Erectile Dysfunction: Effects On Mental Health And Treatment Options
Despite being common, erectile dysfunction (ED) can cause significant challenges with relationships, sexual activity, and self-esteem. Some people don’t know why it occurs, and symptoms may lead to distress about a person’s ability to satisfy their partner, potentially contributing to mental health and relationship problems. Below, explore symptoms of this form of male sexual dysfunction, its possible causes, and treatment options that doctors may prescribe, plus lifestyle changes that can help treat ED symptoms and improve erectile function.
How an erection works, and why the mind-body link matters
Normal erections typically occur in response to sexual arousal. The autonomic nervous system sends electrical signals to the penis, leading to a penile erection due to increased blood flow to the penile arteries and corpora cavernosa. However, an erect penis isn’t just linked to bodily systems but also mental health. The mind and body can both play roles in arousal, so concerns like relationship tension and performance anxiety can have an effect on erectile function.
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How is erectile dysfunction defined, and what are its causes?
According to the National Institute of Diabetes and Digestive and Kidney Diseases, erectile dysfunction symptoms “include being able to get an erection sometimes, but not every time, being able to get an erection but not having it last long enough for sexual intercourse, and being unable to get an erection at any time.” This condition can be temporary and can stem from a variety of factors, and it’s often possible to improve erectile function and ED symptoms, as well as related concerns, like premature ejaculation.
Having one or two experiences of a lack of an erection during sexual activity may not mean that a person experiences erectile dysfunction. Only a physician can diagnose this condition, and when they do, there are treatments available that can lead to a more satisfactory sex life.
Causes and risk factors of erectile dysfunction: High blood pressure, prostate cancer, and other health challenges
Erectile dysfunction can be frustrating in part because couples may not understand the cause. The following are some possible causes of erectile dysfunction:
- Performance anxiety and other mental health challenges (often called psychogenic erectile dysfunction or psychogenic ED)
- Relationship problems
- Cardiovascular disease
- Metabolic syndrome
- Testosterone deficiency
- Multiple sclerosis
- Substance use
Below, explore other health concerns that could function as an underlying physical cause of ED.
High blood pressure causing lack of an erection
High blood pressure may cause erectile dysfunction in some men due to blockage of blood vessels that allow blood flow to the penis. Some men may not know they have high blood pressure until they experience erectile dysfunction. However, knowing your blood pressure can lead to early detection and treatment, which may address your health and erectile dysfunction simultaneously.
Atherosclerosis
Atherosclerosis is a hardening of the arteries, often due to plaque buildup. This complication may happen as a result of high cholesterol, obesity, high blood pressure, smoking, or lack of exercise. As with high blood pressure, erectile dysfunction can sometimes be the first sign of atherosclerosis. Reaching out to a doctor can provide an opportunity for early treatment, which may prevent a heart attack or stroke.
Prostate cancer or other problems
In some cases, surgery on the prostate, including for prostate cancer, may lead to erectile dysfunction. In addition, prescription medications for prostate cancer may lead to ED as a side effect in some people.
Neurogenic causes
In some cases, a person may experience erectile dysfunction due to problems with nerve signals between the brain and the penis. Possible causes include radiation therapy, stroke, and spinal stenosis.
Health conditions that may lead to erectile dysfunction and difficulty having an erection
Several health conditions may increase a person’s risk of developing erectile dysfunction (ED). The following are some common risk factors:
- Type 2 diabetes
- Sleep disorders like sleep apnea
- Renal failure
- Alcohol use and substance use disorders
- Priapism
- Depression
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What diagnosis looks like
Diagnosis typically involves a doctor asking about your medical and sexual history, as well as performing a physical exam. Your doctor may ask about any ED symptoms you’re experiencing and your general erectile function, including nocturnal penile tumescence. In some cases, testosterone labs and/or a penile Doppler ultrasound may be necessary for an accurate diagnosis.
How can erectile dysfunction be treated?
The proper treatment for erectile dysfunction may depend on the cause. A doctor may assess each individual for specific erectile dysfunction symptoms, underlying health conditions, and family medical history before determining the best course of treatment. This assessment may include questions about a person's medications, including prescription medications or illegal drugs. While some people may feel awkward answering questions about their sex life and substance use, these questions can help the doctor recommend the best treatment.
A doctor may recommend quitting smoking and limiting or quitting drinking (if applicable) for someone with high blood pressure or cholesterol. They may also recommend cardiovascular exercise. However, this factor may depend significantly on a person’s specific situation. Someone with severely high blood pressure or high cholesterol may be asked to begin exercise slowly.
In some cases, a doctor may provide a prescription medication for ED. Talk to a doctor before taking any medications for erectile dysfunction. There may be some side effects for people who take medication for blood pressure or other conditions. The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. This content provides generalized information that is not specific to any one individual. Do not take any action without consulting a qualified medical professional.
The treatment ladder: What comes first vs. later
Options to treat ED often include lifestyle changes like regular exercise and quitting smoking. Talking to a sex therapist or trying other integrative health modalities can be helpful for ED caused by concerns like performance anxiety.
Often, the first-line treatment options include oral medications. Other options include testosterone therapy, a vacuum erection device like a vacuum pump, penile prostheses, and surgical treatment. Clinical trials for new treatment options may be available as well.
Does sex therapy help with ED?
For some people, sex therapy may be recommended for erectile dysfunction (ED). A sex therapist may be able to help people understand underlying relationship challenges, personal fears, or other factors that could cause challenges during sexual relations. Sex therapists may also be able to help individuals or couples understand some of their intimate desires and ways to communicate them with each other.
Related sexual concerns and relationship support
Concerns like erectile dysfunction can occur together with premature ejaculation and mental health challenges, such as the following:
- Performance anxiety or other forms of anxiety
- Shame related to sexual activity
- Avoidance
Relationship problems can also contribute to sexual dysfunction, so it can be beneficial to work with a couples therapist if you and your partner are experiencing challenges.
How a mental health professional might help
Erectile dysfunction can sometimes cause emotional and relational challenges that a mental health professional can help address. ED can also be caused by depression. Therapists often use evidence-based techniques like cognitive-behavioral therapy (CBT) to treat depression and many other mental health challenges. In some cases, CBT may be helpful for the mental health impacts of living with erectile dysfunction, such as performance anxiety.
Some people experiencing erectile dysfunction may be hesitant to engage in traditional in-office therapy. For these people, speaking to a therapist online may be more comfortable. With online therapy through a platform like BetterHelp, people experiencing ED can connect with a therapist from home or anywhere with an internet connection. They can also choose a communication method that’s comfortable for them, whether audio, video, or live chat.
Online therapy also allows individuals to reach out to their therapist anytime through in-app messaging, and their therapist will respond when they are able. Some people may find this option valuable if they experience challenges with intimacy or relationship problems between therapy sessions, as they don’t have to wait until their next session to communicate what they’re feeling.
A number of studies demonstrate the effectiveness of online therapy for various mental health conditions. One study published in 2020 suggests that online therapy may even be more effective than in-person therapy for depression. In some cases, this treatment option may alleviate symptoms of erectile dysfunction or relieve anxiety as a person receives medical treatments, such as medication therapy.
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Find your matchTakeaway
Although erectile dysfunction is a common condition, it can be a complex subject to discuss. This condition can lead to embarrassment, low self-esteem, and various relationship challenges. However, there is help available through doctors, sex therapists, and mental health professionals. A therapist can help you address challenging emotions related to ED, which may decrease anxiety. If you’re experiencing challenges related to intimacy, know that you’re not alone. Consider reaching out to a therapist online or in your area for support.
What’s the relationship between erectile dysfunction and high blood pressure in health?
High blood pressure can lead to erectile dysfunction in some people. This condition can be the result of blood not being able to get through the blood vessels to the penis, which normally facilitates an erection.
How is erectile dysfunction diagnosed?
To diagnose erectile dysfunction, a physician typically assesses a person’s medical and sexual history. They may also ask about any medications or substances a person is taking.
Do penile implants work, and can they affect your health?
Doctors may not recommend penile implants until other treatments have been attempted. Failure of an implant procedure due to infection occurs in less than 2% of cases. In the right patient, these implants may fix erectile dysfunction satisfactorily.
Why can't I keep an erection?
There are many potential reasons why you can’t keep an erection. Decreased blood flow to the erectile tissue often contributes to erectile dysfunction in older men, and emotional concerns like anxiety, depression, and stress may lead to ED in younger men. It is best to schedule a physical exam with your doctor to determine the cause of ED and develop a treatment plan.
What helps ED immediately?
Sexual stimulation with a sexual partner may be helpful, but many men take over-the-counter or prescription medication to combat ED. Talk to your doctor if you’re interested in learning about medication options.
What is the best treatment for ED?
There are many ways to address erectile dysfunction:
- Quitting smoking (if applicable)
- Exercising regularly
- Maintaining a healthy weight
- Addressing any emotional factors that could be impacting your sexual health
- Using a penis pump to increase blood flow
- Working with a sex therapist
- Talking to a doctor about taking over-the-counter or prescription medication
- Considering testosterone replacement therapy
Identifying the underlying cause of erectile dysfunction can also be helpful. For example, certain medicines can lead to ED as a side effect, so switching to a different medication could be beneficial. Drinking too much alcohol can also contribute to sexual problems, so decreasing alcohol consumption could reduce erectile dysfunction. Similarly, erection problems related to medical conditions may be alleviated when the underlying conditions are treated. Choosing to treat high blood pressure, heart disease, spinal cord concerns, and other conditions (if applicable) can help with ED and overall health.
Is ED permanent or temporary?
Erectile dysfunction can be temporary or permanent, depending on its cause. In many cases, ED is treatable.
How do I help my husband with erectile dysfunction?
Being supportive, open, and compassionate may be helpful if your partner is experiencing erectile dysfunction. In some cases, trying new things together in your intimate life can also be beneficial. Encouraging your partner to see their doctor may lead them to solutions as well.
Can you fully recover from erectile dysfunction?
A full recovery is often possible, depending on the underlying causes of ED. Addressing any health problems and making lifestyle adjustments may lead to significant improvement.
At what age do men start having erectile issues?
While erectile challenges can begin at any age, around half of men over age 40 experience erectile dysfunction. The odds of experiencing ED tend to increase with age.
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