Psychological treatments for erectile dysfunction

CommentaryHealth and Wellbeing2026

Apr 7

Around half of men aged 40–70 experience difficulty in getting or maintaining an erection, known as erectile dysfunction (ED). Prevalence increases sharply with age, but around a quarter of men under 40 are affected. The number of men experiencing this issue has increased over the past few decades due to factors like obesity, diabetes, and cardiovascular disease.

Research shows about 40% of cases of ED are caused by psychological (psychogenic) factors alone, especially in younger men, though psychological and physiological (organic) causes can interact. If you can achieve an erection through masturbation but not with a partner, then the cause is probably psychogenic. If you can’t achieve an erection at all, the cause is probably organic.

The main causes of psychogenic ED are depressed mood, low self-esteem, anxiety, and stress. The causes can be grouped into three categories: performance anxiety, recent stressful life events, and vulnerabilities from childhood and adolescence.

The main organic causes of ED are: cardiovascular disease (blood pressure, cholesterol), diabetes, surgery to prostate (prostatectomy), loss of T (e.g. due to ADT androgen deprivation therapy in prostate Ca), drug & alcohol intoxication or side effects.

Interpersonal factors can also impact ED; relational dynamics, such as poor communication about sexual preferences, reduced intimacy, and partner-related conflict, can play a key role. A 2021 position statement from the European Society of Sexual Medicine strongly recommends involving the partner in assessment and treatment for better outcomes.

We know that Viagra has a good success rate, but how well does ED respond to psychological therapies? Hypnotherapy has been found to be successful in 70% of cases of ED, though the number of studies of hypnosis for ED is limited. However there is lots of research finding that reviews confirm that combining psychological interventions (such as group CBT) with Viagra (or other PDE5 inhibitors) often yields better results than medication alone. Psychological interventions also compared well to local injection and vacuum devices for ED. The success of group interventions echos evidence that group therapy and educational (information-sharing) interventions a sometimes more successful in ED than more traditional one-to-one psychological approaches, and this would be in line with other research on gender differences in preferences for therapy. In addition to psychological support, current guidelinesrecommend lifestyle changes and screening for underlying conditions like heart disease or diabetes, as ED can be an early indicator.

So what should you do if you experience ED? First of all, try not to worry about it, because effective therapies are available, and worry can contribute to a vicious cycle. Try to establish the cause by asking yourself questions such as: can you achieve and erection by yourself but not with a partner? Do you have an undiagnosed medical condition such as heart disease or diabetes? Are you under a lot of stress at work? If in any doubt visit your GP. And remember that although most men don’t exactly brag about it, ED is a pretty common condition, and one that can be successfully treated.

This article was first published on the Male Psychology Network website in 2019, and updated in April 2026.

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