Stress, PTSD and ED: what the research shows

The short version: stress and post-traumatic stress disorder (PTSD) are both linked to erectile dysfunction (ED). The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, part of the NIH) names “anxiety, depression, or stress” among the mental health or emotional issues that “can either cause ED or make it worse” (NIDDK, Symptoms & Causes of ED). Studies of veterans add a sharper picture for PTSD: sexual problems, including ED, show up far more often in men with PTSD than in men without it. This guide covers what everyday stress can do, what the PTSD research does and does not show, how PTSD medicines fit in, and the kinds of help that exist.

Can stress cause ED?

Stress can contribute to ED, according to the NIH, which lists it alongside anxiety and depression as issues that “can either cause ED or make it worse.” The same NIH list includes feeling isolated or lonely, low self-esteem and lack of confidence (NIDDK, Symptoms & Causes of ED). The NIH also says that “taking care of your mental and emotional health can help prevent ED,” and suggests relaxation techniques, with deep breathing as a simple one you can do anywhere (NIDDK, Treatment for ED).

Stress is also not the only possible cause. The same NIH page lists diabetes, heart and blood vessel disease, hormone problems, many common medicines, heavy drinking, smoking and drug use as other causes (NIDDK). If the worry centers on sex itself, our guide to telling ED from performance anxiety covers the clues clinicians use, and overcoming performance anxiety covers the approaches that have evidence behind them.

How is PTSD linked to erectile dysfunction?

Erectile dysfunction and PTSD are linked in study after study of veterans, though the strength of the link for erections specifically varies between studies. In the largest one, a review of VA health records for 405,275 male Iraq and Afghanistan veterans, 10.6% of men with PTSD had a sexual dysfunction diagnosis, a prescription for sexual dysfunction, or both, compared with 7.2% of men with another mental health diagnosis and 2.3% of men with none. After adjusting for background and military service factors, other illnesses and medicines, PTSD was tied to more than three times the risk (adjusted risk ratio 3.61) (Breyer et al., Journal of Sexual Medicine, 2014).

Smaller studies asked about erections directly. In a study of 90 male combat veterans using a standard erectile function questionnaire, 85% of the men with PTSD met the threshold for ED, against 22% of the men without PTSD, and moderate to severe ED was found in 45% against 13% (Cosgrove et al., Urology, 2002). A 2021 systematic review of 43 studies in veterans and military personnel concluded that PTSD was linked to a higher risk of at least one sexual difficulty, most clearly overall sexual function, desire, satisfaction and sexual distress, while results for ED specifically were “mixed” (Bird et al., Journal of Sexual Medicine, 2021).

Sources: Breyer et al., 2014; Cosgrove et al., 2002; Protuđer et al., Healthcare, 2023; Wang et al., Annals of General Psychiatry, 2021; Bird et al., 2021.

These are associations in groups of men. They do not mean PTSD is the cause of any one man’s ED, and most of the research is in veterans, so it may not carry over neatly to men whose trauma came from somewhere else.

Why might PTSD affect erections?

Researchers do not have a settled answer, but several threads show up in the studies. A 2015 review summarized by VA Research found that “PTSD impairs sexual functioning across multiple domains: desire, arousal, orgasm, activity, and satisfaction,” with ED, premature ejaculation and loss of interest in sex the most common problems reported (VA Research Currents, 2015). The 2021 review found that the PTSD symptoms most often tied to sexual difficulties were avoidance and negative changes in thinking and mood (Bird et al., 2021).

Other problems that travel with PTSD can add to it. The VA summary notes that veterans with PTSD may be more likely to misuse alcohol and other substances, which “further increases the risk of sexual dysfunction” (VA Research Currents). Depression is another overlap, and the 2021 review names the difficulty of separating PTSD from depression as a limit of the research (Bird et al., 2021). Our page on depression, antidepressants and ED covers that link in both directions.

Do PTSD medicines play a part?

They can, but they do not explain the whole link. The VA’s National Center for PTSD recommends three medicines for PTSD, sertraline (Zoloft), paroxetine (Paxil) and venlafaxine (Effexor), and notes that only sertraline and paroxetine are FDA-approved for PTSD (National Center for PTSD, Clinician’s Guide to Medications). Its patient page says that with these medicines “some people have sexual side effects, such as decreased desire to have sex or difficulty having an orgasm,” and that some side effects may last as long as the medicine is taken (National Center for PTSD, Medications for PTSD).

The large VA records study found the highest risk of sexual dysfunction in veterans with mental health disorders, particularly PTSD, who were also prescribed psychiatric medicines (adjusted risk ratio 4.59). Its authors still concluded that PTSD raised the risk “independent of the use of psychiatric medications” (Breyer et al., 2014). The VA summary of the 2015 review makes the same point: veterans who were not prescribed medication still had problems (VA Research Currents). In the Taiwan study, psychotropic medicine use was not associated with ED risk, though that study had only 8 ED cases in total (Wang et al., 2021).

Source: National Center for PTSD, Clinician’s Guide to Medications for PTSD and Medications for PTSD. Our page on medicines that can affect erections covers other drug groups on the NIH list.

What help is available?

Help can cover both the PTSD and the sexual problem. The National Center for PTSD says the talk therapies that work best are Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure, with paroxetine, sertraline and venlafaxine as the medicines with the most evidence (National Center for PTSD, Treatment Basics). A 2015 review of PTSD and sexual dysfunction concluded that “the treatment of PTSD must include attention to sexual dysfunction and vice versa” (Yehuda et al., Journal of Sexual Medicine, 2015).

On the ED side, the American Urological Association (AUA) guideline says men with ED should have “a thorough medical, sexual, and psychosocial history,” and that for men being treated for ED, “referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship” (AUA Erectile Dysfunction Guideline). The NIH adds that counselors can help lower anxiety and stress about sex, and may invite a partner to sessions (NIDDK, Treatment for ED).

Whether any ED medicine suits you depends on your health and your other medicines, and is a decision for a prescriber. Raising the subject is often the hardest step. Veterans in the research consistently said it would be easier if their provider brought it up first (VA Research Currents), and the 2021 review urges clinicians to ask about sexual health alongside PTSD symptoms (Bird et al., 2021). If you would rather not wait to be asked, our guide to talking to a doctor about ED has plain wording you can use.

When should you talk to a clinician?

Talk to a clinician if erection problems keep happening, if they began after a traumatic event or after starting or changing a PTSD or mood medicine, or if stress, nightmares or low mood are wearing you down. ED can also have physical causes that deserve a look in their own right, which is why the AUA asks for a full medical history and exam (AUA guideline). Our guide on when to see a doctor about ED explains what that visit involves.

Sources

Every clinical statement on this page traces to one of these sources:

• NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases, NIH), Symptoms & Causes of Erectile Dysfunction, last reviewed October 2024. Anxiety, depression and stress as issues that can cause ED or make it worse; other causes: niddk.nih.gov, ED symptoms and causes
• NIDDK, Treatment for Erectile Dysfunction, last reviewed October 2024. Reducing stress, counseling with a partner, and “Do not stop taking any medicines on your own”: niddk.nih.gov, ED treatment
• American Urological Association, Erectile Dysfunction (ED) Guideline. Statement 1 (medical, sexual and psychosocial history) and Statement 6 (referral to a mental health professional): auanet.org, ED guideline
• National Center for PTSD (U.S. Department of Veterans Affairs), Medications for PTSD, last updated September 2026. Recommended medicines and their sexual side effects: ptsd.va.gov, medications for PTSD
• National Center for PTSD, Clinician’s Guide to Medications for PTSD. 2023 VA/DoD guideline recommendations; only sertraline and paroxetine FDA-approved for PTSD: ptsd.va.gov, clinician’s guide
• National Center for PTSD, PTSD Treatment Basics, last updated May 2026. Talk therapies and medicines with the most evidence: ptsd.va.gov, treatment basics
• VA Office of Research and Development, Sexual dysfunction a common problem in Veterans with PTSD (VA Research Currents, March 2015). Summary of a 2015 Journal of Sexual Medicine review: research.va.gov, VA Research Currents
• Cosgrove DJ, et al. Sexual dysfunction in combat veterans with post-traumatic stress disorder (Urology, 2002). 90 combat veterans; ED in 85% with PTSD vs 22% without: pubmed.ncbi.nlm.nih.gov/12429320
• Breyer BN, et al. Sexual dysfunction in male Iraq and Afghanistan war veterans: association with posttraumatic stress disorder and other combat-related mental health disorders: a population-based cohort study (Journal of Sexual Medicine, 2014). 405,275 veterans; adjusted risk ratios 3.61 and 4.59: escholarship.org, Breyer et al.
• Bird ER, et al. Relationship between post-traumatic stress disorder and sexual difficulties: a systematic review of veterans and military personnel (Journal of Sexual Medicine, 2021). 43 studies; mixed results for ED specifically: pmc.ncbi.nlm.nih.gov, PMC8726013
• Protuđer M, Stevanović A, Letica-Crepulja M. Sexual dysfunctions among veterans with and without PTSD (Healthcare, 2023). 250 veterans with PTSD and 187 without: pmc.ncbi.nlm.nih.gov, PMC10340479
• Wang SC, et al. Posttraumatic stress disorder and the risk of erectile dysfunction: a nationwide cohort study in Taiwan (Annals of General Psychiatry, 2021). 1,079 men with PTSD and 3,237 without; 8 ED cases in total: pmc.ncbi.nlm.nih.gov, PMC8480081
• Yehuda R, Lehrner A, Rosenbaum TY. PTSD and sexual dysfunction in men and women (Journal of Sexual Medicine, 2015). Review: pubmed.ncbi.nlm.nih.gov/25847589
• 988 Suicide & Crisis Lifeline, Get Help. Call or text 988; veterans can call 988 and press 1 or text 838255 for the Veterans Crisis Line: 988lifeline.org, get help