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Erectile dysfunction (ED) is often seen as a purely physical condition, but emerging research reveals that the brain also plays a crucial role in both the onset and treatment of ED. Affecting an estimated 30 million men in the United States alone (National Institute of Diabetes and Digestive and Kidney Diseases, 2020), ED can significantly impact not only physical health but mental well-being, interpersonal relationships, and overall quality of life. (Leslie, 2024) While we are still learning about the connection between the brain and body, research shows that many treatments already exist that can target both physical and physiological aspects of ED.
Understanding ED: Symptoms and Causes
Erectile dysfunction is typically defined as the inability to achieve or maintain an erection sufficient for sexual activity (National Institute of Diabetes and Digestive and Kidney Diseases, 2020). ED can be a short or long-term problem and may present as the occasional inability to get or maintain an erection, or it could be a persistent issue.
The more physical causes of ED range greatly, from certain diseases and conditions impacting the endocrine system, cardiovascular system, and nervous system, to physical injury, certain medications, and lifestyle habits. Psychological or emotional issues can also cause ED to develop or worsen. This includes anxiety, depression, low self-esteem, stress, guilt, or fear of failing sexually. (National Institute of Diabetes and Digestive and Kidney Diseases, 2020)
Because these psychological aspects can significantly worsen ED symptoms and cause strain on interpersonal relationships, finding holistic approaches for treating ED is incredibly important.
The Role of the Brain in ED
The brain is an essential part of the sexual response cycle, and dysfunction at the neurological level can directly affect a man’s ability to achieve an erection. (Calabro, 2019) The sexual arousal process actually begins in the brain, due to sensory and mental stimulation. Then the brain sends signals to the penis through the nervous system to trigger the physiological response of an erection. (Cleveland Clinic, 2023) Certain mental conditions, psychological factors, and medications used to treat these conditions can interfere with the brain’s neurotransmitters, which may lead to difficulty feeling aroused, experiencing sexual desire, or fully enjoying pleasurable feelings. (Cleveland Clinic, 2023)
Holistic Treatment Approaches for ED
Given that ED is often a multifaceted condition, many providers recommend finding holistic treatments for managing ED. Targeting the physical effects and causes of ED with medications, devices, or surgery, and the psychological aspects with therapy, counseling, lifestyle changes, and more, may be more effective for the holistic treatment of ED. In fact, one study found that men who paired a pharmacological treatment (PDE5s) with therapy had more favorable results than those using the medication alone. (Khan, 2019)
By combining treatment approaches, you can find what works best for you and your partner. Remember to always consult a healthcare provider before moving forward with any new treatments or major lifestyle changes.
National Institute of Diabetes and Digestive and Kidney Diseases. (July 2017). Erectile Dysfunction. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
Leslie SW, Sooriyamoorthy T. Erectile Dysfunction. [Updated 2024 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562253/
Calabrò, R. S., Cacciola, A., Bruschetta, D., Milardi, D., Quattrini, F., Sciarrone, F., la Rosa, G., Bramanti, P., & Anastasi, G. (2019). Neuroanatomy and function of human sexual behavior: A neglected or unknown issue?. Brain and behavior, 9(12), e01389. https://doi.org/10.1002/brb3.1389
Cleveland Clinic. Erection. April 2023. Retrieved from https://my.clevelandclinic.org/health/articles/10036-erection
Cleveland Clinic. Depression and Sex. December 2020. Retrieved from https://my.clevelandclinic.org/health/diseases/9296-sexual-problems-and-depression/
Bilal, A., & Abbasi, N. U. H. (2020). Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study. Sexual medicine, 8(3), 396–407. https://doi.org/10.1016/j.esxm.2020.05.005
Khan, S., Amjad, A., & Rowland, D. (2019). Potential for Long-Term Benefit of Cognitive Behavioral Therapy as an Adjunct Treatment for Men with Erectile Dysfunction. The journal of sexual medicine, 16(2), 300–306. https://doi.org/10.1016/j.jsxm.2018.12.014