Erectile dysfunction can be psychological, physical or both, and each question people ask about the mind's part is answered below. The whole condition — every cause, how a GP works out yours, and treatment — is in our guide to erectile dysfunction: causes, symptoms and treatment; medicines that can cause it are in which medicines and conditions can cause ED.

Can Viagra or Cialis treat psychological erectile dysfunction?

Yes, they often help: in the trials behind the European Viagra label, 84% of men whose erectile dysfunction was psychogenic (psychological in origin) reported that sildenafil improved their erections — more than the 68% of men whose cause was physical, and 75% of men with depression (EMA product information). What the tablets do not touch is the cause: they help blood flow when you are sexually excited, but they do not increase libido, and they do not work for everyone (healthdirect). The full answer is in can Viagra or Cialis treat psychological erectile dysfunction?

Nerves can blunt the first dose. The Australian Cialis leaflet says: "Sometimes if you're feeling anxious or nervous you may not respond to the first tablet. Don't give up, it may take a few doses before you get the full benefit" (Cialis CMI), and Australian Prescriber advises trying a tablet on five to six occasions before judging it, because the response "can be affected by anxiety, alcohol, excessive expectations" (Australian Prescriber). Nerves before sex are their own question: can Viagra help with performance anxiety? In Australia every ED tablet needs a prescription after a doctor has assessed you, and none can be taken with nitrates, the medicines for angina (healthdirect).

Can lorazepam (Ativan) or other anxiety medicines cause erectile dysfunction?

The Australian lorazepam leaflet and product information do not list erection or sexual problems among its side effects — but anxiety medicines as a group are linked with ED, and so is the anxiety they treat. Lorazepam belongs to the benzodiazepines, is "used to relieve anxiety", and its common side effects are drowsiness, dizziness, sleepiness, unsteadiness, weakness and memory loss; benzodiazepines "should be taken for short periods only (for example 2-4 weeks)" (lorazepam CMI). Australian Prescriber lists anxiolytics (anti-anxiety medicines), antidepressants and antipsychotics among the medicines associated with erectile dysfunction. The drawn question: does lorazepam cause erectile dysfunction? Do not stop an anxiety medicine on your own — the leaflet asks you to speak to your doctor or pharmacist first. Antidepressants are covered in can Zoloft or sertraline cause lasting ED?, and taking an ED tablet alongside them in Viagra with antidepressants and anxiety medication.

Is erectile dysfunction physical or psychological?

It can be either, or a mix: "Erectile dysfunction can have a range of causes — physical, psychological or a combination. Sometimes it only happens in certain situations." (healthdirect). Australian Prescriber notes that the old split into organic, psychogenic or mixed has given way to the view that the causes are "biological, psychological, sociocultural, relational and sexual" at once. More in is erectile dysfunction physical or psychological? and the psychological causes of ED and how they are managed.

The psychological causes healthdirect names are problems or conflicts within a sexual and emotional relationship; anxiety about sexual performance, "most common at the start of a new relationship"; stress; and mental health conditions such as depression or anxiety. Each has its page: can anxiety cause erectile dysfunction? and can stress cause ED? Post-traumatic stress disorder is a mental health disorder that can follow a traumatic event, and depression or anxiety can follow trauma too (healthdirect): can PTSD cause erectile dysfunction?

A doctor tells them apart with questions and a check-up. Your GP asks about your sexual history, general health, relationships and "psychological relationship with sex", and may offer to talk to your partner (healthdirect). Whether the problem is "intermittent, global or situational", and the quality of morning erections and of erections during masturbation, help show the underlying cause (Australian Prescriber). A physical check matters even when stress seems the obvious reason: erectile dysfunction is often the first sign of heart disease, diabetes, high blood pressure or high cholesterol (healthdirect).

Can a marriage survive erectile dysfunction?

Yes. Healthy Male puts it plainly: "It is possible to have a satisfying sex relationship without penetrative sex, so an erection is not an absolute requirement for a satisfying sex life. You can have an orgasm and ejaculate without an erection." (Healthy Male). Left alone, erectile dysfunction can lead to low self-esteem and confidence, anger, depression or anxiety in either partner (healthdirect), which is why treatment, and therapy that can include both of you, is worth starting. Relationships Australia has resources for couples (healthdirect). More in can a marriage survive erectile dysfunction or impotence?

How can you support a partner with erectile dysfunction?

Keep talking, keep close, and be part of the treatment if they want you to be. Sex does not have to mean penetration (Healthy Male); ED tablets still need arousal — "You and your partner will need to engage in foreplay, just as you would if you were not taking a medicine for erectile dysfunction" (Cialis CMI); and a GP may offer to talk with you as well (healthdirect). The practical side is in how to support a partner with erectile dysfunction, and starting the conversation in how do you talk to your partner about ED?

How is psychological erectile dysfunction treated?

With therapy, often alongside a tablet. "Your doctor may recommend therapy if your erectile dysfunction is caused or triggered by psychological factors. Examples include cognitive behavioural therapy, or sex therapy, and may also include your partner." A GP, psychologist or mental health professional may provide it, and trained sex therapists offer specialised education and counselling (healthdirect). Australian Prescriber says sex therapy is indicated "particularly when there is a significant psychological contribution" and when tablets have not worked, and that men do best with a mix of lifestyle change, medical treatment and psychosexual counselling. The options are set out in treatment options for psychogenic erectile dysfunction; what helps with nerves before sex, in how to overcome performance anxiety. Every other treatment, from injections to devices, is in our guide to treating erectile dysfunction.

Sources