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What's up everyone? Today, we're going to get very specific with erectile dysfunction (ED)... psychological ED. If you're experiencing some issues downstairs and asking yourself "How do I know if my ED is psychological?" then this blog post is for you.
We wanted to create this post because determining whether the cause of your ED is physical or psychological can actually be quite difficult if you're unsure what to look for or what causes it. A lot of times, psychological issues like stress, depression, distress, relationship issues and anxiety can play a role in erectile dysfunction. So, how do you know if this is the case for you?
If you suspect that something more than just medical issues could be causing your ED, we've got you covered. To get this started, let's talk understand psychological ED
What Psychological ED Is And What It Isn't
It's important to learn how to differentiate what's physical versus what could be emotional or even situational that is preventing you from performing.
It can be hard to tell....I know....but here are some thoughts to consider:
What ED is not...
If you have issues achieving or maintaining an erection every now and then (not frequently but "once in a while"), then that's completely normal.
That's not ED.
You're not a light switch ready to go "every" single time there is a sexual encounter. Sometimes you might be tired and not in the mood (it happens). Sometimes you could be dehydrated, a little too drunk, sick with a cold, or just caught off guard from a partner who jumps your bones and you're not "ready" just yet.
It doesn't mean you're broken or for you to panic.
When it's actually psychological ED...
Sometimes it's arguments or disagreements in relationships that can put a halt on being intimate with that person (regardless if sexual desire is there). It could be a negative experience, such as a fear of ejaculating too early, or just unpleasant emotions about yourself (feeling inadequate) or with that partner that's preventing you from focusing on the eroticism of the moment.
It could also be distress in your current lifestyle that is preventing you from desiring to want to have sex, or anxieties that make you avoid it, etc.
If you can produce an erection on your own with no issues (example: masturbation or from viewing explicit content/porn), or randomly/regularly getting an erection throughout the day, but NOT with a partner during sex, then that right there tells you something...it could potentially be psychological and associated with one of the above scenarios.
The reasonings are endless which may inadvertently cause you to have doubt in your ability to perform or in the long run, "slowly strip away" your sexual confidence.
When ED Is A Physical Problem
The only time when it's actually a "physical" cause or worrisome, is if difficulty obtaining or maintaining an erection becomes "progressively" more challenging and frequent, especially as you age. This can be due to health issues associated with aging that cause poor blood flow issues (diabetes, cardiovascular disease, high blood pressure, etc.), physical trauma to the penis, nerve damage, spinal cord injury, hard flaccid or even hormonal imbalances affecting mood and libido.
This is called "sexual decline" and we all face it eventually where we are challenged to take preventative action to maintain our vitality and sexual health (otherwise it's a halt to our sex lives).
All of the above of course, MUST be confirmed with a medical professional because you CAN'T self diagnose yourself or assume. They can perform testing that you can't do on your own (it's their job).
Can Having Physical ED Lead To Psychological ED?
Yes! Sometimes you could have a combination of both physical causes and psychological causes (distress of having physical ED and not knowing how to communicate with a partner). Thus, leading to poor communication and recurring bad sexual experiences.
Or it could be just strictly psychological because of your upbringing. For instance, a byproduct of what we learn about sex, relationships, the human body, etc. from poor social learning environments like social media, religion, pornography, etc. can potentially threaten our sex lives.
Let that sink in and please reflect on this note...
If you didn't get a good sex education in school, and you're relying on what you see and hear in porn, then you're most likely "stuck" or misinformed like some, if not most guys about the realities of sex. This leads to poor perspectives on what sex should look like, the roles you and your partner(s) play during sex, what sex should and shouldn't feel like, etc.
Which can potentially lead men to having performance issues in the bedroom based on "misguided" expectations.
Let's Normalize Having Healthier Discussions About Sexual Health In Men
Sexual health is a crucial aspect of everyone's well-being, and yet, we often shy away from discussing it. This is true with men, since some like to "assume", rather than research, or ask questions, or discuss sexual performance issues openly with professionals, friends, their partners, etc.
Psychological erectile dysfunction, much like any other type of ED, is a condition that a lot of men can develop from situational events, poor social learning environments or from frustration and distress that BUILDS UP overtime!
In our recent blog, "The Erection Process: How Does It Happen And How Erectile Dysfunction Can Disrupt It", we highlighted 3 plausible reasons/experiences that men with psychological ED face (with examples), including:
how erections and sexual response are misperceived in our society
And how erections are supposed to work!
How Can You Get Better At Recognizing the Signs of Psychological ED?
The experiences or "categories" men face that sounds the alarm for you to recognize it's potentially a case of mental ED or obstacles preventing you from being able to proceed sexually are:
Partner related issues
Performance anxiety
Psychological distress
These are just umbrella categories, that one can dive even DEEPER into more subcategories. For instance, some of these categories are in the graphic below, but there are other scenarios like mental disorders that could be in the mix as well.
Now, it’s important that you reflect on your own erections and recognize these signs of psychological ED, so that it can help propel you towards finding a solution. The goal is to become more aware of your own body and how it works (the point of this blog).
We highly suggest tackling ED from all angles with a "multi step" approach because treating ED isn't exactly a linear path. Not everyone is going to have the same experiences as you. Therefore, we need to explore all areas so you can have the knowledge to tackle it on your own.
The way we see "psychological ED" here at BDEStyle.com...
If "unpleasant" feelings replace feelings of sexual pleasure, men will experience the following signs that will "mimic" physical ED symptoms:
The inability to have an erection or maintain it before/during sex
Premature ejaculation and/or delayed ejaculation
Trouble with desire for sex (feeling disconnected “mentally” in the presence of a sexual partner)
Sexual avoidance or sexual anorexia because of FEAR of failure or fear of recurring bad experiences (a vicious cycle)
Treating Psychological ED Starts With Self-Reflection And An Understanding Of How Your Own Penis Works!
Your everyday lifestyle choices are going to have a massive effect on the whole erection process. Understanding that and having a clear understanding of how erections work is going to be a key step in moving forward with your sexual performance.
So with that in mind, think about your own lifestyle choices. Think of these questions.
What choices am I making in my lifestyle that could potentially be disrupting my erection process?
Are my lifestyle choices slowly destroying my sexual health and erections?
Next: Pay Attention to ‘Erection Triggers’ Versus ‘Erection Killers’
Think of these questions:
What triggers me to become aroused versus what turns me off?
Can I reflect on the days/nights where I had difficulty achieving or maintaining an erection with a partner?
What killed my erection during the moment?
On days/nights you had successful sex, can you remember the environment, the mood, or stimulating activities you and your partner did that made you hard?
Can you replicate the erection "triggers" that kept you going?
By reflecting on the above, you can understand the "Where", What's", "Why's" and "How's" when it comes to your erections. Maybe there are certain unpleasant thoughts that fill your head that make you go soft. Or maybe there are pleasant feelings and "context" specific situations where you're more likely to get hard versus others.
An example would be feeling uncomfortable having "unexpected" car sex, or fear of getting caught that causes you to have trouble getting and maintaining an erection at that exact moment.
You might be the type of person that wants the right conditions for sex to be met for your standards. This may include specific sexual stimulation and stimuli that gets you going. Others may want more connection or trust (more intimacy's) to get erect and stay erect. Everyone is different, so it takes some "reflection" and exploration to figure it out.
Here are some other examples for erection triggers and erection killers...
Top Erection Killers For Men:
Unexpected sexual encounter where you're not aroused yet
Too much alcohol
Concerns about penis size
Trying to conceive or pressure to make a baby
Difficulty putting on a condom
Guilt from "cheating"
These killers can manifest from the following factors:
Anxiety before, during or after sex
Non-realistic expectations for sexual performance (men viewing pornography as a source of education creating false expectations)
Tension in a relationship
Stressful daily routines (work, newborn children, or children in the house, etc.)
Not enough privacy or emotional intimacy
Partner's sexual dysfunctions (bodily changes, sexual decline, and desire changes overtime)
Stress/depression
If you approach sex and you start to feel anxious, frustrated, overheated, and negative thoughts fill your head, you may be “unintentionally” feeding that performance anxiety "monster".
Thoughts like:
Is this normal? Do other guys experience this? Am I the only one!?
Does this mean I am not "man" enough"?
Will it happen again?
I must get an erection! I must satisfy them!
I am unable to have a sexual thought
Will my partner reject me? Will they leave me for this?
And so on
These thoughts or as I like to call them, "unpleasant" feelings, will soon replace feelings of sexual pleasure. I said this earlier, in case you weren't paying attention.
Erection Triggers You Want To Capitalize On
‘Erection triggers’ are the stimuli that gets you going, and encourages the processes involved for you to get an erection. Anytime, you have a good erection day, I want you all to take note of what you felt emotionally and physically, so that you can go into the next sexual encounter with a similar approach and positive mindset (and hopefully, an “erection”).
Think of these things to help you define your ‘erection triggers’:.
Is the mood right? Or does the moment feel rushed and doesn’t allow me enough time to get adjusted?
Do I feel uncomfortable, or feel tension in certain areas of my body (muscle tension is a symptom of anxiety...just so you know)
What can make me feel relaxed and focused on the eroticism of the moment?
Do I need to change the environment? Or is it a safe environment for me to become fully intimate and able to express myself in the moment?
Am I ‘showing up’ to the encounter with a positive attitude or am I distracted and in a bad mood?
Do I need to slow things down for my body and mind to adapt and register that sex is happening?
Do I trust this person to open myself up to (get naked and be vulnerable with them)?
What stimuli do I find the most arousing for me to get erect? (kissing, a blowjob, playing with your partner, etc.)
What feelings did I experience in the moment that influenced arousal? Can I replicate those “pleasant” feelings in future encounters?
Depending on the relationship you want sufficient stimuli to induce the process of an erection and for you to go through the entire sexual response cycle.
Remember, arousal requires men to be calm and able to concentrate their attention on enjoying the moment. Anything that distracts attention can interrupt one’s erection.
Arousal comes from the 5 senses and from mental fantasies. And as the relationship grows, you may need more stimuli or intensity. Caution for LONG TERM relationships: Repeating the same moves or approach will result in complacency and boredom in the bedroom. Or you might have difficulty becoming aroused because it's a little too vanilla for you after doing the same moves or "sexual scene" a thousand times...
You want to capitalize on your erection triggers...all of them ,and continue to explore and communicate with your partner to be effective at getting and maintaining an erection.
What About Medical Treatments for Psychological ED?
Are there any medical treatments? Why can’t I just take a pill and call it day?
The truth is, you need to adopt a “multi-step” or holistic approach when navigating ED. Having a “simplistic” view on ED is only going to make it harder for you to navigate through all of your causes. You don’t want to overlook a strategy or treatment option that might be specific to your case. Everyone is different, which is why we have to talk about ALL scenarios, with many examples.
Can Viagra or Cialis help with psychological ED?
Will I build a tolerance to these pills if I don’t need them?
Do they work if you have performance anxiety?
Will it give me the confidence I need to perform?
There are various medications available, which can be used to treat ED if caused by physical health issues and physical abnormalities. These medications help you achieve and maintain an erection by increasing blood flow to the penis, such as Tadalafil, Sildenafil, or Viagra/Cialis.
Now, to be clear, there are NO additives or chemicals in these pills to make you become addicted to them. However, you can psychologically grow to depend on them when you don’t need them.
In order for these pills to work, you have to be aroused. Some guys use them recreationally thinking it’ll be a “fail safe” for when they’re too drunk or too nervous, but if you learned anything from this blog…erections are dependent on arousal.
And if you’re too drunk or have performance anxiety, it doesn’t matter how much you take as dick pills are not the solution in this case. In the long run, the unspoken truths, the anxieties and other insecurities will carry into future relationships if you don’t address it.
Lastly, if you are the type of guy to live a poor lifestyle and you keep ruining your sexual health, then the penis and all the mechanics involved to make your erections will decline even further. As a result, these pills will start to lose their effects when you get older and you will have to take higher doses because you’ve ruined your body all these years (this is common sense, guys…take care of your sexual health!).
Treat Psychological ED By Improving Your Views Around Sex
Besides understanding erection triggers and erection killers that I mentioned earlier, I am also a big advocate of understanding/explaining the reasons why we behave the way we do.
With that being said, lifestyle changes, sex therapy and having more conversations with your partner about sex are areas for you to explore. Why? because if you look internally with the guidance of a mental health professional, you can discover things in your lifestyle and relationship that may be the reasons why you get anxious or frustrated during sex.
And perhaps, your views on sex or your tendencies to compare yourself to others may be hindering you from being in the moment with your partner(s), or getting out there and seeking a partner. And of course, there are other reasons and scenarios, but that’s for you to explore and find out.
Replace The Word “Performance” With Experience
Sometimes, there are guys who get caught up with the size of their penis and think it’s the pinnacle of sex. This can make them feel anxious or inadequate to have sex. The truth is, sex is more than just PIV.
We recently partnered with OMGYES, which is a platform that does research into female pleasure and sexuality where not only do they help improve your views on sex, but they also focus on how you can improve the overall experience. They go over external and internal pleasure as well as debunk a lot of the misconceptions you hear about female pleasure in Hollywood movies, pornography and social media.
This will help you approach sex with a better mindset instead of preoccupying yourself with your penis or that PIV is the pinnacle of sex when It's not...
Lastly, the moment you replace the word performance with the word experience, you’ll start to have an improved mindset around sex. You'll feel relaxed knowing that if you're not "ready" just yet, that it's not the end of the world. You'll get there eventually.
From there, you can start to have better experiences and conversations with your partner(s) and soon be able to recognize how your body responds in these sexual situations and what to do to get in that state of arousal that works for YOU.
Having an Honest Conversation With Your Partner About Your Erections
Issues in the relationship can definitely have an adverse effect on your sexual performance. Whether you're struggling with communication, insecurities, feeling disconnected, or having trust issues, these are factors that can lead to difficulties in achieving and maintaining an erection.
A happy and communicative relationship is a core part of having a good quality sex life. You don’t want to avoid these conversations because they can bottle up inside causing you and your partner more frustration as well as a halt to your fun in the bedroom (dead bedroom concept).
We highly suggest enhancing your emotional intelligence so that you can cultivate a stronger bond and work through the erection hiccups, together! Nothing is sexier than a man who can express themselves sexually and be able to admit the issues at hand and spark creativity to solve these issues together.
This is how you keep things exciting, including working on insecurities, anxieties, sexual misconceptions you both may have, etc.
Navigating Through Performance Anxieties, Together!
You also never want to make a person feel uncomfortable or pressured to get hard. “Sexpectations” like expecting the "man" to always be hard like a robot often creates barriers for arousal. While engaging in any sexual activity, it is important to create an environment that is IDEAL for arousal, rather than go into it expecting the encounter to be like what you saw in a porn video you watched the night before.
If you or your partner doesn’t get hard right away, trying harder in that EXACT moment will prove INEFFECTIVE. Instead, try to take a pause, calm your physiology and then try again. Sometimes, this might mean going back to foreplay, getting a massage, or slowing everything down so that you or your partner can get back into the eroticism of the moment (relax to get hard!).
Learn To Tap Into Each Other’s Sexual Desires
At the same time, understand your sexual desire type and your partner's, too. You may be a "response" driven guy where you need more context specific situations to get aroused for desire to then build after you're aroused. Others might be spontaneous driven and will need to fuel this when the moment arises (continued stimuli).
As some like to call it, "mismatch" of desires, it's really about learning to tap into each other's desire types. There is no right way to desire. Both are completely normal to experience and regardless of gender, you can experience both or fluctuate back and forth on the spectrum depending on biological, social and psychological factors.
Address Pornography Consumption And Misconceptions About Sex
Pornography can INDIRECTLY contribute to psychological ED. Now before you jump the gun and push this one to the side, listen up. It's not uncommon for men who watch a lot of porn to experience difficulties getting or maintaining an erection.
But How?
This is because our brain becomes desensitized to regular sexual stimulation and needs increasingly intense stimulation in order to achieve an erection.
Some, if not most men also view pornography as a source of education. It’s the same thing as Hollywood movies where they show the man approaching a sex scene with an automatic or instantaneous erection. This puts a lot of pressure on younger guys because they see these actors already hard and assume that they have to be hard once the clothes come off.
Some guys can also become addicted to porn where they avoid sex or the act of seeking out partners. It may not overnight but too much of anything is never good. We talked about this in our blog on the connection between dopamine and erections. Depleting your body's dopamine levels after busting a nut will decrease your motivation to pursue real life relationships or find sexual partners and the encounter, enticing.
It's also the act of masturbating to porn that can often feel "safe" and comfortable, that when you do whip out your penis for a potential partner, anxiety will creep in and the ‘unpredictability’ of the sexual encounter will throw you off, causing you to feel "uncomfortable" and awkward because it's not what you're used to.
Failure to address these issues can carry on into future sexual encounters, if not addressed appropriately.
Recap On Figuring Out If It’s Psychological ED, Physical Or A Mix of Both
Regardless if it’s psychological ED, you should still seek out medical advice to rule out physical causes. Seeing a doctor should ALWAYS be one of the first steps you take.
Speaking with a doctor can help you assess any “physical” underlying medical issues and help you understand what might be going on. Tests such as blood work, dopplers and scans can determine if there are any physical issues causing your difficulties in the bedroom.
It's important to take note of any lifestyle changes, relationship issues, stress levels, depression symptoms, etc., that could be playing an impact on your sexual performance. If all signs point to psychological ED, it's time for a change!
So...
Speak with a doctor
Get tests done
Look at your lifestyle choices and your relationship for things that “Block” intimacy
Do not self-diagnose or assume. You do not have the capabilities to test yourself. We mentioned earlier that consulting with a doctor will help you RULE OUT physical causes. If after multiple attempts, a few doctor opinions, testing, etc. and results are still coming back "normal", then don't knock out sex therapy or guidance from a mental health professional.
Have these emotionally intelligent conversations with your partner about your erections and sex life as well as work through the issues together
Get treatment if it’s a mix of physical ED and psychological ED
AND DON’T FALL FOR THE SELF DIAGNOSIS TRAP!
If you're the type of guy who seeks out "testing" or goes to multiple doctors on a hunt for a "physical" diagnosis (The want or need to find something “physical” to blame other than yourself) and your results STILL come back "normal", then that's a sign that you might be in distress and not evaluating or considering your personal relationship or current lifestyle to be a possible factor.
I often see this happening with guys in their 20s and 30s (or even late teens) on online forums who are "healthy", but in distress. They end up spiraling down a rabbit hole to try out every treatment option for ED like high doses of Viagra or Cialis and are still not addressing their anxieties and fears around sex.
I'm speculating that this is why SOME of the younger generations of men, go down a rabbit hole of trying pills and are self diagnosing without considering that maybe they just got nervous, couldn't relax, or didn't allow enough time for them to get in the mood. Or maybe they need a more contextual approach and the right environment (the right conditions) so that they can feel comfortable to have sex. Or maybe their views on sex are skewed because they never had a comprehensive sex education to begin with (they learned from porn
ED, Mental Health, & Moving Forward
It's important to understand that erectile dysfunction is often tied to mental health issues and your sexual confidence. If you're dealing with ED, it's essential to take the time to address any underlying problems that could be contributing and find the root cause of it. Once you find the root cause, you can begin working towards restoring your sexual performance and having a healthier sex life.
If you're still struggling, or there is a “physical” cause in the mix, then speak with your doctor and consider the different treatment options available such as lifestyle changes, therapy, medications, or shockwave devices like The Phoenix that can treat the penis.
It's also important to have an honest conversation with your partner so they better understand what's going on and help support you throughout this journey.
Lastly, guys, remember that you're not alone! There are millions of other men out there who experienced the different sides of psychological ED. It’s just a matter of going through the many nuances to see what resonates with you and what you can try in your day to day life to overcome some of these obstacles.
Hopefully, this article has helped you understand more about psychological ED and how to move forward in treating it. Although I did not include all scenarios, this is a good start for those of you trying to navigate or "approach" their psychological ED.
If you guys have any questions about psychological ED, feel free to reach out!
Much Love,
-Rich