For many reasons, cultural as well as situational, anxiety over sexual performance may provoke an intense fear of failure and self-doubt on the part of the individual. Often called performance anxiety, these feelings can sometimes set off a cycle of chronic anxiety-induced impotence. When anxiety is experienced, the brain releases chemicals known as neurotransmitters that constrict the smooth muscles of the penis and its arteries. This constriction decreases the blood flow into and increases the blood flow out of the penis, resulting in impotence. Simple stress may promote the release of brain chemicals that negatively affect potency in a similar way.
Depression is another disorder that is strongly associated with erectile dysfunction.
It is not clear which condition causes the other. Depressed people may have difficulty functioning sexually because of inhibited sexual desire and inattention to the sexual partner. Problems in relationships often have a direct impact on sexual functioning. Partners of men with erectile dysfunction may feel rejected and resentful, particularly if the affected man does not confide his own anxieties or depression. Both partners commonly experience guilt for what they each perceive as a personal failure.