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  • Writer's pictureFabio Castiglione

Psychological Impotence : What is it?. Dr. Fabio Castiglione Urologist London.

Dr. Fabio Castiglione Urologist London and Director HolisticAndrology Clinic and Diga33. The center uses a therapeutic approach based on the most recent clinical studies, on the guidelines of the international scientific societies of sexual medicine of which Dr. Castiglione, andrologist London, is a member of the commission.

dr. Fabio Castiglione | urologist london

Today we will talk about Psychological Impotence, because if it is true that the causes of male impotence and erectile dysfunction (ED) fall into three categories: physical / medical, lifestyle and psychological; in the end the dynamics of this common disorder are not so separable. For many, such difficulties start out as physical but eventually become primarily mental and emotional ED.

Psychological impotence: what to do?

Although erectile dysfunction can be thought of as an older man's problem, statistics show that this condition affects men of all ages. In fact, some research suggests that about 26% of new ED cases are men under the age of forty. If in older men, erectile dysfunction is often linked to underlying health problems, such as heart disease or diabetes; what can we say regarding young and healthy men? What explanation is there why a 30-year-old man in perfect health can have erection problems?

How important is the psyche?

psychological causes of ED

In the absence of physical health problems, we need to investigate a little to determine the underlying cause of erectile dysfunction. What you may not know is that psychological factors are a major contributing factor for many ED cases, up to 20%. If you have erectile dysfunction and there are no underlying health causes, your problems are all in your head. Although psychological problems may be at the root of your problem, they are just as valid as the physiological causes of ED.

What are the most common psychological causes of ED?

Psychological impotence

When erectile dysfunction is caused by psychological triggers, it is referred to as psychological impotence. Some of the more common causes of this type of ED include the following:

· Fatigue.

· Anxiety.

· Relationship problems.

· Depression.

· Performance anxiety.

· Fault.

· Low self-esteem.

· Addiction to pornography.

Many of these triggers are related, and the person may be affected by more than one. Let's now take a closer look at each of these psychological ED causes.

Can Stress and anxiety cause ED?

Although stress and anxiety are two different things, they are closely related when it comes to erectile dysfunction problems. In many cases, stress is the underlying factor. But that stress causes anxiety, which then triggers more stress, turning it into a vicious cycle. If you take a look at the physical side of things, however, you will see that stress and anxiety are even more closely related than you might imagine.

There are several types of penile erections

To be precise, there are three. A reflexive erection is due to physical stimulation, a psychogenic erection, triggered by visual or mental images and finally the nocturnal erection, the one that occurs during sleep. All three involve specific body systems, including hormones, muscles, blood vessels, nervous system, and emotions. If any of these systems are compromised, it can cause ED.

The brain that goes haywire

In the case of anxiety and stress, these things can affect the brain's ability to send the signals necessary to activate the desired physical response: an erection. Stress and anxiety can also contribute to an ongoing cycle of ED.

Relationship problems

Cultivating and maintaining a healthy relationship isn't easy. It takes time to truly know someone and trust them. If you and your partner are having problems with your relationship, they could very well ruin your sex life. As indeed it could also be the other way around, erectile dysfunction is creating problems in the relationship. Here is another example of the ED cycle that can affect many different aspects of your life.


Unless you have experienced depression directly, you may think of it as something akin to sadness. Clinically speaking, it is much more. Depression works much like an anchor, weighing down the body and mind, affecting all aspects of life, physical and mental. The researchers were able to conclude that there is a relationship between depressive symptoms and erectile dysfunction and it is independent of age and demographics.

Performance anxiety

In many ways, performance anxiety becomes a self-fulfilling prophecy, in which you become nervous about being able to satisfy your partner. Eventually that nervousness can lead to sexual dysfunction. In some cases, performance anxiety is triggered by negative internal speeches: worries about being able to achieve an erection, please a partner or ejaculate too soon. If you have had erection problems in the past, those experiences will add to the burden of performance anxiety.

Guilt and low self-esteem

Many men with erectile dysfunction feel guilty for not being able to please their partner. If the problem persists, the guilt becomes more than just a side effect - it can also contribute to the ongoing cycle of ED. Guilt is often associated with low self-esteem, and not just in men with erectile dysfunction. Guilt and shame are feelings commonly linked to mental health problems such as depression, this can affect your ability to perform sexually, but also lead to low self-esteem. If you have pre-existing low self-esteem or are struggling with other self-image problems, you may experience ED due to performance anxiety.

Conversely, if you suffer from erectile dysfunction, whether it is caused by psychological or physical problems, research suggests that you may experience feelings of depression, along with low self-esteem, anxiety, etc. The relationship between erectile function and depression, anxiety and self-esteem is complex, but the relationship is there, all the same.

Addiction to pornography

Porn addiction is a potential cause of erectile dysfunction that many men do not consider. If you spend a lot of time watching and masturbating in front of pornography, you may develop unrealistic expectations about sex or your sexual partners. Researchers actually studied this effect and gave the condition its name: porn-induced erectile dysfunction (PIED). What you go through is hyperstimulation, in essence, you learn to get more physical stimulation from masturbation than from sexual intercourse.

How do you know if your ED is psychological?

For years, men have believed that sexual problems are a normal part of life and in particular of aging. Fortunately, modern medicine and changing attitudes have dispelled this myth. The first step to discovering the cause of your ED is to talk to your doctor who can refer you to the specialist, the Andrologist. This is because the andrologist is the specialist indicated to identify the exact cause of ED, excluding any physical form.

Medical causes of erectile dysfunction

Some of the medical causes often linked to ED include conditions such as diabetes, hypertension, high cholesterol, coronary heart disease, obesity, hormonal disorders, alcoholism, and metabolic syndrome. To rule out these medical conditions, your doctor may perform the following tests:

· Complete blood count (CBC)

· Fasting glucose or glycated hemoglobin (A1C)

· Complete metabolic profile

· Thyroid stimulating hormone

· Lipid profile

· Total serum testosterone


In addition to these laboratory tests, your doctor may also ask you to complete a self-assessment to assess your level of sexual function. Depending on your responses and the results of your lab tests, your doctor may recommend a psychological evaluation to further explore the potential cause of your ED.

Important signs of ED

Whether or not you have spoken to a healthcare professional, there are some signs to look for that may suggest that erectile dysfunction is psychological in nature. Ask yourself the following questions:

Are you interested in sex and attracted to your partner, but having trouble performing?

Can you achieve an erection while masturbating?

Do you have morning erections?

Are you very stressed or are you experiencing an abnormal amount of anxiety?

Do you get nervous about your partner's pleasure?

If you answer "yes" to any of these questions, your ED may have a psychological connection. To confirm this diagnosis, you may want to complete a full psychological evaluation. This is especially important if you suspect your ED has something to do with a mental health problem such as anxiety or depression, which may require additional medical or psychological treatment.

Treatment options for psychological impotence

Although the psychological causes of erectile dysfunction may be more complex than the medical causes, they are still treatable. You should know, however, that resolving psychological impotence may not be as simple as taking Viagra (sildenafil citrate). ED medications are designed to evade the physiological causes of ED, such as low blood pressure or vascular damage, which means they won't help you with anxiety, stress, or low self-esteem issues.

The best treatment for psychological ED will address the problem at its root.

Cognitive behavioral therapy (CBT) is a common treatment for psychological problems in general, but also for ED. Facilitated by a therapist, this type of treatment helps to identify and modify unhealthy thought and action patterns that can contribute to your erection problems.

This type of treatment is based on the idea that the situation itself (your inability to achieve or maintain an erection) is not the main problem, but rather your reaction to it. If you can learn to understand yourself and your thought patterns better, you can change them in a positive way to solve your problems.


Erectile dysfunction is a problem that can compromise the quality of life, as well as being a sensitive subject for men. The goal of Dr. Fabio Castiglione, Urologist in London, like any good specialist, is to eliminate, if possible, the causes that lead to this disorder, aiming to achieve a significant improvement in the quality of sexual life of patients.

HolisticAndrology, urology clinic in London, has always been at the forefront to improve the quality of life for all people suffering from Impotence. If you are interested and want more information, do not hesitate to contact us.

Contact HolisticAndrology, andrology clinic in London (tel. +44 (0) 7830398165) to book an andrological consultation with dr. Fabio Castiglione, Urologist London.

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