The Mind, Erectile Dysfunction and Libido
Can Psychological Factors Cause ED And Libido Problems?
A psychological issue or problem is characterized by a disturbance in an individual’s thinking process, mental functions or emotions, which then causes a ‘dysfunctional’ behavior. A psychological problem often causes difficulties having a satisfactory social life, family life, a functional work situation, etc.
Erectile dysfunction and libido problems are often thought to be caused by physical causes, such as unhealthy eating habits, diabetes, medication, excess stress, old age, etc. However, these sexual problems can also be caused by factors residing predominantly, or entirely, in the mind.
If a person is not in a good place mentally or if a person’s mind is preoccupied with negative thoughts, several health problems may pop up. One of these problems can be erectile dysfunction. Another can be a low sex drive. Although we literally don’t have sex with our brains, the pleasures experienced from sex are in fact experienced in the brain. If the brain is filled with obsessive or negative thoughts, this may give less space for happy sexual thoughts and experiences.
The mind can be a tricky thing, and it is not necessarily easy to understand it. We are after all using the mind itself to try to understand the mind. Sometimes it may even seem like it has a life of its own.
It is also difficult to measure and diagnose things happening in the mind. It’s not as simple as taking a blood test to measure testosterone levels. Therefore, it may be more difficult to get to the bottom of mental causes of problems such as erectile dysfunction and libido issues. It is however still estimated that as many as 10-20% of these conditions may be due to factors that are predominantly psychological.
- Stress: Stress can be caused by a number of factors in life, such as work, career, ambition, friends, parenting, family, finances, beliefs, religion, etc. Stress, or the sensation of stress, kicks in when we face a situation that requires special attention, such as a potentially dangerous event. Stress is designed to make us highly alert and able to quickly deal with this situation. It puts the mind out of its normal balance, and puts a significant amount of resources towards handling the threat. This means less attention is given to normal functions. This is OK for a short period. However, elevated stress-levels that are experienced over long periods of time this will often have several negative effects on the body and the mind. To learn more about my experiences with stress on Truelibido, please go here.
- Anxiety and Fear: Anxiety can be very closely related to stress and could have the same source. Anxiety however, is often linked to fear. This is normally fear of something negative happening to that person or something that the person cares about. This can be a rationally justified fear of something real and relevant, but it can also be a fear that is created in the mind without much justification in real life. Anxiety also normally comes with a significant amount of worrying. The result of this is often a mind in overdrive and a mind filled with negative and unpleasant emotions. Similarly to stress, this anxiety or fear is likely to cause the body to divert energy and focus away from sex and reproductive functions, towards fear and worries. As a consequence, a reduced libido and erectile dysfunction may manifest themselves.
- Sexual Performance Anxiety: Sexual performance anxiety is anxiety or fear that one will not be able to perform sexually. If a man starts asking himself questions such as, “Do I have an erection yet?” or “Am I going to go limp this time?”, a negative process of anxiety is likely to develop where the focus is taken away from enjoying sex and is instead put towards worrying. Sex should normally be an enjoyable activity far removed from worries, but once a man has first experienced erectile dysfunction, it is not uncommon to worry that it may happen again. In other words, fear of erectile dysfunction may in itself lead to erectile dysfunction. A person can also experience other forms of performance anxiety that are not related to sex, such as work-related or social performance anxiety. If severe enough, this can also cause a man to experience erectile dysfunction and libido problems.
- Depression: Depression can be caused by a traumatic or negative event earlier in life, conflicts, self-esteem problems, loss of family member / friend, social problems, etc. A person suffering from depression generally has less interest in activities that formerly interested him. Life and daily events may become less fun or even be perceived as pointless. A person in this situation will often also have less interest in bonds with other people and sex. As a result, libido is often low and erectile dysfunction may also be prevalent.
- Guilt: Guilt is a sensation that takes hold when one does something that is against ‘the rules’. Guilt is experienced when one does something one ‘knows’ one shouldn’t do. Guilt could be rooted in a person’s culture, religion, beliefs, expectations, norms of the community / society, etc. Guilt could also potentially be related to a former negative sexual experience. When one is doing something one ‘knows’ one shouldn’t do, the focus is on negative emotions, and with this, erectile dysfunction and a reduced libido may present themselves.
- Low self-esteem: Low self-esteem (or insecurity, or social disapproval, etc.) will often cause a person to think he is not good enough, that he doesn’t deserve something, is not worthy, etc. For instance, if a man thinks his body is inadequate, and he worries about what his partner is thinking about his body, thoughts are again removed from enjoying sex and instead diverted to worries and negative thoughts. As a result, his sex drive will often be very low and he may also struggle with erectile dysfunction. Low self-esteem can also be linked with many other psychological factors, such as depression, anxiety, guilt, etc.
- Psychological disorders: Specific psychological disorders such as obsessive-compulsive disorder, bipolar disorder, multiple personality disorder, schizophrenia, post-traumatic stress disorder, etc., can also in many cases lead to erectile dysfunction and loss of libido. Disorders like these will often have a direct negative effect on sexual health. In addition, such disorders will often also take up mental space so that attention and focus is diverted away from sex.
- Distrust: A lack of trust in oneself or a partner, may also, if severe enough, cause erectile dysfunction and loss of libido. Similarly to many of the other conditions mentioned above, distrust causes negative thoughts to take hold in the mind. Distrust will often make a person overthink, second-guess, worry extensively, analyse, be on guard, etc. As a result, these negative thoughts will occupy a man’s mind and therefore there will be less mental space for thinking about things such as love and sex.
I think it’s relatively common to underestimate the effect that psychological issues can have on sexual functioning and libido. In our modern lives, we often experience significantly more stress than what is probably good for us, and its also difficult for us to link this directly with sexual problems. I know first-hand what a low self-esteem can do to my libido and erectile functioning.
Once my body is out of balance, for instance caused by stress, my libido plummets and it gets difficult for me to get an erection and perform sexually. And in fact, it doesn’t take too much distress to crash my system.
I also don’t think I am special in this regard, so I would think there are lots of people out there that are just as sensitive to psychological problems (and other forms of distress) as I am. One very important thing I have learned through my years of trying to solve my sexual problems, is that the body is a very sophisticated and complex system, and it often only takes a little harm to cause certain functions to stop working.
Not only do I think it is easy to underestimate the effect of psychological imbalances, but overall, many, if not most men who suffer from erectile dysfunction and libido problems, will not know the cause of their problems. Based on current estimates, as many as one in five men may suffer from these problems because of psychological or mental factors – and many of these men have no idea what the cause is.
Although psychological problems can cause conditions such as erectile dysfunction and libido problems, this goes both ways. Because erectile dysfunction and libido problems can also cause stress, depression, anxiety, etc. In fact, it often does. And one side of the equation can influence the other, which again can influence the first, etc., which can lead to a vicious cycle of problems.
I have had close encounters with at least three of these causes. One was stress I experienced in an unpleasant work-situation, another was sexual performance anxiety, and the third was a long period of low self-esteem after I once quit my job and joined a friend in a failed business venture.
I was once working in a small company with about 10 employees. We shared a small office space and I had no privacy. In addition, I founds some of the people at the company very hard to deal with. So after a while, I started strongly disliking working there. My days would be filled with stress. I would feel anxiety and fear from several angles and I became overall miserable. My mood was poor, I was unhappy and I had no sex drive. The times when I tried to have sex, I also normally failed as I just couldn’t maintain an erection. To learn more about my experience with stress on Truelibido, please go here.
I have fought battles against erectile dysfunction and libido problems for more than a decade, and many times during this period did I have sexual performance anxiety. When I had sex, I would start doubting myself. I would try to sense and feel my erections and I would ask myself “Am I still hard?” or “Am I going limp again?”. Needless to say, having these thoughts on my mind did not help keeping theerection as it more or less completely took my mind away from enjoying sex and instead put my mind through worries and anxiety. Whenever I would have these thoughts, I would not be able to have sex.
I also once quit my job and joined a startup that a friend of mine had launched. It was initially lots of fun, but the fun ceased and I left after a few months. After I quit, I had no job, no income and my job prospects were almost non-existent because of very bad economic times. I felt like a failure and had pretty no self-esteem. This was at times particularly strong when I was in social circles with successful friends and acquaintances with good jobs. My self-worth had taken a dive and I just felt terrible.
Looking back now, I feel silly for going through this, but sometimes things can be hard to deal with at that moment. In this period, I had very little sex drive as sex just wasn’t on my mind. I also had significant difficulties having successful sex in this period.
Althof SE, Leiblum SR, Chevret-Measson M, Hartmann U, Levine SB, McCabe M, Plaut M, Rodrigues O, Wylie K. Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med. 2005 Nov; 2(6):793-800.
Barlow, DH. Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, Vol 54(2), Apr 1986, 140-148.
Cera N, Di Pierro ED, Ferretti A, Tartaro A, Romani GL, Perrucci MG. Brain networks during free viewing of complex erotic movie: new insights on psychogenic erectile dysfunction. PLoS One. 2014 Aug 15; 9(8):e105336. DOI: 10.1371/journal.pone.0105336.
Chou PS, Chou WP, Chen MC, Lai CL, Wen YC, Yeh KC, Chang WP, Chou YH. Newly diagnosed erectile dysfunction and risk of depression: a population-based 5-year follow-up study in Taiwan. J Sex Med. 2015 Mar; 12(3):804-12. DOI: 10.1111/jsm.12792.
Derogatis LR, Meyer JK. A psychological profile of the sexual dysfunctions. Archives of Sexual Behavior. May 1979, Volume 8, Issue 3, pp 201-223.
Dunn KM, Croft PR, Hackett GI. Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey. J Epidemiol Community Health 1999; 53:144-148 DOI:10.1136.
Fadzil MA, Sidi H, Ismail Z, Hassan MR, Thuzar K, Midin M, Nik Jaafar NR, Das S. Socio-demographic and psychosocial correlates of erectile dysfunction among hypertensive patients. Compr Psychiatry. 2014 Jan; 55 Suppl 1:S23-8. DOI: 10.1016/j.comppsych.2012.12.024.
Forbes MK, Schniering CA. Are sexual problems a form of internalizing psychopathology? A structural equation modeling analysis. Arch Sex Behav. 2013 Jan; 42(1):23-34. DOI: 10.1007/s10508-012-9948-0.
Gralla O, Knoll N, Fenske S, Spivak I, Hoffmann M, Rönnebeck C, Lenk S, Hoschke B, May M. Worry, desire, and sexual satisfaction and their association with severity of ED and age. J Sex Med. 2008 Nov; 5(11):2646-55. DOI: 10.1111/j.1743-6109.2008.00842.
Hale VE, Strassberg DS. The role of anxiety on sexual arousal. Arch Sex Behav. 1990 Dec; 19(6):569-81.
Hartmann U. Erectile dysfunction: psychological causes, diagnosis and therapy. Ther Umsch. 1998 Jun; 55(6):352-6.
Hedon, F. Anxiety and erectile dysfunction: a global approach to ED enhances results and quality of life. Int J Impot Res. 2003 Apr; 15 Suppl 2:S16-9.
Huang SS, Lin CH, Chan CH, Loh el-W, Lan TH. Newly diagnosed major depressive disorder and the risk of erectile dysfunction: a population-based cohort study in Taiwan. Psychiatry Res. 2013 Dec 15; 210(2):601-6. DOI: 10.1016/j.psychres.2013.06.012.
Kalaitzidou I, Venetikou MS, Konstadinidis K, Artemiadis AK, Chrousos G, Darviri C. Stress management and erectile dysfunction: a pilot comparative study. Andrologia. 2014 Aug; 46(6):698-702. DOI: 10.1111/and.12129.
Latini DM, Penson DF, Colwell HH, Lubeck DP, Mehta SS, Henning JM, Lue TF. Psychological impact of erectile dysfunction: validation of a new health related quality of life measure for patients with erectile dysfunction. J Urol. 2002 Nov; 168(5):2086-91.
Latini DM, Penson DF, Wallace KL, Lubeck DP, Lue TF. Clinical and psychosocial characteristics of men with erectile dysfunction: baseline data from ExCEED. J Sex Med. 2006 Nov; 3(6):1059-67.
Laurent SM, Simons AD. Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension. Clin Psychol Rev. 2009 Nov; 29(7):573-85. DOI: 10.1016/j.cpr.2009.06.007.
Ludwig W, Phillips M. Organic causes of erectile dysfunction in men under 40. Urol Int. 2014; 92(1):1-6. DOI: 10.1159/000354931.
McCabe M, Althof SE, Assalian P, Chevret-Measson M, Leiblum SR, Simonelli C, Wylie K. Psychological and interpersonal dimensions of sexual function and dysfunction. J Sex Med. 2010 Jan; 7(1 Pt 2):327-36. DOI: 10.1111/j.1743-6109.2009.01618.
McCabe MP, Althof SE. A systematic review of the psychosocial outcomes associated with erectile dysfunction: does the impact of erectile dysfunction extend beyond a man’s inability to have sex? J Sex Med. 2014 Feb; 11(2):347-63. DOI: 10.1111/jsm.12374.
Melnik T, Abdo CH, de Moraes JF, Riera R. Satisfaction with the treatment, confidence and ‘naturalness’ in engaging in sexual activity in men with psychogenic erectile dysfunction: preliminary results of a randomized controlled trial of three therapeutic approaches. BJU Int. 2012 Apr; 109(8):1213-9. DOI: 10.1111/j.1464-410X.2011.10516.
Mourikis I, Antoniou M, Matsouka E, Vousoura E, Tzavara C, Ekizoglou C, Papadimitriou GN, Vaidakis N, Zervas IM. Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation. Ann Gen Psychiatry. 2015 Oct 29; 14:34. DOI: 10.1186/s12991-015-0074-y.
Quek KF, Sallam AA, Ng CH, Chua CB. Prevalence of sexual problems and its association with social, psychological and physical factors among men in a Malaysian population: a cross-sectional study. J Sex Med. 2008 Jan; 5(1):70-6.
Rajiah K, Veettil SK, Kumar S, Mathew EM. Psychological impotence: Psychological erectile dysfunction and erectile dysfunction causes, diagnostic methods and management options. Scientific research and essays. 03/2012; 7:446-452. DOI: 10.5897/SRE11.1065.
Rosen RC. Psychogenic erectile dysfunction. Classification and management. Urol Clin North Am. 2001 May; 28(2):269-78.