“I could never trust myself again.” What followed was not a physical problem, but a profound loss of confidence, a struggle rooted in his faith in his own body, abilities, and sense of self-worth
For many men, a single experience of underperforming in bed under pressure can leave a lasting mark on their confidence. What may begin as an isolated incident often leads to anxiety about future sexual encounters, prompting some to turn to sildenafil (Viagra) as a safety net. But is erectile difficulty always a sign of an underlying health problem, or can it sometimes be rooted in the mind?
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According to mental health experts, not every case of erectile dysfunction has a physiological cause. While medical conditions such as diabetes, cardiovascular disease, hormonal imbalances, and neurological disorders can certainly affect sexual performance, psychological factors like stress, anxiety, shame, low self-esteem, relationship difficulties, and fear of failure can be equally influential. In many cases, the fear of not performing well becomes a self-fulfilling cycle, where anxiety itself interferes with sexual function.
In many cases, the fear of not being able to satisfy a partner, unrealistic expectations shaped by social narratives and pornography, or even a single negative sexual experience can create intense pressure around performance. As a result, some men begin taking sildenafil as a precautionary measure, believing it will guarantee success and prevent embarrassment. Over time, this can develop into a psychological dependence, where confidence becomes tied to the pill rather than their own abilities.
Dr. Ankur Bhattacharya, Assistant Professor, Department of Psychiatry, Diphu Medical College & Hospital, sheds light on how performance pressure and loss of self-confidence can sometimes be mistaken for a purely physical problem, highlighting the often-overlooked connection between mental health and sexual well-being.
According to Dr. Bhattacharya, society frequently defines masculinity through ideas of strength, competence, and control, leaving little room for vulnerability, especially when it comes to sexual health. As a result, many men grow up believing they must always be ready, perform flawlessly, and never experience difficulty in intimate situations.
“We cannot have an honest conversation about Viagra misuse without confronting what society tells men about what it means to be a man,” he said.
He explained that human sexuality is influenced by a range of factors, including stress, emotions, physical health, and life circumstances. However, when unrealistic expectations clash with this reality, many men experience shame and self-doubt.
“Boys grow into men without ever being taught that variation in sexual performance is normal. Instead, they absorb the message that they must always be capable and always in control,” Dr. Bhattacharya noted.
This pressure, he said, often discourages men from seeking professional help. Rather than discussing their concerns with a doctor, therapist, or even their partner, many choose to self-medicate in silence because they fear that acknowledging a problem may be seen as a sign of weakness.
Drawing from his clinical experience, Dr. Bhattacharya said he has treated numerous educated, successful, and emotionally aware men who had been taking sildenafil without medical supervision for years before seeking help.
“When I ask why they never spoke to a healthcare professional, the answer is almost always the same: ‘I was embarrassed.’ That embarrassment is not a personal failing, it is the predictable outcome of a culture that gives men no safe language for sexual vulnerability,” he said.
Dr. Bhattacharya also pointed to the growing influence of social media and pornography, which he believes have intensified performance-related anxieties among young men.
“The sexual performances people see online are not representative of ordinary human experience, yet many men treat them as benchmarks,” he explained.
Dr. Bhattacharya emphasised that addressing Viagra misuse requires not only medical awareness but also broader conversations about masculinity, self-worth, and the pressures men face around sexual performance.
Speaking with GPlus, Dr. Zabir Zaman, Medical Officer, clarified a common misconception surrounding Viagra, noting that Viagra is a brand name, not the drug itself. The active ingredient is sildenafil, which is manufactured and sold by several pharmaceutical companies under different brand names.
Explaining the risks associated with excessive use, Dr. Zaman said that an overdose of sildenafil can lead to a range of side effects, including a sudden drop in blood pressure, nausea, vomiting, palpitations, dizziness, and shortness of breath. In more severe cases, excessive consumption may result in priapism, a prolonged and often painful erection lasting more than four hours that occurs without sexual stimulation. Priapism is considered a medical emergency and can cause permanent damage if not treated promptly.
Many men in India rely on Viagra, even though a significant number do not have any underlying erectile dysfunction. For some, its use is driven not by a medical condition but by performance anxiety, self-doubt, and a lack of confidence, leading them to view the medication as a source of reassurance rather than a treatment.
Speaking about why some people use Viagra even when they do not have erectile dysfunction, Dr. Ankur Bhattacharya, said that the reasons are often psychological rather than physical.
“In many cases, it is not the body that is the problem, it is anxiety, expectations, and the pressure men place on themselves to perform sexually,” he explained.
According to Dr. Bhattacharya, performance anxiety is one of the most common reasons behind the unnecessary use of sildenafil. A man may experience a single episode of erectile difficulty due to factors such as stress, exhaustion, or alcohol consumption. However, instead of viewing it as an isolated incident, he may begin to fear that it will happen again.
Dr. Bhattacharya also highlighted the role of pornography and media-driven expectations in shaping perceptions of sexual performance. He noted that many young men develop unrealistic ideas about what is considered “normal,” leading them to judge themselves against exaggerated and often unrealistic standards.
“I frequently see young men who believe they have a problem when, in reality, they are comparing themselves to scripted and highly unrealistic portrayals of sexuality,” he added.
Another growing trend, according to the psychiatrist, is the recreational use of Viagra. Some men take the drug before dates or social events as a form of “insurance,” believing it will improve sexual performance or enhance pleasure.
“There is a widespread misconception that sildenafil increases pleasure or sexual intensity. It does not. Its action is primarily vascular, but the belief persists through peer influence and misinformation,” Dr. Bhattacharya said.
“Combining Viagra with other substances without medical supervision can be risky. This kind of self-medication is one of the pathways that can lead to accidental overdose and other complications,” he cautioned.
Dr. Bhattacharya shared a composite case of a 34-year-old professional who had been taking Viagra before every sexual encounter despite having no medical signs of erectile dysfunction.
The issue began after a single episode of erectile difficulty during a stressful period, followed by a negative remark from his partner.
According to Dr. Bhattacharya, the problem was not physical but psychological. Through CBT (Cognitive Behavioural Therapy) and counselling, the patient regained confidence and eventually stopped using sildenafil.
“His body was never the problem; it was the fear and self-doubt that followed one negative experience,” he said.
According to discussions with Dr. Ankur Bhattacharya, psychological dependence on Viagra can often be addressed effectively through therapy, particularly when there is no underlying medical cause for erectile difficulties. In such cases, the issue is usually rooted in performance anxiety, low self-confidence, negative past experiences, or relationship-related stress rather than physical dysfunction.
One of the most effective approaches is Cognitive Behavioural Therapy (CBT), which helps individuals identify and challenge the anxious thoughts and fears that contribute to performance pressure. Therapy enables patients to break the cycle of fear and self-doubt that often leads to reliance on medication. In cases where relationship dynamics play a role, couples counseling can help improve communication, reduce pressure, and foster a better understanding between partners.
Specialised sex therapy may also be beneficial, particularly for those who have developed long-standing anxieties around sexual performance. For some individuals, treatment may additionally involve addressing underlying issues such as anxiety disorders, trauma, body image concerns, or depression.
While sildenafil remains an effective treatment for medically diagnosed erectile dysfunction, experts suggest that its growing use among individuals without an underlying physical condition raises important questions about the role of anxiety, self-confidence, and societal expectations in sexual health. As awareness around mental well-being and sexual performance continues to grow, greater attention may need to be paid to the psychological factors that influence intimacy, factors that medication alone cannot always address.