Chronic Stress Often Links Men’s Top Two Sex Problems

On the sex Q&A site I publish, many men express great distress over one or the other of men’s two leading sex problems, premature ejaculation (PE) or erectile dysfunction (ED). When men experience one of them, their tone is usually upset but rational. They ask why the problem developed and request information about treatment. But when men suffer both ED and PE simultaneously, they often freak out, lamenting that their lives are totally out of control. Many doubt their sanity. (With mild to moderate ED, men retain sufficient erection function to suffer PE.)

Sexologists generally consider ED and PE separate and distinct. Yes, the two complaints are often unrelated. But a recent study by Taiwanese researchers shows that many men who complain of one also report the other. This raises two questions: Are ED and PE linked? And if so, why would having one raise risk for the other?

ED and PE Frequently Overlap

Several studies show that ED and PE are risk factors for each other:

• The Taiwan study just mentioned reviewed the sexual histories of 1,893 men complaining of ED and 483 men reporting PE. In addition to their presenting complaint, one-third of both groups also reported the other problem.
• Other Taiwanese researchers recruited 937 members of a men’s social club for an online sexuality survey. Compared with those who did not report ED, those who did had 10 times the typical likelihood of PE. Compared with participants who did not have PE, those who did reported 13 times the general likelihood of ED.
• Italian researchers reviewed the research on ED and PE and concluded: “ED and PE frequently overlap. ED is an important risk factor for PE and vice versa.”
• Another group of Italian researchers analyzed 18 studies that included 57,229 men. More than 20% of these men (12,144) reported PE. Having PE more than tripled the risk of ED (P < 0.0001). (The researchers did not explore how ED affected PE risk.)

Why Premature Ejaculation Increases Risk of Erectile Dysfunction

The main reason is anxiety/stress. Acute stressors—roller coasters, horror movies, near-accidents while driving—are not the issue. The problem is chronic anxiety, ongoing psychological distress over time. Chronic stress makes the nervous system more excitable—and more likely to trigger ejaculation before men want to.

Chronic emotional stress is quite prevalent; in fact, it’s a hallmark of contemporary living. According to the National Institute of Mental Health, 30% of Americans suffer clinical anxiety disorders at some point in life. PE adds to that stress burden. It makes many men feel seriously out of control, often spiking men’s anxiety/stress levels.

Stress is not the main cause of ED. Most often, it’s the result of cardiovascular disease—diabetes, heart disease, high blood pressure. These conditions narrow the arteries that carry blood into the penis. (Erection drugs open those arteries.) But in addition to cardiovascular issues, the chronic anxiety/stress that causes PE also triggers the release of the body’s stress hormone, cortisol. It constricts the penile arteries, which reduces the flow of blood into the penis’s spongy erectile tissue. Less blood means softer erections, or possibly no erections at all. Consequently, PE raises the risk for ED.

Worse, the PE-ED connection may become a vicious cycle. PE produces stress that contributes to ED, which in turn adds to the stress that contributes to both conditions.

Why ED Increases Risk of PE

ED can cause tremendous anxiety and self-doubt, sending men’s stress levels through the roof. Typical causes of erection-deflating stress include: sex-negative upbringing, sexual inexperience, relationship turmoil, family problems, and job, money, or legal woes. These stressors also raise the risk of PE.

In the recent Taiwanese study, compared with men who reported neither ED or PE, those who reported one problem were plagued by significantly more anxiety. And men who reported both ED and PE showed even greater stress.

Men with ED may think (consciously or subconsciously), I better use it before I lose it. Concerned that their erections might wilt at any moment, they suffer stress that spurs them to ejaculate before they want to. The research on this is scant, but on my Q&A site, I’ve received many questions from late-middle-aged men who say: In my 20s, I suffered PE. Eventually I developed good ejaculatory control. Now at 50 (or 55 or 60), I have PE again. Help! In email exchanges, many said they’d recently developed ED, which would support use-it-before-I-lose-it.

What to Do

• Understand that PE and ED raise the risk for each other.
• Understand that chronic stress is a key cause of PE and an important contributor to ED.
• Take steps to manage your stress. Exercise regularly. Try meditation or yoga. Take hot baths or showers. Do whatever helps you relax.
• Limit alcohol and other recreational drugs. Drugs make it harder to tune into your body and control yourself sexually. Alcohol is also a key cause of ED.
• Learn more about PE and ED.
• If your presenting problem is ED, you may consider erection medication, but understand that these drugs don’t work for every man. If you pay out of pocket, they’re not cheap. And the side effects might feel bothersome.
• Finally, consider sex therapy. If you’re unfamiliar with it, sex therapists are psychotherapists with extra training in sexual issues. They provide relationship therapy as well as science-based insights into sex problems.

Stress Essential Reads

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If you’re in a relationship, sex therapy usually works best when both partners participate. If your partner won’t, consider going by yourself. That’s suboptimal, but the therapist may still be able to offer helpful insights and suggestions.

To find a therapist, please visit the Psychology Today Therapy Directory.