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Let's Talk About PTSD and Erectile Dysfunction

Let's Talk About PTSD and Erectile Dysfunction

Erectile dysfunction is frequently described as a medical issue. Some of the most common causes are linked to biological factors such as high blood pressure, atherosclerosis or diabetes. For a significant number of men, however, erectile dysfunction is rooted in psychological causes which may be even more difficult to identify and to treat—like post-traumatic stress disorder. In fact, there are plenty of studies out there that show PTSD and erectile dysfunction are related (but more on that later).

Psychological impotence affects between 10% and 20% of men, a number that may not seem significant until you consider that erectile dysfunction, on the whole, may affect roughly 50% of men in their thirties and over 40% of men in their 40s and fifties. This would suggest that as many as 2 in 5 cases of erectile dysfunction have psychological roots.

While psychological erectile dysfunction has been linked to a number of causes, one that many people don’t like to talk about is post-traumatic stress disorder. Post-traumatic stress disorder is something people usually associate with veterans returning from war, but the truth is that any traumatic or life-threatening event can trigger PTSD and the effects can last for years, even decades, after. Keep reading to learn more about the link between PTSD and erectile dysfunction.

Understanding Post-Traumatic Stress Disorder

It is completely natural to feel fear during, and even after a traumatic situation. Fear is a form of stress that triggers the body’s “fight or flight” response, also known as the acute stress response. When faced with some kind of threat, the body launches a series of physiological changes designed to protect you from harm. A sudden increase in hormones stimulates the adrenal glands to start pumping out adrenaline and noradrenaline, which boost your heart rate, blood pressure and breathing rate. These changes prepare your body to face the threat head-on or to escape from it.

Unfortunately, the body has a difficult time differentiating between stress caused by a physical threat and emotional or psychological stress. Many people who experience traumatic events suffer flashbacks of the event or the feelings associated with it. They relive the trauma in their mind, experiencing the same physical symptoms of that “fight or flight” response. These symptoms can also be accompanied by nightmares and frightening thoughts which may eventually lead to avoidance, increased reactivity, and changes in mood or cognition.  

Though PTSD is frequently associated some kind of life-threatening experience, the diagnostic criteria for the condition cover a variety of traumatic events including exposure to death, threatened death, actual or threatened serious injury, and actual or threatened sexual violence. This exposure can occur directly, through witnessing the trauma, by learning of a close friend or relative who was exposed to the trauma or through indirect exposure such as through the course of professional duties. Other diagnostic criteria for PTSD include re-experiencing symptoms, avoidance of trauma-related stimuli, negative thoughts or feelings that began or worsened after the trauma, and arousal and reactivity symptoms beginning or worsening after the trauma. All of these symptoms must last for more than one month, and they must cause distress or functional impairment.

What's the Link Between PTSD and Erectile Dysfunction?

In a 2002 study published in the journal Urology, 85% of combat veterans undergoing treatment for PTSD reported symptoms of erectile dysfuanction compared to just 22% of the control group. While PTSD is commonly associated with combat in men, the authors of a study published in the Journal of Sexual Medicine suggests that women are more likely to experience rape or other sexual trauma. One of the conclusions drawn from this study is that sexual dysfunction related to trauma does not depend on the type of trauma.

According to the study, as many as 6% of men and 13% of women will experience post-traumatic stress disorder at some point in their lives. Another conclusion drawn by the study authors is that sexual dysfunction in PTSD cases occurs when the brain forms a connection between the sensation of arousal and aggression instead of with healthy and normal sexual function. Both PTSD and sexual activity induce physiological arousal similar to the “fight or flight” response discussed earlier. The problem occurs when a PTSD victim becomes aroused, and the involuntary response triggers PTSD symptoms which may impede healthy sexual function.

Take a moment to think about what it takes to have an enjoyable sexual experience with a partner. First and foremost, you need to feel safe. You need to be comfortable enough with this person (and with yourself and your own sexuality) to open yourself up to this kind of contact. You need to have some kind of emotional or physical connection to this person, a feeling of intimacy. You also need to be able to let your guard down in order to experience sexual pleasure.

Now, think about the kind of things a person with PTSD experiences on a daily basis. They may deal with near-constant anxiety or, at the very least, anxiety triggered by certain factors which elicits both a mental and physical response. They might feel constantly tense or on edge, they may be easily startled, and they may have trouble sleeping. Many people suffering from PTSD also have negative thoughts about themselves and may also experience symptoms of depression such as loss of interest in enjoyable activities, low mood and withdrawal from family and friends.

Even if you haven’t experienced post-traumatic stress disorder for yourself, you can see how the symptoms may be incompatible with the basic requirements for healthy sexual function. There are other factors to consider as well. For example, many people suffering from PTSD take medication for treatment, and those drugs could cause sexual side effects. Psychotherapy is an important piece of the puzzle in managing and recovering from trauma. It can also play a role in managing psychological impotence, regardless of any connection to past trauma.

PTSD Erectile Dysfunction Treatment and Recovery

The first thing you need to know about recovering from post-traumatic stress disorder and any related sexual dysfunction is that it will take time. You should also know that it is difficult to recover completely on your own. Seeking help from a therapist or another mental health professional is an important piece of the puzzle. Even if you aren’t ready to seek this kind of help, start by joining a support group or, at the very least, connect with people online who are going through the same thing you are.

Recovering from post-traumatic stress disorder involves many of the same tenets of recovery from psychological ED. While you may be dealing with some actual physiological changes in your brain, it is your response to those changes that you must learn to manage. With the help of a therapist, you can learn coping mechanisms to reduce the severity of your PTSD symptoms and, in time, you will learn to deal with the psychological repercussions of those symptoms. In time, you will be able to enjoy a trusting and fulfilling relationship once more along with the sexual intimacy that comes with it.

As you combat PTSD and erectile dysfunction, work with your doctors to find out what treatment is right for you. But, be careful, because psychological impotence requires a different course of treatment than medical causes for erectile dysfunction and taking drugs could have adverse effects. If you are suffering from PTSD, psychological erectile dysfunction or both, you should talk to your doctor about the options.

Important Safety Information


Do not take Sildenafil (sildenafil citrate) if you:

  • take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
  • are allergic to sildenafil, as contained in Sildenafil and REVATIO, or any of the ingredients in Sildenafil

    Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or
nausea during sex, seek immediate medical help

    Sildenafil can cause serious side effects. Rarely reported side effects include:

  • an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, get medical help right away.
If it is not treated right away, priapism can permanently damage your penis
  • sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called
non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking Sildenafil and call your healthcare provider right away if you
have any sudden vision loss
  • sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have
these symptoms, stop taking Sildenafil and contact a doctor right away

    Before you take Sildenafil, tell your healthcare provider if you:

  • have or have had heart problems such as a heart attack,
irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
  • have had heart surgery within the last 6 months
  • have pulmonary hypertension
  • have had a stroke
  • have low blood pressure, or high blood pressure that
is not controlled
  • have a deformed penis shape
  • have had an erection that lasted for more than 4 hours
  • have problems with your blood cells such as sickle cell
anemia, multiple myeloma, or leukemia
  • have retinitis pigmentosa, a rare genetic (runs in families)
eye disease
  • have ever had severe vision loss, including an eye problem
called NAION
  • have bleeding problems
  • have or have had stomach ulcers
  • have liver problems
  • have kidney problems or are having kidney dialysis have any other medical conditions

    Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins,
and herbal supplements.

    Sildenafil may affect the way other medicines work, and other medicines may affect the way Sildenafil works, causing side effects.
Especially tell your healthcare provider if you take any of the following:

  • medicines called nitrates
  • medicines called guanylate cyclase stimulators such as Adempas (riociguat)
  • medicines called alpha-blockers such as Hytrin (terazosin
HCl), Flomax (tamsulosin HCl), Cardura (doxazosin
mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl),
 Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).
Alpha-blockers are sometimes prescribed for prostate
problems or high blood pressure. In some patients, the use
of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
  • medicines called HIV protease inhibitors, such as ritonavir (Norvir), indinavir sulfate (Crixivan), saquinavir (Fortovase or Invirase), or atazanavir sulfate (Reyataz)
  • some types of oral antifungal medicines, such as
 ketoconazole (Nizoral) and itraconazole (Sporanox)
  • some types of antibiotics, such as clarithromycin (Biaxin),
telithromycin (Ketek), or erythromycin
  • other medicines that treat high blood pressure
  • other medicines or treatments for ED
  • Sildenafil contains sildenafil, which is the same medicine found
in another drug called REVATIO. REVATIO is used to treat a
rare disease called pulmonary arterial hypertension (PAH).
 Sildenafil should not be used with REVATIO or with other PAH
treatments containing sildenafil or any other PDE5 inhibitors
(such as Adcirca tadalafil)

    Sildenafil does not protect against sexually transmitted diseases, including HIV.

    The most common side effects of Sildenafil: headache; flushing; upset stomach; abnormal vision, such as changes in color vision
(such as having a blue color tinge) and blurred vision; stuffy or runny nose; back pain; muscle pain; nausea; dizziness; rash.

    Sildenafil (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).

    Sildenafil is not for women or children.