Is It ED or Just Nerves? How to Tell the Difference

More than half of Australian men aged 18–55 report at least one sexual difficulty over a 12‑month period, and around 10–12% feel anxious during sex. That’s not a niche problem – that’s your mates, your colleagues, your neighbours… and possibly you.

When things don’t go to plan in the bedroom, it’s easy for your brain to jump straight to: “I’ve got erectile dysfunction.” But here’s the tricky part: performance anxiety can look and feel exactly like erectile dysfunction (ED). The more you worry about it, the worse it seems to get.

In this article, we’re going to unpack that exact question:

Is it ED or just nerves – and how can you actually tell the difference?

We’ll walk through:

• What erectile dysfunction really is (and isn’t)
• What performance anxiety feels like in real life
• Key differences between erectile dysfunction vs anxiety
• How doctors tell psychological ED from more physical ED causes
• Practical, evidence‑based steps you can take from today
• How online care in Australia (including our team at NextClinic) fits into the picture

We’re an Australian telehealth clinic that helps men with sexual health, prescriptions and referrals every day. We see this specific worry – “What if it’s ED?” – come up constantly in our ED treatment consults, so we’ve written this as an accessible, no‑judgement guide for Aussie men and their partners.

This is general information only, not personal medical advice. But by the end, you’ll have a clearer idea of what might be going on, when it’s time to see a doctor, and how to get help without the awkward waiting room.

First things first: what actually counts as ED?

Let’s clear up a big misconception straight away:

One “bad night” is not erectile dysfunction.

According to Healthdirect (Australia’s national health information service), erectile dysfunction is an ongoing problem getting or keeping an erection firm enough for sexual intercourse.

Key points:

• ED means difficulty getting or keeping an erection most of the time
• It’s usually been happening for weeks or months, not just once after too many drinks
• It can be mild (sometimes soft, sometimes fine) through to complete (never able to get hard enough)

Australian data suggest more than 1 in 10 males are affected by ED, with rates increasing as men get older. The Australian Institute of Health and Welfare (AIHW) reports that in a large sample of men aged 18–64, about 26% had experienced ED.

So if you’ve been struggling for a while, you are definitely not alone.

ED can be physical, psychological – or both

Healthdirect and Better Health Channel (Victoria’s government health site) both emphasise that ED usually comes from a mix of factors:

Physical ED causes can include:

• Heart and blood vessel disease (e.g. atherosclerosis, high blood pressure, high cholesterol)
• Diabetes
• Hormonal issues (e.g. low testosterone, thyroid problems)
• Nerve problems (e.g. after prostate surgery, spinal cord injury, neurological conditions)
• Side effects of some medications (e.g. certain antidepressants, blood pressure medications, prostate treatments)
• Smoking, heavy alcohol use, some recreational drugs
• Obesity, lack of physical activity, sleep disorders

Psychological ED causes can include:

• Performance anxiety
• Stress (work, money, family, study)
• Depression and general anxiety disorders
• Relationship conflict or lack of emotional connection
• Past negative sexual experiences or trauma

In real life, it’s often a bit of both. Maybe blood flow is slightly reduced and you’re stressed and overthinking. Or you had one physical blip, then developed intense anxiety about it happening again.

That’s where performance anxiety comes in.

What is performance anxiety?

Performance anxiety is when the fear of “failing” sexually becomes so strong that it causes or worsens the very erection problems you’re worried about.

Sexual Health Australia describes performance anxiety as a vicious cycle: after one episode of “inadequate sexual performance”, anxiety kicks in before or during every new sexual encounter, making the problem more likely to repeat.

Typical features of performance anxiety:

• You’re anticipating that things won’t work (“What if I can’t get it up again?”)
• Your mind is racing and self‑critical during sex (“I’m taking too long”, “This is embarrassing”, “They’re going to leave me”)
• You’re monitoring your erection constantly instead of enjoying touch and connection
• You may avoid sex or intimacy altogether because it feels safer than “failing”

Crucially, performance anxiety doesn’t mean “it’s all in your head” or that your problem is less real. The anxiety has very real physical effects on your body.

How nerves can shut things down: a quick science explainer

Erections rely on your “rest and digest” (parasympathetic) nervous system. When you’re relaxed and aroused:

• Blood vessels in the penis open up
• More blood flows in
• The veins that drain blood away compress
• The penis becomes firm and stays that way during stimulation

When you’re anxious, your “fight or flight” (sympathetic) system takes over. Your body thinks there’s a threat, so it:

• Pumps out adrenaline
• Diverts blood away from the skin and extremities towards your heart and big muscles
• Increases heart rate and breathing
• Makes it much harder to get or maintain an erection

So if you’re lying there thinking, “Don’t lose it, don’t lose it, don’t lose it…” your body hears: “We’re in danger, abort mission.”

That’s why psychological ED (ED driven largely by anxiety, stress, or other mental factors) can feel identical to physical ED from the neck down.

Erectile dysfunction vs anxiety: how can you tell?

Let’s be clear: you can’t 100% diagnose yourself at home. Only a doctor can properly assess what’s going on.

But there are patterns that can help you and your GP (or one of our telehealth doctors) work out whether it’s erectile dysfunction vs anxiety, or a bit of each.

Think of the following as reflection questions – not a test.

Signs it’s more likely to be performance anxiety (psychological ED)

You might be dealing mainly with performance anxiety if:

1. It came on suddenly, often after a specific incident

• Maybe you lost your erection once with a new partner
• Or things didn’t work after a big night of drinking, and you panicked

From then on, you start worrying before sex even starts.

2. It’s situational

• Erections are usually fine when you’re on your own (masturbation, porn)
• You might still wake up with morning or nighttime erections
• The difficulty mostly appears with a specific partner, in new relationships, or in particular situations (e.g. with condoms, certain positions)

3. Stress and pressure make it worse

• You notice it’s more likely to happen:
  • after a stressful day
  • when you’re exhausted
  • when you feel you “need to perform” (first time with someone, makeup sex after an argument)
• Relaxed, low‑pressure encounters go better

4. Your thoughts are harsh and self‑critical

During sex, your inner monologue sounds like:

• “This is pathetic.”
• “Real men don’t have this problem.”
• “They’re going to think I’m broken.”

That internal commentary fuels anxiety and keeps your body in fight‑or‑flight mode.

5. You’re generally worried or anxious in other areas

• You might already struggle with social anxiety, generalised anxiety, or perfectionism
• You worry about work, money, or what others think of you
• Sexual performance becomes another arena where you feel you must not “fail”

Australian research has found that current psychological factors like performance anxiety are strongly associated with male sexual difficulties, including erectile problems.

If several of those points sound familiar, psychological ED or performance anxiety is likely playing a big role – even if there are also physical contributors.

Signs it might be more physical ED

On the other hand, your doctor will be more suspicious of a physical cause if:

1. The problem has crept in gradually

• Erections used to be consistently strong
• Over months or years, they’ve become weaker, less frequent, or don’t last long enough
• There wasn’t a clear single “trigger event”

2. It happens in every situation

• Difficulty getting or keeping an erection:
  • during sex with any partner
  • during solo masturbation
• Morning or nighttime erections are reduced, weaker or absent

(That’s not a perfect rule, but persistent lack of spontaneous erections is a red flag for physical ED.)

3. You’re older or have known health issues

For example:

• You’re over 40–45 and/or
• You have:
  • high blood pressure
  • high cholesterol
  • diabetes or pre‑diabetes
  • obesity
  • heart disease
  • sleep apnoea
  • low testosterone
• You smoke or vape regularly, or drink heavily

Large studies of Australian men show ED is more common in those with conditions like diabetes, heart disease, depression/anxiety, and in men who smoke, are sedentary, or have a higher BMI.

4. You’re taking medicines known to affect erections

For example, some:

• antidepressants
• blood pressure medications
• treatments for prostate disease
• other drugs that impact hormones or nerves

5. You’ve had pelvic or prostate surgery, radiation, or trauma

Procedures and injuries in that area can affect nerves and blood vessels directly.

If several of these fit, your doctor will lean towards physical ED – but anxiety usually joins the party at some point, even if it wasn’t the main cause to begin with.

The messy truth: it’s often both

The “ED vs anxiety” debate is a bit of a false choice.

You might start with mostly performance anxiety. After months of worry and avoidance, you move less, drink more, sleep badly – and your physical erections genuinely start to suffer.

Or you might start with mainly physical ED (say, early diabetes affecting blood vessels). The first few times you can’t get it up, you feel embarrassed and ashamed. You start dreading sex. Performance anxiety then makes each attempt even harder.

This is why the best treatment plans usually look at:

• Body (heart health, hormones, medications, lifestyle)
• Mind (anxiety, stress, mood, self‑talk)
• Relationship (communication, expectations, emotional connection)

Not just “a blue pill”.

Common ED causes in Australian men

Because ED is strongly linked to other aspects of men’s health, it’s a genuine sexual health and whole‑body health issue – not just a bedroom inconvenience.

Australian data highlight that:

• Around a quarter of adult men (18–64) in the Ten to Men study reported erectile dysfunction
• Over half of men aged 18–55 reported at least one sexual difficulty over a 12‑month period
• Erectile difficulties became more common with age and were more likely in men with poor self‑rated health, disability, mental health conditions, obesity, smoking, and daily pain medication use

Put simply: your penis is often an early barometer for your overall health.

That’s one reason we take persistent ED seriously in our telehealth consults at NextClinic. When a man comes to us asking about treatment, we’re not just thinking about erections – we’re also screening for red flags like possible cardiovascular disease, diabetes or depression, and arranging GP or specialist follow‑up when needed.

How doctors tell ED from performance anxiety

You don’t need fancy gadgets to start working out what’s going on. Most of the time, the key information comes from a good conversation.

According to Healthdirect and Australian clinical guidance, an ED assessment typically includes:

1. Medical history
   • Current conditions (heart disease, diabetes, high blood pressure, mental health diagnoses)
   • Medications and supplements
   • Smoking, alcohol, and other substance use
   • Sleep, exercise, weight changes
2. Sexual history
   • When the problem started (sudden vs gradual)
   • How often it happens
   • What situations it occurs in (solo, partnered, specific partners)
   • Changes in morning erections
   • Orgasm/ejaculation and libido (sex drive)
3. Relationship and psychological factors
   • Stress level at work/home
   • Relationship quality and any conflict
   • Past traumatic or negative sexual experiences
   • Symptoms of depression or anxiety
4. Physical examination
   • Blood pressure, heart and lungs
   • Signs of hormonal issues (e.g. body hair, testicle size)
   • Pulses in the legs and groin
   • Sometimes a focused genital or prostate exam
5. Blood tests
   • Glucose/HbA1c (for diabetes)
   • Cholesterol profile
   • Kidney and liver function
   • Morning testosterone
   • Sometimes thyroid tests and others depending on the situation

In person, a doctor may also order tests of nocturnal erections or blood flow in particular cases. But for many men, a good history, exam and basic blood tests are enough to distinguish mainly psychological ED from primarily physical ED – and to guide a safe treatment plan.

When you complete our online ED assessment at NextClinic, we ask similar evidence‑based questions about your health, lifestyle, erections, and sexual confidence. A registered Australian practitioner then follows up with a telehealth consult to clarify anything that isn’t clear before prescribing or recommending further tests.

What you can do right now if you’re worried

If you’ve had one or a few “off” nights and your brain is spiralling, here are some calm, practical steps.

1. Zoom out: look at the pattern, not a single night

Ask yourself:

• Has this been going on for weeks or months, or was it a one‑off?
• Does it happen in every situation, or mainly with a partner?
• Are morning or solo erections still basically okay?

If it’s been persistent or distressing for several weeks, it’s worth booking a proper assessment – either with your regular GP or an online doctor.

If it’s truly just a one‑off, try to notice the context (exhaustion, alcohol, stress) and gently move on rather than turning it into a global judgment about your masculinity.

2. Dial down the pressure in the bedroom

Whether the cause is physical or psychological, pressure is the enemy of erections.

You might try:

• Focusing on touch, kissing and pleasure rather than “must have penetrative sex”
• Taking intercourse off the table for a short while and exploring other ways to be intimate
• Letting your partner know you’re feeling a bit anxious so they don’t misinterpret it as lack of attraction
• Avoiding clock‑watching or checking your erection every few seconds – stay with sensations instead

If you want more ideas on reshaping expectations around performance and ED pills, our blog post on “3 Big Myths About ED Pills You Need to Stop Believing” goes deeper into how cultural myths mess with men’s sexual confidence.

3. Check in on lifestyle basics

Because ED and performance anxiety are both heavily influenced by overall health, even small shifts can help:

• Cut back on smoking or vaping (or get support to quit)
• Trim alcohol, especially heavy sessions before sex
• Add some regular physical activity – even a 30‑minute brisk walk most days
• Aim for decent sleep (and get tested for sleep apnoea if you snore loudly or feel exhausted)
• Eat more plants and fewer ultra‑processed foods – what’s good for your heart is good for your erections

Better Health Channel notes that steps like quitting smoking, losing excess weight and moving more can reduce some ED risk.

4. Talk to your partner (yes, really)

It’s incredibly common for partners to misread erection issues as:

• “They’re not attracted to me”
• “They’re cheating”
• “They don’t care about sex anymore”

A simple, honest conversation – “This is a physical/mental thing, not about you, and I’m getting it checked” – can remove a huge layer of pressure and shame.

Often, once the fear of judgment eases, both performance anxiety and ED improve.

5. Consider professional support for performance anxiety

If your main issue feels like a racing mind and fear of failing, psychological support can be a game‑changer:

• GP + Mental Health Treatment Plan

In Australia, if you’re diagnosed with a mental health condition such as an anxiety disorder, you may be eligible for a Mental Health Treatment Plan from your GP, giving you Medicare‑subsidised sessions with a psychologist or other mental health professional under the Better Access scheme.

• Psychologist or sex therapist

Therapies like cognitive behavioural therapy (CBT) and sex therapy can target the thought patterns and avoidance behaviours that keep performance anxiety going.

Many psychologists now offer telehealth as well as in‑person sessions, which can be more convenient and less awkward.

If we spot significant performance anxiety during an ED consult at NextClinic, we’ll often talk about whether involving a mental health professional could help, and can provide referrals or recommend talking to your GP about a plan.

Treatment options: mind, body, and everything in between

The good news: both psychological ED and physical ED are usually very treatable. The exact mix of strategies depends on what’s driving your particular situation.

When performance anxiety is a big part of the picture

Helpful approaches can include:

• Education and myth‑busting

Challenging unrealistic beliefs like “real men are always ready” or “sex isn’t real without a rock‑hard erection” can take huge pressure off. Sexual Health Australia highlights how these myths feed performance anxiety.

• Gradual exposure and focus on pleasure

Working slowly from non‑penetrative intimacy (touching, oral, mutual masturbation) towards intercourse, with an emphasis on enjoyment over performance.

• CBT and sex therapy

Learning to notice and challenge catastrophic thoughts (“If this happens again, my partner will leave”), building more balanced self‑talk, and breaking avoidant patterns.

• Mind‑body techniques

Simple breathing exercises, mindfulness, and grounding techniques can help shift your nervous system out of fight‑or‑flight and back into a state where arousal is possible.

Sometimes, doctors will also use ED medication as a short‑term confidence bridge while you work on the psychological side – especially in younger men whose main issue is anxiety plus a few modifiable lifestyle factors.

When more physical ED causes are present

If assessment suggests a significant physical component, evidence‑based options include:

• Addressing underlying conditions
  • Optimising diabetes control
  • Managing blood pressure and cholesterol
  • Treating hormonal problems like low testosterone (when appropriate)
  • Changing or adjusting medications that affect erections, where possible
• Prescription ED medicines

Medicines such as sildenafil and similar drugs (PDE5 inhibitors) help increase blood flow to the penis in response to sexual stimulation. They’re usually first‑line for many men with ED and are generally safe when prescribed by a doctor who knows your medical history and other medications.

• Other physical treatments

For some men, options like vacuum erection devices, penile injections, low‑intensity shockwave therapy, or penile implants may be considered, usually under the care of a urologist.

• Lifestyle changes

As mentioned earlier, quitting smoking, moving more, improving diet, and reducing alcohol can directly improve erections and reduce the need for higher medication doses.

At NextClinic, our ED service focuses on the safe use of prescription ED medications in Australia, combined with lifestyle and mental‑health advice. We screen for red flags that would make these medicines unsafe (like nitrate use for chest pain), and we emphasise that pills are part of the toolkit – not the only solution. If you’d like a deeper dive into how different ED medicines compare, our blog guides on ED medications and tadalafil vs sildenafil break this down in practical, everyday language.

How telehealth can help Aussie men with ED and performance anxiety

If embarrassment has been stopping you from seeing someone in person, telehealth can be a gentle first step.

With our online ED treatment at NextClinic:

• You complete a confidential 5‑minute assessment about your health, symptoms, and goals
• An Australian‑registered practitioner reviews your answers and calls you for a private phone consult
• If it’s safe and appropriate, they’ll create a personalised ED treatment plan for you
• You can choose home delivery in discreet packaging, or use an eScript at any Australian pharmacy

We also:

• Screen for conditions like cardiovascular disease and diabetes that might be showing up as ED
• Talk openly about performance anxiety and psychological ED – not just prescriptions
• Suggest GP follow‑up, specialist referrals or mental health support when that’s in your best interest

For many men, that combination of privacy, convenience, and proper medical oversight is what finally gets them moving from late‑night Googling to actually doing something about their sexual health.

When ED or anxiety might be an emergency

Most erection issues are not emergencies. But there are a few situations where you should seek urgent help:

• Chest pain, breathlessness or severe dizziness during sex or after ED medication

Call 000 or go to the nearest emergency department – this could be a heart problem.

• An erection that lasts more than 4 hours and is painful (priapism)

Go straight to an emergency department. Healthdirect notes prolonged erections can damage the penis if not treated quickly.

• Severe distress, suicidal thoughts, or feeling like you can’t go on

Call Lifeline on 13 11 14, or speak with your GP or a mental health crisis service. Sexual difficulties and anxiety can hit self‑esteem hard, but help is available 24/7.

Bringing it all together (and your challenge for this week)

Let’s recap the key points:

• Erectile problems are incredibly common in Australian men – more than half report a sexual difficulty in a given year, and ED itself affects a significant proportion across all adult ages.
• Performance anxiety and psychological ED can look exactly like physical ED, because stress and fear switch your body into fight‑or‑flight mode.
• Signs pointing towards performance anxiety include sudden onset, situation‑specific problems (but okay solo/morning erections), and a loud inner critic in the bedroom.
• Signs suggesting more physical ED causes include gradual worsening across all situations, fewer spontaneous erections, older age, and underlying health conditions or medications.
• In reality, mind and body are usually intertwined, so the best approaches look at heart health, hormones, mental health, relationships, and realistic expectations – not just a single pill.
• Evidence‑based help can include lifestyle changes, psychological support, and (when appropriate) prescription ED medications, all guided by a proper medical assessment.
• Telehealth services like ours at NextClinic can make getting that assessment and treatment plan easier, more private, and more convenient – without compromising on safety or quality.

Your challenge for this week

If this article resonated with you, don’t just close the tab and go back to worrying.

Pick one of these actions to take in the next 7 days:

1. Book an appointment – with your GP or an online ED doctor – to talk honestly about what’s been going on.
2. Have a brave conversation with your partner about how you’re feeling and what you’re doing to address it.
3. Make one health change that supports your sexual health (e.g. cut down smoking, start a daily walk, reduce mid‑week drinking).
4. Start a simple anxiety tool, like a 5‑minute breathing or mindfulness practice before bed or before sex.
5. Write down your pattern – when things go well vs not – and bring that to a doctor as a starting point.

Then, if you’re reading this on our blog, scroll down and tell us in the comments:

Which strategy did you choose, and how did it go?

Your story might be exactly what another Aussie bloke needs to see to realise that what he’s going through is common, understandable, and – most importantly – treatable.

References

• Health and lifestyle factors associated with sexual difficulties in men – results from a study of Australian men aged 18 to 55 years | BMC Public Health | Full Text
• Erectile dysfunction - symptoms and treatment | healthdirect
• The health of men in Australia - Australian Institute of Health and Welfare
• Performance Anxiety
• Erectile dysfunction: Having Problems with Erections | The Hart Centre
• Psychosocial factors associated with male sexual difficulties - PubMed
• 3 Big Myths About ED Pills You Need to Stop Believing | NextClinic
• Erectile dysfunction | Better Health Channel
• Understanding costs | Medicare Mental Health
• ED Treatment Online | NextClinic Australia
• Sildenafil (Viagra) | healthdirect

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