How Erectile Dysfunction Is a Nervous System Response

When my partner Dallas experienced erectile dysfunction in his mid-twenties, he felt broken. He believed something was fundamentally wrong with him, and struggling with anxiety and PTSD only added fuel to those feelings. Erectile dysfunction is often attributed to age, hormones, or attraction, but when it happens in your twenties, the confusion feels even sharper. The shame can spiral quickly when you love your partner but your body still goes into protection mode.

In this episode of The RISE to Intimacy Podcast, Dallas joins me to talk about his journey. We discuss how silence and misunderstanding lead to conflict and why this is actually a nervous system response rather than a lack of attraction. We look at how performance pressure and hypervigilance keep the body stuck and why there is no "quick fix" for these complex patterns. Dallas shares how he used emotional regulation to stop being afraid and find his way back to pleasure.

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00:52 – Common myths about erectile dysfunction and what you should do before you see a sex therapist

2:56 – What Dallas was thinking before sex even began and how one difficult experience can create an anxiety loop that feeds itself

5:59 – Statistics that prove how common erectile dysfunction really is

7:08 – The conflict that grew between Dallas and his ex-partner when he couldn’t talk about sex

8:12 – Why performance pressure blocks pleasure at the nervous system level and the role of hypervigilance, dissociation, and emotional withdrawal

10:36 – Why 12 weeks of therapy is rarely the full story and the importance of practicing regulation skills outside the therapy room

14:19 – How waiting too long to seek help can harden resentment and how long you should wait to re-engage in sex conversation after regulation

18:18 – What you can start doing if you’re experiencing erectile dysfunction

21:20 – Dallas’ final words of wisdom and how he feels now after therapy

Mentioned In How Erectile Dysfunction Is a Nervous System Response

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Full Transcript

Valerie McDonnell: Welcome to The RISE to Intimacy Podcast. I’m your host, Valerie McDonnell, and for over a decade, I’ve worked as a sex and couples therapist because intimacy used to feel really overwhelming for me. I felt a lot of pressure to perform, I was disconnected from my body, and I often felt like desire was out of reach for me.

But through my own trauma work, I stopped checking out of my body and started feeling connected to it again. I learned what it’s like to experience intimacy without fear, without shutting down, and without numbing out. Now I’m on a mission to help you do the same thing.

This podcast exists because trauma doesn’t get the last word. You can learn how to calm your body, change the story you’ve been carrying, and rebuild real connection, first with yourself and then with the people you love. Let’s begin.

On today’s episode, we’re going to be discussing how anxiety and PTSD often co-occur with erectile dysfunction. I’m so happy to have a guest joining me today, and that is my partner, Dallas. 

Dallas: Hey, how you doing?

Valerie McDonnell: And tell us why you are joining me today.

Dallas: Well, I’m joining you today because I have experience with erectile dysfunction due to PTSD and anxiety.

Valerie McDonnell: That’s right. When you first started experiencing this, about how old were you?

Dallas: I was in my 20s.

Valerie McDonnell: Right. You’re like mid to late 20s, right?

Dallas: Mid to late 20s, yeah.

Valerie McDonnell: Okay. It’s very important to point that out because this is a very common myth that if you’re experiencing erectile dysfunction, you must be in your 40s, 50s, or older. Also, if you are, that the problem is most likely testosterone. But neither of those things are true. There are multiple things that can actually cause erectile dysfunction.

So before you come and see a sex therapist like me, you should go talk to a doctor. I would suggest your primary care physician and also a urologist, and get things like your blood flow checked out, your hormones. Ask if any of the medications you’re taking could affect erections. If you’re having difficulty sleeping or not getting good quality sleep, that certainly can affect the quality of your erection. Also, substance use and sometimes neurological factors can also cause erectile dysfunction.

But if you get all that checked out, you can absolutely—and you should—come and seek out a sex therapist because erectile dysfunction that is mostly caused by anxiety or PTSD is absolutely fixable.

Let me ask you first, Dallas. When you were first experiencing this, can you tell me some of the things that would run through your mind that either confused you or didn’t feel good, and how you first experienced this before you got any help?

Dallas: Yeah, so I felt like I was broken. I felt like something was completely wrong with me. I didn’t know what it was at first. At that time, I didn’t even know I had PTSD.

Valerie McDonnell: When all that was happening, did you feel comfortable at all trying to talk to your partner about it?

Dallas: No, not one bit, because it always came back to where she thought that she was unattractive. I wasn’t attracted to her, that there was something wrong with her.

Valerie McDonnell: Right. Yeah, that is such a good point because many of the men that I see in therapy that are coming to me for erectile dysfunction tell me that their partners are saying these same exact things. I would say, at least in my professional experience, that the most common thing I hear female partners say is that this is happening because he’s not attracted to me. Or it might be something like, "If he was attracted to me, he would just easily get an erection." It’s not just a flip you can switch. Is that right?

Dallas: It’s not a flip you can switch, especially dealing with PTSD. I would give myself anxiety before we had sex. Or if I knew we were about to have sex, I would worry about, “Am I going to be able to maintain this erection? Am I going to be able to finish?” Because I know that’s the most important thing, when both partners finish.

Valerie McDonnell: Right. Yes. All right. Yeah, that’s very common. So that anxiety—this is something I also hear all the time—which is essentially you have one time that occurs where you’re not able to either get or maintain an erection. Then that essentially sets off this anxiety loop of now this person has anticipatory anxiety.

Like you’re saying, this is having these thoughts of, “Am I going to be able to please my partner? Am I going to be able to finish? Am I going to be able to get an erection?” And that’s before sex starts. But also during sex, you might be having anxious thoughts running through your mind as well, which is like, “Is my partner going to finish if I don’t finish?” Many, many things.

When all that is happening and we have all these ruminating thoughts going through our mind, that focus on those thoughts takes us out of being able to be present enough during the sexual experience. If we’re not present enough during sex, we cannot experience pleasure.

So I’m just going to give some statistics around how common erectile dysfunction actually is. Among men who are being treated for erectile dysfunction, a large study found that anxiety and depression were present in about 80% of patients with erectile dysfunction. Among people with PTSD, sexual dysfunction, including erectile dysfunction, is typically much higher than in the general population.

So anxiety and PTSD do not cause erectile dysfunction in all men, but they are statistically and clinically significant risk factors, and they often co-occur. But as we were saying before, while many people are feeling like they are broken if they’re experiencing erectile dysfunction, this is simply not what this means. It is almost always a nervous system response, meaning that anxiety-related erectile dysfunction happens when the body goes into protection mode, even when desire is still there.

So in this moment, when we were having a lot of ruminating thoughts and experiencing anxiety, and then, like in your case, Dallas, when you weren’t even really sure what was going on and therefore you weren’t comfortable talking to your partner about it, what was happening before you went and sought out help with this? What was the dynamic when you didn’t know how to talk about it?

Dallas: There was a lot of fighting, a lot of anger. I didn’t know how to regulate my emotions. I only felt angry and sad before I went to therapy. It wasn’t until I went to therapy that I learned about emotional regulation, learned about the emotion wheel that helped me out a lot. And using my emotions and regulating my emotions and understanding my emotions helped me to be present in the moment, helped me to understand what was going on. So that way I wasn’t putting all this pressure on myself.

Valerie McDonnell: Yeah, because pressure just keeps your body dysregulated. When you’re dysregulated, your body is essentially just in protection mode. When we are on high alert like that, there’s just no space for arousal to be present because sexual desire and arousal just don’t exist with pressure to perform.

So some common things that show up in the clients I see that are having challenges in this area are hypervigilance, evaluating their performance, feeling a loss of control, also maybe freezing or shutting down or dissociating, and then emotional withdrawal after sex. Did you experience any of these things, Dallas?

Dallas: Absolutely. Yes, I did. I would feel like I would be hypervigilant. I would shut down, and I would pretty much dissociate myself in the moment.

Valerie McDonnell: Yes. So I just want to reiterate that having sexual desire and feeling connected to your partner can exist alongside challenges with erections. However, if you are connected and this starts happening and you have no ability to talk about this challenge, discuss it, and navigate it in a way where you’re not consistently getting caught up in conflict, argument, yelling, fighting, or shutting down, then the emotional connection is going to go away.

So it’s very important to also have the skills to learn how to communicate with your partner in a way that you can navigate tough discussions and stay regulated, meaning staying mostly calm in the moment so that you can get to a resolution versus ending in resentment.

Dallas, you told us how this experience felt for you when it was first starting—how it was frustrating, you would feel angry, and also that you and your partner didn’t know how to navigate it together. Y’all lacked the ability to communicate about it, which makes sense, especially since you weren’t exactly sure what was going on at first.

Then we talked about how you went to therapy, you learned about emotional regulation, you used the emotion wheel, which is a tool we use to help clients identify what they are feeling. Both those things certainly do lend to the ability to be able to stay calm in the moment of distress or when you’re experiencing anxiety or PTSD.

So then can you tell us a little bit about when you were going through therapy? That was a little bit of that time when you were with the ex-partner, right?

Dallas: Correct.

Valerie McDonnell: When you were doing that, how quickly did you start feeling like things were changing for you in terms of the challenges?

Dallas: Not quickly. It wasn’t quick at all. I went through therapy for 12 weeks, couples therapy for 12 weeks. At the end of it, she thought that I would be fixed. All the problems would be gone. I’d just go back to being this good, old, healthy person. But that was totally not the case.

Now, looking back at it, it has been almost four years since I’ve been in therapy. I’m at the point now where I am able to talk about it. I’m able to regulate my emotions, and I’m actually not afraid anymore. Looking back four years now, I wasn’t able to talk about this stuff. But now I’m actually happy and excited, and I have the best partner ever to talk about it with.

Valerie McDonnell: Just like another quick note on when you’re saying that at that time when you were in couples therapy and your partner had these expectations that after 12 weeks of therapy you guys would see some concrete results—I do think that many people, when they first come to therapy, have an expectation that after a few months maybe everything is going to be changed or fixed.

Therapy for something like anxiety, and certainly for something like PTSD, is more of a long game. There are many things to be educated on. PTSD is very complex. While many people experience some of the same symptoms, it’s not the same for every person. So it’s not going to be something that you’re going to be able to tackle and overcome just within a 12-week period.

So for everybody, especially if you’re in couples therapy, patience is certainly going to be your friend.

Dallas: Patience is very, very huge, I would say.

Valerie McDonnell: Also, do work outside of the therapy session. Like if you were learning how to play a brand new sport for the first time, you wouldn’t go to a coach for just one hour a week, work with them, and expect that you’re going to be a professional athlete at the end of a three- to six-month period. You would know that you’re going to have to practice some of the skills that you’re learning with your coach outside of the in-person sessions with your coach. You don’t necessarily have to do that, but then it’s going to take longer to make progress. So the more you practice the skills you’re learning in therapy sessions, the quicker progress is going to be.

Dallas: Also, what I would say is don’t sit on the problem too long.

Valerie McDonnell: That is so true. Very, very true. So many people come into couples therapy and they say something to me like, “Well, this is our last-ditch effort before divorce.” I think, “What? The last-ditch effort?” Like, when you guys first start even thinking, “Hey, maybe we need couples therapy,” that is certainly the time to just go ahead and schedule couples therapy. It shouldn’t be used as something that once there is a mountain of problems and resentment or betrayals, that now we consider getting help.

Consider getting help when you’re not that far gone, because you can actually learn skills in couples therapy that you can use from that point until the rest of your life. For me, I like to teach all my couples how to communicate in a way that no matter what they’re discussing, they know they will get to resolution. Almost always, that is because they will learn how to regulate themselves so that if somebody does get triggered or becomes upset, that isn’t going to derail the conversation and you never come back to it or sweep it under the carpet because you don’t want another fight. Because all those things lead to resentment.

Dallas: Right. And how long would you say you would wait until, let’s say, you needed a break for that conversation, how long would you say, as a therapist, you need to wait in order for us to come back and talk about it?

Valerie McDonnell: Oh, yes. So of course that’s going to be dependent on, you want to take a pause. During that pause or break, you both should take some time apart and regulate your nervous system. That’s going to be probably different for both of you. But you should not return to the conversation and continue having it until you are regulated.

For some people, like some clients who come see me when we first start this process, they’re taking days. They’re taking days of not discussing the conversation again because they don’t feel ready to do it. They’re not regulated, or they’re worried their partner isn’t regulated. I think that’s too long. I like everybody to come back to the conversation within 24 hours. Twelve hours is even better.

Me and Dallas, I would really appreciate not going more than a couple of hours. What do you think?

Dallas: Yeah, no. The longer you wait, the harder it’s going to be.

Valerie McDonnell: Right.

Dallas: It’s best to just tackle the situation. When you both calm your nervous system down, you both calm down. I feel like the sooner you tackle it, the better off you’ll be.

Valerie McDonnell: Yeah, that is so true because the longer you wait, the more you’re forgetting what you’re actually talking about. Then your partner might bring up something and you’re like, “That’s not what I said,” or “That’s not what happened.” Then now we’re getting into conflict over who’s right or wrong about what actually occurred.

This is so common, too. I try to tell everybody, almost always we’re arguing about who’s right or wrong about a situation. You’re never going to win. There is no winner in that because it’s not actually about who is right or wrong. Everybody has a different perspective on a situation. No matter if you’re sitting in the same room, everyone is experiencing a situation or event or conversation or interaction differently, even if it’s the same thing.

So we’re not going to win there. It’s more about how did I feel, or what meaning did I make out of this based on what occurred for me, like how I perceived this event or situation.

So now I’m going to discuss some things that you can start doing if you are experiencing erectile dysfunction. Again, the first one is going to be learning how to regulate your body when you are feeling anxious or stressed out. We’ve talked about this a lot already today, but that’s very important because learning how to regulate your body—which is learning how to calm yourself if you are having anxious thoughts or just feeling stressed out or even afraid—is where you bring your nervous system back online, which means your brain is back online, your body is back online, and therefore you can experience pleasure, but you can also navigate a conflictual conversation with your partner.

Other things you can do are to start slowly and navigate that experience in a slow way. You don’t have to rush to orgasm. In fact, even using orgasm as the main expectation or the main goal during sex is something that can continue to increase and perpetuate anxiety for someone experiencing challenges with erection. So slowing down, taking your time, also helps you stay present in the moment.

Then again, being able to name what’s going on with you, how it feels for you, and what the experience is like, and then communicate that with your partner will certainly help decrease the anxiety around it because we’re bringing it to the surface. We’re no longer keeping it hidden. When we do that, it only increases the shame around it.

Now, of course, you can bring this up to your partner. You can tell them how this experience feels, what you think about it, and some of your fears. But if they don’t have much education, or any around erectile dysfunction, or if they don’t have the ability to remain calm when they hear something that might be upsetting to them, then you’re still going to struggle with anxiety.

So one of the best things you can do is find a really good sex and couples therapist. Because in couples therapy, yes, a lot of times we are tackling things like communication, betrayals, or some type of rupture in the relationship. We might be unpacking resentments and trying to get some resolution around them. But one of the things that most couples therapists are not doing—because they are not educated in it and they’re not comfortable with doing it—is tackling the challenges related to sex. The best way to do that, again, is to come and see a sex and couples therapist.

Dallas: So guys, I just want to reiterate, if you are struggling with erectile dysfunction and you don’t know what it is, it is okay, you are not the only one dealing with it. You just need to follow the steps. Make sure you get that medical help first. If it’s not that, please go see a sex therapist. It is very important to take care of yourself in that situation so that you can be happy and your partner can be happy.

Valerie McDonnell: Yes. And would you say now, after doing the work around this, do you feel like you went from a place where you felt like this was nearly impossible and you had no idea how to change this or how to have an exciting, healthy sex life again that was pleasurable for both you and your partner, and do you feel like that’s where you’ve gotten now?

Dallas: I never thought I’d be feeling like I was 18 again, to be honest with you. It has completely changed everything about my life. Now that I finally get to have sex again, it’s unbelievable. It’s a great experience, and I just go crazy.

Valerie McDonnell: On that note, we really appreciate you all listening to this episode today. I am extremely grateful that my partner joined me on this episode and had so much openness and courage to talk about this topic because it is something that most men are not talking about with anybody. So I just appreciate him so much for being that open, and we hope that you guys will join us for the next episode. Thanks so much.

Thanks for listening to The RISE to Intimacy Podcast. If today’s episode resonated with you, know that healing is possible and you don’t have to do it alone. If you’re enjoying the show, please leave a rating and review for us at ratethispodcast.com/rise. It really helps others find us.

I’m so grateful for all your support. You can learn more about my coaching packages for individuals and couples at risetointimacy.com. Remember, sex therapy isn’t for people who are broken. It’s for people brave enough to look beneath the surface.