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Erectile Dysfunction and Mental Health – What Helps?

by Anne Frier

Erectile dysfunction (ED) can be difficult to talk about, but is an issue across age groups.

And while it can be treated with medication and the mental health aspect ignored, this approach can lead to slower recovery or other long-term issues. 

How common is erectile dysfunction?

It seems that numbers are on the rise when it comes to erectile dysfunction.

A 2002 review of research across four continents placed ED as affecting only 2% in men younger than 40, but rising to 86% in men 80 years old and over (1).

But by 2011, an Europe-wide research review revealed that up to 28% of men between 18 and 40 had ED issues. This was echoed by a 2014 study in Canada that concluded 24% of men aged 16 to 21 had ED difficulties. (2,3)

Isn’t erectile dysfunction a physical issue?

It can be related to medication, which adds to the reason it is more common in older men who are more likely to be taking medication.

And there is an age component. Older men do need more stimulation to have an erection and need more time between erections.

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In younger men with erectile dysfunction, it can be caused by narcotics abuse, alcoholism and certain rare diseases.

Erectile dysfunction and psychology

Performance anxiety is definitely a contributing factor.

Once men have first noticed erection problems, they often obsess about it during sex, and their worries affect future erections. In young men, it can be worries about being new to sex, or to a partner.

Does performance anxiety play a part even if ED is a result of natural ageing? Typically the result of long-term damage to blood vessels, erectile dysfunction makes slow, gradual progress.

The associated mental distress it brings, on the other hand, can take effect much faster. It can effectively shorten the time from first noticing an erectile problem to complete flaccidness.

On the upside, this psychologically reinforced side to ED can be helped.

The truth about growing numbers of young men with ED?

The rise of readily accessible internet porn in the past two decades is driving ED problems in younger generations.

There’s now a vast amount of literature on the subject. This includes Gary Wilson’s insightful book Your Brain on Porn: Internet Pornography and the Emerging Science of Addiction.

The bottom line is that the brain is overstimulated by excessive porn use (greater than one hour daily) and requires ever greater stimuli to release dopamine and trigger sexual arousal. ‘Vanilla’ sex with a partner then no longer does it for the brain, and the penis stays soft.

The good news is that several months of porn abstinence can restore a man’s libido. Of course porn, like any addiction, is difficult to just ‘cold turkey’. Support, such as counselling, is suggested. 

What can help if you are struggling with erectile dysfunction?

1.Communicate with your partner.

Sit down with your partner and talk frankly about your ED issue, and the associated mental stress and feelings of shame or guilt you may have. Also seek to better understand what your partner considers a fulfilled sex life. Most likely, you’ll discover that you have to throw out some of your earlier assumptions.

2. Get creative.

Explore new aspects of sex together, by expanding the foreplay and relishing the emotional intimacy of the act more deeply. For both partners there are many roads to a fantastic orgasm (even older men with complete erectile dysfunction can still enjoy orgasms).

Broadening your understanding and scope of sex will take away the focus from intercourse, making it more of an optional side show rather than the obligatory end of all sex.

3. Apply mindfulness.

Aspect of mindfulness have been successfully applied to sexual problems for a long time, well before “mindfulness” was coined as a term. William Masters and Virginia Johnson developed a sex therapy in the 1970s called “sensate focus”, where partners are asked to focus on their senses and sensations during sex, rather than thinking about the goal of having an orgasm. 

Recent research on mindfulness therapy for ED includes a 2018 pilot study at the University of British Columbia, led by Lori Brotto, author of Better Sex Through Mindfulness. The study found that mindfulness therapy can help men with situational, psychologically-induced ED. (4)

Mindfulness applied to ED means that calm awareness of the present moment helps  block performance anxiety or other negative thoughts creeping in. You’ll learn better accept your sexual state and note details you bypassed before, like how nice your partner smells, the feel of skin, or sensation of touch.

Not sure you want to learn mindfulness alone? You can also work with a a mindfulness-based therapist.

[Not even sure what mindfulness is? Use our easy how to “Guide to Mindfulness“.]

4. Consider CBT therapy

Cognitive behavioural therapy means cognition (your way of thinking) is used to identify and change negative thoughts, attitudes and behaviours. And there are CBT therapists who specialise in erectile dysfunction.  

CBT can also help you overcome porn addiction (and thereby resolve the accompanying ED issues). 

5. Go to couples counselling together. 

Many health professionals helping patients with restoring penile erection favour a holistic approach with patient and partner involved, over just focusing on erectile dysfunction as an isolated issue.

That said, the study at Queen’s university in Canada found that less than 10 per cent of clients offered counselling took the opportunity. To their detriment. As the study explains, even if  the ED got better, serious relationship problems remained. 

“Once the recovery of erectile function takes place, major changes may occur in relationship dynamics. The present study showed that a large percentage of partners were either indifferent or unhappy about future sexual activity. These attitudes of the partners will undoubtedly present new conflicts in relationships with pre-existing problems.”

 A few sessions of couples counselling can greatly improve communication skills between partners, teaching them how to better listen and express themselves. It can help avoid the relationship falling apart even if your erectile dysfunction improves. 

Ready to seek support for yourself and your relationship? We connect you with some of London’s most highly regarded psychotherapists and counselling psychologists. Not in London? Use our booking site to find a registered therapist near you, or an online therapist you can chat to from anywhere. 


Still have a question, or want to share your experience about ED recovery? Post below. Comments are monitored to protect our readers. 

  erectile dysfunction Anne Freier is a medical and science writer. She has an MRes in Biomedical Research and a MSc in Neuroscience & Neuropsychology.






  1. Prins, J., Blanker, M., Bohnen, A. et al. Prevalence of erectile dysfunction: a systematic review of population-based studies. Int J Impot Res 14, 422–432 (2002). https://doi.org/10.1038/sj.ijir.3900905
  2. Park, Brian, et al. “Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports.” Behavioral Sciences, vol. 6, no. 3, 5 Aug. 2016, p. 17, 10.3390/bs6030017.
  3. JC Lee, DHC Surridge, A Morales, JPW Heaton. Erectile dysfunction: The perspectives of patients and partners on counselling. J Sex Reprod Med 2002;2(1):11-15.
  4. Bossio, Jennifer A, et al. “Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study.” The Journal of Sexual Medicine, vol. 15, no. 10, 2018, pp. 1478–1490, www.ncbi.nlm.nih.gov/pubmed/30297094, 10.1016/j.jsxm.2018.08.013.


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