Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 7/14/2022
Erectile dysfunction, or ED, is a common sexual performance issue that affects men of all ages and backgrounds. In fact, an estimated 30 million men in the United States report some degree of erectile dysfunction.
Most cases of ED are caused by physical health issues, including high blood pressure, diabetes and atherosclerosis (clogged arteries).
However, for many men, mental health problems also play a significant role in the development of erectile dysfunction. These include depression, anxiety about having sex and post-traumatic stress disorder (PTSD).
In fact, there are plenty of studies out there that show PTSD and erectile dysfunction are related (but more on that later).
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.
The good news is that both PTSD and psychological erectile dysfunction are treatable, generally with a combination of therapy and medication.
Below, we’ve covered what erectile dysfunction is, as well as how psychological issues such as post-traumatic stress disorder can play a role in its development.
We’ve also explained what you can do if you have erectile dysfunction and think it may be linked to PTSD, including treatment options that you can access from home.
Before we get into the specifics of post-traumatic stress disorder and sexual dysfunction, let’s go over the basics of what ED is and the factors that can potentially cause it.
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.
ED can vary in severity. Some men with ED find it difficult or impossible to get an erection at all, while others may be able to get an erection but find it difficult to maintain it during sex, or simply find it challenging to get an erection that’s firm enough to penetrate their partner.
Because of its effects on your ability to have sex, ED can have a serious impact on your quality of life and the closeness of your relationships.
A wide range of physical, psychological and lifestyle-related factors can all potentially play a role in the development of erectile dysfunction.
Potential physical causes of ED include cardiovascular disease, high blood pressure, diabetes, multiple sclerosis, chronic kidney disease and damage to the nerves or other tissue around the penis, such as from surgery or injury.
Certain medications, such as antiandrogens, blood pressure medications, antidepressants and medications used to promote calmness or sleep, may also contribute to or cause ED.
Psychological factors that may play a role in erectile dysfunction include anxiety about sex, low self-esteem, fear of sexual failure, psychological distress and depression.
When ED is caused by a mental health issue, it’s often referred to as psychological impotence, or psychological ED.
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, or PTSD, is a disorder that can develop following exposure to an event that’s scary, shocking or dangerous.
While most people associate PTSD with veterans returning home from war, the truth is that any traumatic or life-threatening event can potentially trigger PTSD, with symptoms that can last for years or decades.
PTSD develops as a result of your body’s “fight-or-flight” response, which is triggered when you need to protect yourself from harm. After a traumatic event, it’s common and normal to develop emotional symptoms, including many that may be severe.
For most people, these symptoms improve naturally. People with recurrent, long-term symptoms after a stressful or traumatic event may be diagnosed with PTSD.
PTSD can involve a wide range of symptoms, most of which begin to occur within three months of the three months of the causative event. Common symptoms of PTSD include:
Flashbacks of the traumatic event, often with a simultaneous physical reaction
Bad dreams and/or frightening thoughts
Avoidance of places, objects or events that act as reminders of the traumatic event
Deliberately avoiding feelings or thoughts related to the event
Difficulty sleeping, relaxing and general feeling of being tense
Being easily startled and/or experiencing angry outbursts
Difficulty remembering certain aspects of the causative event
Negative thoughts about yourself and feelings or blame or guilt
A reduced level of interest in your normal hobbies and interests
For many people, the symptoms of PTSD develop at the same time as depression or an anxiety disorder.
Certain factors may increase your risk of developing PTSD. These include feeling horror, fear or helplessness, experiencing a traumatic event such as sexual assault, experiencing trauma as a child, getting hurt or seeing another person become hurt.
You may also be more at risk of developing PTSD if you deal with major stress after a traumatic event, or if you have a history of substance abuse or other mental disorders.
Researchers have studied the potential relationship between PTSD and erectile dysfunction for several decades, with studies suggesting that 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 had 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.
A cohort study published in the journal Annals of General Psychiatry in 2021, which used 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.
Put simply, there appears to be a significant link between post-traumatic stress disorder and an increased risk of dealing with erectile dysfunction.
Although PTSD is commonly associated with combat in men, the authors of a review published in the Journal of Sexual Medicine note that women are also likely to develop sexual dysfunction as a result of post-traumatic stress disorder.
One of the conclusions drawn from this study is that sexual dysfunction caused by trauma does not depend on the type of trauma.
Another was that the sexual dysfunction caused by PTSD may be underpinned by an inability to regulate and redirect the arousal that’s required for sexual function from intrusions and aversive hyperarousal that can occur with post-traumatic stress disorder.
Both PTSD and sexual activity induce physiological arousal that’s similar to the “fight-or-flight” response. Problems such as ED may occur when a person with PTSD becomes aroused, and the involuntary response triggers PTSD symptoms which impede healthy sexual function.
To get an idea for what this may be like, take a moment to think about what it takes for you to have an enjoyable sexual experience with your partner.
First and foremost, you need to feel safe. You need to feel comfortable enough with this person (as well as with yourself and your own sexuality) to open yourself up enough and allow this type of close, intimate contact to take place.
You need to have some kind of emotional or physical connection to this person, a shared feeling of intimacy. You also need to be able to let your guard down around them 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 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.
They might feel constantly tense or on edge, be easily startled, or have difficulty with sleeping or other important everyday activities.
Many people suffering from PTSD also have negative thoughts about themselves, as well as an increased risk of 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.
There are also other factors to consider as well. For example, 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. However, it can take time -- often weeks, months or years -- for many people 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.
We offer online therapy for post-traumatic stress disorder and other mental health conditions, as well as online, anonymous support groups.
Currently, the most widely-used medications for PTSD are antidepressants. 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 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.
We offer several 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 keeping yourself active, 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.
A range of different factors can play a role in the development of erectile dysfunction, including mental disorders such as post-traumatic stress disorder.
If you think you might have PTSD, you can 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.