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

24 Ways You or Your Penis-Having Partner Can Increase Penile Sensitivity

24 Ways You or Your Penis-Having Partner Can Increase Penile Sensitivity

Medically reviewed by Jennifer Litner, LMFT, CST — Written by Adrienne Santos-Longhurst on October 14, 2020

This article is a repost which originally appeared on Healthline

Edited for content

For many folks, sexual satisfaction is all about the feels, so if you or your penis-having partner are experiencing decreased sensitivity down there, it could really mess with your ability to get off.

There are a few things that can cause a decrease in penile sensation, from the way a person masturbates to lifestyle habits and hormone imbalances. The good news: There are ways to get back that lovin’ feeling.

Quick distinction: Less sensation vs. numbness

To be clear, there’s a big difference between less sensation and numbness.

Having less sensation — which is what we’re focusing on in this article — means you don’t feel as much sensation in your peen as you did before.

A numb penis is a whole other ball of wax and refers to not being able to feel any normal sensation when your penis is touched.

If it’s related to your technique

Yep, how you pleasure yourself might be affecting your penile sensation.

What does this have to do with it?

The way you masturbate can lead to decreased sensitivity. Some people call this “death grip syndrome.”

The gist is that people who masturbate using a very specific technique or tight grip can become desensitized to other types of pleasure over time.

When this happens, coming or even getting any pleasure without the exact move or pressure becomes difficult.

If you’re feeling all the feels just fine when you masturbate but find that partner sex is where the sensation is lacking, there are a couple potential reasons.

A thinner or smaller-than-average penis, or even too much lube (natural wetness or synthetic), can mean less friction — and ultimately sensation — during intercourse.

What can you do to help address this?

Just switching up your technique should do the trick and help you recondition your sensitivity.

If death grip is the issue, depending on how you’re used to masturbating, this might mean loosening your grip, stroking at a slower pace, or both.

You could also mix things up with a sex toy made for penis play, like the Super Sucker UR3 Masturbator, which you can buy online, or TENGA Zero Flip Hole Masturbator, which is also available online. And don’t forget the lube!

If intercourse is the issue, some positions make for a tighter fit and therefore more friction.

Here’s a little secret: Tweaking any position so your partner can keep their legs tight together during sex should work.

Plus, if anal sex is what you’re both into, the anus is by nature a tighter squeeze. Just be sure to use a lot of lube if you take it to the backside.

And speaking of a lot of lube: If an abundance of wetness is making sex feel a bit like a Slip ’N Slide, a quick wipe with some tissue should fix it.

If it’s related to your lifestyle

Certain lifestyle habits can be to blame for your peen’s lessened sensitivity.

What does this have to do with it?

Do you bicycle a lot? Do you masturbate frequently? These things can cause the sensitivity in your peen to tank if you do them often.

When it comes to masturbation, how often you do it matters if you’re doing it a lot, according to research that has linked hyperstimulation to decreased penile sensitivity.

As for bicycling, bicycle seats put pressure on the perineum — the space between your balls and anus. It presses on blood vessels and nerves that provide feeling to the penis.

Sitting in a hard or uncomfortable chair for long periods can do the same.

What can you do to help address this?

Masturbation is healthy, but if the frequency of your handy treats is causing a problem, taking a break for a week or two can help get your penis feeling back to itself.

If you sit or bicycle for long periods, take regular breaks. Consider swapping out your bike seat or usual chair for something more comfortable.

If it’s related to your testosterone levels

Testosterone is the male sex hormone responsible for libido, not to mention a bunch of other functions.

If your testosterone (T) level drops, you might feel less responsive to sexual stimulation and have trouble getting aroused.

T levels decrease as you age. Damage to your danglers — aka testicles — can also affect T, as well as certain conditions, substances, and cancer treatment.

Your doctor can diagnose low T with a simple blood test and treat it using testosterone replacement therapy (TRT). Lifestyle changes, like regular exercise, maintaining a moderate weight, and getting more sleep can also help.

If it’s related to an underlying condition or medication

Certain medical conditions and medications can affect sensation in the penis.

What does this have to do with it?

Diabetes and multiple sclerosis (MS) are just a couple conditions that can damage nerves and affect sensation in different body parts, including the penis.

Medications used to treat Parkinson’s disease can also reduce penile sensation as a side effect.

Ensuring that any underlying condition is well managed might help bring the feels back.

If medication’s the culprit, your doctor may be able to adjust your dose or change your medication.

If it’s related to your mental health

Sexual pleasure isn’t just about your D. Your brain plays a big role, too.

What does this have to do with it?

If you’re dealing with anxiety, stress, depression, or any other mental health issue, getting in the mood can be near impossible. And even if you really want to get down to business, your penis may not be as receptive.

What can you do to help address this?

It really depends on what’s going on mentally.

Taking some time to unwind before sexy time can help if you’re feeling stressed or anxious.

A hot bath or shower can help your mind and muscles relax. The warm water also increases circulation, which can help increase sensitivity and make your skin more responsive to touch.

If you’re regularly struggling with feelings of anxiety or depression, or having trouble coping with stress, reach out for help.

Talk to a friend or loved one, see a healthcare provider, or find a local mental health provider through the Anxiety and Depression Association of America (ADAA).

Things to keep in mind if you’re struggling

Not to be punny, but try to not beat yourself silly over this.

We get how frustrating it must be to not be able to enjoy the sensation you want or expect during sexual activity.

Here are some things to keep in mind if you’re struggling.

It’s probably not permanent

Chances are your lessened penile sensation can be improved.

As we’ve already covered, changes in technique, getting in the right frame of mind, or some lifestyle tweaks may be all that’s needed to get your penis feeling right again.

A healthcare provider can help with any underlying medical or mental health issues and recommend the right treatments.

Go easy on yourself

We’re not just talking about choking your chicken either! Stressing about this and putting pressure on yourself will only make things worse in the pleasure department.

Give yourself time to relax and get in the mood before play, and permission to stop and try another time if you’re not feeling it.

Don’t be embarrassed to ask for help

Penis health and sexual health are just as important as other aspects of your health.

If there’s something going on with your penis or your ability to enjoy sexual activity, a professional can help.

Good penis health is in your hands

You can’t control everything, but there are things you can do to help keep your penis healthy:

  • Eat a healthy diet, including foods shown to boost penis health by lowering inflammation and improving T levels and circulation.
  • Get regular exercise to improve mood and T levels, manage your weight, and lower your risk for erectile dysfunction and other conditions.
  • Learn to relax and find healthy ways to cope with stress to improve your T levels, mood, sleep, and overall health.
Things to keep in mind if your partner is struggling

If it’s your partner who’s struggling with lessened sensitivity down there, don’t worry. Chances are there’s a good reason for it, and it’s probably not what you think.

Here are some things to keep in mind if it’s getting to you.

Don’t take it personally

Your first instinct may be to blame yourself if your partner isn’t enjoying sex. Try to not do this.

Sounds harsh, but: Not your penis, not your problem.

As a loving partner, of course you want them to feel good. But unless you’ve damaged their penis by taking a hammer to it, their lessened penile sensitivity isn’t your fault, so don’t make it about you.

I repeat, don’t make it about you

Seriously, it’s not your penis!

As frustrated as you might be, keep it to yourself

Not trying to dismiss your feelings or anything, but as frustrated as you may be that your partner isn’t feeling it even when you pull out your best moves, it’s probably a lot more frustrating for them.

That said, if your partner’s lack of sensation results in a marathon shag sesh that causes chafing to your nether regions, of course you have the right to take a break or stop. It’s your body, after all. Just be mindful of how you say it.

Ask what your partner needs from you

EVERYONE should be asking what their partner needs when it comes to sex and relationships. It’s the key to making both great.

Do they need a little time to relax before action moves to the peen? Do they need more foreplay that focuses on other pleasure spots to help them get in the mood? Do they want to just stop altogether? Don’t be afraid to ask.

The bottom line

If you’ve lost some of that lovin’ feeling down below, your lifestyle and pleasure routine — solo or partnered — may provide some clues. If not, your doctor or other healthcare provider can help.

In the meantime, be patient and kind with yourself, and consider some of your other pleasure zones for satisfaction.