Phosphodiesterase type 5 inhibitor therapy has revolutionised the management of erectile dysfunction (ED). However, emphasis on the biological causes and treatment of ED may overlook the importance of psychological, psychiatric and relational/social factors associated with this symptom. This chapter explores the association between these factors and ED while highlighting the importance of the inter-relationships between psychological, psychiatric, relational/social and biological factors. The role of anxiety, depression and stress as a driver of hormonal changes that may lead to the development of ED is also considered. Notably, there is a correlation between psychological well-being and physical health outcomes, and ED may serve as an indicator of the risk of poor health. This has important implications for the management of ED, where psychological interventions such as cognitive-behavioural therapy may play an important role in improving outcomes. The implications of ED as a pre-emptive sign of potential mental health concerns are considered from a practice perspective, underlining the importance of screening for mental health problems or psychological symptoms in patients with ED.