Psychosocial and Relationship Issues in Men With Erectile Dysfunction

Patrick J. DiMeo, BSN, RN, OCN


Urol Nurs. 2006;26(6):442-446. 

In This Article

Emotional Effects: Anxiety, Depression, and Low Self-Esteem

Men who experience ED can suffer the effects of anxiety, depression, low self-esteem, and decrease in quality of life (QoL) (Feldman et al., 1994). Men who have ED are not just affected physically but emotionally as well. In general, men are more introverted and keep their feelings to themselves without expressing how they truly feel. This has led them to become emotionally distant from the people in their lives. Men with erectile difficulties tend to emotionally and physically withdraw from their partners. They fear that any physical affection will precipitate a request or desire for intercourse from their partners and remind them of their inability to achieve an erection. Men who are more prone to have a decrease in their sexual response are more at risk to lose their sexual interest and erectile responsiveness when anxious or depressed (Bancroft & Janssen, 2001). It is believed that negative thinking about sexual behaviors may lead to increased performance anxiety, poorer sexual function, and perhaps, avoiding sexual activity (Fichten et al., 1998).

Men who judge themselves solely on sexual performance may think of themselves as failures. This problem causes a lapse of confidence and a drop in self-esteem. Men commonly report that sexual performance occupies a lot of their mental energy.

There is a documented association between ED and depression. Successful treatment of ED can critically improve depression scale scores in men (Shabsigh et al., 1998). In a Columbia University study, 152 men with mild-to-moderate depression were enrolled. None of the men were taking any antidepressant medications. All of these men had ED for at least 6 months, with a mean of 6 years. Half of the men were given a PDE5 inhibitor and the other half a placebo. The results showed the PDE5 group had better results in restoring erectile function than the placebo group. Seventy-six percent of the men treated successfully for ED also had better erectile function and experienced an improvement in their overall QoL and depressive symptoms (Harvard Medical School, 2004).


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