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Can Stress Cause Erectile Dysfunction?

Mike Bohl, MD, MPH, ALM

Reviewed by Mike Bohl, MD, MPH, ALM

Written by Geoffrey C. Whittaker

Updated 04/09/2024

The stress caused by erectile dysfunction (ED) often leaves men contemplating a chicken-or-the-egg question: Can erectile dysfunction cause stress, or can stress cause erectile dysfunction?

The connection between poor erectile function and poor stress management is a lot deeper than most guys suspect. Stress is among the leading causes of erectile dysfunction, along with high blood pressure and other cardiovascular health problems. 

But stress can have more than one effect on your ability to get or maintain an erection.

Does stress cause erectile dysfunction? Below, we’ll explain the relationship between ED and stress, how it can affect bedroom performance, and what treatment options you should consider for stress and ED management.

Stress can trigger sexual dysfunction or exacerbate erectile dysfunction risk factors. Over time, chronic stress might cause a lack of sleep, high blood pressure, emotional fatigue or overall poor physical health, all of which can make maintaining an erection difficult.

There’s plenty of information out there showing how stress can ruin your health. On top of contributing to things like blood pressure issues or cardiovascular diseases, stress can affect you in the bedroom.

Research has shown that common life stressors can cause anxiety and lead to ED. Unfortunately, this can create a vicious sex-stress cycle. You’re stressed, which leads to ED, then your ED makes you self-conscious, and it leads to more stress.

Hence, the “chicken-or-the-egg” analogy.

A study from 2015 looked at 64 men struggling with ED or premature ejaculation (PE). It found a significant connection between ED and anxiety or depression. 

For a majority of participants, the anxiety or depressive disorders started before the sexual dysfunction. In other words, mental health issues — including stress-related conditions — can lead to erectile dysfunction.

Stress can affect sexual function in three ways:

  • Erectile dysfunction

  • Performance anxiety

  • Reduced libido or sex drive

How it does this speaks to exactly how serious a health risk chronic stress can be.

So, how does stress cause erectile dysfunction? Let’s start from the bottom.

Erectile dysfunction is a condition in which a man can’t get or maintain an erection during sexual stimulation. The causes can be physical, mental or both.

Many physical conditions can cause ED: cardiovascular issues, heart disease, blood pressure issues, diabetes, and obesity. Psychological causes — anxiety, depression and chronic stress among them — can also lead to ED symptoms.

Stress can interfere with your mental state as well as with the signals that your brain sends to increase blood flow to your penis.

See our blog to learn how to increase blood flow to your penis.

Even if the blood flows fine throughout your body, life can get in the way of erections, making it really hard to get excited — sexually or otherwise.

Some types of stress that have specifically been linked to ED include work or financial stress, relationship stress, anxiety and performance nerves. Here’s what to know.

Work or Financial Stress

Money and career woes are two very common stressors in life.

In fact, according to a study by the American Psychological Association from 2020, 63 percent of people say they’re stressed about the economy. In the same survey, 64 percent reported work as a big source of stress.

Research published in 2020 also found that a job loss or concerns over losing a job can affect sexual desire, potentially resulting in ED.

Relationship Stress

Frustrations in intimate relationships can lead to erectile dysfunction.

If stress in your relationship is affecting your sexual function (and thus, your level of intimacy with your partner), that lack of intimacy can eventually lead to more stress.

Another “chicken-or-the-egg” conundrum. See the pattern?

Anxiety

Up to 37 percent of men with ED also have an anxiety disorder.

Some experts think anxiety can affect the sympathetic nervous system, which plays a crucial role in getting an erection. Because of this, those with anxiety disorders may find themselves navigating ED as well.

Another study found that men with post-traumatic stress disorder (PTSD) are more likely to experience ED too.

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Performance Nerves

Another type of stress that can lead to ED? Worrying you won’t be good enough in bed. This stress is often called sexual performance anxiety.

Research has found that performance anxiety is closely connected to sexual dysfunction in men.

Performance anxiety can result in different types of sexual dysfunctions — including ED. For instance, you may worry about getting hard, finishing early or your skills in bed. All of this can make it tough to get an erection.

Watching porn can also lead to performance anxiety, which could then result in ED. If you’re comparing yourself to a porn star, you may feel insecure and could have a tough time getting hard.

Our blog goes into more detail about porn-induced ED.

A whole host of things can cause stress. Common culprits include:

  • Work pressure, such as deadlines or a demanding boss

  • Losing a job

  • Financial problems

  • The demands of parenting

  • Legal issues

  • Divorce or a breakup

  • Loss of a loved one

  • Social confrontation

  • Busyness and burnout

Even good change can lead to stress. So don’t discount positive life transitions, like getting married, moving into a new home you like better than your last one or starting a job you’re really excited about.

How Do You Know If You’re Too Stressed?

Some stress is normal and to be expected. But when is it too much?

Severe, chronic stress could result in a loss of focus, mood swings, sleep issues, fatigue, overeating or undereating, weight loss or gain or elevated blood pressure.

In some cases, the effects of stress could contribute to erectile dysfunction.

Stress causing ED likely means the sources of stress in your life are getting to be too much. You’re wise to find healthy methods to reduce stress and manage its sources. 

Luckily, there are a number of ways to approach a less stressful lifestyle. 

Get Your Sweat On

There’s some proof that a good workout can help you battle stress.

A 2014 study looked at the effects of physical activity on 111 healthy men and women who did and didn’t report regular physical exercise.

The researchers found that those who exercised as infrequently as once a week had a lower heart rate at rest than non-exercisers. More importantly, people who didn’t exercise reported a steeper decline in mood than those who did.

How much exercise do you need? Your goal should be about 150 minutes of moderate-intensity aerobic activity a week (which comes out to about a half-hour five days a week). Or, you could opt for 75 minutes of high-intensity aerobic exercise (that would be just 15 minutes five days a week). You should also build strength training into your exercise routine.

Choose your chew

Consider Meditative Moments

You probably aren’t surprised to hear that meditation can lower stress. After all, that’s kind of the whole point of it.

A 2014 study found that just 20 minutes of mindful meditation can decrease stress and anxiety.

Not sure how to meditate? No problem. There are plenty of apps that contain easy-to-follow guided meditations.

Our guide to meditation for anxiety has tips for getting started.

Try Talk Therapy

Cognitive behavioral therapy (CBT) is a great option for treating both stress and ED. You can talk about things that stress you out, along with how erectile dysfunction impacts your life.

In CBT, you’ll focus on patterns (or triggers) that may cause you stress. Then, you and a mental health professional will come up with ways to change these stress-inducing behaviors and adopt healthy coping strategies.

If you think stress specific to sex is behind your ED, you could also try sex therapy. 

In sex therapy, you might talk about your sexual history, past sexual health issues and mental obstacles you face during sexual activity.

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Stress and erectile dysfunction are two issues that create combined problems — and sometimes make each other worse. Though managing stress may take time, treatment for erectile dysfunction can provide relatively quick results.

Does stress cause ED in your life? Consider the following:

  • Whether you’re dealing with stress from work, sexual performance anxiety or stress caused by mental health conditions like anxiety disorders, it can really hurt your sex life and erectile function.

  • If you’re experiencing physical symptoms of erectile dysfunction, you might try incorporating exercise and meditation into your daily routine.

  • Other healthy lifestyle habits that may help minimize stress and improve sexual function include eating a nutritious diet, maintaining a healthy weight, getting outside daily, limiting alcohol and quitting smoking.

  • Think about talking to a healthcare professional about trying erectile dysfunction medication. Options include PDE5 inhibitor drugs, like sildenafil (generic Viagra®), tadalafil (generic Cialis®) and avanafil (sold as Stendra®). Another option is our chewable ED hard mints.

If you’re interested in speaking to someone about sexual performance issues or ED and exploring medical treatments, schedule an online appointment with a healthcare provider.

You can also learn more about psychological ED and the different types of therapy in our blog. 

20 Sources

  1. Erectile Dysfunction (ED) (June 2108). Urology Care Foundation. Retrieved from https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed)
  2. Symptoms & Causes of Erectile Dysfunction (July 2017). National Institute of Diabetes and Digestive and Kidney Disease. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
  3. Hedon, F., (2003). Anxiety and erectile dysfunction: a global approach to ED enhances results and quality of life. International Journal of Impotence Research. Retrieved from https://www.nature.com/articles/3900994
  4. Rajkumar, R., Kumaran, A., (2015). Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychology. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25818906/
  5. Stress in American 2020. American Psychological Association. Retrieved from https://www.apa.org/news/press/releases/stress/2020/report-october
  6. Dadomo, H., Ponzi, D., Nicolini, Y., et al., (2020). Loss of Socio-Economic Condition and Psychogenic Erectile Dysfunction: the Role of Temperament and Depression. Adaptive Human Behavior and Physiology. Retrieved from https://link.springer.com/article/10.1007/s40750-019-00125-0
  7. Velurajah, R., Brunckhorst, O., Wagar, M., et al., (2021). Erectile dysfunction in patients with anxiety disorders: a systematic review. International Journal of Impotence Research. Retrieved from https://www.nature.com/articles/s41443-020-00405-4
  8. Wang, S. Chien, W., Chung, C., et al., (2021). Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study in Taiwan. Annals of General Psychiatry. Retrieved from https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00368-w#:~:text=The%20patients%20with%20PTSD%20had,treating%20patients%20with%20erectile%20dysfunction.
  9. Rowland, D., van Lankveld, J., (2019). Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground. Frontiers in Psychology, 10: 1615. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646850/
  10. McCabe, M., (2005). The role of performance anxiety in the development and maintenance of sexual dysfunction in men and women. International Journal of Stress Management, 12(4): 379-388. Retrieved from https://psycnet.apa.org/record/2006-01347-006
  11. What is the difference between sexual performance anxiety and erectile dysfunction (ED)? International Society for Sexual Medicine. Retrieved from https://www.issm.info/sexual-health-qa/what-is-the-difference-between-sexual-performance-anxiety-and-erectile-dysfunction-ed/
  12. How Much Exercise Do I Need? Medline Plus. Retrieved from https://medlineplus.gov/howmuchexercisedoineed.html
  13. Zeidan, F., Martucci, K., Kraft, R., et al. (2013, May 21). Neural correlates of mindfulness meditation-related anxiety relief. Social Cognitive and Affective Neuroscience, 751-759. Retrieved from https://academic.oup.com/scan/article/9/6/751/1664700
  14. Treatment for Erectile Dysfunction. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
  15. What is Cognitive Behavioral Therapy? American Psychological Association. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
  16. What Happens During Sex Therapy? International Society for Sexual Medicine. Retrieved from https://www.issm.info/sexual-health-qa/what-happens-during-sex-therapy/
  17. How do pills for erectile dysfunction work? International Society for Sexual Medicine. Retrieved from https://www.issm.info/sexual-health-qa/how-do-pills-for-erectile-dysfunction-work/
  18. Childs E, de Wit H. Regular exercise is associated with emotional resilience to acute stress in healthy adults. Front Physiol. 2014 May 1;5:161. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013452/
  19. Dhaliwal A, Gupta M. PDE5 Inhibitors. [Updated 2022 May 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549843/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Mike Bohl, MD, MPH, ALM

Dr. Mike Bohl is a licensed physician, a Medical Advisor at Hims & Hers, and the Director of Scientific & Medical Content at a stealth biotech startup, where he is involved in pharmaceutical drug development. Prior to joining Hims & Hers, Dr. Bohl spent several years working in digital health, focusing on patient education. He has also worked in medical journalism for The Dr. Oz Show (receiving recognition for contributions from the National Academy of Television Arts and Sciences when the show won Outstanding Informative Talk Show at the 2016–2017 Daytime Emmy® Awards) and at Sharecare. He is a Medical Expert Board Member at Eat This, Not That! and a Board Member at International Veterinary Outreach.

Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. He is currently pursuing a Master of Business Administration and Master of Science in Healthcare Leadership at Cornell University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health.

Dr. Bohl is Certified in Public Health by the National Board of Public Health Examiners, Medical Writer Certified by the American Medical Writers Association, a certified Editor in the Life Sciences by the Board of Editors in the Life Sciences, a Certified Personal Trainer and Certified Nutrition Coach by the National Academy of Sports Medicine, and a Board Certified Medical Affairs Specialist by the Accreditation Council for Medical Affairs. He has graduate certificates in Digital Storytelling and Marketing Management & Digital Strategy from Harvard Extension School and certificates in Business Law and Corporate Governance from Cornell Law School.

In addition to his written work, Dr. Bohl has experience creating medical segments for radio and producing patient education videos. He has also spent time conducting orthopedic and biomaterial research at Case Western Reserve University and University Hospitals of Cleveland and practicing clinically as a general practitioner on international medical aid projects with Medical Ministry International.

Dr. Bohl lives in Manhattan and enjoys biking, resistance training, sailing, scuba diving, skiing, tennis, and traveling. You can find Dr. Bohl on LinkedIn for more information.

Publications

  • Younesi, M., Knapik, D. M., Cumsky, J., Donmez, B. O., He, P., Islam, A., Learn, G., McClellan, P., Bohl, M., Gillespie, R. J., & Akkus, O. (2017). Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo. Acta biomaterialia, 63, 200–209. https://www.sciencedirect.com/science/article/abs/pii/S1742706117305652?via%3Dihub

  • Gebhart, J. J., Weinberg, D. S., Bohl, M. S., & Liu, R. W. (2016). Relationship between pelvic incidence and osteoarthritis of the hip. Bone & joint research, 5(2), 66–72. https://boneandjoint.org.uk/Article/10.1302/2046-3758.52.2000552

  • Gebhart, J. J., Bohl, M. S., Weinberg, D. S., Cooperman, D. R., & Liu, R. W. (2015). Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis. Journal of pediatric orthopedics, 35(6), 565–570. https://journals.lww.com/pedorthopaedics/abstract/2015/09000/pelvic_incidence_and_acetabular_version_in_slipped.5.aspx

  • Islam, A., Bohl, M. S., Tsai, A. G., Younesi, M., Gillespie, R., & Akkus, O. (2015). Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair. Clinical biomechanics (Bristol, Avon), 30(7), 669–675. https://www.clinbiomech.com/article/S0268-0033(15)00143-6/fulltext

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