The Connection Between Anxiety and Erectile Dysfunction

Anxiety can stop a hard-on in its tracks, but there are ways to cope

July 13, 2023 6:03 am
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It turns out that when it comes to successfully achieving and maintaining erections, mental health might play as big of a role as physical health. During sexual activity, anxiety, fear and worry can be about as helpful to a penis-owner’s privates as a dive into a chilly swimming pool.

Unfortunately, many remain unaware of this fact. 

“So much of my human sexuality education focuses simply on how the body works, which [is where] the vast majority of American education fails us,” says Ty David Lerman, a psychotherapist and certified sex therapist.

Those who struggle with erectile dysfunction (ED) may think they’re just broken and unfixable, their self esteem devastated. In a sex-negative world, we’re not encouraged to explore or learn about sexuality in an empowered way, but being better informed is a starting point for people who want to break disruptive, harmful cycles of thought and behavior that a person with ED might be stuck in. 

How Do Erections Happen in the First Place?

In order to better understand ED, we need to learn how erections come about. They’re actually not the simple, straightforward occurrences that they may appear to be.

Erections happen when penis owners start to become sexually aroused and blood begins to circulate into the erectile structures throughout the body, causing them to expand and enlarge, explains Dr. Lee Phillips, Ed.D, a psychotherapist and certified sex and couples therapist. The blood vessels constrict, keeping the penis erect.

This whole process is possible because the brain sends a signal to the genitals that it is time to begin the sexual response cycle. The brain and body send messages back and forth all the time, so this messaging system needs to stay open and reciprocal for a penis to stay erect and reach ejaculation. It’s a complex biological and psychological process. When our nervous system is in a relaxed state, these messages can travel freely and effectively. But should the nervous system become activated, trouble could turn up. 

How Anxiety Takes Down Erections 

When we experience nervous system dysregulation, we often experience anxiety. Lerman says anxiety occurs when our coping mechanisms aren’t sufficient in dealing with a change in our environment, whether real or not. In sex, this can look like getting into your head and worrying you might lose your erection, worrying you won’t last long enough, or feeling generally self-conscious.

Nervous system activation is a survival response to perceived danger, something that was forged at some point in our evolution so that we knew to run away quickly from, like, lion attacks and other threats. “There is a domino effect that occurs so that we are better able to fight for our lives, or to flee,” Lerman explains. “Our stomach stops digesting, our brain functioning literally shuts down higher levels of reasoning and logic, and we become much more reactive and instinctual — impulsive, if you will.”

When we’re anxious during sexual activity, the blood vessels contract and constrict the flow of blood throughout the body, Philips explains. “When the person tries to control their response,” he adds, “the blood flow stops causing the person to lose their erection.”

Your brain begins churning out stress hormones, too. “Our brain sends signals to the body to secrete adrenaline and cortisol and our heart rate increases as a result,” explains Jordan Dixon, a clinical sex and relationships psychotherapist.

Your brain is now screaming to your boner that this is not a safe situation, you are in danger, and it is time to put that erection down. So, the erection withers away, and your blood flow is sent to your extremities so you can run like hell from that (probably make-believe) lion.

Legit, who is going to keep an erection under these circumstances?

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Ongoing Anxiety Can Lead to Ongoing ED 

The mind-body relationship is incredibly important to erections. 

When penis owners are anxious a lot, especially about our erections, ED can become a self-fulfilling prophecy. You’re anxious, so you have erection problems — which leads you to be anxious about your erections — which causes erections not to happen, and so on. “We have this trigger response to some perceived threat: not being able to sexually ‘perform’ well with your partner,” says Lerman, “which sets off the SNS [Sympathetic Nervous System] and we lose our erection. Then, our brain fixates on the physical reaction to our stress response (the fact that you cannot get/stay hard), which further sets off the SNS and releases even more cortisol, which amps up the Fight, Flight, Freeze respond.”

This is the anxiety cycle that perpetuates ED.

Philips also warns that anxiety-induced ED may not always be about the erections themselves, but born out of other stressors that we have trouble letting go of during sex. “They may have emotional problems with their relationship, work stress and other health issues,” Philips says.

All in all: It’s hella complicated.

5 Ways to Manage Anxiety for Stronger, More Reliable Erections

1. It All Starts With Breathing

Before we can calm anxiety and start to return the nervous system to a state of relaxation, we have to learn how to breathe. “Deep breathing is a natural and very effective way to trigger the PSN [parasympathetic nervous system] and communicate to your body that the stress/threat has passed and you’re allowing yourself to relax again,” says Lerman. 

Try breathing in for a count of four, holding it for a count of four, and then releasing it for another count of four. This may require you to take a break during sex in order to feel calm again. Communicate with your partner when necessary.

2. Take “Performance” Off the Table 

When any of us think that successful sex is dependent upon whether or not we can “perform,” we really do ourselves a disservice. Dixon says that when we let go of performance and focus on pleasure, we can have more expansive and fulfilling sex — without all the pressure. After all, “we are intricate, complex, powerful, and subtle,” she says. 

This can also mean expanding your definition of “sex” to include elements that are, say, not strictly tied to intercourse. 

“It is recommended the person tap into their erotic template on what they find erotic and identify their turn ons,” Philips says. “They may also have fantasies, fetishes and/or kinks to explore as well.”

3. See a Doctor to Explore PDE5 Inhibitors

If you’re curious about medical options, Philips suggests seeing a doctor to see if you are a candidate for an ED treatment, such as a prescription to Viagra or a similar drug. It’s important to note that these types of drugs can help maintain erections, but they don’t automatically give you one. With that being said, having them as one of your tools can be very reassuring — which lessens anxiety.

4. Get In-Tune WIth Your Sensory Experiences

Being too “in our heads” during sex robs us of enjoyment and can lead to ED. To remedy this and get you back into your body, sex therapists use sensate focus. “What this means is to focus your attention — your entire being — on the sensations you are experiencing,” Lerman says. “This gets us out of our heads, and brings us into the present with our partner(s). We become hyper-aware of giving and receiving sensation, what we literally sense.” When we’re this in-tune with our senses, we don’t stay trapped in the cycle of self-doubt.

5. Go to Therapy

A qualified sex therapist can be a wonderful support system when you’re coping with ED. You can work with them to manage your anxiety responses and come to feel better equipped to deal with perceived threats.

There is nothing wrong with needing a little assistance because, as Lerman puts it: “You deserve a happy, healthy sex life — we all do!”

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