Psychological Impotence: Diagnosis, Causes, and Treatments

Psychological impotence is a real thing, and it is much more common than you might think. The good news is that there are solutions that can help address the problem.
Psychological Impotence couple

Psychological impotence is more common than you might think

Psychological impotence (also called psychological erectile dysfunction) is a difficult problem to grapple with. Although it isn’t something people enjoy talking about openly, it is more common than you might imagine —and despite what you may think, it is a treatable condition.

What is psychological impotence?

Psychological impotence is a condition caused by psychological factors, in which a man struggles to get or maintain an erection. Stress, depression, guilt, low body image, relationship issues or anxiety—including performance anxiety, could all lead to ED.

Physical impotence, on the other hand, may happen naturally due to ageing or medical conditions that affect genital blood flow.

As such, psychological impotence is not the sort of condition that should be treated by taking a pill — but it can be treated if you address the underlying cause right at the source.

How common is psychological impotence?

Erectile difficulties shouldn’t come as a surprise because they’re fairly common. How common, exactly? The Cambridge Well-Being Institute suggests that as many as 10% to 20% of us have experienced psychological erectile dysfunction at some point in our lives.


20% of men suffer from psychological impotence

Up to 20% of men face the problem of psychological impotence


However, the true number may be even higher than 20%. People who are ashamed may neglect to tell researchers about their embarrassing experiences. This means that psychological impotence is more common than most would think.

Men tend to take their erections for granted, and those who suddenly experience impotence are often shocked when it happens to them for the first time. You could be experiencing no problems in achieving or maintaining erections one day and then suddenly have erectile problems with no obvious explanation the next.

Sex Therapist, Kamil Lewis (MA, LMFT), shares for her experience “Struggling to maintain or achieve erections is incredibly common. There is often an association between masculinity and the quality of an erection, so if ever there comes a time when your body doesn’t experience an erection, it’s likely that you will immediately feel shame or disappointment.

These subsequent feelings tend to compound upon themselves. For instance, the fear or anticipation of not being able to achieve an erection may end up as a self-fulfilling prophecy. Because our bodies don’t always behave exactly how we want them to, psychological impotence happens much more often than we might assume!

Psychological impotence can happen to anyone

Sure, this condition might be common – but isn’t erectile dysfunction a problem that only middle and senior-aged men get? It is true that erectile problems are common in older men. But this study showed that a quarter of all men under the age of 40 experience erectile dysfunction of some kind!

Study shows quarter of men under 40 experienced ED

Psychological erectile dysfunction is a problem that can happen to both younger and older men, regardless of their physical health or sexual experience.

Let’s look at some questions you can ask to work out whether your erectile dysfunction is psychological in nature.

How can you tell if your impotence is physical or psychological?

Behavioral neuroscience researcher and certified sex therapist Dr. Nan Wise explains, “If you rule out medical causes, you can probably attribute ED to psychological factors, especially if you have morning erections, can masturbate, or only experience the ED in certain circumstances.


Do you have morning erections?

It’s always a good idea to consult your family doctor to rule out potential medical causes of erectile dysfunction such as heart disease, hypertension, diabetes, or illnesses that impair nervous system functioning.


Can you get an erection alone while masturbating?

Typically, stress is the culprit. It hijacks the nervous system into flight or fight mode, which is physiologically not conducive to the state of relaxed arousal that is necessary for erection.  Men who get anxious about occasional erection issues can develop performance anxiety that creates a vicious cycle.”

But what else can make a man experience psychological impotence? Let’s explore the most common underlying causes.

Causes of psychological impotence

These are some common psychological factors that can affect your erection by interrupting the signal between your brain and body:

Performance anxiety

People with sexual performance anxiety experience a debilitating fear of failure related to their performance in the bedroom. This might be a matter of worrying about your penis size, ejaculatory control, erectile function or ability to satisfy a partner.

Ironically, the more you worry about these sorts of things, the more likely you are to experience ED. This happens when your fear of failure is so overwhelming that it has a paralyzing effect.

When you’re stressed or anxious, your brain releases stress hormones such as adrenaline and cortisol. These cause your muscles to tense and your heart to beat rapidly. In some cases, it reduces blood flow to your penis which prevents you from having an erection.

These hormones trigger the famed “fight or flight” response. This primes us, physically and mentally, to evade danger. But, when your brain and body are focused on surviving a threat, getting an erection is simply not the sort of physical response that is prioritized!

Depression and ED go Hand-In-Hand

Performance anxiety can be the original cause of ED, or it could be a result of a bad sexual experience. This could be caused by one of the ED factors listed below. The sexual performance anxiety cycle happens when you fail to achieve an erection once and then become so worried about it the next time that you fail again.

Stress and anxiety

We all know what stress feels like – and some of us experience it more often than others. Maybe it’s your job or a difficult life event; maybe it’s conflict at home or financial concerns. Whether you experience chronic stress, occasional worries or even a full-blown anxiety disorder, this is likely to result in psychological impotence. Why?

When your brain and body are concerned about danger, they can’t necessarily be concerned about sex. Like we mentioned earlier, stress hormones are released to the blood stream when we’re stressed. These stress hormones prevent our bodies from achieving an erection.


Depression and ED go Hand-In-Hand

Depression can impact all aspects of your existence. It can feel like an anchor that weighs you down and makes life that much harder to live. Research shows that 75% of people with depression also have problems in the bedroom.

This isn’t all that surprising. When you feel blue and low on energy, it can be extremely difficult to perform at your sexual peak. Furthermore, depression is linked to changes in your brain chemistry and nervous system. Some of these areas also affect your sex drive and ability to have an erection.

This means that depression can change the way your brain works, making psychological ED more likely.

Relationship issues

Is your relationship experiencing troubled times? Well, this can “bleed over” into your sex life!
You may find it hard to have an erection when you’re in conflict with your partner

Dr. Laurie Betito, clinical psychologist with a specialty in sexual wellness explains, “When a couple is experiencing tension, frequent conflict, constant bickering, resentments, etc., the result is a feeling of disconnect.

When a couple feels disconnected, they tend to feel awkward around each other, they do not feel warmth and closeness, and thus they have difficulty being vulnerability with one another.

This directly affects desire for sex. When a person does not feel “safe”, when there is a lack of emotional intimacy, it is often difficult to engage in the intimate act of sex.

Without desire, it is difficult for both men and women to get aroused. For men, however, it is far more obvious as it results in difficulty with erections.

Men have added pressure to perform as they often ascribe to myths that “men should always want sex” and that they are “always willing and able”. These kinds of pressures reinforce the erectile dysfunction.

When there are lots of negative thoughts and feelings occupying the mind, there is little room for the experience of pleasure (and the easy blood flow to the penis).

Pornography dependence/addiction

Excessive Porn Watching Habits May Lead to ED

For some men, a dependence on pornography can cause impotence problems. Particularly when is it used as an aid to masturbation. You may find that you can only get an erection when you’re watching porn.

This is because on a neurochemical level the brain can become “trained” to expect and need pornography for sexual arousal to occur. Aside from that, watching porn can lead you to develop unrealistic expectations about your body and sexual abilities. This, in turn, can cause performance anxiety and psychological ED.

You can learn more about porn-induced erectile dysfunction here.


Guilt is a painful and gut-wrenching emotion. It is identified in this article as one of the possible causes of psychological impotence. If your guilt is strong enough, it interrupts the signals between your brain and body, stopping you from getting an erection. It’s almost as if the unconscious mind punishes you by denying you pleasure in response to the guilt that you feel.

This is often seen in men who are having an affair. They often find that they can’t quite get it up for their illicit mistress – possibly due to the guilt that they feel about being unfaithful. However, guilt can also cause impotence in men who view sex as being shameful for religious or cultural reasons.

Low self-esteem

low self esteem may lead to ED

Low self-esteem and erectile dysfunction feed off one another. One study of Brazilian men showed that 95% of those with ED also had poor self-esteem! While it’s no surprise that erectile dysfunction can cause low self-esteem, did you know that the opposite is also true?

For example, men who start out with a low self-esteem may see themselves as unsexy or inadequate. This can lead to erectile problems in bed. Furthermore, people with a low self-esteem are more vulnerable to experiencing guilt, depression, anxiety and fear of rejection.

All of these factors make psychological ED more likely. Once this happens once, the man’s self-esteem takes yet another blow. He’s then likely to become trapped in a vicious cycle of poor self-worth and ongoing impotence.

Sexual indifference

There are many circumstances that could lead a man to become sexually indifferent. Long-term relationships which become marked by routine, boredom, and conflict represent one major culprit. It shouldn’t come as a surprise that if you’re not really interested in having sex anymore, you’re not likely to have an erection. What’s the brain science behind this?

Thinking about sex creates a burst of dopamine, which is a brain chemical that’s linked to excitement, motivation and pleasure. It also plays a crucial role in helping you to get an erection! In a man who is bored with or indifferent about sex, thinking about the act is unlikely to be accompanied by that dopamine burst, making it likely that the man will experience erectile dysfunction.

Treatment options for psychological impotence

If you think you’re suffering from psychological impotence, don’t lose heart. It’s a common issue that, fortunately can be treated easily. Let’s take a look at some effective options for taking back control.


Practicing mindfulness meditation for about 15 minutes a day can drastically reduce daily stress and anxiety. Not only that, research shown that a specific mindfulness meditation program for ED helped 9 out of 10 men overcome psychological erectile dysfunction.

What’s great about meditation is that other than helping with erectile dysfunction, it is also a fun and calming activity. There are different ways of practicing guided mediation, from in-person groups to apps and online programs.

Certified sex therapist, Angela Skurtu, shares from her experience, “Mindfulness is the practice of being present and in the moment when you engage in various activities. For men who struggle with erectile dysfunction, mindfulness can be a very helpful way to address the problem.

For some men, erectile dysfunction is the result of performance anxiety. Essentially, a man is hyper focusing on his erection and as a result, he is putting a lot of pressure on the sexual situation which then makes it impossible to achieve his erection.

Using mindfulness, men can work on focusing their attention on sexual sensations. A man can use mindfulness to focus on any of his five senses – taste, touch, smell, sound, and sight.

As performance anxiety comes up, the male acknowledges he has anxiety and works to refocus his attention on the things that are sexy or relaxing. For example, he can focus on the sensation of touching his partner’s breasts under his fingertips mindfully.

By refocusing his attention on the things that are sexy and sensations that feel pleasurable, his erection will come naturally as a by-product of engaging in relaxing, sensual activities.

Mindfulness works best if practiced daily. This means practice daily refocusing your attention on the five senses through mindfulness. You acknowledge anxiety is present, but then refocus your attention on the cup of coffee you are drinking. Essentially, you are training yourself to feel your senses fully again.”

Talking to a therapist may help

Although erectile dysfunction is a sensitive subject and a private matter that most men don’t like discussing, speaking with a therapist can be helpful. Also keep in mind that this is a safe space in which you’re protected by confidentiality.

Therapy is a powerful way of targeting any feelings of guilt, shame, anxiety or inadequacy that might underlie your erectile difficulties. Working through your psychological issues or relationship problems with a mental health professional can help to eliminate the effects those issues have on your sexual performance.

Certified sex therapist, Dr. Carli Blau, elaborates, “Penile functioning is often associated with masculinity for many men. When a man’s penis stops working in the way it used to, or in a way that is pleasurable to themselves or their partner, it can make men feel anxious, shame and guilt.

Sex therapy including cognitive behavioral therapy (CBT) and mindfulness can help change unhealthy thinking patterns around sex.

Sex therapy can also help validate a man’s experience with their erectile dysfunction and give them tools to regain functioning in a new way that is pleasurable to both themselves and their partners.

If ED is caused by anxiety or depression, or relationship issues, speaking to a sex therapist can help relieve the stress that is causing the sexual dysfunction to occur.”

Speaking with a Therapist Can Be Helpful for Psychological Erectile Dysfunction

Speaking with a Therapist Can Be Helpful

Consider using guided imagery

Guided imagery therapy has proven very effective in treating psychological impotence. For example, research found that 70% of men treated with Guided Imagery and sexual re-education succeeded in overcoming their mental impotence and were able to get erection whenever they wanted to.

Guided imagery therapy is similar to guided meditation. The client is asked to relax, close his eyes and undergo visualization exercises that allow the mind to reassert control over the body by simply letting go of any unhelpful thoughts or feelings.

Guided imagery can be done with a therapist, or simply by listening to recordings that guide you through the process in the comfort of your own home.

Talk it out with your partner

Communication is key: don’t try to hide your erectile dysfunction from your partner, or avoid discussing it out of embarrassment or shame.

Kate Moyle, Psychosexual Therapist and Host Of The Sexual Wellness Sessions Podcast, shares for her experience, “Struggling with psychological erectile dysfunction can be made worse by assumptions, and assumptions can be broken down by communication as it offers clarity.

This is why communication is key to managing any part of your sex life, but particularly if you are experiencing sexual challenges or difficulties.

Our assumptions about what our partner might be thinking often jump to the worst-case scenario, as where we have an information gap we fill it with our thoughts which often holds a negative and self-criticizing bias.



Talk to your partner

So talking to your partner about what you are going through can help you both to acknowledge, clarify and also help you to both tackle it as a shared problem rather than it being so personalized and focused on you.

This in itself can alleviate pressure which is one of the main causes of psychological erectile dysfunction, and with less pressure and performance anxiety you can get back to focusing on what feels good and pleasurable, which is key to you getting the most out of your physical experience of arousal and desire.“

Re-educate yourself and adjust your expectations

There are a bunch of inaccurate and unhelpful misconceptions about sex that we men fall victim to. Because men expect the impossible from themselves, they often develop performance anxiety due to feelings of inadequacy and guilt. Contrary to what so many of us believe, this is what the latest research is saying:

  • Penis size isn’t actually that important;
  • The majority of women do not have an orgasm during penetrative sex, and this is perfectly okay.
  • Clitoral stimulation is more important than penetration when it comes to satisfying sex.

Sex experts recommend that men with psychological ED re-educate themselves. By doing this, you can start to readjust your unrealistic expectations about yourself. This can reduce anxiety which will help you to take back control of your erectile functioning.

Can Viagra help psychological impotence?

ED medications such as Viagra are not the ideal treatment for men with psychological impotence.

Karen Washington, certified sex therapist explains, “In my clinical observation, Viagra does not consistently solve psychologically induced erectile inconsistency.

The penis owner is not having an issue with blood flow. Until the penis owner can learn to manage the [often] anxiety-based responses they experience, they will continue to encounter uncertainty about sexual encounters.

Depending on how long the person has been dealing with the erectile inconsistency, they likely also perceive increased pressure to “perform” i.e. achieve/maintain erection throughout the sexual experience until climax.

That pressure also contraindicates a successful sexual experience by contributing to/exacerbating the anxiety they experience.”

To sum things up

Today more than ever, science is telling us that the body and mind are closely connected. There is no clearer demonstration of this than psychological erectile dysfunction. Psychological ED is an emotional barometer: it tells you that there are other areas of your life that need your attention.

Don’t ignore the signs that your body is sending – Take action and treat your psychological ED. Talking about it with your partner, seeing a sex therapist, re-educating yourself, and using mindfulness meditation will all help you take back control of your body, mind, and destiny.

About Daniel Sher, MA

Clinical Psychologist and Sex Therapy Expert

Daniel is a registered clinical psychologist and a sex therapy expert practicing in Cape Town, South Africa. He is the creator of the Between Us Clinic’s Performance Anxiety Program, an online mindfulness meditation program for erectile dysfunction.

He 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 also treats patients at his clinic for male sexual dysfunctions including, premature ejaculation, erectile dysfunction and sexual performance anxiety.