Depression and erectile dysfunction: The link, causes, and treatment

What to know about depression and erectile dysfunction

Medically reviewed by Nicole Washington, DO, MPH — By Mary West on November 14, 2022

This article is a repost which originally appeared on MEDICAL NEWS TODAY.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our takes:

‧ There are many potential causes of Erectile Dysfunction (ED).

‧ Anxiety and emotional stress appear to be common underlying factors.

‧ Medical professional assistance is available for treating ED.

Research has shown that there is a link between the two conditions. If a person has depression, they have a higher risk of developing erectile dysfunction (ED).

The above information comes from a 2018 review published in The Journal of Sexual Medicine.

Researchers do not fully understand the connection. However, theories suggest the underlying causes may include sexual performance anxiety or antidepressant side effects.

If a person with depression experiences ED, their doctor may prescribe a medication such as sildenafil (Viagra). Alternatively, they may recommend trying a different antidepressant.

Read on to learn about the symptoms of ED, how depression can cause it, treatment options, and more.

Signs and symptoms of erectile dysfunction

The signs of ED include‧:

‧ ability to get an erection only sometimes, despite a desire to have sex

‧ inability to get an erection at any time

‧ ability to get an erection, but being unable to sustain it throughout sex

Can depression cause erectile dysfunction?

Research from 2018 evaluates 49 studies to determine the relationship between depression and ED. It finds that a person with depression was 39% more likely to have ED than a person without depression.

Experts do not fully understand the factors that underlie how depression may cause ED. However, the current theories include:

‧ Behavioral: Depression involves negative thoughts and low mood. Either or both can lead to performance anxiety that hinders erectile function.

‧ Antidepressants: Many people with depression take antidepressant medications to manage their symptoms. However, these medications can cause low libido and inhibit the ability to have or maintain an erection.

‧ Low testosterone: The male hormone, testosterone, plays a key role in sexual performance. As such, low levels often correlate to ED. There is an association between depression and low testosterone levels in men.

The previously mentioned 2018 review also finds that people with ED are 192% more likely to have depression. This means that the link between depression likely goes both ways. For example, a person with depression may have ED for the reasons listed above. Similarly, a person with ED may also be more likely to experience depression.

Low self-esteem, self-consciousness about sexual performance, and other negative thoughts could contribute to depression in people with ED.
Other causes

There are a wide variety of factors besides depression that can cause ED. They include:

physical health conditions, such as:

‧ type 2 diabetes

‧ high blood pressure

‧ heart and blood vessel disease

‧ multiple sclerosis

‧ Peyronie’s disease (curvature of the penis)

‧ chronic kidney disease

‧ surgery for bladder cancer

‧ injury to the penis or pelvic area

certain medications, including:

‧ antidepressants, such as fluoxetine (Prozac)

‧ blood pressure drugs, such as atenolol (Tenormin)

‧ tranquilizers, such as diazepam (Valium)

‧ antiandrogens (medications that block the effects of testosterone), such as bicalutamide (Casodex)

‧ appetite suppressants, such as phentermine (Adipex-P)

Mental health factors can also increase a person’s likelihood of ED. In addition to depression, these include:

‧ anxiety

‧ low self-esteem

‧ fear of sexual failure

‧ stress

‧ guilt about certain sexual activities

Treatment options

Treatment for ED and depression includes medication, lifestyle changes, and psychotherapy. The treatment a healthcare professional recommends depends on the underlying cause of a person’s symptoms.

Medications for erectile dysfunction

Older research from 2001 explains when depression and ED occur simultaneously, treating one condition may improve the other. The findings indicate that treating ED with Viagra can alleviate the issue and lead to a notable reduction in depression.

Despite this, the research did not investigate how long the improvement lasts.

Doctors commonly prescribe Viagra for ED. It works by relaxing the muscle and increasing blood flow to the penis during sexual arousal. Other medications in the class include:

‧ vardenafil (Levitra)

‧ avanafil (Stendra)

‧ tadalafil (Cialis)

Additionally, if a person has low testosterone, a doctor may prescribe supplemental hormones.

Another treatment option that can trigger an erection is alprostadil. This comes in the form of an injection (Caverject) or a suppository (Muse).

Medication change for depression

A study from 2017 notes that sexual dysfunction is a common side effect of many antidepressants. For that reason, changing medication can help. Low libido and difficulty maintaining an erection are common side effects of antidepressants. However, some medications are less likely to have these effects.

The study’s authors recommend the following antidepressants for people who consider sexual functioning important:

‧ desvenlafaxine (Pristiq)

‧ trazodone

‧ vortioxetine (Trintellix)

‧ vilazodone

Lifestyle changes

Lifestyle changes may also reduce symptoms‧ of ED. These changes include:

‧ stopping smoking, if applicable

‧ eating a nutritious diet

‧ exercising regularly

‧ maintaining a moderate weight

‧ limiting or stopping recreational drug use, if applicable

Psychotherapy

The following psychotherapy interventions may help a person manage the emotional and psychological effects of depression and ED.

‧ Sex therapy: This involves counseling partners about their relationship or sex-related concerns.

‧ Cognitive behavioral therapy (CBT): This helps a person identify unhelpful thoughts and develop healthier ways of responding to challenges.

‧ Mindfulness therapy: This mental exercise consists of focusing on the present moment.

When to contact a doctor

If a person thinks they may have ED, it is a good idea to make an appointment with a doctor.

Additionally, people should seek medical attention if they have symptoms of depression. The sad feelings associated with depression last weeks and months, not days.

If they have suicidal thoughts, they should get immediate medical attention.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

Ask the tough question: “Are you considering suicide?”
Listen to the person without judgment.
Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
Stay with the person until professional help arrives.
Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Summary

People with depression are more likely to have ED, and ED is also associated with higher rates of depression. Symptoms of ED include being unable to attain and sustain an erection long enough to have sex.

If a person has both depression and ED, treating one condition is likely to improve the other. Medication and psychotherapy interventions, such as mindfulness, may help someone manage both conditions.

Sources:

Chokka, P. R., et al. (2017). Assessment and management of sexual dysfunction in the context of depression.
https://journals.sagepub.com/doi/10.1177/2045125317720642
Liu, Q., et al. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis.
https://www.jsm.jsexmed.org/article/S1743-6095(18)31007-5/fulltext
Lue, T. (n.d.). Erectile dysfunction (ED).
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
Overview – clinical depression. (2019).
https://www.nhs.uk/mental-health/conditions/clinical-depression/overview/
Seidman, S. N., et al. (2001). Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.10.1623
Walther, A., et al. (2019). Association of testosterone treatment with alleviation of depressive symptoms in men.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976

Vaseline in Place of Viagra: Is It Safe and Effective?

Can You Use Vaseline in Place of Viagra?

Medically reviewed by Matt Coward, MD, FACS — Written by James Roland on March 17, 2021

This article is a repost which originally appeared on Healthline

Edited for content.

If you experience erectile dysfunction (ED), you may be willing to try just about anything to restore healthy sexual function.

However, there are plenty of potentially dangerous options that people have tried, including the injection of Vaseline or other petroleum jelly products into the penis.

For many years and in many cultures, the practice of injecting or inserting something into the penis to make it larger or to improve sexual stamina has been done, often without the guidance of medical experts.

If you’re tempted to use Vaseline in place of Viagra or any other approved treatment for ED, don’t waste your time or take the risk. There are plenty of safer and more effective options available.

You may also have heard of topical gels or essential oils for ED, but there has yet to be any evidence to suggest that applying Vaseline as a topical treatment to your penis will have any effect on sexual function.

The science

Numerous studies have shown that injecting Vaseline into your penis is a danger, rather than a cure. The practice can lead to:

  • infections
  • serious skin and tissue injury
  • other medical complications

In a small 2008 study of 16 people who were treated for Vaseline injections, researchers found that “urgent surgery” was necessary to prevent further injury.

A 2012 case report concluded that Vaseline injections are usually done without medical supervision and can lead to severe complications if the petroleum jelly or other foreign objects aren’t removed promptly.

Clinical treatments

Instead of trying risky self-help solutions for ED, consider proven medications and other treatments that have a track record of success.

Oral medications

While Viagra, known clinically as sildenafil, may be the best known ED pills, there are other FDA-approved medications. They all vary somewhat in their:

  • potency
  • how quickly they take effect
  • duration of effectiveness
  • side effects

Other ED medications on the market include:

  • Tadalafil (Cialis). It’s available in a generic form and can be taken daily at low doses or as needed in higher doses.
  • Vardenafil (Levitra). It’s available in brand-name and generic versions. it tends to remain effective a little longer than sildenafil.
  • Avanafil (Stendra). It’s not yet available in generic form, Stendra is unique among ED medications in that it can become effective in about 15 minutes, while others take between 30 and 60 minutes to take effect.

Your lifestyle may help determine the best ED medication for you.

Vacuum pumps

This treatment involves the use of a tube that fits over your penis and attaches to a pump that withdraws air from the tube to create a vacuum.

The vacuum created around your penis helps draw blood to fill the blood vessels within and produce an erection. An elastic ring is also placed around the base of your penis to help maintain the erection.

A 2013 research review noted that the use of vacuum devices to treat ED is usually safe and effective, particularly when combined with ED drugs known as PDE-5 inhibitors, which include:

  • tadalafil
  • sildenafil
  • other standard medications

Penile injections

Certain medications can be injected into your penis to increase blood flow and create a firmer erection for intercourse. Those include:

  • papaverine
  • phentolamine
  • prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex)

There are also combinations of the above medications available.

Penile implants

Some people choose to treat ED with surgically-implanted, flexible, or inflatable rods that you can activate on demand.

Penile implants are generally reserved for individuals who have not had success with other traditional ED treatments.

Alternative treatments

Many safer and more effective alternatives to Viagra are available, including several prescription medications and over-the-counter (OTC) supplements, as well as complementary therapies, such as acupuncture, according to a 2016 research review.

Some people have had success using herbal supplements to treat ED. Some OTC products that have been supported by research include:

  • Korean red ginseng. It’s a plant that grows in Asia and may help both ED and alertness with relatively few side effects.
  • L-arginine. It’s an amino acid that serves as a building block for certain proteins. A small 2019 research review of 10 studies found that L-arginine used in doses of 1,000 to 1,500 milligrams significantly improved ED symptoms compared with placebo.
  • Yohimbe. It’s an herbal supplement commonly used in West African cultures, proved to be at least partially effective in treating ED in about one-third of people who participated in an old 1989 study.

Lifestyle changes

In addition, improving your health may improve ED symptoms and provide other benefits, including:

  • more energy
  • better sleep
  • greater cardiovascular fitness

The following lifestyle changes may pay dividends in terms of sexual health:

  • regular aerobic exercise, at least 150 minutes per week
  • maintaining a manageable weight
  • no smoking
  • consuming little or no alcohol
  • maintaining a healthy blood pressure
  • getting 7 to 8 hours of sleep each night
  • managing stress through meditation, yoga, or other strategies

When to talk with a doctor

The first step in finding the solution that’s right for you is to talk with your primary care physician or a urologist.

And while ED can be an embarrassing and frustrating topic to discuss with anyone, understand that ED is a common condition, affecting an estimated 1 in 3 adults with penises.

In other words, you won’t be the first person to ask your doctor for advice or treatment in this department.

Occasional concern

If ED occurs occasionally, then you may not need any treatment at all. In this case, it may usually be chalked up to:

  • stress
  • fatigue
  • relationship concerns
  • a side effect of misusing alcohol

Keep in mind that ED can be a symptom of many physical and emotional health conditions, including:

  • cardiovascular disease
  • obesity
  • hypertension
  • diabetes
  • depression
  • anxiety

Sometimes treating an underlying condition can lead to improved sexual function.

Persistent concern

If ED is a persistent concern, then a conversation with your doctor is recommended. Your concerns may be an inability to:

  • achieve an erection at all
  • achieve an erection that is firm enough for satisfactory intercourse for you and your partner
  • maintain an erection for the duration necessary for satisfactory intercourse
  • become erect at certain times or with certain partners

Regardless of the nature of your ED, there is a range of treatments that may be helpful. Psychotherapy and relationship counseling may be very helpful too, so you may want to talk with your doctor about referrals for therapy.

But because medications are generally tolerated, the first approach may be a prescription for Viagra or any of the other approved ED medications.

The bottom line

ED can affect several aspects of your life, including self-esteem and relationships, so it’s not something to ignore — especially when viable treatments are available.

And rather than rely on unproven and potentially very harmful treatments on your own — such as injecting Vaseline or any foreign substance into your penis — address this common medical condition with your healthcare professional.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.