It happens to far more men than will ever say so. Here’s how stress, anxiety and depression feed erection problems, when it’s a sign to see a doctor, and what actually helps.
Erectile difficulty is common, and the mind plays a real part: anxiety, stress and depression can cause it, and it can worsen them. It can also be an early sign of heart disease or diabetes, so see a doctor, and consider talking therapy too.
How common is it?
Most men have an occasional off night, usually from stress, tiredness or too much alcohol. Problems that keep happening are different.
Local studies in Nigeria, mostly in hospital clinics, have found erectile difficulty in roughly a quarter to over half of men, most of it mild. It becomes more common with age, but young men aren’t spared: one clinic study in Bida found it in about three in ten men in their twenties.
Yet few men mention it. At that same clinic, only about one man in 20 had ever raised it at a hospital, while two in three had tried performance enhancers.
How the mind gets involved
Performance anxiety. One difficult night leads to worry about the next. During sex, attention shifts from pleasure to watching yourself, which makes arousal harder, and the worry grows. Guidelines recognise this cycle as a common cause.
Depression. Depression and sexual problems are linked in both directions: each makes the other more likely. Low mood dampens desire and energy, and erection problems chip away at confidence. In a study of married men in Umuahia, erectile difficulty went hand in hand with depression and strain in the marriage.
If low mood ever turns into thoughts of ending your life, call Safe Place Nigeria on 0800 800 2000, free and open 24 hours, or 112, or 767 in Lagos, if you’re in danger.
Stress and the relationship. Money worries, work pressure, conflict and feeling distant from your partner all show up in the bedroom.
What about porn? There’s no good evidence that watching porn causes erectile difficulty. Men who feel their porn use is out of control report more problems, but studies haven’t shown that one causes the other. If your use worries you, a therapist can help you sort it out.
Suggested read: Losing a Spouse: Grief and What Comes After
When it’s a sign to see a doctor
Erections depend on healthy blood vessels, so problems can be an early warning of heart disease or diabetes. In large studies, men with erectile difficulty had about 1.4 to 1.6 times the risk of later heart disease or stroke. In US data, they were about twice as likely to have diabetes nobody had diagnosed yet.
A doctor may check your blood pressure, blood sugar and cholesterol, sometimes your testosterone, and ask about your medicines, smoking and alcohol. Get checked even when stress is clearly part of it: physical causes turn up in many younger men too.
If you still wake with erections, or have no trouble on your own, that can point to stress or worry playing a big part. It’s a clue, not a diagnosis.
Medicines can play a part
Some antidepressants, some blood pressure medicines and other medicines can affect erections. If you think yours are involved, tell the doctor who prescribed them. Don’t stop suddenly: stopping some medicines abruptly causes withdrawal symptoms, and there are usually other options. In a Benin City study, many men with medicine-related sexual problems had quietly stopped taking their medicine properly, which can bring its own problems.
Be careful with “man power” products
NAFDAC describes sildenafil, the drug in many erection medicines, as prescription-only. Yet many products sold as herbal or “man power” contain hidden drugs:
- In 2022, NAFDAC shut an illegal factory in Zaria that was dissolving erection tablets and an antidepressant into a mixture labelled “100% herbal”.
- In 2024, it warned of a falsified herbal mixture with a fake NAFDAC number and hidden sildenafil above the maximum daily dose.
- In 2025, it found counterfeit erection tablets being sold openly in Abuja.
Hidden erection drugs are especially dangerous for men with heart problems, and for anyone taking heart medicines called nitrates. Get erection medicines only on a doctor’s prescription, from a licensed pharmacy. You can report suspected fakes to NAFDAC on 0800 162 3322.
What helps
- See a doctor first, to check your heart, blood sugar and medicines. A doctor may offer medicine if it’s right for you.
- Talking therapy. Psychosexual therapy and cognitive behavioural therapy (CBT) work on performance anxiety, low mood and relationship strain. European guidelines recommend therapy that includes your partner, alongside medical care. The research is small, but it’s encouraging, especially when therapy and medical treatment go together.
- Take the pressure off. Some therapists use structured touch exercises that shift the focus from performance to closeness for a while.
- Look after your body. Stopping smoking, drinking less, moving more and sleeping well all help.
You can find a therapist for sexual health concerns, privately, by video, voice or chat. Read more about anxiety and its physical signs.
Talking to your partner
Silence often hurts more than the problem. A partner left guessing may think it’s about them. In one Nigerian study, wives said they found it hard to talk about their husbands’ problems with anyone outside the marriage.
Choose a calm moment, not in bed. Say that it’s common, that it isn’t about them, and that you’re getting it checked. You could invite them to come to an appointment.
Why Movember matters here
Every November, Movember raises money and awareness for men’s health: mental health and suicide prevention, prostate cancer and testicular cancer. Erectile difficulty is also common after prostate cancer treatment. Talking about it is part of looking after men’s health. For the bigger picture, read our guide to men’s mental health in Nigeria, the signs of depression in men, and how to check on your guy friends.
Suggested read: Living With a Partner Who Has Bipolar
Frequently asked questions
Can anxiety cause erectile dysfunction?
Yes. Anxiety, especially worry about performance, can make erections harder to get or keep, and the worry can build after each difficult night. A doctor’s check and talking therapy can both help.
Is erectile dysfunction a sign of depression?
It can be. Depression and erection problems are linked in both directions, so it’s worth asking yourself about your mood. A doctor or therapist can help you work out what’s going on.
Can erectile dysfunction be treated?
Usually, yes. Treatment depends on the cause: it may include medical care, changes to medicines, lifestyle changes and talking therapy, often together.
Are “man power” herbal mixtures safe?
Not reliably. NAFDAC has found erection drugs and other medicines hidden in products sold as herbal, and fake NAFDAC numbers on some. They can be dangerous, especially with heart problems.
Should I stop my antidepressant if it affects my erections?
Don’t stop it suddenly. Talk to the doctor who prescribed it. There are usually other options.
Can therapy help with erectile dysfunction?
Yes, especially when anxiety, depression or relationship strain are involved. Psychosexual therapy and CBT help, and they seem to work best alongside medical care.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
