Psychological Erectile Dysfunction and Performance Anxiety - UK Treatment Guide

Erectile dysfunction (ED) is a common condition where men are unable to achieve or sustain an erection that’s firm enough for sex. Although it can be caused by a variety of physical things, psychological factors are a big contributor.

While ED becomes more common as men get older, many younger men experience ED. In fact, some studies suggest that around 35% of men under 40 have ED. Psychological erectile dysfunction is the most frequent type in younger men.

This common condition can knock your confidence or even affect your relationships, but there are several effective treatment options that can help. In this article, we’ll explore psychological ED, including what causes it, how to break the cycle, and the role of ED medication.

What Is Psychological Erectile Dysfunction?

Psychological erectile dysfunction is when a man finds it difficult to get an erection due to emotional or psychological factors. It’s the most common cause of erectile dysfunction for young men in their 20s, 30s, and 40s but can also impact older men.

It can be very stressful, worrying, or even upsetting when your body doesn’t respond in the way you expect it to. Many men find it hard to understand why they’re unable to get an erection when they feel turned on or interested in sex, or why they lose their erection during sex when they’re enjoying it.

Psychological ED is a complex condition. Stress, anxiety, relationship problems, mental health disorders, and/or lack of confidence can all contribute – you may even find it hard to work out exactly why you’re experiencing this issue at all.

Some men lose confidence after experiencing erectile dysfunction which can start a vicious cycle of anxiety around ED and sex. However, as with erectile dysfunction caused by physical issues, there are several treatments that can help.

Psychological vs Physical ED: How to Tell the Difference

Erectile dysfunction can be physical, psychological, or a combination of the two. But how do you tell the difference?

Psychological ED is more likely to happen suddenly while you’ll probably notice the symptoms of physical ED start gradually as the cause of ED develops. Often, psychological ED begins after a stressful event.

Physical ED usually occurs more consistently. This can mean having difficulty getting an erection most or all of the time, including when masturbating or first thing in the morning.

With psychological ED, you may not struggle to get an erection when alone but typically have issues when with a partner. The symptoms can also come and go, with you able to get an erection with a partner sometimes but struggling at other times.

Having physical ED can cause stress and performance anxiety around sex which can add an extra psychological element. In this way, there’s some overlap with the two types of ED.

What Causes Performance Anxiety in the Bedroom?

Performance anxiety is a specific type of psychological erectile dysfunction. It happens when a man feels anxiety and pressure to perform sexually and the fear of failure can prevent arousal.

When a man feels stressed about performing, it can activate the fight-or-flight stress response. This spikes adrenaline levels which diverts blood flow to the muscles and away from the penis, making it physically harder to get an erection.

Often when a man is alone and isn’t experiencing the same pressure, the performance anxiety disappears and he’s able to get an erection. This means men with performance anxiety often have no issues with getting hard when masturbating.

Lots of different factors feed into performance anxiety including:

• Self-esteem and body image (including worries around penis size)

• Previous negative sexual experiences

• Ideas about gender roles/masculinity

• Relationship problems or dynamics

• Mental health issues

• Life stress

• Unrealistic expectations (often from watching pornography)

The Anxiety-ED Cycle: How It Perpetuates

We know that feeling anxious about sex and getting an erection can cause performance anxiety, but some men get stuck in an anxiety-ED cycle.

It’s normal for every man to have issues getting an erection sometimes, but for some men, just one bad experience can be enough to trigger performance anxiety. There may not be any underlying problem, but when a man feels stressed about whether he’ll be able to get an erection he can become his own worst enemy.

This stress and anxiety can trigger the fight-or-flight response, making it physically more difficult to achieve an erection.

Once a man is unable to get an erection again, he might then believe he will now always struggle with erections. He may now get stressed every time he’s in a sexual situation, and the anxiety will continue to make it difficult to get hard, perpetuating the cycle.

In this situation, it can be challenging to break the cycle without help.

ED in Young Men: Why It's Often Psychological

In older men, physical ED tends to be the more common cause of ED as they’re more likely to have health problems that damage the nerves and blood vessels supplying the penis.

However, younger men tend to be healthier and have fewer medical issues. Although it’s possible for men younger than 40 to have physical ED, psychological ED or performance anxiety is more common.

Older men can also experience psychological ED – they’re affected by the same societal pressures, relationship problems, and mental health struggles as younger men. Still, younger men may face additional stigma as ED can be seen as an older men’s problem. This stigma may cause extra shame and stop younger men seeking help for their ED.

How to Break the Cycle of Performance Anxiety

To break the cycle of performance anxiety, it’s important to get to the bottom of what’s causing the stress around getting an erection.

Men who experience what they see as recurring sexual “failures”, such as from struggling to get an erection, can start to view sex and sexual arousal differently. They may no longer see sex as an opportunity for pleasure and feeling closer to their partner, but as a situation where they will fail.

This self-narrative triggers stress and anxiety and leaves no room for enjoyment. To break this cycle of performance anxiety around sex, it’s essential to change this narrative.

There are a variety of different techniques that can help men to reframe their narrative and thought patterns around sex, helping them to relax and see it as a positive experience. Other techniques that help to lower anxiety levels can also help.

Alongside these techniques, psychological therapy can also help men to understand sexual satisfaction isn’t just based on getting and keeping an erection. Taking the pressure off can then eventually make the process of getting an erection easier in the future, especially in combination with medication.

Short-Term: Can Medication Help?

Medication can be a useful short-term tool for improving performance anxiety and psychological ED.

When men are stuck in the cycle of performance anxiety, they often worry they’re unable to get an erection. Taking erectile dysfunction medication gives men the confidence that they will be able to get hard, helping to break the cycle.

ED medications work well for ED caused by a variety of causes, including psychological ED. In fact, a review article found that medications were effective for psychological ED, especially when combined with psychological interventions. This combination improved symptoms more than either treatment alone.

Some men prefer the idea of medications such as sildenafil or tadalafil, as they seem to offer a quick fix. However, it’s important to take these medications alongside psychological therapy or self-work to deal with the underlying thought patterns and narratives around sex that trigger performance anxiety.

Longer-Term: Psychological Approaches

Psychological therapies can help to reduce anxiety, challenge beliefs around sex and erections, and disrupt sexual avoidance. Therapy can also involve things like communication skills training that can help with men’s relationships.

Common types of therapy for sexual performance anxiety include:

• Cognitive behavioural therapy (CBT) – to address negative thought patterns

• Mindfulness – to learn to be more in the moment and improve mind-to-body awareness

• Acceptance and Commitment Therapy (ACT) – to promote acceptance of thoughts, sensations, and feelings

• Psychoeducation and sex therapy – focusing on a couple’s communication and sexual beliefs/behaviours

There’s evidence that younger men can particularly benefit from psychological therapy for ED as they often experience high levels of stress and lower sexual satisfaction.

When to See a Professional

If you’ve experiencing difficulty getting an erection and it’s an ongoing problem, it’s a good idea to seek help from a professional. Your GP can explore any underlying medical causes for your erectile dysfunction and refer you for psychological therapy if needed.

For men looking to buy ED medication, Quick Meds can help. We’re a UK-based GPhC-accredited online pharmacy that prides ourselves on providing a professional, attentive service.

Complete an online ED consultation to discuss the different erectile dysfunction medication options. Our pharmacists can prescribe the most appropriate treatment for you and offer advice on how and where to access psychological therapies. After a prescription is issued, your ED medication will be shipped safely and discreetly to your door or local delivery point.