The Relationship Between PTSD and Erectile Dysfunction

Erectile dysfunction can be a confusing experience, and pinning down the cause can sometimes take some work. In general, sexual arousal is a multi-layered process that calls upon the body and the brain to work together, and to get and keep an erection, body and brain must do just that. 

So when things aren’t working, the causes can be physical, psychological or a combination of both. 

While post-traumatic stress disorder (PTSD) may not necessarily cause ED, PTSD may increase the risk for erectile dysfunction in men who have it — particularly in patients with comorbidities like obesity, poor diet and poor cardiovascular health.

The good news is that both are extremely treatable with the right knowledge. If you’re someone experiencing some of the sexual side effects of PTSD (or know someone who is), you’re in the right place. 

Below, we’ve outlined ED’s connection to psychological issues including post-traumatic stress disorder, and what you can do if you have erectile dysfunction and think it may be linked to PTSD.

Let’s back up a bit: erectile dysfunction is a common sexual health issue in which you’re unable to get or sustain an erection that’s firm enough to have sex. It affects an estimated 30 million men in the United States. 

Many men may experience psychological erectile dysfunction, wherein mental health problems play a big role in erectile health. These include depression, anxiety about having sex, low self-esteem, fear of sexual failure and yes, post-traumatic stress disorder (among others).

In fact, several studies suggest PTSD and erectile dysfunction are related (but more on that later).

For many men, when mental health problems like these go unaddressed, erectile problems may appear as a symptom. 

Medications like antidepressants can also contribute to ED, but many cases of ED are caused by physical health issues, including high blood pressure, diabetes and atherosclerosis (clogged arteries). Cardiovascular disease, high blood pressure and diabetes are just some of the physical causes.

When a mental health issue contributes to ED, it’s often referred to as psychological impotence, or psychological ED, and there are plenty of studies out there that show PTSD can be a culprit.

Post-traumatic stress disorder, or PTSD, is a disorder that can develop following exposure to an event that’s scary, shocking or dangerous, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)

Most people associate PTSD with veterans returning home from war, but the truth is that any traumatic or life-threatening event can potentially trigger PTSD, with symptoms that can last for years or decades. That means that anything from childhood trauma to natural disasters can lead to PTSD.

After a traumatic event, it’s common and normal to develop emotional symptoms, including many that may be severe. For many people, the symptoms of PTSD develop at the same time as depression or an anxiety disorder.

PTSD can involve a wide range of symptoms, most of which begin to occur within three months of the causative event. The ongoing presence of the predictors below is typically a sign of complex PTSD.

Common symptoms of PTSD include:

• Flashbacks of the traumatic event, often with a simultaneous physical reaction

• Bad dreams and/or frightening thoughts

• Avoiding places, objects or events that act as reminders of the traumatic event

• Deliberately avoiding feelings or thoughts related to the event

• Difficulty sleeping or relaxing and general feelings of tenseness

• Being easily startled and/or experiencing angry outbursts

• Difficulty remembering certain aspects of the causative event

• Negative thoughts about yourself and feelings of blame or guilt

• A reduced level of interest in your normal hobbies and interests

As you might expect, all of this can make feeling sexual desire, confidence, pleasure and excitement very difficult.

Problems like ED may occur when a person with PTSD becomes aroused, and the involuntary response triggers PTSD symptoms, which get in the way of healthy sexual function. 

Researchers have studied the potential relationship between PTSD and erectile dysfunction for decades, and findings suggest men with PTSD tend to be more likely to develop ED than their peers. 

In a study published in the journal Urology in 2002, 85 percent of combat veterans undergoing treatment for PTSD reported symptoms of erectile dysfunction. In comparison, just 22 percent of men in the control group reported symptoms of ED.

The men affected by PTSD were also more likely than their peers to report moderate to severe ED, which affected 45 percent of men with PTSD and only 13 percent of the men in the control group.

Clinicians who published a cohort study in the journal Annals of General Psychiatry in 2021, using data from more than 1,000 patients, found that men with post-traumatic stress disorder had a higher risk of developing ED than men in a non-PTSD group.

Although PTSD is commonly associated with men, the authors of a systematic review published in the Journal of Sexual Medicine note that women may also develop sexual dysfunction as a result of post-traumatic stress disorder. 

A person with PTSD may deal with near-constant anxiety as a result of their post-traumatic stress disorder, or, at the very least, anxiety that’s triggered by factors that elicit both a mental and physical response. This anxiety can make it difficult to perform, feel sexual arousal or focus on sex in the moment.

Many people suffering from PTSD also have negative thoughts about themselves, as well as an increased risk for experiencing symptoms of depression.

Even if you haven’t experienced the symptoms of post-traumatic stress disorder for yourself, it’s easy to see how these symptoms may be incompatible with the requirements for healthy sexual function. 

In addition, many people suffering from PTSD take medication for treatment, and some psychiatric medications can cause sexual side effects. 

These factors can all combine to make many aspects of sexual function, from being able to feel comfortable with your partner to getting and maintaining an erection, more challenging if you’re affected by post-traumatic stress disorder.

Post-traumatic stress disorder is a treatable condition. But it’s important to know that it can take time — often weeks, months or years — to fully recover from trauma. 

Currently, the most effective treatments for post-traumatic stress disorder are psychotherapy (or “talk therapy), medications and lifestyle changes. Many mental health providers suggest using a combination of approaches to overcome PTSD.

Psychotherapy involves talking to a therapist or other mental health professional, typically in the form of a private, one-on-one therapy session. Several forms of therapy are used to treat PTSD, including cognitive behavioral therapy (CBT) and exposure therapy. 

Currently, the most widely-used medications for PTSD are antidepressants like selective serotonin reuptake inhibitors (SSRIs). Your mental health provider may prescribe an antidepressant if you have emotional symptoms from PTSD, such as sadness or feelings of worry.

In addition to an antidepressant, your healthcare provider may prescribe medication to help you deal with sleep difficulties, nightmares or other PTSD symptoms.

Our list of antidepressants provides detailed information about medications used to treat PTSD and depression. 

Erectile dysfunction is almost always treatable. In addition to improving your mental health by treating post-traumatic stress disorder, you can treat erectile dysfunction by using medication and making healthy, positive changes to your habits and lifestyle. 

Currently, the FDA has approved four oral medications to treat ED, all of which belong to a class of drugs called PDE5 inhibitors:

• Sildenafil. The active ingredient in Viagra^®, sildenafil provides relief from ED for around four hours per dose.

• Tadalafil. The active ingredient in Cialis^®, tadalafil is a long-lasting medication that can provide relief from ED for up to 36 hours per dose.

• Vardenafil. The active ingredient in Levitra^®, vardenafil provides relief from ED for four to six hours per dose.

• Avanafil. Available as Stendra^®, avanafil is a newer ED medication that works in 15 to 30 minutes and has a reduced risk of causing side effects. 

These medications work by increasing blood flow to your penis, making it easier for you to get and maintain an erection when you feel aroused. There are also other medications for ED that are taken in different ways.

Hims offers several oral ED medications online, following a consultation with a licensed physician who will determine if a prescription is appropriate. 

Beyond using medication, making simple changes to your daily habits can help to reduce your risk of dealing with recurrent erectile dysfunction. These include exercising, eating a balanced diet, quitting smoking and maintaining healthy sleeping habits. 

Some of these changes may also offer benefits for your mental health. Our list of natural ways to improve your erections goes into more detail about how you can change your daily habits to enjoy better sexual function and wellbeing.

Quality of life is about more than an absence of health conditions — it’s about living life to the fullest.

If you have PTSD, you may find it more difficult to get an erection when you’re sexually aroused, or to maintain it during sex. This can have a serious impact on your ability to maintain a fulfilling, satisfying sexual life. 

• A range of different factors can play a role in the development of erectile dysfunction, including mental disorders such as post-traumatic stress disorder.

• Both military personnel and the general population can experience PTSD related sexual impairment.

• For most people, these symptoms improve over time. People with recurrent, long-term symptoms after a stressful or traumatic event may be diagnosed with PTSD.

• The good news is that both PTSD and psychological erectile dysfunction are treatable, generally with a combination of therapy and medication.

• Left untreated, sexual problems can continue to get worse, so if you think you might have PTSD, get help by talking to a psychiatrist in your area, or by using our online psychiatry services. 

You can also learn more about treating erectile dysfunction and maintaining a healthy sex life in our guide to the most common ED treatments and drugs.