Psychological vs Physical Erectile Dysfunction: How to Tell the Difference

Persistent difficulties with getting or maintaining an erection can be understood as primarily due to physical or psychological problems. While most of the time it is a mixture of both, understanding how they can present differently matters. Whether the erectile dysfunction is primarily psychological or physical can guide further investigations and the management plan for symptoms. In this article we answer some commonly asked questions such as how to know if ed is mental or physical

What is Physical Erectile Dysfunction?

So what is physical erectile dysfunction (ED)? This condition refers to problems in getting or maintaining an erection due to a medical problem. It might be helpful to think of this as physiological ed or having an organic or biological cause. This might include issues with blood flow, problems relating to the nerves involved, or hormonal imbalances. For example, some characteristics of physical erectile dysfunction are:

• The problem starts gradually or progresses slowly over time rather than happening very suddenly
• The difficulty in getting or maintaining an erection is not limited to specific scenarios, instead the problems can occur during sex with a partner or masturbation. There may also be difficulties in achieving an erection in the morning.
• With physical erectile dysfunction, it is also likely that the person has a pre-existing medical condition or takes regular medication. For example, a past medical history of diabetes, any heart or blood vessel problem, problems with hormonal balance, high blood pressure, previous surgery in the pelvis, previous stroke, or certain psychiatric drugs.

In fact, erectile dysfunction can be an early symptom or warning sign for certain health conditions (e.g cardiac, vascular, or haematological problem) so an assessment by a medical professional is warranted.

Understanding Mental ED and Psychological Impotence

Now that we have discussed physical erectile dysfunction, it is worth explaining psychological ed before we get into how the two of these differ. Psychological erectile dysfunction or impotence comes from non-biological factors including relationship dynamics, emotional factors, and cognition rather than a medical problem in the body. For example:

• Performance anxiety – feeling worried about sexual performance, or a sense of failure or inadequacy. Stress from other parts of life may spill into this intercourse and bring about mental ed. 
• Relationship problems – difficulties in a relationship such as communication issues, unresolved arguments, or lack of trust in your partner may bring about difficulties with maintaining an erection.
• Mood disorders such as depression or generalised anxiety disorder – these conditions may be accompanied by symptoms of low self-esteem, loss of interest in things that someone used to enjoy, reduced sex drive etc. This may also worsen any existing performance anxiety and stress.

As such, psychology ed is usually specific to a situation (for example after a stressful event) but the person is able to achieve or maintain an erection in other contexts (e.g when waking up in the morning, during masturbation etc). When the problem is more psychological than medical, the pattern of difficulties getting an erection may also be of sudden onset or fluctuation (i.e some days are fine and some days are not).

How to Know if ED is Mental or Physical

From the first sections of this article, it might seem like the two categories of erectile dysfunction are very separate and people either have one or the other. The reality is a lot more complex as most people with ED have elements of both psychological and physical factors. Hence, when someone goes to the doctor for help with erectile dysfunction, the doctor will usually want to take a comprehensive history and potentially conduct a physical examination. Some questions they might ask may feel quite private or potentially embarrassing, but it is kept strictly confidential and only used for the purposes of getting a better understanding of the problem and how to manage it. For example: 

• When did the problems start?
• Is there a pattern to when this happens?
• Do you have any pre-existing medical problems? e.g heart problems, diabetes, high blood pressure, asthma, inherited conditions
• The doctor may conduct a general physical examination which may include a genital exam
• Blood tests may be requested to assess the levels of hormones, glucose, lipids etc.

Erectile dysfunction is often multifactorial, however, there are some ways to see when it is mainly physical versus mainly psychological ED:

Common Causes of Psychological ED

There is rarely a single root cause for psychological ED, usually the problem is multifactorial including social, environmental, and mental health factors:

Treatment Approaches for Physiological ED vs Psychological ED

There is likely to be overlap between the treatment approaches for erectile dysfunction that is primarily physiological (or biological/medical) and the psychological form. The goal is to start treatment tailored to the individual’s unique situation as well as the underlying cause. Thus, the multifactorial nature of ED means that a combined approach is recommended. Regardless, it might be helpful to go through an overview of key elements of treatment for physiological vs psychological ED.

When to Consult a Healthcare Professional

So when should someone consult a healthcare professional about erectile dysfunction? Generally, if the erectile difficulties last for a few weeks or the problems keep coming back despite recovering for a bit, then you may benefit from speaking to your GP. At the consultation, they will ask you questions to assess the situation and your overall health. Then, if indicated they may arrange for some blood tests and/or refer to relevant services. Some more specific examples of when you might seek medical advice include:

• if the erectile dysfunction starts to affect your relationship or quality of life
• if you notice the problems started after beginning new medication
• if you are under the age of 40
• if you have noted any other concerning symptoms (lethargy, prone to infection) alongside a new onset of erectile dysfunction
• if you have any cardiac risk factors e.g high blood pressure, high cholesterol, diabetes, obesity, or you are a heavy smoker
• if you start to experience symptoms of depression or anxiety e.g persistent low mood, loss of interest in things you used to enjoy, panic, persistent worry etc.