Anxiety and erectile dysfunction

Yes, anxiety can cause erectile dysfunction (ED). When you feel anxious, your body switches into fight-or-flight mode, which pulls blood and focus away from arousal, so it gets harder to get or keep an erection even when your body is physically healthy (Nguyen et al., 2017).

The good news is that anxiety-related ED usually responds to the same tools that help with anxiety in general.

Can anxiety cause erectile dysfunction?

Yes. Anxiety and erectile dysfunction are closely linked, and the connection has a name: performance anxiety.

Your body has two nervous system modes. One, your parasympathetic nervous system, helps you feel calm and relaxed, and feeling relaxed makes it easier to become aroused. The other, your sympathetic nervous system, kicks in when you sense danger, real or imagined, and triggers the fight-or-flight response.

When you feel anxious before or during sex, your body can slip into this fight-or-flight mode. Blood flow shifts away from arousal and toward the muscles you'd need to run or fight. That makes it harder to get or keep an erection (Nguyen et al., 2017).

The anxiety-ED cycle

One tough experience in bed can start a cycle that feeds itself.

Here's how it usually goes. One time, you don't get or keep an erection, maybe because you were tired, stressed about work, or just in your head. Nothing serious happened, but you start to worry it will happen again.

That worry follows you into the next time you're intimate, and you may feel anxious before anything even starts. Your body senses that anxiety and reacts with the same fight-or-flight response, so the erection struggle repeats. Each repeat adds a little more worry.

This loop is called the anxiety-ED cycle. It comes from your nervous system reacting to a threat that isn't actually there. Once you see it as a loop, it gets easier to interrupt.

How common is anxiety-related ED?

It's common. Up to 30% of men under 40 have had erection difficulties at some point (Nguyen et al., 2017), and about 22% of men will have an anxiety disorder at some point in their life (Kessler et al., 2005). Anxiety also became more common worldwide during the COVID-19 pandemic, rising by 25% along with depression (World Health Organization, 2022).

If anxiety is playing a role in your erections, you're far from alone.

Anxiety-related ED vs. other causes of ED

Erectile dysfunction can have more than one cause, and the causes don't always show up the same way.

Anxiety-related ED, also called psychological erectile dysfunction or psychogenic ED, tends to be situational. Physical causes, like blood flow or hormone problems, tend to be consistent no matter the situation. The table below breaks down the main differences.

If you're not sure which pattern fits you, read how to tell whether ED is physical or psychological for a full breakdown. Keep in mind these causes can overlap. A physical cause can bring on anxiety of its own, which then makes the physical problem worse.

Ways to manage erectile dysfunction caused by anxiety

You can train your nervous system to calm down. A few approaches can help.

Learn how erections work. Erections naturally come and go, even during a single encounter. Knowing that one difficult time doesn't mean something is wrong can take a lot of the fear out of the next time.

Calm your nervous system first. Slow breathing and grounding exercises tell your body it's safe. Try breathing in for four counts and out for six, several times, before and during sex, to shift out of fight-or-flight and back into a state where arousal can happen.

Consider mindfulness-based practice. Early research suggests mindfulness-based practice may improve erectile function, though more trials are needed (Valderrama Rodríguez et al., 2023). Use it alongside the other steps here. A simple starting point is Mojo's community guide to mindful masturbation.

Talk to your partner. Anxiety about sex often grows in silence. Telling your partner what's going on takes the pressure off you both and makes it a shared problem.

Take the goal out of sex. When every encounter has to end in penetration or orgasm, the pressure builds before you've even started. Try sex without a goal for a while, and focus on touch and closeness.

When should you see a professional about anxiety and ED?

See a professional if this has been going on for more than a few weeks, if it's affecting your relationship or self-esteem, or if you're also feeling low or hopeless most days. Depression and anxiety often show up together, and a professional can help you work out what's driving what.

A few options, depending on what's going on:

• A sex therapist can help you understand what's going on, work through performance anxiety directly, and give you exercises to rebuild your confidence.
• A doctor can rule out physical causes first, like blood flow or hormone issues, especially if the pattern is consistent rather than situational.
• A psychologist or counselor, such as accredited COSRT and BACP therapist Amanda Barge, can help if anxiety is affecting more than just sex.

For a broader look at what's available once a physical cause has been ruled out, see Mojo's guide to ED treatment options.

How Mojo's Erection Reset helps with anxiety-related ED

The Erection Reset is Mojo's expert-led program for working with the stress response behind anxiety-related ED. It's built around nervous-system regulation and arousal conditioning, the same tools covered in this guide, structured into a step-by-step program led by Dr. Shannon Chavez.

The Erection Reset doesn't diagnose or treat ED as a medical condition. It gives you an evidence-based way to work with the anxiety behind it, at your own pace.