What is psychological impotence and what causes it?

Recent clinical and doctor-patient studies have conclusively proven that psychological impotence directly affects only 10% to 20% of men. 

However, because of the perceptions men attach to their sexuality and virility, and the subsequent feelings of frustration, anxiety and depression caused by impotence, it can be the indirect result of impotence brought about by a physical condition.

What causes psychological impotence?

The brain plays an integral part in the physical process of creating an erection. It can also be equally responsible for preventing one. 

If the portion of the brain responsible for sending impulses to the penis that result in an erection receives negative rather than positive messages, it will respond by releasing chemicals that constrict the blood vessels in the penis and inhibit the natural process that causes an erection.

Therefore, feelings of inadequacy, anxiety, stress, guilt, depression or sheer boredom can result in what is called psychogenic or psychological impotence - the inability to achieve or maintain an erection due to psychological rather than physical causes.

Most men will experience this condition at least once in their adult life, so it's important to know that an occasional episode is not a diagnosis for on-going impotence. In most cases, isolated episodes are more likely to be due to fatigue, stress or an over-indulgence in alcohol.

However, many men react to an occasional episode of impotence by becoming more anxious, which results in further sexual problems, hence more anxiety. This is called the "impotence domino effect" of anxiety - failure - more anxiety - more failure. 

Despite the enormous advances men and women have made about their sexual roles and identity since the sexual revolution of the 1960's, many men still feel enormous pressure to "perform" sexually. Very often their feelings of self-worth and masculinity are intricately interwoven with their ability to "get it up". So it's easy to see why impotence, even if it is an isolated incident, can lead to "performance anxiety" and the subsequent loss of self-esteem. 

The most important thing to remember is that occasional episodes of impotence are normal. Unless there is an underlying physical cause for impotence, or the episodes increase in frequency, there is no need for treatment. 

Factors contributing to the issue

Depression

Depression and anxiety disorders are cited as the most common causes of psychological impotence.  However, depression and anxiety can be both the cause and the consequence of impotence.  

In many cases, it can be very difficult to determine whether depression and anxiety disorders cause impotence, or if impotence leads to feelings of depression and anxiety. A bit like "the egg and the chicken" - which comes first?

Clinical depression can cause psychological impotence because it interferes with the brain function necessary to stimulate sexual arousal and produce an erection.  Depression also suppresses positive feelings and emotions, which inhibit libido and the desire for sexual activity. 

Medications

A number of prescription drugs used to treat severe depression and anxiety disorders are known to cause psychological impotence. These include certain anti-depressants, anti-psychotics, tranquilizers and lithium.

Relationship Issues

The answer to relationship issues often lies in good communication.  Problems with impotence can put severe pressure on the healthiest relationship, so it's important that both you and your partner share your feelings. 

Reducing your anxiety prior to sexual activity is vital.   By working together, you and your partner can enhance your relationship by creating a stress-free, intimate and stimulating environment.

Stress

Stress is one of the leading causes of psychological impotence. While a little stress helps drive achievement and success, too much stress is not good for you.  Most of us live fairly stressful lives these days, so stress can be work-related, financial, marital, sexual or any one of a number of other reasons.   

Most men have experienced either a loss of libido or an inability to maintain an erection during periods of stress, however these episodes are usually transient.  In most cases, once the stress has been reduced, full sexual function returns.

Fatigue

Like stress, fatigue affects us all at certain times and is a common cause of temporary psychological impotence. Fatigue drains mental and physical energy and can result in anxiety if the problem is not addressed.  Like stress, once fatigue is reduced, normal sexuality is restored.  

On-going fatigue may be a symptom of an underlying medical illness, so consult your doctor if the symptoms persist.

So what's the bottom line with psychological ED causes?

Psychological components may play a role in your impotence issue, or may just be the main cause.  The good news is that most of the time this can be treated effectively.

Talk to your doctor about any depression, fatigue or stress that you are feeling and see what your options are as far as dealing with the issue.  Once those issues are resolved, it's quite possible that your impotence will be cured as well.