Most blokes don’t want to talk about it, but erectile dysfunction (ED) is more common than you’d think. For Aussie men under 40, it often sneaks in when life gets stressful. For those over 40, it might be the body sending an early warning sign about the heart, hormones or blood vessels.
So how do you tell if it’s “in your head” or in your body? And more importantly, why does it matter?
What’s the difference?
Psychological ED usually kicks in suddenly. You might be fine one week, then struggle the next after a stressful event, rough patch in a relationship, or a bout of performance anxiety. Morning erections or ‘solo’ sessions still work fine.
Organic ED is different. It builds up slowly. Erections become weaker over time, morning erections fade, and it doesn’t matter how relaxed or in the mood you are — things just don’t work like they used to.
Guidelines from the American Urological Association and Healthy Male point out that most men actually have a mix of both. Stress makes a physical problem worse, and physical problems feed stress.
Why it matters for your health
ED isn’t just about sex. The Princeton IV Consensus makes it clear — ED can be an early sign of cardiovascular disease. Studies show that ED often appears two to five years before a bloke has a heart attack.
That means your body might be waving a red flag. Ignoring it is like ignoring chest pain before a footy game.
What I’ve seen in practice
As a doctor, I’ve worked across emergency, medicine safety, mental health, injury management and chronic pain. Time and time again, I’ve seen how ED sits at the crossroads of mind and body.
In emergency, I saw young blokes with chest pain who’d brushed off years of ED. In mental health, I saw anxiety and depression feed into ED, which then knocked blokes’ confidence even harder. In chronic pain clinics, meds and stress piled up and affected performance.
This mix is why I believe in a holistic approach — looking at hormones, heart health, relationships and mental wellbeing together.
Spotting the signs yourself
Before you even get to the GP, there are clues you can notice in your own body:
Morning erections check: Still waking up with strong erections? That often means your plumbing is fine and stress might be the main culprit.
Timing: Did things change overnight, maybe after a rough patch at work or in your relationship? That leans towards a psychological effect. If it’s crept up slowly over months or years, organic causes like blood vessels or hormones are more likely.
Consistency: Do you get erections when you’re solo but not with a partner? (or with different partners 🥴?, or in a particular situation?) That points towards performance anxiety or stress. If you struggle both solo and partnered, your body might be playing a bigger role.
Other health changes: Weight gain, high blood pressure, diabetes, tiredness or low sex drive can all link to organic ED.
These aren’t fool-proof, but they give you a sense of what’s going on. Your GP will then add the medical piece — blood tests, blood pressure checks, and a chat about your lifestyle (give us a break, we're just doing our job).
What about treatment?
If it’s psychological:
Counselling, stress management and couples therapy can help.
Performance anxiety is real, but it’s treatable.
If it’s organic:
Lifestyle changes (fitness, diet, cutting smokes and booze) can improve blood flow.
Pills like sildenafil work well but come with side effects.
Testosterone replacement can help if levels are low but you need to know the potential long term effects (needing to replace testosterone for a very long time).
In some cases, devices, injections, or surgery may be needed.
The RACGP and AUA guidelines also recommend involving a mental health professional when anxiety is part of the picture.
Questions for you
Do you still get morning or solo erections?
Has it come on suddenly or crept up over time?
Are you more stressed than usual?
Do you know your blood pressure, cholesterol, or blood sugar levels?
These are the kinds of questions that point you in the right direction.
Where to from here?
If you’ve had a frustrating experience with a doctor before, don’t give up. Get wise, think about your lifestyle. And see your GP.
Check out more info at www.drjames.au/blog
ED isn’t just a bloke’s bedroom problem. It’s a window into your physical and mental health. Whether it’s stress, blood vessels, hormones, or a mix, the best step is a proper assessment with your GP.
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Disclaimer: This article is for information only. It is not personalised medical advice. Always speak to your own GP about your situation.
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