Mental stimulation plays a major role in sex, both in its overall enjoyment and in mediating the physiological pathways of arousal. There are a number of reasons for psychological impotence. Often, stress or exhaustion may be possible explanations for impotence. Anxiety, depression, or post-traumatic stress disorder also may result in impotence, as can a history of sexual or physical abuse. Guilt associated with a sexual relationship or encounter or problems in a relationship may also contribute. One often-overlooked reason for psychological impotence is confusion over ones sexual identity.

Unfortunately, most people are unaware that the vast majority of impotence cases are the result of an underlying physical disorder. If someone is unaware of this disorder, anxiety and stress may build up over a period of time to worsen impotence and in turn cause more stress. It is therefore always a good idea to rule out a physical explanation for impotence before evaluating psychological reasons. For many people, psychological impotence may be situational or only with a certain sex partner. It is important to differentiate between situational and ongoing psychological impotence, as the approaches taken in treating these may be very different.

A person suffering from true psychological impotence may benefit greatly from counseling. This may help identify if the underlying reason can be removed or its effect reduced through appropriate treatment. For example, people suffering from depression or anxiety may need treatment to improve their condition. People who have suffered from post-traumatic stress disorder or abuse may need counseling on coping skills and may also be depressed. For those whose impotence is worsened because they dont understand the physical condition thats causing it, a simple explanation of the underlying condition and reassurance that impotence is treatable may suffice. An evaluation of psychological impotence should assess the persons sexual identity, as confusion in this area may be the cause.