Written by Alice Child, Somatic Sexologist
Sydney-based Somatic Sexologist and Sex & Intimacy Counsellor Alice Child explains the Psychological Effects Of Erectile Dysfunction and Erection Difficulties and gives her top tips for overcoming them.
This guide contains general advice only. If you need more tailored advice, please book in a session.
Having erection trouble from time is very normal and isn't a cause for concern. However, experiencing ED can be extremely stressful and upsetting, and can cause a negative mental spiral. The more we worry about it happening - the more likely it will happen again!
If you or your partner have ever experienced difficulty getting or maintaining an erection, let me first reassure you that this is completely normal. In fact, most men and penis owners will experience erectile difficulty at some point in their lifetimes.
As men get older, erections naturally come less and less frequently. As a teenager, they are so frequent they can be inconvenient and very unpredictable! This usually steadies into your twenties and early thirties, and then as each decade passes, the frequency and ease in which erections come gradually decreases. By the time you reach your forties, fifties, and sixties, you will likely start to notice a change. This is in part due to decreasing levels of testosterone.
Having erection trouble from time to time isn't usually cause for concern. However, experiencing ED can be extremely stressful and upsetting, and can cause a negative mental spiral. The more we worry about it happening - the more likely it will happen again!
For many, it becomes an ongoing issue that impacts their confidence, sex life, and relationships. On the bright side there are lots of things to use as treatment. If you or your partner is struggling with ED, the first step is getting expert-led sex-positive education. Often, the problem is less about what’s going on in your body and more about what’s going on in your head.
From erectile treatments, causes, and medication, keep reading to learn more about overcoming ED.
What is Psychological Erectile Dysfunction?
Erectile Dysfunction - or erectile difficulty - can be caused by many factors. Most people assume if they are experiencing ED that, there must be something physically wrong with them. While there are lots of physical causes for ED (heart disease, high blood pressure, high cholesterol, diabetes, obesity, smoking, low testosterone, alcohol, prostate cancer, etc.) many causes are psychological or emotional.
Psychological ED is when a man or penis owner struggles to get or maintain an erection for psychological or emotional reasons that are not physical.
How Can You Tell if Your Erectile Dysfunction/Difficulty is Psychological?
If you are still getting an erection at night or in the mornings, and/or you are still able to get an erection in specific circumstances (e.g. during masturbation or self-pleasure but not during partnered sex), then your erectile difficulties are probably psychological/emotional.
The fact that your body is still able to give you erections in sleep is a sign that everything is in fine physical shape, but something might be blocking you emotionally.
If you notice that your morning erections are less frequent or less rigid, it is worth visiting your GP, as it may be a sign of an underlying health condition.
What Are the Causes of Psychological ED?
Many factors can be at play when ED is psychological including:
🌟 Stress is a huge mood killer. When we are stressed (inside or outside the bedroom, our body releases cortisol. This is a hormone that inhibits testosterone - the primary male sex hormone responsible for sex drive and blood flow changes that cause an erection. If we are continually stressed in life it can start to impact our sex life.
🌟Performance anxiety - Similarly, if you are nervous about pleasuring your partner or performing in bed, this performance anxiety can lead to erectile difficulties. The problem is the more you worry about staying hard, the more performance anxiety you get, and it becomes a vicious cycle.
🌟Busy mind - When our mind is busy and we are stuck in our head, it is much harder to drop into our body and feel pleasure. We might find our mind wandering or struggle to stay in the moment. This is why mindfulness, mindful masturbation and meditation can be so important for sexual happiness.
🌟Guilt/shame - Most of us were raised in a conservative and sex-negative environment, meaning sexual shame and anxiety are very common. When we experience sexual shame, it stops us from enjoying the moment and accessing pleasure. Many people who experience ED often get even more embarrassed or shameful when they ‘struggle to perform’, which again becomes a vicious cycle.
🌟Low body confidence - Low self-esteem can trigger performance anxiety. The more you worry about your looks in bed, the more stressed you become. All this tension may lead to erectile difficulties.
🌟Porn reliance - If you become over-reliant on audiovisual stimulation such as porn, erotica, or fantasies to build arousal and erections, you might struggle to achieve the same sexual response in other situations - e.g., during partnered sex. This is why mixing it up and trying new things during self-pleasure is so important. Try removing the porn gradually, and focus on the physical sensations.
🌟Relationship issues - If we don’t feel happy or safe in a relationship, or you are struggling to maintain great sex in your relationship, our body and nervous system are in a heightened state of alert and up-regulation. All of this tension and stress could result in physical symptoms such as ED.
🌟Mental illness - Depression and other mental health disorders, like anxiety, can trigger imbalanced brain chemicals and lead us to not being able to perform the way we want. Feelings of frustration, anxiety, or depression make ED even worse. In fact, men with clinical depression are about twice as likely to develop ED, according to a recent study.
🌟Sleep issues - Sleep deprivation and tiredness may cause a man's testosterone levels to dip. Researchers have also suggested that stress and fatigue related to lack of sleep may make sexual problems worse.
What are the questions you can ask to find out?
If you suspect you or your partner is struggling with ED for emotional or psychological reasons, the first thing to do is try and remove any shame, blame or guilt. Approach the conversation with love, respect, and empathy to create a space for emotions. Remind yourselves that ED is extremely normal, and silence and shame will make overcoming it harder not easier!
Here are some questions you could gently explore to find out if your ED is psychological:
Do you experience morning erections?
Are you under a lot of stress or anxiety at the moment?
Do you find your mind wandering during sex and that it’s hard to stay in the moment?
How are you sleeping?
Are you feeling any conflict or stress in the relationship at the moment?
Are you drinking or smoking a lot at the moment?
Are you able to achieve an erection while masturbating?
If so, what are your masturbation/porn watching habits?
Do you get nervous or anxious during partnered sex?
How is your mental health at the moment?
What is Psychological impotence?
Impotence is defined as the inability to achieve or maintain an erection and/or orgasm. Psychological impotence - similarly to Psychological ED - means the root cause for the issue is mental or emotional rather than physical.
In penis owners, there are three types of erections; psychogenic, reflexogenic and nocturnal.
🌟Psychogenic - when you are turned on by your brain - eg, through audiovisual stimulation (eg porn, erotica) or through fantasy. Impulses from your brain activate the erectile process
🌟Reflexogenic - when you are turned on by your body - eg through touch or stimulus to the body/genitals. Impulses spread from the nerve endings throughout the body and then activate the erection centers.
🌟Nocturnal - occurs during deep sleep (during the REM cycle)
Psychological impotence usually only impacts Psychogenic and Reflexogenic erections. You are still able to get hard in your sleep.
What is Sexual Performance Anxiety
Performance anxiety is the pressure to perform or please a partner during sex. People of all genders can experience performance anxiety, and it reduces our ability to stay present, build arousal, and enjoy sex and intimacy.
For men and penis owners, performance anxiety could express itself by having the following thoughts during sex and intimacy:
Is my partner enjoying this?
Am I hard enough?
Will I loose my erection?
Am I big enough?
Am I doing the right thing?
Does my body look good?
Am I going to last long enough?
Am I going to be able to stay hard?
Am I making strange noises?
Am I sweating too much?
Performance anxiety is one of the major causes of ED.
How to your partner with Psychological Erectile Dysfunction
Everyone is responsible for their own pleasure - it is not your job to ‘fix this’ for them. That said, if you think your partner is experiencing psychological erectile dysfunction and/or performance anxiety, there are lots of things you can do which might help:
🌟Communicate - Remove the cone of silence that often surrounds sex, and create a safe, happy, shame-free environment to talk openly. Reassure them that ED is not a big deal. Practice being really clear about your desires before and during sex, and having chats afterwards about what you enjoyed, what was hot for you, and what you are curious to try next time.
🌟Compliment - Everyone needs a bit of reassurance now and again, and it can really help with performance anxiety. Practice complimenting to your partner during sex, saying things like “I love it when you touch me like that”, “you look so hot right now” and “that feels amazing.” Build connection in your relationship everyday - the entire realtionship is foreplay.
🌟Explore other types of sex and intimacy - There are lots of amazing ways to have sex without penetration! If your partner is worried that they will experience ED, try other forms of intimacy that don’t require an erection to feel great. Oral sex, sensual full body massages, genital massages, dirty talk, steamy showers, watching porn together, watching you masturbate, strip teases, reading erotica together, breathwork and tantra - the list is as long as your imagination. Talk about your sexual fantasies, and find new ways to connect.
🌟Slow it down - There is no rush! Slow down your sex and intimacy to be more sensual. Allow the desire and pleasure to build at its own pace. Enjoy the journey - not the destination.
🌟De-stress the nervous system first - If your partner is stressed, try and encourage them to do some form of physical activity or mindfulness exercise that is designed to help them relax and drop into their body. For example a bath, shower, massage, mindful masturbation, meditation, walk or a work out.
🌟Breathe - A great way to relax and down-regulate the nervous system is to deepen your breath and lengthen your exhale. Practice breathing together with long, slow, deep breaths. This can also be highly arousing and erotic and breathwork is the foundation of erotic practices such as tantra.
🌟Book a session with certified Sex Counsellor or Sexologist. We help people learn the tools for how to build pleasure and desire in the body, such as breath, movement, sound, touch and mindfulness.
🌟Get medical support - if you are worried your partner might be suffering from clinical depression, anxiety or another form of mental health concern, encourage them to seek professional help.
What can you do if you are experiencing emotional ED?
🌟Take the pressure off yourself- Remember the goal of sex is PLEASURE not pressure, and it can take time for arousal to build. Go easy on yourself, and remember that bodies often take us surprise. It doesn't mean there is anything wrong with you. Instead of focusing on YOUR pleasure/body, it can be helpful to learn new skills for how to give your partner pleasure to help increase your confidence in other ways - like learning how to give a vulva massage.
🌟Think about your turn ons- What are your usual turn ons (aka accelerators) when it comes to sex? How can you bring more of them into your space, and reduce your turn offs (aka breaks?). What is your own personal recipe for hot sex?
🌟Explore other types of sex and intimacy - There are lots of amazing ways to have sex without penetration! If you are worried - try other forms of intimacy or talk about new sexual fantasies that don’t require an erection to feel great and that will help get you in the mood.
🌟Practice Kegel exercises - I teach people who experience ED kegel exercises because they often need more awareness of the pelvic floor muscles. Clenching and releasing these muscles during sex can really help build arousal and blood flow. You can practice this alone first during masturbation.
🌟Practice Edging alone - Edging is when you go to the edge or orgasm and deliberately bring your arousal back down without orgasming. You can do this once, twice, as many times as you like! It helps give you more control of your arousal, more awareness of your body, and makes the eventually orgasm more powerful.
🌟Sex Counselling - Sexologists or Sex Counsellors will be able to help you uncover what might going on for you, and give you the tools to help you overcome it. Book in a session today.
🌟Guided Imagery - Guided imagery is a method for managing your stress. It’s a relaxation technique that involves visualizing positive, peaceful settings like a beautiful beach or a peaceful meadow. This technique is also known as visualization or guided meditation. It can be useful for ED as it helps you ground and relax before getting physical intimate. If abstract images like a calm beach don’t do it for you, it can also be helpful to visualise the sexaual energy in your body flowing into your genitals. ;)
🌟Meditation - Mindfulness or meditation is another useful tool that helps feel more calm , present and connected to our body. These are great skills for anyone experiencing ED. Practice your mind/body connection through mindfulness exercises such as body scans to help you still your mental world and focus on your physical sensations.
💥🌟Summary
ED is much more common than people like to admit, and it is very, very normal. Everybody experiences times of stress, worry, or anxiety in life, and it is only natural for this to affect our sex life. Sadly, the silence, embarrassment and shame that often surround these conversations makes the problem worse, not better.
Instead, try and create an environment where pleasure and relaxation is the goal, and remove the pressure for an erection. When you stop fixating on the erection, you will discover that you are still capable of so much pleasure.
Alice Child - Somatic Sexologist, Sex Therapy & Sex Counsellor - helps people achieve happier and healthier sex lives through 1:1 sex coaching, couples sex counselling, hens parties, and workshops. Book a session here.