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Exploring the psychological mechanisms underlying the relationship between depression and anxiety and sexual health


Depression and other anxiety disorders have a significant impact on the development of erectile dysfunction. The relationship between depression and erectile dysfunction is considered complex and multifactorial. Most researchers conclude that depression is considered an independent risk factor for the development of erectile dysfunction. A psychological factor is present to one degree or another in the vast majority of cases of erectile dysfunction, even if it is caused by organic structural disorders of a physiological nature. The cause-and-effect relationship between erectile dysfunction and depression can be expressed in different forms. On the one hand, erectile dysfunction may itself be a symptom of depression. On the other hand, depression can be secondary to erectile dysfunction, that is, it can be caused by problems that a man experiences in terms of his potency. In this case, improved erectile function may lead to reduced symptoms of depression. Depression and erectile dysfunction (ED) are closely interrelated and in the vast majority of clinical cases aggravate each other. In this paper, our goal is to provide an overview of the research on the psychological mechanisms that underlie the relationship between depressive and anxiety conditions and male sexual health. The relevance of this study is due to the fact that a huge number of men suffer from erectile problems accompanied by anxiety and depression. Understanding the connection between depression and erectile dysfunction can help improve both men’s psychological health and their sexual health.

Depression-ED bond

Depression is the most common mental disorder. At the same time, the growth in their prevalence rates has been rapid in the last two to three decades. The incidence of depressive disorders among men averages from 5 to 10% of the population. Moreover, this level is higher than that of women, and many experts attribute this phenomenon to the fact that men accumulate negative emotions within themselves for a long time, not knowing how to give them a way out, how to live through them and relate to them correctly. Being brought up emotionally alienated and not having the right to weakness, crying, worry, grief, they develop increased anxiety, self-doubt and depression.
The connection between depressive states and pathologies in the sexual sphere has been the subject of attention of domestic and foreign researchers for many decades. Certain experts believe that a depressed patient, even if he is not diagnosed with clinical depression, ceases to experience desires, since any goal seems unattainable to him. This creates almost insurmountable obstacles to the awakening of sexual desire. Psychologists and psychiatrists say that sexual disorder very often becomes a consequence of a man’s mental register switching to the area of anxiety, in particular those related to the decrease or loss of potency. Thus, they believe that anxiety about decreased libido or symptoms of erectile dysfunction can finally put an end to a man’s normal sex life.
For a long time, great importance was attached to sexual disorders, and mood disorders were considered more likely to be their consequences. However, in recent decades, disorders in the sexual sphere have begun to be viewed not as a cause, but as a consequence of mental illness. This began to concern primarily the psychosomatic aspects of depressive disorders, masked depression, as well as somatic equivalents of depression, in which sexual disorders were described as a manifestation of dysfunction of the autonomic nervous system.
At the moment, unfortunately, there is no single register of data on the prevalence of sexual disorders in the population. Figures vary widely depending on the type of disorder and the age of the respondents. This is due to the fact that for many, problems in the intimate sphere are taboo, and they hide their existing sexual dysfunctions. However, overall, the incidence of sexual problems in depressed men is at least twice that of the general population. In addition to erectile dysfunction, men with depression often suffer from premature ejaculation, as well as orgasmic disorders.
The modern understanding of the connection between sexual and depressive disorders suggests that depression is characterized by a number of somatic disorders, various biochemical changes, and hormonal imbalances. Of course, they also include violations related to the sexual sphere. For those suffering from depression, a decrease in sexual desire is typical, as well as the occurrence of erectile dysfunction and ejaculation. At the same time, most clinically depressed men lose the ability to enjoy sexual fantasies. Moreover, such fantasies, instead of stimulating libido, begin to upset men, forcing them, for example, to experience complexes about the inconsistency of their sexuality with the ideal they imagine.
Functional sexual disorders are almost obligatory components of depression. Modern psychology considers a noticeable decrease in libido and potency as one of the most important signs of depression, the so-called symptom of symptoms. Moreover, most often, persistent fear of erectile dysfunction is one of the symptoms of a depressive cycle. However, some scientists believe that, despite the fact that a decrease in various types of drives, such as sexual and food, are characteristic of the depressive syndrome, they are most pronounced in melancholy and apathetic depression. Meanwhile, in their opinion, with anxious depression there may be an increase in desires: uncontrolled appetite, increased sexual desire. However, such situations are much more rare.
If we turn to the pathogenesis of depression itself, it is currently considered from a systemic perspective, including morphofunctional (neuroanatomical, neurophysiological, neurochemical) and pathopsychological components. Within the first, much attention is paid to the pathological functioning of brain structures, in particular the limbic-thalamic and hypothalamic-pituitary regions. It has now been established that in depressive disorders, disturbances in the production of neuropeptides (hypothalamus-releasing factors) are detected. Through the pituitary gland, they influence various hormonal functions of the body. Deficiency of adrenergic neurotransmitters and associated hypercortisolism contribute to the occurrence of depressive disorders by forming a “pathological circle” in the hypothalamic-pituitary-adrenal axis with positive feedback.


The clinical picture of sexual disorders is determined by the depth and psychopathological structure of the depressive state. Of great importance in modern medical practice is the identification of hidden mild forms of depression, such as masked, erased, and larvae. With them, men often don’t even realize that they have a psychological disorder, they simply believe that they are in a bad mood. However, it is sexual disorders that come to the fore.


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