The Psychology of Erectile Dysfunction
Dr. Jess     
Dr. Jess's guest blogger Daniel Michaels brings a scientific approach to one of the most sensitive topics in sexuality: erectile dysfunction.

In my first post, I introduced you to the fascinating field of Sex Science and how studying the brain might help explain some of the big Why questions that everyone has about their sex life.

What I’d like to do now is come up with some answers to these questions, starting with what most men describe as their biggest sex-related fear… erectile dysfunction.

Erectile Dysfunction

For those of you who don’t identify as playing an “active” insertive role in sex, don’t exit the screen just yet; I promise you’ll be in the spotlight soon enough. But for now, I’d like to focus on the penile partners.

We’ve all been there, that moment when it seems like everything to do with sex is up except your penis. Or when you felt as though you were about to orgasm but couldn’t climax regardless of how hard you focused. If any of these situations apply to you, then you’re probably pretty…normal.

That’s not to say that for some people, erectile dysfunction is not a cause for concern. If erectile dysfunction is something that you live with each and every day, then you may want to refer yourself to a physician. Since erections are the result of coordination between various physiological systems, such as the nervous system and cardiovascular system, dysfunction may be a sign of another underlying problem. However, I’ll leave that type of medical education to the urologists.

All right, so let’s say that you have a hard time getting erect or maintaining an erection, some but not all of the time, why might this be the case? Let’s use what we have gained from neuroscience to answer this question.

Erections and ejaculation are the result of coordination between two divisions of our autonomic nervous system, the parasympathetic (rest or digest) and sympathetic (fight or flight) systems, respectively. Initiation of an erection can be broadly categorized as reflexogenic (stimulation of the penis) or psychogenic (result of erotic stimuli that leads to top-down control of an erection by the brain).

Regardless of how an erection starts, the physiology behind them is a fairly complicated balance in the nervous system. Where I’d like to focus is on the psychological factors that might disrupt this balancing act that the male body is expected to perform.


Stress, a word that we all know too well, is our body’s way of coping with any kind of demand or threat from our environment. Interestingly, this threat does not necessarily need to be real but in many cases may also be imagined. As a reaction, our bodies natural defenses kick in, we activate the sympathetic (fight or flight) division of our autonomic nervous system and mount a stress response.

How does this all relate to erections? Overstimulation of the sympathetic nervous system can inhibit blood flow to the penis. Honestly, it doesn’t take much psychological distress to interfere with sexual functioning. Feeling anxious, depressed, changes in your confidence level, doubt, disappointment, negative body image, unrealistic expectations regarding sexual performance, and adjustment to new living conditions (to name a few) can be stressful.

The thing about depression is that one of its hallmark symptoms is anhedonia, or the lack thereof pleasure, so it’s clear why living with a mental illness may interfere with our sex life. Interestingly, antidepressants may sometimes help with this, but can often interfere with sexual desire and performance as well.

Did you know that even success can interfere with your sex life? If you were surprised, then you probably didn’t know that stress can also arise from things that we evaluate as positive as well.


If you remember what I said about the male body’s complex balancing act, it’s no wonder that drugs can influence our sexual behavior.

Let’s start with prescription drugs, which include medications to control high blood pressure, antihistamines, pain medication, muscle relaxants, antiarrhythmic drugs, medications used to manage Parkinson’s, and chemotherapeutic drugs.

Then we have the drugs that everyone knows and loves, i.e. psychotropics, which are chemical substances that change brain function and result in alterations in perception, mood, or consciousness. These include stimulants like amphetamine, cocaine, caffeine and nicotine, depressants like alcohol, barbiturates, benzodiazepines and heroin, hallucinogens such as marijuana and LSD, antidepressants, and antipsychotics. Each of these drugs acts on different neurochemical pathways in the brain that are important for sexual desire, performance and orgasm. Some these substances increase desire but completely wipe out our ability to experience sexual pleasure and climax.

Performance Anxiety

Those who frequently struggle with performance anxiety understand how debilitating it can be. Performance anxiety cripples our ability to experience sexual satisfaction, not only in the here and now, but in the future.

But where is this all coming from? Why does performance anxiety even exist?

The problem is that we’ve been socialized to think that sex is an act with a clear set end goal, i.e. the orgasm. We’ve been programmed to think that a component of our masculinity is tied to our performance in bed. So we set up unrealistic expectations, usually established by what the media portrays as a sexy body and fantastic sex, fail to reach those expectations, and experience guilt and shame as a result.

Think about it: do other animals experience performance anxiety in the context of sex?

They don’t, and it’s probably because of what I like to refer to as the SEXIEST structure in the human brain, the prefrontal cortex. While the evolution of this brain structure has allowed for advanced human cognition, it also brought with it the ability to fear judgement, to experience embarrassment and shame, and to project ourselves into the future and worry about things that may or may not even be threatening. (That’s an oversimplification, since other animals do in some cases show signs of emotions that we once thought couldn’t exist in our furry friends, but I’m trying to make a point here.)

Speaking of the animal kingdom, why is it that in many animals, sex is actually controlled by females and not males, yet in humans we have this perception of females playing a passive role?

For instance, in the wild, female rats control the number of intromissions a male rat makes in order to reach an optimal vaginal code for fertility. Male black widow spiders engage in copulatory suicide, where they sacrifice their body as sustenance for the female to ensure that their genes live on. Some insects will even present their female partners with nuptial gifts, i.e. food items or inedible tokens that are exchanged during courtship or copulation.

But in our “advanced” human species, we have repressive gender roles that portray females as passive partners. Hopefully you’re beginning to understand that these gender norms also contribute to performance anxiety. Imagine if sex could be a judgement-free space filled with euphoria, mutual respect, care and concern for each other? What if sex was an experience that emphasized developing a deep-rooted bond, as opposed to just experiencing an orgasm? Would performance anxiety still exist?

So, what do we do now? As with last time, let me leave you with some neuroscience-guided wisdom.

  1. Ease the stressors in your life.
  2. Practice mindfulness and relaxation techniques.
  3. Openly communicate with your partner.
  4. Sex is not a race – take your time.
  5. Try to increase your self-efficacy and confidence through positive self-talk, since behavior influences our attitudes you’ll begin to believe what you tell yourself.
  6. Focus on the pleasure and explore other zones of stimulation apart from just your genitals.
  7. Explore new options while being realistic about your lovemaking – having sex in an airplane bathroom when you’re afraid of flying is probably not the most productive idea.
  8. Forget about the erection – let your body do the hard work.
  9. Switch it up a bit – don’t always take the active or passive role in sex.
  10. Take charge of your own body and your own orgasm – if it doesn’t feel right, communicate that to your partner and change to a position that works for the both of you.

If you’re continuing to experience performance anxiety, speak with a professional. They’ve got a whole toolbox of psychotherapeutic techniques that can help. Daniel Michaels holds a Bachelor’s of Science in Psychology and is currently a PhD candidate in Neuropsychiatry. His expertise as a scientist includes not only his work on sexual trauma, but also all things to do with sex and the brain. He has collaborated and trained with some of the leading scientists in the field of sex neuroscience. Daniel is also a regular contributor to PornHub’s Sexual Health and Wellness website. He is passionate about psychoeducation and has spoken at various academic and public events.

Dr. Jess

"An award-winning speaker, Jess has worked with thousands of couples from all corners of the globe to transform their relationships via her wildly successful Marriage As A Business program. From Prague and Istanbul to Albuquerque and New York City, her relationship retreats receive rave reviews from some of the most powerful couples in the world who are drawn to her enthusiastic, practical and no-nonsense approach to happily ever after. Jess's doctoral research focused on sexual health and relationship education and she is passionate about accessible, classroom-based education. When she isn't globetrotting for speaking engagements, she volunteers with students, teachers and social service organizations to empower young people to embrace healthy, happy relationships. As a global ambassador for several brands, Jess contributes regularly to the biggest names in international media. You'll find her advice weekly in the likes of Women's Health, Men's Fitness, Cosmopolitan, SELF, Showtime and The Movie Network. Her insights into couple' issues reaches millions of homes across America as the host of the hit reality series Swing, which just capped its fifth season on PlayboyTV. Canadian-born and Chinese-Jamaican and Irish by descent, Dr. Jess loves ultimate frisbee, crab, airplane turbulence, cheese and red wine. Makes perfect sense, right?"
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