Can Stress Cause Erectile Dysfunction?

Can stress cause ED? Discover how emotional stress affects erections and how to overcome stress-related erectile dysfunction.

Illustration that depicts a man who suffers from erectile dysfunction due to stress

Can stress and anxiety cause impotence? The short answer is – yes, stress can cause erectile dysfunction! If you have high levels of emotional stress, this can definitely lead to erectile dysfunction.

Ultimately, erectile dysfunction can be caused by a variety of factors. For some, the cause of erectile dysfunction is physical. Health issues such as diabetes, heart disease, high blood pressure, high cholesterol levels, and obesity can cause ED.

At times, however, ED can be caused by psychological factors, such as stress, anxiety, and depression (which we discuss in more detail down below). In fact, experts suggest that 10% to 20% of all erectile dysfunction cases are caused by psychological factors. We call this condition ‘psychological erectile dysfunction‘.

Stress usually causes a temporary form of ED. When stress goes away, erectile dysfunction resolves itself.

Erectile dysfunction is incredibly common. One study estimated that about 18 million men suffer from ED in America alone! In reality, however, the true number is likely far higher, given that us men tend to under-report sexual issues!

The risk for erectile dysfunction increases with age but, younger men are also at risk. According to the Massachusetts Male Aging Study at the age of 40, just under half of all men had ED! So, younger guys certainly aren’t immune – even people who are fit and healthy.

How does stress affect erectile dysfunction?

How does stress affect a man sexually? Both short-term and long-term (chronic) stress can lead to sexual issues such as low sex drive, premature or delayed ejaculation, and erectile dysfunction.

Erections require the body to synchronize a variety of systems: muscular, hormonal, vascular, nerve-based, emotional, and psychological. If there’s a problem in any of these systems, it can result in erectile dysfunction.

Before getting an erection, psychological stimulation happens, which leads to excitement that triggers blood flow to the penis.

Stress has a direct physiological effect on the brain and body. Specifically, stress interrupts the brain signals that the body sends to your penis. It stops the brain from sending signals that redirect the blood flow to the penis which is needed for an erection to happen.

To have an erection, you generally need to be sexually aroused. This causes the sympathetic nervous system to trigger a chain of events that leads to an erection. So, if you’re distracted by a looming deadline or a recent conflict, you’re not likely to get or maintain an erection. If you’re having sex mindlessly, without actually paying attention to the senses and experiences that arise, your chances of experiencing ED are high.

Chronic stress can also lead to low testosterone, which in turn is associated with erectile dysfunction. Moreover, stress can lead to a lack of sleep that can cause erectile dysfunction in and of itself.

Sex performance anxiety and the cycle of ED

Stress and anxiety about erectile dysfunction and sexual performance can lead to performance anxiety. People with sexual performance anxiety have excessive worries about their ability to perform sexually. At times, a single occurrence of erectile dysfunction – which may be triggered by stress – is enough to set in motion a vicious cycle of ED, stress and anxiety.

When this happens, you become increasingly anxious about your ability to perform. This, in turn, creates a self-fulfilling prophecy in which your anxiety makes it harder to achieve an erection, which then makes you more anxious!

Stress and anxiety are a part of a natural biological mechanism, sometimes referred to as the “fight-or-flight response”. When you are in a state of acute stress or anxiety, the body increases the production of adrenaline, which sets in motion a series of events with the goal of protecting you from danger. One thing that happens is the redirection of blood from non-essential organs (such as the penis) to essential organs such as the hands and back. When this happens, you are unable to get or maintain an erection.

an illustration of the sexual performance anxiety cycle

Depression

Depression can cause erectile dysfunction. Usually, stress causes temporary ED; but if you have chronic stress, you are more likely to develop depression as well. Both stress and depression affect erections and can lead to what seems like permanent ED. Erectile dysfunction can also lead to low confidence, self-esteem issues, irritability and other mental health problems which in turn can lead to depression which will only worsen ED.

Anxiety

Anxiety can also cause erectile dysfunction. People with chronic stress or anxiety disorders have higher levels of cortisol (a hormone which is involved in the fight-or-flight response) in their blood stream. As a result, they have a higher chance of experiencing erectile dysfunction.

Sources of stress that can lead to erectile dysfunction

Here is a list of common stressors that may lead to stress induced ED dysfunction:

  • Work stress
  • Financial stress
  • Performance anxiety
  • Depression
  • General anxiety
  • Relationship issues and conflicts
  • Losing a loved one
  • Confrontations
  • Deadlines
  • Parenting
  • Retirement and other significant lifestyle changes
  • Excessive alcohol or drug use
  • Consuming too much caffeine
  • Post-traumatic stress disorder
  • Mental illness

How to treat erectile dysfunction due to stress?

Fortunately, stress related ED can be treated with good results. Is there a simple trick to cure ED? Some men will find that using one of the techniques listed below can help them overcome ED quickly, while other may need a little but more help.

Learning to overcome nervousness and becoming more relaxed is usually enough to fix the issue. Let’s take a look at some methods for treating stress-induced erectile dysfunction:

1. Mindfulness Meditation

Mindfulness meditation is one of the latest treatments for erectile dysfunction. Although it is not a new technique, in recent years it has been studied and developed as a therapeutic tool for stress reduction, erectile dysfunction and other sexual issues. In fact, a recent 2018 study showed it to be very effective in treating men with situational erectile dysfunction.

“Much of our anxiety and stress resides in the past and the future; either ruminating over things that have happened or will happen. Mindfulness is essentially bringing awareness to the present moment, the moment we are actually in.

Mindfulness can help stress-induced erectile dysfunction in two ways: as long term practice to reduce overall life stress levels, and more acutely in the moments of sexual activity.

Evidence-based programs like Mindfulness Based Stress Reduction (MBSR) have been profoundly successful at reducing overall stress levels. High levels of stress impact the body’s ability to function. By learning mindfulness skills, our brain sends messages to the body that it can relax, and thus when it is time for sexual engagement, an erection is more possible.

Learning mindfulness skills can also help in the moment of sexual activity. If someone notices their mind is racing with worries about sexual performance or the ability to get an erection, the body will react and impede on the ability to actually obtain that erection.

Mindfulness skills, like slowing down the breath, can help return us to the present moment, regulate the body’s nervous system, and prime the body for enjoyable sex.”

Julia Simone Fogelson, Psychotherapist, Sex Therapist

Yoga for erectile dysfunction is another mindfulness technique that can help with stress reducing while also helping you become more physical active.

2. Talk to your partner

In many cases, simply talking with your partner about ED will take off some of the pressure you are carrying with you. A partner who knows you might help you understand where the stress is coming from. It could also help bring you closer together.

How to talk to your partner about ED? Ideally you should find time for an honest conversation outside the bedroom, when you both have time and will not be disturbed.

3. Manage sources of stress

Try to identify the areas in your life that cause you a lot of stress that may lead to erectile dysfunction. If for example troubles at work are causing you emotional stress and ED, think about what changes you could make. Instead of trying to “contain” stress, address the issue at its source.

4. Exercise regularly

Exercising has been shown to reduce stress, improve erectile function and mental health.

5. Make lifestyle changes

There are a few lifestyle choices which contribute to both stress and erectile dysfunction. These include smoking, unhealthy diet, excessive alcohol drinking, and illegal drug use. Too much caffeine can lead to increased stress. Although caffeine has been thought to help physical ED by improving blood flow, it may lead to stress-induced ED.

6. Therapy

If you feel like you need more help, working with a therapist can help. A therapist can work with you on identifying the sources of stress, explain how they relate to erectile dysfunction, and give you tools and techniques to deal with them. A therapist will assist you in developing a more balanced and healthy approach towards stress and sexual performance.

If you have problems in your relationship, a relationship counselor might be a better choice. And if stress and anxiety revolve specially around sex, it can be best to speak to a sex therapist.

7. Medication

Although this shouldn’t be the first line of treatment, medication can help. Anti-depressants and anti-anxiety medications can help reduce stress levels and by that help the erectile issues. The problem is that some of these medications have negative sexual side effects. For example, a common antidepressant named Zoloft can cause erectile dysfunction.

Can ED medications such as Viagra help stress induced erectile dysfunction? Not always. ED medications improve blood flow, but if you are not getting sexually aroused because of stress (which is usually the case) then medication would not work.

It is always better to treat the root cause of the issue when there isn’t a physical issue that forces us to use medications.

When to see a doctor?

If you’re not sure whether ED is due to stress or not, consult with your doctor. Your GP can run a test to make sure there isn’t a physical issue that is affecting your erection.

Erectile dysfunction stress test

If you’re having erectile issues despite being young and physically healthy, it’s likely that your ED is caused by psychological factors. Nonetheless, young men can also be affected by physical erectile dysfunction and older men can also experience stress-induced ED.

Dr. Rowland Rees, urological surgeon and andrologist at London Men’s Clinic explains some of the key features that may suggest that your ED might be caused by stress:

  1. “Situational ED: where the ED is worse in some situations (e.g., with a partner) than others (e.g., masturbation)
  2. Intermittent symptoms
  3. Preservation of night-time or early-morning erections
  4. A more abrupt onset, perhaps after a stressful event
  5. Associated other anxiety symptoms or psychological history

The important thing to remember is that in ‘psychogenic’ ED, the necessary physical components such as nerves, blood vessels and muscles are all present and intact, but it is the signaling from the brain that is preventing full erection.”

If you’re still worried, consult with your doctor. Your GP can prescribe a device that is used to measure nocturnal erections while you sleep. This test is called nocturnal penile tumescence (NPT) stamp test and the device that is used is called RigiScan.

De-stress for a better sex life

Stress: we’ve all experienced it and we’ve all heard about the possible negative consequences of a high-stress lifestyle for our physical health. What many people underestimate, however, is the extent to which stress can negatively affect our relationships, sex lives and overall wellbeing!

Stress is a common cause of erectile dysfunction and a host of other physical, emotional and sexual issues. Fortunately, stress can be managed. So, don’t forget to take a deep breath, keep calm and allow yourself to experience your full sexual potential!

About Daniel Sher, MA

Clinical Psychologist and Sex Therapy Expert

Daniel Sher is a registered clinical psychologist and a sex therapy expert practicing in Cape Town, South Africa. Daniel gained his master’s degree in clinical psychology from the University of Cape Town (UCT) in 2014. A component of his training and practice involves working in the context of sexual and sex-related issues.

Daniel is a professional consultant for the Between Us Clinic, where he writes, edits, and reviews, professional materials and articles. He also treats patients at his clinic for male sexual dysfunctions including, premature ejaculation, erectile dysfunction and sexual performance anxiety.