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Possible causes - Psychological

EPs can be associated with an underlying mental health condition, like depression or anxiety. It can be linked to stressful events; job instability or workload, for example.1 These can include: 2,3

Psychological causes of erection problems

The pressures of everyday life can take their toll on men; with work, financial demands or family commitments all contributing to stress and anxiety.

These issues can distract from sexual stimuli and interfere with arousal that usually triggers an erection via the release of neurotransmitters (nitric oxide [NO], acetylcholine) which cause smooth muscle relaxation and increased blood flow to the penis.

Stress and anxiety

Stress is any demand placed on the brain or physical body. Being under pressure is a normal part of life, but when people become overwhelmed by stress, it can impact both physical and mental health.

Anxiety is a feeling of fear, worry or unease, and can be a reaction to stress. Stress and anxiety can produce physical symptoms (e.g. stomach ache, muscle tension, rapid heartbeat, sweating, difficulty sleeping), and psychological or emotional symptoms (e.g. panic or nervousness, difficulty concentrating, restlessness).

Frequently occurring stress and anxiety, or the feeling of the reaction being out of proportion to the stressor may be signs of an anxiety disorder. People with these disorders may experience uncontrollable worry and feel anxious and stressed daily and for prolonged periods.

In one study, 4 out of 10 men with EPs identified stress, followed by tiredness (36%) and anxiety (29%) as the reason for their erection problems.4

In many cases, it is a vicious cycle where stress is the underlying factor causing anxiety and, in turn, triggering more stress. EPs can also be associated with an underlying anxiety disorder. In a study 23.4% of men suffering from EPs were found to have comorbid anxiety, and in the majority of cases, this was present before the onset of EPs.5

Depression

People suffering from depression can experience a loss of interest in activities they usually enjoy, as well as feelings of sadness, loss, fatigue, anger and a sense of worthlessness.

The severity of depression can range from mild and temporary to severe and ongoing episodes. Depression is considered a serious medical condition that can worsen without proper treatment.

Depression is associated with reduced sexual desire as well as EPs, with evidence that approximately 25% of men with depression may also experience EPs. 6

  • EPs are also associated with the onset or worsening, of depression.
  • Decreased sexual activity and satisfaction can trigger depressive symptoms.
  • Men may also experience feelings of guilt or shame as they are not able to satisfy their partner, both of which are linked to mental health issues such as depression.
  • 21% of men with EPs reported suffering from mental health problems as a result of their erection problems.2

Selective serotonin reuptake inhibitors (SSRIs) and other antidepressant medications can also have adverse effects on sexual function, including EPs.7

Low self-esteem

Men with EPs may have low self-esteem, leading to a lack of confidence and sexual relationship satisfaction.

Low self-esteem can relate to poor body image, such as concerns about being overweight, physical attractiveness or penis size, or worries about sexual abilities.

While self-esteem can be affected by the perceptions of others, it is how someone feels in themselves. If a man with low self-esteem believes that he is not capable of satisfying his partner and has a negative view of himself, this can create negative emotions that lead to EPs. Low self-esteem can also be a sign of other psychological issues such as depression.

References
  1. International Society of Sexual Medicine (ISSM) - https://www.issm.info/sexual-health-qa/how-does-erectile-dysfunction-ed-affect-a-mans-self-esteem/?ref_condition=erectile-dysfunction. Accessed on 21 Jan 2021
     
  2. Nguyen HMT, Gabrielson AT, Hellstrom WJG. Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors. Sex Med Rev. 2017;5(4):508-520. doi:10.1016/j.sxmr.2017.05.004
     
  3. Rastrelli G, Maggi M. Erectile dysfunction in fit and healthy young men: psychological or pathological? Transl Androl Urol. 2017
     
  4. Co-Op Pharmacy Erectile Dysfunction PR survey – Insight & intelligence Atomik Research April 2020
     
  5. Rajkumar RP, Kumaran AK.  Depression and anxiety in men with sexual dysfunction:  a retrospective study.  Comprehensive Psychiatry (2015)
     
  6. Williams K, Refnolds MF.  Sexual Dysfunction in Major Depression.  CNS Spectr. Aug 2006
     
  7. WebMD. Drugs linked to erectile dysfunction. WebMD.com Web site. https://www.webmd.com/erectile-dysfunction/guide/drugs-linked-erectile-dysfunction. Updated September 7, 2017. Accessed November 6, 2018