By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):
What is the relationship between stress and sex? If you are trying not to die in the next 10 minutes, how good is your erectile function and sex life? Probably not real great. What about day to day or normal stress?

The physiology of serious stress is all about survival. Reproduction can wait. The physiology of sex is: “things are good and we can relax and anticipate success in reproducing.” This explains why major stress has a very deflating immediate effect on erectile function.

It is important to recognize that sex hormones, like testosterone, create a lot of our sex drive, which is a kind of tension or stress. Mother Nature wants to push us to reproduce.

Good sex can be a great stress reliever, relieving the obvious tension or stress of our sex drive, but also other tension. Good sex produces a deep relaxation and sense of satisfaction. This is why we refer to having sex as “sleeping together”. Are we really talking about “sleeping” in the same bed without having sex?! Of course not! That’s ridiculous! Sex is the real point, but sleep is the natural result. We use that as an expression to describe sex. Two people find great pleasure and satisfaction together and nature is in a good place to potentially make babies.

What if you are stressed about having sex? Stressed about “performing” in a certain way or to a certain level? This “performance” stress becomes a big problem for some. Which points us back to the relationship and what it is based on, and what it is about us as people that makes us valuable.

Relationships that are healthy and based on whole people and not primarily sex are far more safe and relaxing. The physiology will be in a much better place to have great erectile function and satisfying sex. If your relationship or value as a person is just a product of the desired performance of certain sensitive tissue…well, you have bigger issues than ED.

Stress is draining. A lot of stress takes a lot of energy, leading to fatigue. Exhaustion does not make for good sex.

It is important to recognize that most of our stress is not a matter of our stressors — the things around us. Stress physiologically is mostly a matter of what happens between our ears in how we relate to, or process, the challenges of life. Which means the best treatment for ED for some is learning the skills of resilience — how to have great shock absorbers for the stressors of life.

If NASA is worrying about incoming nuclear missiles, they aren’t going to be spending much effort on sending a rocket to the moon to collect some rocks or plant a flag, until the nuclear threat is in the rearview mirror.

Effectively dealing with our stress experience is often effective treatment for stress induced ED.

Neural pathways and central sites involved in penile erection: neuroanatomy and clinical implications. Steers WD. Neurosci Biobehav Rev. 2000 Jul;24(5):507-16. Review.

Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis. Schmidt HM, Munder T, Gerger H, Frühauf S, Barth J. J Sex Med. 2014 Jun;11(6):1376-91. doi: 10.1111/jsm.12520. Epub 2014 Mar 19. Review.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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