When You Know ED Is in Your Head

Stressed man putting chin on folded hands

Erectile dysfunction (ED) is an interesting phenomenon because while we understand that it is often a very normal part of aging, many men are also very embarrassed by its onset. We know that ED, for many, represents a loss of virility, and it’s one of the reasons why we rarely use the word impotence despite it being a common medical term.

With the obvious physical component in any discussion about ED, some patients need to understand that there is a psychological component as well, though it may not be as widespread. In this article, we’ll talk about the signs that ED could be psychogenic and what we can do about it. 

Please note that while there are some telltale signs of psychogenic ED, every person is different. Don’t delay seeing a men’s health urologist like Dr. Engel just because you believe ED is in your head. A consultation with a qualified urologist is a great way to diagnose and treat physical or psychological symptoms.

Speed of Onset

The speed with which erectile dysfunction has come on is a significant indicator as to whether it is a normal part of aging or somehow related to the psyche. In most cases, age-related erectile dysfunction is a slow march. It may start with an occasional poor erection and continue to worsen over many months to many years. By the time a patient is ready for ED meds, they may have suffered from inconsistent erections for quite some time. They may have lost morning erections, for example, well before that. Ultimately, the common denominator is slow progression.

On the other hand, if erectile dysfunction occurs immediately – for example, the inability to maintain an erection from one day to the next we may suspect a psychological cause. Note: this assumes the absence of any trauma or surgical procedure like prostatectomy.


As you can imagine, erectile dysfunction typically affects men reaching middle age and later. This is not to say that younger men can’t suffer from ED caused by physical factors, and some do. However, younger age is certainly a consideration in determining the cause of ED. Why? You may ask. Younger men outside of monogamous relationships typically have active sex lives, and a circumstance in which they cannot perform is troublesome, to say the least, and can cause “stage fright” and more episodes of erectile function.

Relationship With a Partner

The fact is that some relationships have soured sexually and otherwise, and in this case, it may be tough to build the desire to have sex with a partner. In this case, while the man may not be able to achieve an erection, it may be primarily or entirely due to relationship issues and concerns.

Complete Loss of Erectile Function

Once again, we go back to the typical slow progression of ED. Part of the slow progression is also the degree to which the patient can achieve and maintain an erection. Only some ED patients are not able to achieve an erection at all. Once again, if the progression to no erection whatsoever is rapid, there may be a psychological component at play.

The Bottom Line

A sex life with strong and long-lasting erections is predicated on several psychological and physical attributes working together. On the one hand, the patient must have the desire to have sex along with the confidence to achieve and maintain an erection with their partner. On the other hand, the patient must be healthy enough, particularly from a blood flow standpoint, to achieve and sustain an erection in the first place. This interplay of psychological and physical creates a very delicate balance in how ED is treated. To that end, consulting with a urologist like Dr. Engel, who specializes in men’s health, is very important to get the correct diagnosis and ultimately develop a treatment plan that works.



Urologic Surgeons of Washington is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

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