related stress and fatigue are among the most common causes of low libido. Stress can also hinder the brain from sending signals that redirect blood flow to the penis, which is necessary for an erection to occur.
  2. Performance Anxiety: Approximately 40% of men with low libido also experience anxiety before sex, a rate about 2.5 times higher than men without low libido. In research, men who felt insecure about their ability to have an erection were 4.9 times more likely to suffer from low libido. Performance anxiety is also the leading psychological cause of erectile dysfunction. Therefore, experiencing performance anxiety puts you at risk of both ED and low libido.
  3. Depression: Depression is another psychological condition associated with both low libido and erectile dysfunction.
  4. Low Testosterone: While research suggests that medical conditions are usually not the primary cause of low libido in men, there are cases where they play a role. Studies show a higher frequency of low libido in men with low testosterone. Although low testosterone itself rarely causes ED, it can contribute significantly if you have other medical conditions that cause ED. Low testosterone is also linked to type 2 diabetes and heart disease, both of which can lead to erectile dysfunction.
  5. Medication Side Effects: Most antidepressants, antipsychotics, and psychiatric medications can have sexual side effects, including both low libido and erectile dysfunction.

How do you fix low libido and erectile dysfunction?

If low libido is caused by the frustration of erectile dysfunction, we recommend that you treat erectile dysfunction first. In many cases, after treating erectile dysfunction, the low libido issue will resolve on its own.

If erectile dysfunction is the result of low libido, it is better to treat low libido first. Sometimes, having more desire to have sex will make it much easier to have more frequent and stronger erections.

Generally speaking, keeping yourself physically and mentally healthy is the best way to prevent both low libido and erectile dysfunction!

Treating erectile dysfunction

In cases when erectile dysfunction is the original sexual issue, you’ll need to explore whether the issue is physical or psychological. If you can have erections in a stress-free environment, while masturbating, or if you have morning erections, then the problem is probably psychological.

If it’s hard for you to have an erection in any situation, or if you have other medical conditions that can contribute to erectile dysfunction, the problem might be physical, and we recommend seeing a doctor.

Psychological erectile dysfunction

As mentioned earlier, stress, performance anxiety, and depression are the leading psychological causes of erectile dysfunction and low libido.

The reason is that when your mind is preoccupied with negative thoughts during sex, it blocks arousal, preventing an erection. When you’re aroused, your brain signals the body to send blood to the penis, causing an erection. If you’re too distracted to become aroused enough, an erection will not happen.

One technique we love recommending to our patients is mindfulness meditation. This technique teaches us how to anchor our experience to the present moment, avoiding distractions and being non-judgmental of our thoughts.  

By staying focused on the sexual experience, distractions are reduced, and erections happen without interruption.

A recent study showed that 9 out of 10 men who practiced mindfulness meditation for 4 weeks were able to regain their erections.

For men dealing with psychological ED, we’ve created the Performance Anxiety Program—an online mindfulness meditation course.

A few other recommended therapeutic techniques that can help with erectile dysfunction and low libido caused by stress, anxiety, and depression include guided imagery, cognitive-behavioral therapy, and in-person sex therapy.

Physiological erectile dysfunction

Physiological erectile dysfunction can be addressed through various treatment options.

If the main issue is limited blood flow to the penis, oral medications, primarily phosphodiesterase-5 (PDE5) inhibitors, serve as a primary line of defence. Medications like Viagra®, Cialis®, Levitra®, and Stendra® enhance nitric oxide levels in penile blood vessels, facilitating improved blood flow for stronger erections.

If oral medications don’t work, penile injections offer an alternative. Given before sex, these injections produce satisfying results for about 90% of men, although with some initial pain or bruising. It’s crucial to consult a doctor for proper training in injection techniques and be vigilant for the rare occurrence of priapism.

Vacuum devices, which use suction to help get an erection, are another choice. While they might change the way an erection feels a bit, many men say they have good results. These devices work well if you’re in a steady relationship since they may make things a bit less spontaneous.

For those with more severe cases, surgical options such as penile implants can be considered. A urologist should assess the patient’s suitability for surgery, and success rates are generally high, leading to high levels of satisfaction.

It’s crucial to check the medications you’re taking to see if they might be causing erectile issues. Some medicines, like cimetidine, SSRI antidepressants, and certain blood pressure medications, can lead to erectile dysfunction. Trying different medications could sometimes help fix ED caused by these side effects.

ED can be a result of other medical issues such as high blood pressure, diabetes, obesity, high cholesterol levels, Parkinson’s disease, and multiple sclerosis. Treating these contributing issues can help resolve ED and, therefore, also low libido.

Making lifestyle changes, such as stopping smoking, drinking less alcohol, exercising, losing weight, and improving your diet, has been shown to be as effective as ED medications.

Treating low libido

Low libido is a complex problem that can happen for different reasons. When dealing with low libido in men, it’s important to consider what’s really causing it.

If low libido has been lifelong, meaning you’ve always had low libido, hormonal issues or developmental factors could be more likely. In that case, speaking to a medical doctor or a sex therapist is recommended. Lifelong low libido is very rare, with estimates suggesting it affects less than 2% of men.

If low libido is acquired, meaning it has started suddenly, a good idea is to examine what changed in your life during this time. Acquired low libido is much more common than lifelong low libido.

The most common causes of acquired low libido in men are psychological in nature and have to do with stress, performance anxiety, negative self-talk, and relationship conflicts. These issues create barriers that prevent sexual desire from organically appearing.

Mindfulness meditation

A few studies have shown a relationship between men’s natural tendency to be mindful in daily life and low libido. Mindfulness means being completely in the moment, fully engaged without passing judgment. It’s about paying attention to your thoughts, feelings, and what’s happening around you in a calm and accepting way, without reacting hastily.

The studies showed that having low levels of mindfulness leads to fewer automatic sexual thoughts. By improving your ability to be mindful, you can increase your sexual desire.

Learning to be more mindful can also eliminate automatic negative thoughts, which can often occur if you have high levels of stress, anxiety, or depression.

Our Performance Anxiety Program, an online course for men who suffer from psychological erectile dysfunction, can help you remove negative thoughts surrounding sex and improve your overall mindfulness levels.

Therapy

A therapist can help you deal with issues of stress, anxiety, depression and unhelpful sexual beliefs that lead to low libido. A therapist can choose from a number of therapeutic techniques, such as cognitive behavioral therapy, talk therapy, sensate focus, mindfulness based therapy, relaxation techniques, etc.

The upside of seeing a therapist, as opposed to self-help techniques, is that they can tailor the treatment protocol to your specific needs. Since therapy is more expensive and time consuming, it is usually a better option for men who experience more complicated cases of low libido.

culties we can sometimes automatically fix sexual performance anxiety.

Man having online telehealth consultation with a sex therapist
If you need professional advice, our highly trained sex therapists are here to support you.

Relationship counseling

Resolving conflicts in your relationship can also help improve libido. Conflicts in the relationship serve as turn-offs, which, over time, can diminish sexual desire. When you’re angry at your partner, it makes sense that you’ll be less likely to want to have sex with them.

Over time, a vicious cycle of guilt, blame, alienation, and avoidance can occur. Seeking the assistance of a relationship counselor can help resolve many of the conflicts that hurt your relationship and ultimately lead to libido issues.

Medication side effects

Sometimes, switching medications that have a side effect of low libido can quickly fix the issue. Medications, such as antidepressants, antipsychotics, and psychiatric medications can often lead to low libido.

Low testosterone and hormonal issues

Testosterone replacement therapy has been shown to be effective in helping improve libido and erectile dysfunction, but only in  hypogonadal cases – those diagnosed with low testosterone levels.

Lifestyle changes, such as discontinuing alcohol, drug use, and smoking, as well as reducing stress, exercising, and maintaining a healthy diet, can also enhance testosterone levels.

It’s important to note that only about one in three men with low testosterone levels complains about low libido. This means that just having low testosterone doesn’t necessarily lead to experiencing low libido or erection problems.

If you suspect that you have low testosterone, it is best to consult a doctor. If you don’t have low testosterone, taking actions to increase your testosterone levels will likely not help.

Summary

Low libido and erectile dysfunction are two very common sexual dysfunctions that can often co-occur and even lead to one another. Treating the root issue, whether it’s low libido or erectile dysfunction, can often help resolve the second issue.

When both low libido and erectile dysfunction co-occur, it makes sense to suspect the issue is psychological. In that case, mindfulness meditation can be a great self-help tool that addresses both issues. In more complicated cases, in-person therapy may be a better option.

If there are medical conditions involved, consulting a doctor is a good idea. Sometimes, simply switching medications can resolve both ED and low libido, but at other times, medical interventions are necessary.

In all cases, it’s important to remember that both low libido and ED can be treated successfully. There’s no need to suffer in silence. Take action today to improve your sex life.

About Bailey Hanek PsyD

Clinical Psychologist and Certified Sex Therapist

Dr. Bailey Hanek is a clinical psychologist and an AASECT-certified sex therapist. She serves as a professional consultant for Between Us Clinic. Dr. Hanek provides sex therapy and general psychotherapy to adults in her private practice. In addition, she works to increase access to information about relationship and sexual health through her founding role in The Relationship Coaches.