Can stress cause erectile dysfunction?

Psychological and behavioral issues can play a key role in the development of erectile dysfunction, particularly in younger men. Stress at work or because of an interpersonal relationship could have an effect on a man’s ability to produce or maintain an erection. Erections are complicated processes that require focused attention and when that focus becomes compromised, erectile dysfunction may be the consequence.

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Men under the age of 40 years are more likely to suffer erectile dysfunction because of psychological issues than men above the age of 50. But before you write off your erectile disorder as a psychological issue, it’s best to double-check that you do not suffer from any of the following physical conditions that could cause erectile dysfunction:

Testosterone imbalance
Peyronie’s disease
Trauma to the penis
Drug or alcohol abuse
Certain medications may interfere with normal erectile functioning

Because abnormal erections can underlie other health conditions in men, it’s important to address any issues you may be having and consult a doctor as soon as possible.

Common psychological causes for erectile dysfunction

Erectile dysfunction caused by psychological conditions is often a combination of different causes. The most common ones are:

Anxiety. Stressful life events such as the death of a loved one, couple-related issues (e.g. divorce) and health worries (e.g. illness) can all lead to increased anxiety in men. This may provoke performance anxiety and lowered self-esteem. The consequence is that the brain releases stress hormones causing a fight-or-flight response and some men will try to avoid sexual experiences altogether. Cognitive-behavioral therapies are recommended to treat anxiety.
Depression. Low mood and depression can have a serious effect on all areas of your life, including sexual activity. It is estimated that around 12% of men experience depression at some point in their lives. When energy and motivation are low, it can be difficult to find enjoyment in the experiences that used to make you happy. Medical therapies using selective serotonin-reuptake inhibitors (SSRIs) have been shown to be successful in helping to stabilise mood. Talk therapies are also recommended to address the causes of depression.
Stress. Cortisol is a hormone released by the adrenal glands during stressful situations. But when levels of cortisol are high, the muscles in the body tense up and cause rapid heartbeat. This leads to a reduction in blood flow to the penis which can make it harder to maintain an erection. If you are chronically stressed, it’s important to determine the reasons and find ways to reduce stress (e.g. meditation and yoga).
Low self-esteem. Low self-esteem may not only be a cause of erectile dysfunction but could be a consequence of sexual dysfunction. For many men, a healthy erection is a sign of their ‘manhood’. If sexual performance is hampered this can lead to lowered self-esteem. A study of 274 male patients found that sildenafil – a popular drug treatment for erectile dysfunction – improved sexual function and boosted self-confidence in men.
Guilt. Feeling guilty about an extramarital affair or spending money you shouldn’t have in a partnership can disrupt the signals between the brain and body and hamper erections. Men who view sex as shameful because of religious beliefs may also experience higher levels of impotence.

References

Hedon, F. (2003). Anxiety and erectile dysfunction: a global approach to ED enhances results and quality of life. International Journal of Impotence Research, 15/S2: S16-S19. DOI: https://doi.org/10.1038/sj.ijir.3900994
Seidman, S., Roose, S., Menza, M., Shabsigh, R., & Rosen, R. (2001). Treatment of Erectile Dysfunction in Men With Depressive Symptoms: Results of a Placebo-Controlled Trial With Sildenafil Citrate. American Journal of Psychiatry, 158/10: 1623-1630. DOI: https://doi.org/10.1176/appi.ajp.158.10.1623
Kobori, Y., Koh, E., Sugimoto, K., Izumi, K., Narimoto, K., Maeda, Y., … Namiki, M. (2009). The relationship of serum and salivary cortisol levels to male sexual dysfunction as measured by the International Index of Erectile Function. International journal of impotence research, 21(4), 207–212. doi:https://doi.org/10.1038/ijir.2009.14
Althof, S. E., O' Leary, M. P., Cappelleri, J. C., Glina, S., King, R., Tseng, L. J., … US and International SEAR study group (2006). Self-esteem, confidence, and relationships in men treated with sildenafil citrate for erectile dysfunction: results of two double-blind, placebo-controlled trials. Journal of general internal medicine, 21(10), 1069–1074. doi:https://doi.org/10.1111/j.1525-1497.2006.00554.x