Psychological impotence

Erections depend on brain signals, emotions, nerves, blood flow and hormones. Worry after one difficult experience can increase tension and make another erection harder, creating a self-reinforcing cycle. Some people have erections during sleep or on waking but struggle during partnered sex; this pattern can suggest a psychological contribution, although it does not prove one. Erectile difficulty may also occur with depression, hypertension, obesity or type 2 diabetes, and reduced desire may be a separate concern.

Arrange a GP consultation if the problem recurs, lasts or causes distress. Share when it began, whether erections occur at other times, medicines you take, alcohol or drug use, sleep, stress and relationship concerns. A clinician may check blood pressure, examine relevant health factors and discuss a blood test or diabetes screening when appropriate. Counselling or sex therapy can help with performance anxiety and communication; involve a partner only if you want to.

Seek prompt medical advice for sudden persistent change, penile pain or injury, loss of sensation, urinary symptoms or a marked change in sexual desire with low mood. Get urgent help for severe chest pain, breathlessness or neurological symptoms occurring with sexual activity. If depression includes thoughts of self-harm, seek immediate mental-health support.

Could a medicine or health condition be contributing? Would a blood test or diabetes screening help? What psychological treatment is available? How can I discuss this with my partner?