Erectile dysfunction (ED) – difficulty getting or keeping an erection firm enough for intercourse – is a common problem. It’s often linked to physical health issues, like diabetes, low testosterone, and heart disease.

But sometimes, ED has emotional or psychological causes. In this case, it is called psychogenic ED. It may happen when a man is feeling depressed or anxious, having problems with his relationship, or dealing with stress. Men who feel conflicted about sex because of religious or cultural beliefs may also experience psychogenic ED.

For many men, the situation leads to performance anxiety. A man may become so anxious about getting an erection and pleasing his partner that when he’s in a sexual encounter, he has erection difficulties.

Fortunately, performance anxiety and psychogenic ED can be managed.

Start by seeing your doctor. Sometimes, ED has both psychological and physical causes, so it’s a good idea to have a full medical exam first. If physical issues are found, those can be addressed.

Here are some other ideas to consider:

• Talk to your partner. Discussing sex with your partner can be awkward, but it’s worth the effort. If you worry about your partner’s satisfaction, they can provide reassurance. Or they might open up and tell you more about what they need and enjoy.
• Remember that erection problems are common. Most men have erection difficulties from time to time. Having ED is not a reflection of your masculinity or your sexual skills. Don’t let it affect your self-esteem or self-confidence
• Remember that there is more to intimacy than penetration. Even without a firm erection, couples can still enjoy closeness together through hugging, kissing, and touching.
• Focus on the moment. During sex, try to focus on the “here and now” – the sensations of touch, taste, smell, sight, and sound. Concentrate on this time with your partner and what you’re feeling at the moment.
• See a sex therapist. If you need additional help, a trained professional can help you develop strategies for better communication and focus. They can also help you work through beliefs that may be getting in the way of your sexual enjoyment.

Learn more:

What are sex therapists? What do they do? How does one choose a sex therapist?

What happens during sex therapy?

Resources

• American Family Physician - “Erectile Dysfunction”
  Rew, Karl T. MD and Joel J. Heidelbaugh, MD
  (November 15, 2016)
  https://www.aafp.org/afp/2016/1115/p820.html

• International Society for Sexual Medicine - “What is the difference between sexual performance anxiety and erectile dysfunction (ED)?”
  https://www.issm.info/sexual-health-qa/what-is-the-difference-between-sexual-performance-anxiety-and-erectile-dysfunction-ed/

• MedicalNewsToday.com - “Overcoming sexual performance anxiety”
  Johnson, Jon
  (Updated: September 29, 2020)
  https://www.medicalnewstoday.com/articles/320574

• Urology Care Foundation - “What is Erectile Dysfunction?”
  (Updated: June 2018)
  https://urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)