Is Erectile Dysfunction Psychological or Physical?

Male and female laughing and getting intimate
Written by

Content by

Last Updated

Last Updated

The availability of Viagra Connect has seen thousands of men flock to their local pharmacies in search of a solution to their erectile problems. Erectile dysfunction (ED), also known as impotence, is the inability to achieve or maintain an erection firm enough for sexual function. It is reported that erectile dysfunction affects around 4.3 million men in the UK.  In other words, 1 in 5 men in the UK suffer from impotence. But will taking a pill solve your problems in the bedroom? How does Erectile Dysfunction treatment work?
When you are sexually stimulated, nitric oxide is released from the nervous system in your penis. The nitric oxide stimulates the production of a messenger called cGMP. The cGMP allows blood to flow into your penis with ease, causing an erection. An enzyme known as PDE-5 breaks down cGMP, so that it is unable to produce erections. ED treatments work by inhibiting PDE-5, in order to maintain a healthy supply of cGMP, which will cause an erection.


What causes Erectile Dysfunction?

An erection happens when you are physically or mentally aroused. Something you have thought, seen, felt, smelt, or heard, will cause nerves in the brain to send chemical messages, allowing arteries in your penis to open. In turn, the arteries allow for a rush of blood to enter the penis, so that it can expand in shape and size. A disruption to this process can cause erectile dysfunction.
There are several factors that can affect this process and they are best described by splitting into two; physical factors and psychological causes of ED.


Physical causes of ED

  • Conditions that affect blood flow to the penis, such as heart disease, high cholesterol, high blood pressure, diabetes and obesity
  • Medication induced ED, caused by taking medication that affects hormonal balance or blood flow to the penis.
  • Conditions that affect the anatomy of the penis such as Peyronie’s disease (resulting in a bent erect penis)
  • Conditions that affect the hormonal balance such as an overactive or underactive thyroid, and other conditions that decrease the levels of testosterone, the male sex hormone.
  • Conditions affecting the nervous system where the transfer of nerve impulses from the brain to the penis are disrupted, such as multiple sclerosis, Parkinson’s, stroke or spinal injury.


Psychological causes of ED


Low self-esteem and energy levels, two characteristics associated with depression can affect your sex drive. Low motivation and energy levels can make it difficult to become sexually aroused and peak at sexual performance.


A stressful event or period you may be going through will not only influence your mind, but also on your body. Throughout stressful periods, hormones are released into your blood stream, making your body aware that there is a potentially threatening situation ahead. Your mind and body enter a different state, where perhaps sex drops down the priority list.


Both chronic anxiety and acute performance related anxiety can influence your sexual ability. Anxiety in general; and being anxious about performing often mean that you are less likely to do so. When this has happened once, it can have a negative impact on your state of mind, which can have a knock-on effect. If not dealt with, anxiety threatens to take the fun out of many of life’s pleasures.

Relationship problems

It is not uncommon for men to experiencing erectile dysfunction when going through a difficult relationship. Being unable to connect with your partner emotionally can often mean you are unable to connect on a sexual level. Poor communication, arguing and a lack of understanding can change the way you feel towards your partner sexually, meaning you may find it difficult to achieve and maintain an erection.

The cause of Erectile Dysfunction can also be a combination of both physical and psychological factors. For example, a physical issue such as diabetes, high blood pressure or cholesterol can cause poor circulation in the arteries, restricting blood flow to the penis, which may cause you to experience erectile dysfunction. In turn, this can cause you to have anxiety in the future when faced with a potential sexual encounter, which may be another contributing factor to erectile dysfunction.


Will medication help if ED is psychological?

Those who are experiencing erectile dysfunction as a result of physical factors, may find that using ED tablets to treat erectile dysfunction work well. There are several different options available, and it is important to have a conversation with your doctor or pharmacist about which one would be best suited for you. Just remember, what works for others may not necessarily work for you, and if you have not had much luck with one option, there are others available.

Where psychological factors are affecting your ability to get an erection, medication is unlikely to be of any use. This is because most men who are experiencing ED related to psychological factors, have no physical condition that impedes their ability to maintain or achieve an erection. Where psychological factors are playing a part in erectile dysfunction, it is often an issue to do with self-confidence, or your state of mind that prevent you from become sexually aroused. Because erectile dysfunction treatments require sexual stimulation, tablets will not be of any use. Remember, cGMP is the chemical that causes blood to flow into your penis causing an erection, and ED treatments only work to prevent the breakdown of cGMP. In order for cGMP to be available, there needs to be sexual stimulation.

In some cases, where men feel confident that taking a tablet such as Viagra will help, it may be seen as a little extra boost, which can help to take their mind off the fear of failing. This will allow them to relax and enjoy sex. After a few occasions, many find that they regain confidence and learn to stop worrying. At this point, tablets may not necessarily be needed anymore. However, this practise is something that should be discussed with an expert.


Performance Anxiety

Whether it is stress, fatigue, or just an off day, most men will experience erectile dysfunction at some point. Whilst some will see it as a one off and not think much of it, others won’t. Others will worry that it will happen again, which in turn, could affect their next sexual encounter and so on. This fear of not being able to “perform” because of a previous experience may consume your mind and worry you to a point where it has a negative effect on your performance. If the issue is not addressed, it can have a negative effect on your confidence both in and out of the bedroom.


How to overcome psychological ED

The first step to getting over psychological ED is to address the issue. If you are a male in good physical health, there is a high possibility that you are experiencing psychological ED. Whilst it may be difficult, seeing your GP to seek help is important in avoiding the knock-on effect that can affect your sexual function in the long term. Whether it’s relationship problems, anxiety or stress, addressing the issue allows you to then deal with it. It can be a long journey; however, the good news is that psychological ED can be cured without the need to take medication. The key is to be persistent and have patience.


Psychological ED treatment

Your GP can offer advice and refer you to people that can help you to overcome ED. Whilst many men will find it embarrassing to speak to their GP about this matter, the truth is that it won’t be the first time your GP will have dealt with such an issue, and it most certainly won’t be the last.

Your GP may refer you to talk to a psychologist or counsellor to help you overcome and break down any mental barriers that can be causing ED. There are also psychologists and counsellors that specialise in sex therapy. They use conventional and proven exercises and routines that can help to restore sexual function.

Attending couples counselling if you are experiencing problems with your partner can also help break down any barriers in communication and help to revitalise your relationship. Cognitive Behavioural Therapy (trying to change the way you think) is another option which can help you to dispel any negative predictions or distorted beliefs you may have, with the aim of changing the way you think and behave. Whichever aspect of mental health is causing erectile dysfunction, there is help out there and it is important not to give up or lose hope.

Whilst all of our content is written and reviewed by healthcare professionals, it is not intended to be substituted for or used as medical advice. If you have any questions or concerns about your health, please speak to your doctor.