You don't have to decide what the problem is before you can begin.

For many men with a strong performance-anxiety component, the pattern begins with one ordinary difficult experience. The difficulty can grow when that experience starts changing what you expect next time.

First: don't force this into a physical-or-psychological box.

Erections depend on physical health, neural and vascular processes, attention, emotion, context and relationship factors. A psychological contribution does not make the problem imaginary. A physical contribution does not mean anxiety cannot also become involved.

If tests and assessment do not identify an obvious physical explanation, that is useful information — but it does not divide erectile difficulties neatly into physical or psychological boxes. Contributors are often mixed.

Read the medical boundary and when to speak to a GP →

Notice what happens around the erection.

• The difficulty is inconsistent rather than identical every time.
• Erections are more reliable in some situations than others.
• Things can be going well until you notice yourself checking.
• One or more difficult experiences changed what you expect next time.
• You find yourself anticipating failure before intimacy begins.
• You have begun avoiding sex, rushing, testing or seeking reassurance.

Choose the next step that feels proportionate.