For any man who has ever experienced erectile dysfunction, there can be an inclination to automatically assume there must be something physically wrong with your manhood or health in general.

But while it is true that impotence can often have a physical cause or be the result of lifestyle factors such as drinking or smoking, men can often underestimate just what an important role their state of mind can play when it comes to getting, and keeping, it up.

Indeed, the causes of erectile dysfunction are often down to psychology, with sometimes just the stresses and worries of everyday life being enough to have an impact on what happens in the bedroom. Here we look at some of the most common psychological issues that can cause impotence.

Stress

Stress is one of the biggest health issues in the modern world, with so many of us under constant pressure from our jobs while worrying about paying the bills, taking care of the kids and trying to balance a hectic lifestyle. All this can weigh on your mind and make it difficult to relax in the bedroom. This can impact on all aspects of sexual performance, including causing erection problems. Stress can also lead to physical changes, such as high blood pressure, which may also affect your ability to get or maintain an erection.

Anxiety

Similar in many ways to stress, a feeling of anxiety can often distract both men and women from being able to have fulfilling sex. Anxiety generally occurs when we worry about a future event or situation - perhaps you have an important job interview coming up or a big exam to sit, for example.

However, some people can also suffer from what is known as generalised anxiety disorder, or GAD, a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event. In such cases, psychological therapy and medication are often prescribed.

Depression

Depression is the most common cause of all sexual problems, including impotence. Almost all men with severe depression will have erectile dysfunction and this is almost certain to continue until the depression has been cured. Unfortunately, men are particularly prone to ignore or suppress depression, meaning they are often reluctant to seek help.

It's important, however, not to confuse clinical depression with simply feeling unhappy or down for a few days. Clinical depression can leave you feeling persistently sad for weeks or months, often with no easily identifiable cause.

Lack of confidence

At the beginning of a new relationship both men and women can sometimes worry about how they're going to live up to expectations in the bedroom. This can be particularly so if it is your first sexual relationship or it has been a long time since your last one. Unfortunately, this lack of confidence and the feeling of anxiety it creates is sometimes enough to prevent men being able to get an erection. This can also lead to something of a vicious cycle - each time you have a problem it gives your confidence another knock, making it more likely the problem will occur again.

Of course, there are myriad other causes of erectile dysfunction and a host of ways to treat them. But often the first step in solving your erection problems is identifying what's behind them.