How to know if ED is physical or psychological

Written with
Dr Matthew Chan

If you’ve been experiencing ED, your brain is probably shouting “why is this happening to me?!”

But don’t panic.

You’ve just asked a really important question, and exploring possible answers is a big step towards getting your erections back on track.

The truth is, there’s lots of reasons why ED can happen.

Here, we explain how to spot the differences between the physical (bodily) causes of ED vs. the psychological (mental) ones, so you can narrow down your search for answers.

How do erections work?

Let’s start at the beginning. Erections are the result of a chain reaction that begins when you get aroused:

  • sexy thoughts or sensual touch spark signals in your brain
  • these get passed through your nerves to the blood vessels in your penis
  • as your blood vessels expand to let blood flow in, you get hard

It might sound like a simple process. But, it’s actually like you’ve got a mini orchestra inside you. Every little bit needs to play its part to get the overall effect.

What’s the difference between physical and psychological ED?

Erectile dysfunction (ED) happens whenever a mental or physical link in the erection chain is broken or can’t do its job properly.

  • psychological ED happens when the brain fails to send the signals which fuel the process. This can happen at any point during sex. That’s why your penis can go soft even if things started well.
  • physical ED happens when something isn’t right in the body. Any problem that blocks or restricts blood flow to the penis, is a good culprit for physical ED.
  • ED can also happen due to a mix of causes. Even a one-time bad experience can grow into bigger psychological worries. It’s easy to get caught in a vicious cycle.

ED can occur during both masturbation (solo sex) or with your partner. Some people get it all the time. For others it only comes up sometimes.  

What are the key signs of physical ED?

If you can’t get an erection in any circumstance, it’s more likely that the primary cause of your ED is physical.

This might sound scary, but there’s loads of ways to treat physical ED, so there’s no need to suffer in silence.

Frustratingly, psychological erectile dysfunction can also stop you getting an erection under any circumstances.

(We know, right?!)

So, it’s worth exploring what mental factors could be influencing your erections as well.

What are the most common physical causes of erectile dysfunction?

There are a lot of common physical causes of ED, including:

  • cardiovascular issues like high blood pressure, high cholesterol and diabetes heart disease
  • narrowing of the penis blood vessels
  • hormone problems, like low testosterone
  • side effects from prescribed medicine or recreational drugs  
  • smoking or too much alcohol
  • obesity
  • injury or damage to nerves or arteries (from to activities like cycling)
  • pelvic floor issues (your pelvic floor can either be too tight or too weak)
  • other underlying health conditions

What are the key signs of psychological ED?

Okay, so now we’ve covered physical ED, let’s move on to psychological ED.

Psychological erectile dysfunction includes all the mental reasons that might be stopping you from getting hard.

It’s likely the primary cause of your ED is psychological if:

  • you have spoken to your Doctor about your ED and have ruled out anything physical
  • you can get good erections when you’re  masturbating, or in some situations but not others
  • you have only had ED for a short time or can clearly remember a time when your erections were more dependable

Mental health usually plays a role in ED for most men (even if it’s just the supporting cast), and you can find out more about it in the list below.

“The term psychological ED is a big net. It catches anything and everything going on in our minds that could be stopping erections from flourishing.

The experience of psychological ED is different for every man because we’re all unique. But the good news is; we can use the same methods to help ourselves get better.”

Silva Neves, Psychosexual and Relationship Therapist

What are the most common causes of psychological ED?

There are lots of psychological reasons why you might not be able to get it up.

In our dedicated post, psychological ED explained, we go into them in more detail and talk about possible treatments to explore. Here’s a sneak preview:

  • stress and anxiety
  • relationship issues
  • poor mental health and depression
  • anxiety
  • performance anxiety
  • lack of sex education
  • boredom or indifference
  • an unhealthy relationship with porn
  • negative feelings around sex, like guilt or shame
  • low self-esteem, lack of self-confidence or body issues
“Erections rely on good blood flow, so anything that disrupts the blood from going to the penis can trigger ED.  But it’s also important to remember that your brain is equally important and our mental barriers can be just as powerful  as any physical cause.”

Dr William Fowler, Urologist and Urological Surgeon

Physical or psychological ED: Which is more common?

We’re working to make ED something we can all talk about openly. Too much shame exists around this topic, and we reckon it’s time for change.

But right now, it’s difficult to get a totally accurate picture of how many men are affected by ED, let alone what percentage of them have been impacted by which specific cause.

On the whole, the data generally suggests:

  • physical causes of ED are more common in older men
  • for younger guys; mental issues are more frequently the underlying issue

However, we’ve seen tons of guys whose experiences of ED don’t neatly fit into these boxes.

That’s why we recommend parking generalisations for the moment to focus on something much more important: you.

“You could write a book about all the different causes of erectile dysfunction and the many ways they impact different men.

However, I know the best way for my clients to move forward is to focus on understanding themselves, not statistics.

The most important thing to remember is: If you have ED, you are normal. No matter what the cause, help is out there for you.”

Dr Roberta Babb, Clinical Psychologist and Psychosexual Therapist

Check out our post for a full list of ED causes here.

Can you self test to find out the cause of your ED?

There are lots of fancy pieces of kit you can buy which claim to monitor your nighttime erections, and check if your ED is physical or not.

There’s also some crazy sounding older tests out there, like ‘The Stamp Test’.

The Stamp Test

This ED stamp test involves sticking an old fashioned string of stamps around your penis at night. Yes, you heard correctly.

Supposedly you’ll know if you’ve had an erection if the chain is broken in the morning.

You don’t need us to tell you that the margin for error here is pretty wide.

And guess what? Not getting hard at night, nor waking up with an erection, are not definite signs of ED.

So, no morning glory = no worries

The best way to know if you can get hard is just to observe yourself.

Remember, you’re an expert on what’s normal for you. If you think something’s not feeling right, trust yourself.

Our best advice: start by seeing your doctor

If you’re worried about what’s causing your ED, the best thing you can do is see your doctor.

They can do some simple tests which can tell you if anything physical is going on.

If everything comes back in check, you can then focus on making psychological improvements.

If this is where you are at the moment, Mojo can help.

All of our courses have been created with experts to give you the knowledge, tools and support you need to get it up and help keep it up.

If you feel ready to learn more about possible physical and psychological erection issues, you can take a peek using our trial.

Need a little extra support?

Our Mojo Community is a safe space where you can:

  • hear from and chat to other guys who have been in your shoes
  • understand more info about physical vs. psychological ED
  • ask questions to other community members and our experts
  • just have a browse and learn more – it’s absolutely fine to participate in your own time and on your own terms

Did we mention it’s anonymous?

We’re all set for you to explore incognito. All you need is a few minutes, and your laptop or phone.

Mojo aims to provide useful wellbeing resources to its users; however, you should not solely rely on opinions or advice available on the Website or given by the Community. Always seek advice from a qualified medical doctor or other healthcare professional before acting.

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