“What’s wrong with me?”

This is one of the most common questions men have when they’re experiencing a sexual problem like erectile dysfunction, and their doctor hasn’t found a purely physical reason to explain it.

In most cases, the answer is both simple and complicated. The simple version: There’s nothing wrong with you. What you’re experiencing is common.

The complicated version: There is a bi-directional relationship between your brain and your body. That means your thoughts, emotions and behaviors can all affect how your body functions, including sexual functioning.

> Concerned about erectile dysfunction? Connect with a men’s health specialist

Valeria Martinez-Kaigi, PhD, Clinical Health Psychologist at Tallwood Men’s Health Center explains.

Assumptions and expectations can lead to performance anxiety, including erectile dysfunction.

What you think, feel and do influences what’s going on in your body — and vice versa. This feedback loop is always happening, even when you’re not aware of it. As a result, your thoughts and beliefs about sexual performance can significantly contribute to your sexual experience.

One example is performance anxiety.

“If you have certain assumptions about what sex “should” look or feel like, or high expectations for your own sexual performance, you may wind up stressing about your body image or your ability to please your partner. That can lead to performance anxiety, including erectile dysfunction,” said Dr. Martinez-Kaigi.

Changing your thought process can help. Instead of having expectations about what the experience “should” be like, try to focus on being in the moment with your partner, taking a mindful approach to the experience at hand.

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Unrealistic expectations, like those shown in pornography, can cause low arousal and erectile dysfunction.

Here’s another clear example of the mind-body connection. Over time, a pornography habit can lead to sexual dysfunction — like low arousal, and erectile dysfunction due to psychological factors (known as psychogenic erectile dysfunction).


“In most cases, adult sexual entertainment doesn’t reflect real-life sexual experiences. So, if a person has conditioned themselves to be sexually aroused by pornography, their body may not respond in the same way when they’re with a partner. Their expectations for real-life intimacy are unrealistic, which affects their body’s physiological and psychological response,” said Martinez-Kaigi.

Anxiety and depression can cause sexual problems too.

Sexual dysfunction is a symptom of depression and anxiety, including loss of interest in sex, ability to be aroused and to orgasm.

“There are many underlying neurobiological mechanisms that play a role in mood and anxiety disorders — and lots of ways to help,” said Martinez-Kaigi.

These are signs that sexual dysfunction is due to psychosocial factors, versus physical factors.

Some of those signs include:

  • Feeling disconnected with a partner emotionally or psychologically.
  • Experiencing symptoms of depression or anxiety.
  • Struggling with mistrust or dishonesty.

There are effective treatments for sexual dysfunction, no matter how long you’ve been experiencing it.

Sexual health is an important pillar of health, reflecting your physical, mental, emotional and social well-being. If you’re experiencing any of the above symptoms, or if you’ve noticed any changes in sexual function that persist for over a month, talk to your doctor.

Your care team can connect you with treatments that address its many factors — biological, psychological, and social — and help you optimize your sexual functioning and satisfaction.