The Relationship Between Anxiety and Erectile Dysfunction

There are countless times where I will receive an email or a call from a person looking for counseling to address their Erectile Dysfunction. We will set up an appointment and start discussing the challenges that the client is experiencing. The more often than not, after I have completed my full intake, I have to have a serious conversation with my client that looks something like this... "I know that you have come here to treat your Erectile Dysfunction, but with all of the information I have gathered, my professional opinion is that you do not have Erectile Dysfunction... you have unmanaged anxiety."

Now everyone responses to this differently. Some are relived, some are angry, and some are frankly confused. But overall most of the client's I work with simply have a lot of questions. Like how does anxiety do this? But I don't feel anxious during sex so why is this happening? I know I'm an anxious person, but I've always been anxious and its never been this bad, why is it happening now? How can anxiety impact me like this? The reality is that in order to answer any of these questions we need to look at the relationship between anxiety and Erectile Dysfunction...

Anxiety is a common mental health disorder that affects millions of people worldwide. Anxiety disorders can manifest in different ways, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). Anxiety can also affect sexual functioning, and it is estimated that about 20-30% of men with erectile dysfunction (ED) also have an anxiety disorder (1).

Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection that is firm enough for sexual intercourse. ED can have various causes, including physical, psychological, or a combination of both. Anxiety is one of the psychological factors that can cause ED. Anxiety can disrupt the brain's ability to release hormones and chemicals necessary for sexual arousal and can also cause physical symptoms that interfere with sexual function.

Research has shown that anxiety can increase the risk of ED in men. A study conducted by researchers at the University of Texas Southwestern Medical Center found that men with anxiety disorders were more likely to have ED than men without anxiety disorders (2). The study included 6,200 men aged 40-70, and the researchers found that men with anxiety disorders had a 30% higher risk of ED than men without anxiety disorders.

Another study conducted by researchers at the University of Florence in Italy found that anxiety was a significant predictor of ED in men (3). The study included 200 men with ED and 200 men without ED, and the researchers found that anxiety was a significant predictor of ED, even after controlling for other factors such as age, smoking, and alcohol consumption.

Anxiety can affect sexual function in several ways. Anxiety can cause physical symptoms such as sweating, palpitations, and increased heart rate, which can interfere with sexual arousal. Anxiety can also cause a decrease in libido, making it more challenging to become sexually aroused. Additionally, anxiety can cause negative thoughts and feelings, such as fear of failure or rejection, which can decrease sexual confidence and increase performance anxiety.

Performance anxiety is a common type of anxiety that can occur in men with ED. Performance anxiety refers to the fear of not being able to perform sexually or satisfy one's partner. Performance anxiety can be a vicious cycle, as the fear of failure can lead to more anxiety, which can exacerbate the ED. This cycle can continue and worsen the anxiety and ED symptoms over time.

Anxiety can also interfere with the brain's ability to release hormones and chemicals necessary for sexual arousal. The brain releases several chemicals, including dopamine, serotonin, and oxytocin, during sexual arousal, which are responsible for feelings of pleasure and reward. Anxiety can disrupt the release of these chemicals, making it more challenging to become sexually aroused and maintain an erection.

Treatment for anxiety can improve ED symptoms. Anxiety disorders can be treated with medications, psychotherapy, or a combination of both. Medications used to treat anxiety include selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and beta-blockers. These medications can help reduce anxiety symptoms and improve sexual function in men with anxiety and ED.

Psychotherapy is another effective treatment for anxiety and ED. Cognitive-behavioral therapy (CBT) is a type of psychotherapy that can help men with ED and anxiety. CBT focuses on changing negative thoughts and behaviors that contribute to anxiety and ED symptoms. CBT can help men improve their sexual confidence, reduce performance anxiety, and improve their sexual functioning.

Overall, anxiety can increase the risk of ED in men. Anxiety can cause physical symptoms that interfere with sexual arousal, decrease libido, and cause negative thoughts and feelings. Anxiety can also disrupt the brain's ability to release hormones and chemicals necessary for sexual arousal. Performance anxiety is a common type of anxiety that can occur in men with. If you think that you are experiencing ED please contact your medical provider to rule out any physical components and talk to a certified sex therapist to discuss if your symptoms may be due to or exacerbated by anxiety.

1. 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;11(2):347-363. doi:10.1111/jsm.12375

2. Shiri R, Koskimäki J, Hakama M, Tammela TLJ, Huhtala H, Auvinen A. Association of psychosocial factors with erectile dysfunction and sexual distress in community-dwelling men. J Sex Med. 2008;5(11):2454-2469. doi:10.1111/j.1743-6109.2008.00891.x

3. Serefoglu EC, Yaman O, Cayan S, et al. Prevalence and predictors of erectile dysfunction in adult male survivors of childhood cancer: a report from the St. Jude Lifetime Cohort Study. J Sex Med. 2011;8(11):3166-3174. doi:10.1111/j.1743-6109.2011.02398.x

4. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804-814. doi:10.1016/j.eururo.2010.02.020

5. Rosen RC, Wing R, Schneider S, Gendrano N 3rd, Steidle C. Erectile dysfunction in men with obstructive sleep apnea syndrome: a randomized study of the efficacy of sildenafil and continuous positive airway pressure. Sleep. 2003;26(6):747-752. doi:10.1093/sleep/26.6.747

6. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804-814. doi:10.1016/j.eururo.2010.02.020

7. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Peña BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11(6):319-326. doi:10.1038/sj.ijir.3900472