If you struggle to get up and stay up, you’re not alone—as many as 30 million men in the U.S. deal with erectile dysfunction (ED) (1). And that number is growing: By the time men are 40, they have a 40 percent chance of having some form of ED (2). More and more people are wrestling with the mental kind, too. While ED often stems from a physical health issue like thyroid problems, low testosterone, or cardiovascular conditions, it can also be rooted in psychological factors (3).
Psychological ED can be born out of a bunch of different mental blockers—from life stress and performance anxiety to a traumatic experience. Sex therapists explain that when you have psychological ED, getting out of your head (the one up north) is crucial for helping your penis perk up—and stay up. That may come as a relief, especially if you’ve tried several prescription medications to treat ED, but none of them really solved your problem.
Psychological ED can be beaten, and the secret lies in tackling intrusive thoughts so you can finally enjoy sex the way you want to.
About the Experts
Lori Brotto, Ph.D, is a professor in the University of British Columbia’s department of obstetrics and gynecology and a registered psychologist in Vancouver, Canada. She is the author of “Better Sex Through Mindfulness: How Women Can Cultivate Desire.”
Jessa Zimmerman, LMHC, is an AASECT-certified sex therapist, couples counselor, and marriage counselor in Seattle, WA. She is the author of “Sex Without Stress: A Couple’s Guide to Overcoming Disappointment, Avoidance & Pressure.”
Ca’ren Hudson, LMFT, is a licensed marriage and family therapist in Raleigh, NC.
What Is Psychological ED?
Psychological erectile dysfunction (also called psychogenic ED) happens when your mind gets in the way of your erection. While it’s most common in men under 40—up to 85 percent of cases in this age group being mental—it can happen at any stage in life (4, 5). In fact, 40 percent of all ED cases may be psychological (6).
But how do you know if your brain is to blame? Psychologist Lori Brotto, Ph.D., says your first move is to rule out physical causes. Getting your testosterone levels checked is a great place to start. If your testosterone levels are normal for your age, and you aren’t on any medications (antidepressants or blood pressure drugs, which can cause ED), there is a good chance your ED is psychological (7).
Symptoms
The clearest sign your ED is psychological? You can get and maintain erections while masturbating alone but struggle to do the same with your partner.
“More often than not, if there are medical contributors, you would have erectile problems in all situations—not just in a partnered context,” Brotto says.
Sex therapist Jessa Zimmerman, LMHC, adds that a common pattern for men with psychological ED is constant stress about not being able to performin the bedroom. The more you worry about getting and keeping an erection, the more difficult it becomes actually to do so, she says.
Drugs like Viagra are often just a temporary fix for deeper psychological issues in this situation.
“[Prescription medications] can give you the confidence to get out of your head a little bit,” Zimmerman says. But they don’t address the root cause. She also warns that you may even begin to feel like you can’t perform without the meds, even though there’s no physical problem to fix.
Psychological ED can come on suddenly (8). Major life-changing events—like losing your job or a loved one—are linked to psychological ED, but you don’t need to experience trauma to develop it (9).
General anxiety is also a common cause. Feeling nervous about having sex with a new partner can be enough to make you lose your erection—in the moment you need it most.
“A lot of times, [psychological ED] comes from anxiety-based issues or life stressors,” says marriage and family therapist Ca’ren Hudson, LMFT. Work stress can strain your performance in bed, and relationship conflicts can also interfere with your ability to get intimate.
“If the relationship is up and down emotionally speaking, you may not feel connected,” Hudson says. “You also may not feel heard, seen, or valued.” All of these factors can lead to psychological ED, Hudson notes.
Unresolved trauma or unaddressed feelings of shame around sex may also be at play.
How to Overcome Psychological ED
Your penis is not the bad guy here—it works just fine. The real challenge? Not letting incessant, confidence-botching thoughts dictate your experience. Luckily, there are expert-backed strategies to help calm your mind and regain control of your performance in the bedroom.
Tap into mindfulness
Brotto focuses on mindfulness with her clients. (If you’re new to the practice, she offers free guided mindfulness recordings on her website, including one specifically aimed at erection issues). She stresses that the goal isn’t about blocking self-defeating thoughts; it’s about reframing them.
“Mindfulness is not about emptying the mind,” Brotto explains. It’s about being fully present and attuned to everything that’s happening in your mind without judgment, she says. Try practicing mindfulness when you’re masturbating or when you’re with a partner.
Mindfulness-based therapy for men with situational ED works, Brotto says. One key reason? It keeps you in the present instead of spiraling down the “what if” scenarios that sabotage performance.
Brotto recommends revisiting what was going on mentally when you were with a partner and lost your erection. Often, men become hyper-focused on the outcome of sex (their climax and their partner’s satisfaction), which can spiral into anxiety and, ultimately, ED.
Brotto suggests explaining, in your own words, the thoughts, feelings, and behaviors that were happening when you lost your erection. Identifying these thoughts and unpacking why they popped up can help you conquer them if they make another appearance.
Try sex therapy with your partner
If you’re having erection issues exclusively during partnered sex, it might be time to see a sex therapist together (10). They can help your partner understand how to support you, which can take the pressure off and relieve your performance anxiety.
Zimmerman works exclusively with couples and explains that partners can unintentionally add pressure. For example, a partner might say things like, “You don’t find me attractive anymore,” or “What’s wrong,” which only heightens pressure. Therapy can help both of you communicate more effectively.
And remember this: Stigma around therapy and other mental health treatment is finally beginning to disappear, Hudson says. There’s no shame in visiting a sex therapist or counselor to get to the root of psychological ED.
Consider cognitive behavioral therapy
In addition to mindfulness, Brotto notes that cognitive behavioral therapy (CBT) can help treat psychological ED (11). CBT helps you challenge negative thoughts and avoid catastrophizing—basically imagining the worst-case scenario in your sexual encounters.
“There’s a lot of evidence that suggests we can change problematic thoughts,” Brotto says. “[CBT] actually changes your body’s stress response system. It changes your emotions and your ability to pay attention to the present.”
Rethink how you define sex
Sometimes the best remedy for psychological ED is to remove your penis from the equation, Zimmerman says. “Worrying so much about [an erection] can make it nearly impossible to have or to keep one,” she says. The way out of this never-ending cycle? “Take the pressure off of the erection,” Zimmerman says so that you can “show up and have pleasure” in other ways.
Zimmerman suggests thinking beyond penetrative sex, even temporarily taking it off the table. Exploring other forms of intimacy takes the pressure off penetrative sex as the end-all, be-all, which can lead to more fun for you and your partner.
“[You may] realize, ‘Oh, there’s all these other ways to play,’” Zimmerman says. When penetrative sex isn’t the main event, losing an erection doesn’t mean the fun has to end—which can be a major confidence boost (and can lead to better p-in-v sex down the road).
Zimmerman adds that in many heterosexual relationships, men believe their erection is paramount to their partner’s experience. “Men tend to worry so much about ‘performance,’ but most women need clitoral stimulation for orgasm,” she says. “So, the importance of an erection can be overblown in the guy’s mind, when it really isn’t that necessary.”
Can you have both physical and psychological ED?
Having both physical and psychological erectile dysfunction is possible. That’s why it’s important to see a primary care doctor or a specialist like a urologist to make sure you’re getting comprehensive treatment.
“Even if you have a physical cause for erectile dysfunction, it’s not going to help you if you’re worried about it,” Zimmerman says, adding that situational anxiety can impact your ability to get aroused.
Need help determining whether or not your ED is physical or psychological? Your doctor may recommend something called “nocturnal tumescence testing,” or NPT, to measure how frequent and rigid your erections are during sleep (12). On average, men without ED have three to six nocturnal erections each night (13). Men with psychological erectile dysfunction typically match that figure. Fewer nighttime erections could signal a physical cause.
The Bottom Line
Psychological erectile dysfunction is when you can’t get and keep an erection for mental, not physical, reasons. If you have erection issues almost exclusively during partnered sex, your ED is likely related to stress, anxiety, or other mental factors. Sex therapists and psychologists say practicing mindfulness, going to counseling, and de-prioritizing penetrative sex are research-backed ways you can treat psychological ED.
Meghan De Maria is a freelance writer based in Raleigh, North Carolina. She focuses on wellness and lifestyle topics and has written for Yahoo Life, Women's Health, Cosmopolitan, Refinery29, and more.
