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Though erectile dysfunction (ED) affects hundreds of millions of men worldwide, research has found that those who struggle with this common sexual performance issue often face feelings of emasculation, poor self-confidence, loneliness, and an increased risk of depression.
For many men, taking ED medications like sildenafil (generic Viagra®) or tadalafil (generic Cialis®) helps to improve erectile function and confidence simultaneously. (Though some research suggests that tadalafil is more effective in improving psychological outcomes in men with ED, potentially due to its longer half-life).
To find out more about how ED can affect a man’s mental health, we talked to Eric M., a 40-year-old man who began having trouble maintaining his erection after having a vasectomy in his mid-30s. We asked him about how having ED impacted his self-esteem and his relationship and what he did to gain his confidence back.
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Eric was in his 30s when he first started having erection issues. “The problem wasn't getting an erection but keeping one,” he says.
But, like many men who face sexual-health issues, he was too embarrassed to raise the problem to his physician. In fact, one national survey of over 1,500 men found that, of the 514 men who reported having ever experienced a sexual-health issue, only around half discussed the issue with their healthcare provider. And even fewer talked about it with their partner.
Eric attributes his erection problems to a vasectomy he had after he and his wife had their third child. Though it’s very unlikely for a vasectomy to cause ED, Eric’s experience was different. “I felt like I had something taken away from me,” he says. “I think it became a mental thing for me, but once I healed up and got intimate again, I started having these problems with keeping an erection.” At first, Eric thought the problem might just be jitters and that would go away once he got back into the swing of things. But after a few attempts of having sex, he kept getting the same result of not being able to sustain an erection.
That’s when his confidence really took a hit.
Though ED can have physical causes, like heart disease, high blood pressure, and atherosclerosis, it can also have psychological causes. This creates a vicious cycle, with ED affecting mental health and mental health issues contributing to the physical markers of ED. Research estimates that 40 percent of ED cases are psychogenic, or caused by psychological factors.
In Eric’s case, having a vasectomy made him feel like something was taken away, and, as he said, the erectile component became “mental.” His physical ED symptoms went on to cause additional psychological damage.
“I never had this issue before, so this really did affect my self-esteem and my confidence,” he says. “I'm the type of person who lives in their own head, so when something bothers me, it bothers me to the fullest.”
At the time his ED symptoms materialized, Eric and his wife had been together for 20 years, and they’d always had an amazing sex life. “I've never been lacking or came up short in that department up—until my procedure,” he says. “I know my wife better than anyone, so I know when she's being satisfied. So when I started not being able to fulfill her needs, it was a huge blow to my confidence, and our intimacy became almost non-existent.”
Eric then stopped initiating sex because he didn't want to disappoint his wife. She responded by giving him the space she believed he wanted and needed. Waning confidence wasn't the only issue bothering Eric, though. “I also developed mood swings,” he says. “Even though I was having ED problems, I was still getting sexually frustrated, which affected my wife and kids. I would just get in a bad mood out of nowhere.”
He also felt isolated, without an outlet to discuss his experience and feelings. “The circle of people I surround myself with don’t talk about things like that, and I would be too embarrassed to even bring it up.”
On social media, Eric came across various advertisements for ED medications and supplements. He was skeptical about trying one, but the fact that he could access ED products online was appealing. It meant he wouldn't have to sit face-to-face with someone and admit he was experiencing an issue that he’d rather not talk about in the first place.
He eventually took the leap and completed a medical evaluation online. The results made him eligible for a prescription of vardenafil (generic Levitra®) as a chewable ED hard mint—and he filled the script. “It didn't take long for my treatment to arrive in the mail, and the same night, I took my first dose and put it to the test.”
Eric was nervous about taking the medication for the first time: He didn't want to disappoint his wife, and he wasn't sure if the treatment would work for him. But his apprehension quickly faded once he and his wife started having sex. “I was keeping up with her,” he says. “The treatment was working, and my confidence had a huge boost because my wife was completely satisfied more than once. Even after I finished myself, I was ready to go again within minutes. The next day, we couldn't keep our hands off each other, and I felt my self-esteem coming back.”
However, Eric didn't tell his wife that he was taking ED medication at first because even though the treatment was working, he still felt uncomfortable about needing medication to have satisfying sex. “Here I was, only in my 30s, and having to take treatment for ED. I still felt a little embarrassed about it, but as I continued taking my treatments and having great sex again, there was no hiding it. I had to share my secret with my wife about how we got back in our groove.”
Her reaction was positive. “She's always been behind me and supports the heck out of me, so it was no surprise when she said I shouldn't be embarrassed about it. Since my treatments started, we've been stronger than ever, in and out of the bedroom.”
Eric’s prescription of vardenafil is a PDE5 inhibitor. This class of medication works by widening your blood vessels to improve blood flow to the penis, which then helps with maintaining an erection during sex. It’s one of many available prescription medications for ED.
Explore more treatments below.
Other PDE5 inhibitors include:
Keep in mind that while PDE5 inhibitors are generally considered safe and effective for most men with ED, some are associated with certain side effects. Additionally, these medications may not be appropriate for people with certain health conditions, like low blood pressure or those taking nitrates for angina. To better understand if any of these medications could be right for you, first talk with your healthcare provider.
Other ways to treat ED include:
Therapy (individual therapy, sex therapy, or couples counseling)
Alprostadil injections, creams, and urethral suppositories
Vacuum erection devices (penis pumps)
In some cases, treating the underlying cause of your ED may contribute to better erectile function. For instance, if your ED is the result of low testosterone, then taking testosterone replacement therapy (TRT) or a medication like clomiphene may improve your symptoms.
Or, if your ED issues are a side effect of certain medications, like antidepressants, Parkinson’s disease drugs, or medication for prostate cancer, your physician may suggest switching to another medication, lowering the dosage, or alternative options. Just be sure to consult your healthcare provider before making any changes to your existing medical regimen.
Other possible causes of erectile dysfunction and known risk factors include:
Obesity
High cholesterol
Multiple sclerosis
Depression and anxiety
Making certain lifestyle changes may improve erectile function and reduce the risk of developing ED (along with other health issues).
They include:
Following a nutritious diet
Getting adequate sleep
Exercising regularly and maintaining a healthy weight
Lowering your stress levels
Limiting alcohol intake
Quitting smoking
In many cases, erectile dysfunction can be reversed or successfully treated. While ED medications like sildenafil and tadalafil aren’t “cures” for ED, they are considered safe, convenient, and effective for 60 to 70 percent of men who take them.
Combining PDE5 inhibitors with lifestyle modifications can lead to even more successful results. For instance, one small study of 60 participants with ED compared PDE5 treatment alone to PDE5 treatment combined with regular aerobic exercise. The findings showed that while PDE5 treatment improved erectile function in 39.3 percent of patients after three months, PDE5 treatment plus exercise improved ED in 77.8 percent.
The duration of ED depends on the underlying cause and treatment. Eric saw results the very first time he took medication, and he still adheres to the treatment three years later.
However, it may be helpful to know that for some men, ED can be a temporary inconvenience due to factors like performance anxiety, stress, excessive drinking, smoking, taking recreational drugs, or even watching too much porn.
Getting advice from a healthcare provider can help you figure out what’s contributing to your ED and what you can do about it with a personalized plan.
Eric says taking ED medication has helped him and his wife feel like they’re in their 20s again, from a sexual point of view. His confidence and mood have improved, and he feels less frustrated overall.
Eric offers this advice for men experiencing symptoms like his: “ED isn't something to be ashamed of. Help is out there, and it's easy to ask for.” He adds that seeking ED treatment has been the best decision he has ever made for his relationship, and he’d recommend it to any man dealing with issues related to ED.
To learn more about what else you can do to treat ED symptoms and improve your confidence, find out how to improve blood flow to the penis, learn how ED medication works, and check out a range of sexual health products here.
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.
Dr. Mike Bohl is a licensed physician, the Director of Medical Content & Authority at Hims & Hers, and a member of the Obesity Medicine Association. Prior to joining Hims & Hers, Dr. Bohl worked in digital health at Ro, focusing on patient education, and as the Director of Scientific & Medical Content at a stealth biotech PBC, working on pharmaceutical drug development. 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, and he is a Medical Expert Board Member at Eat This, Not That!.
Dr. Bohl obtained his Bachelor of Arts and Doctor of Medicine from Brown University, his Master of Business Administration and Master of Science in Healthcare Leadership from Cornell University, his Master of Public Health from Columbia University, and his Master of Liberal Arts in Extension Studies—Journalism from Harvard University. Dr. Bohl trained in internal medicine with a focus on community health at NYU Langone Health, and he has earned a Certificate of Advanced Education in Obesity Medicine from the Obesity Medicine Association.
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 orthopaedic 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.
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