Psychological impotence is a type of erectile dysfunction in which the cause is mental or cognitive rather than physical. Like physical impotence, it may have a number of causes, and sometimes more than one in an individual. These may be emotional, behavioral, or reflective of relationship problems. Treatment approaches include cognitive or behavioral therapy, couples counseling, or education about realistic sexual expectations. Sometimes, the label of psychological impotence may be applied because of sexual stereotypes about men.
Perhaps most often, psychological impotence is seen as performance anxiety, or the fear of being unable to satisfy one's partner. This can have a number of dimensions, including the amount of time spent having sex, achievement of orgasm in either partner, or the fear of being inadequate in some other way. Other factors may include some aspects of social anxiety, such as the fear of being intimate with another person or past experiences like rejection. Often, some combination of the these factors is present in psychological impotence.
Psychological approaches to treatment may include an evaluation of sexual history, individual sexual problems, and relationship issues. At first, therapy will likely be for the man alone. If it is found that problems have arisen because of relationship difficulties, couples counseling may follow. Even when psychological impotence is suspected, an underlying physical problem may still exist or be contributing to the problem. A thorough physical examination can determine whether this is the case.
Impotence can sometimes be caused by psychological disorders like depression and anxiety. These conditions may have gone undiagnosed, and education about their relation to impotence could be beneficial. Anxiety can cause distraction to the point of being uninterested in sex, or difficulty relaxing could make it difficult to achieve erection. Depression can lead to decreased energy or a loss of interest in usual activities, including sex. Either condition can be treated by therapy, medication, or some combination of these options.
At times, instances of so-called psychological impotence may be due to a misunderstanding between partners. This could include stereotypes that men should always want or be able to have sex, regardless of emotional states or other needs. It might also be related to ideas that men should be able to have sex for long periods of time or always be able to bring his partner to orgasm. It may be helpful, and possibly therapeutic, to remember that an erect penis is not always necessary for sexual intimacy and pleasure.