Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 6/07/2020
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.
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.
In a 2002 study published in the journal Urology, 85% of combat veterans undergoing treatment for PTSD reported symptoms of erectile dysfunction 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.
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 ed 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.
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