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Psychosexual problems for men

Erection problems in men

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Impotence, Erection Problems, or ED


The term "impotence" tends to be used to describe a complete inability to get an erection; "erection problems" on the other hand is a less challenging problem, in that a man has erections but they may be unreliable and they may come and go during sex, or from one session of sex to the next.


The work I have done with men has shown me very clearly that there are few things that are more important to most men than being able to respond to a sexual situation with an erection - it's the visible symbol of a man's potency, of his ability to engage in sexual intercourse, to penetrate his partner or gain sexual pleasure through masturbation. When a man's erection goes wrong, his self-esteem suffers hugely. He may want sex, he may desire his partner, but his penis just refuses to get hard. Or perhaps it gets hard, but as soon as he attempts penetration, his erection disappears.


The most common reaction by a man to the loss of his erection is fear that it has gone away forever, or that his erection will never be reliable again: this anticipatory anxiety is itself one of the most significant causes of erection failure. In other words, the anxiety that you may not be able to get erect is an extremely effective inhibitor of the physical response in your penis! The more worried you are ahead of sex that your erection may not work at all, or stay long enough, the more likely you are to have problems with your hardness next time you are having sex. This creates a vicious cycle in which the anxiety and expectation alone can perpetuate erection problems.


One of the problems with erection failure is that a man begins to focus on the wrong things during sex - that is to say, on his erection, and not on his partner or on what he is feeling as he makes love. The more he focuses his mind on his erection, the more fragile it becomes; he starts expecting it to deflate, and sure enough, it does. This weakens his confidence even further.


Things men do to get over this kind of ED

You can see men who have this kind of erection problem resorting to a few well-worn strategies to try and deal with the problem: they may start having  wild fantasies as they make love; they may seek out a younger, sexier partner; they may give up sex altogether; they may start looking for hyper-stimulation like internet porn or new sexual behaviors they have never tried before (paying for sex, talking dirty with their partner, trying BDSM, and so on). But the real answer lies not in seeking more arousal and more stimulation, it lies in being relaxed, focusing on what you are physically feeling rather than on what you are thinking, and being more sensitive to the physical touch of your partner. We shall return to this point later.


Causes of erection problems and impotence


Erection problems are a normal part of getting older for men. As such it does not need to create stress in a man's life as long as he simply accepts that his erections will not be as firm and long lasting as they were when he was in his teens. However, erection problems can also be caused by some things which a man has control over.


There are both physical and psychological causes for ED. And in many cases, physical and psychological factors combine to cause or sustain a man's problem with his erections. In this section I will discuss emotional causes for ED whilst the next section focuses on the physical causes. In general, psychological factors are more often to blame for men's problems with their erections than physical problems.


Anxiety is the most common cause of impotence. As mentioned above, it is easy for men to get into a vicious cycle. If you've lost your erection once, maybe due to having had too much alcohol, you might lose confidence in his body and get worried that it will happen again the next time. The more anticipatory anxiety a man builds up the more likely his erection is not going to work, and so the negative reinforcement continues.


Another cause of ED is the excessive use of fantasy during sex to get aroused. Sure, all men fantasize during sex, but some do it much more than others. Indeed, some young men rely on fantasy to get erect: even when they are in a sexual situation, their arousal comes more from looking at their partner, thinking about what is going to happen, and fantasizing about sex, than the actual physical presence or touch of their partner.


This works when you're a man in your twenties, because your penis will leap to attention at a moment's provocation, but it isn't so good when you're getting into your forties. Indeed, relying on fantasy to get physically aroused is a route to disappointment, for the response of the penis to mental imagery becomes progressively less marked as time goes by. When a man is in his forties and fifties, he nearly always needs physical stimulation - such as the touch of his partner's hand or mouth - to get a full erection.


A man who has learned to become sexually aroused by what goes on in his head may have a hard time getting aroused by the touch of his partner in later life - he may simply have lost touch with his body and his ability to be physically aroused.


In a few cases, a man who has suffered sexual or emotional abuse may lose the ability to get erect as he gets older because his body simply cannot get aroused enough to overcome his lack of trust or his burgeoning anxiety. Such deep-rooted issues are less likely to be cured by self-help programs, though other forms of impotence or erection problems described above are ideally suited to self-help work.


Finally, most men experience their erectile problems within a sexual relationship with another person, be they male or female. Problems with a partner can create a lot of anxiety, which can then manifest itself as an erection problem. One such issue could be around performance anxiety, i.e. that a man believes he must have a rock hard erection to satisfy his partner. Heterosexual men often feel they are responsible for their female lover's orgasms, which is quite an impossible responsibility to take on. Thinks on this: have you ever tried to give somebody "peace of mind"? It's a bit similar trying to fulfill somebody's sexual needs. The other person will either be able to achieve peace of mind for themselves or not, but it's rather impossible to give it to them, although being relaxed, open and loving will probably help.


Homosexual men often feel they have to live up to the ever-sexual, rock hard images of what a gay man needs to be, which can also create a lot of performance pressure. However, the more anxiety and stress a man experiences, the less likely his erections are going to work; pressure to perform is a very strong turn off for every man's penis (including yours!).


Other problems in relationships can also impact a man's erections. These might be around unspoken aggression between partners, lack of trust for various reasons including obvious aggression from a partner, lack of physical attraction to one's partner, a partner's sexual problems, or even a lack of interest in sex. Finally, when a couple is "too close" in an enmeshed or co-dependent relationship pattern where there is no space for individuality, separation or conflict, then passion and sexuality often suffer. This may surface as an erection problem in the man.


Physical problems with the penis


Erection problems caused by serious physical problems are rare in men under the age of 45 or 50. The exceptions are men with diabetes, nerve damage, for example through spinal problems or MS, or serious circulatory problems, where high levels of cholesterol can block the penile arteries.


Many drugs, both prescription and non-prescription, interfere with the erectile response such as medication for lowering cholesterol or blood pressure. If you are taking regular medication for any health issues, please check your drugs for known side effects. Also, Bernie Zilbergeld's book "The New Male Sexuality", 1999, Bantam Press includes a list of medications which might affect your erections. You will find similar listings on the internet or through your GP.


Because your erections are a very impressive and complex achievement of bio-engineering, anything that affects your cardio-vascular health and overall fitness may impact them adversely. This includes lifestyle factors such as drinking or smoking, being overweight, doing too little exercise, and so on. Keeping yourself physically fit and healthy will give your penis the best chance to keep working well into old age.


Erection failure - a problem in the mind or the body?


There are various clues which can help you to determine the origin of your ED. It's important to know if the lack or loss of your erection originates in your mind or your body, because that determines how it can be treated. If you get an erection fairly easily when you masturbate, or during the night, or you wake up with a morning erection, then the problem with your penis is not likely to be physical.  


It is essential that you get good medical advice even if you think your problem is mostly caused by psychological factors. It is easier to rule out physical problems than psychological ones. Also, some physical causes could be very serious indeed, for example, if your erection failure is caused by high cholesterol, this may indicate that a heart attack is not so far away.


There are several options available to treat physically based impotence. The first is Viagra, which has proved to be a minor miracle for many men with erection failure. You can read how Viagra works here. It's not always effective especially in cases where the partner does not accept the use of Viagra.


Another option is the old-fashioned but effective method of using a vacuum pump which draws blood into the penis, producing an erect or semi-erect penis, the hardness of which is maintained by placing a lightly constricting ring around the base of the penile shaft. This process resembles the natural erection mechanism of the penis and does not involve surgery. You can read about this method on the website of a company which supplies this therapeutic device.


For men with spinal injuries or complete impotence, surgery with penile implants is a final solution to managing the loss of their erections. However, it is a step that should never be taken without serious consideration and discussion by both partners.


How to set about curing your erection problems


Just in case you're holding some false assumptions that might be hindering your erection, here are a few of the biggest myths around male sexuality.


1 A man should be a "sex machine", at all times ready, willing and able to have sex

This is a myth perpetrated by society and popular culture. A man is no more likely to be perpetually ready for sex than a woman. Certainly, men do seem on average to have a higher requirement for sexual release through masturbation or sex than women, but this is a very different thing to saying that a man should be able to have sex with anyone, anytime! The stress of life and work, not to mention his own internal emotional and hormonal state, will dictate whether or not a man desires sex. And that's before he even begins to consider whether or not he is actually attracted to a woman who is sexually available to him.


2 A man should be confident and always able to lead during sex

Of course, the myth of the man as the dominant partner has become embedded in popular culture for heterosexual couples, perhaps as a result of the belief that "good" girls have to be demure and innocent. For a woman to be sexual was once seen as a sign of her moral  corruption; from that comes a high burden of responsibility for the man - he has to know what to do, how to take the lead, how to "give" his partner an orgasm. In our somewhat more enlightened times, none of these foolish beliefs need to be seen as true, and certainly none of them should be acted upon. Strong performance pressures also exist in gay subcultures, which perpetuate the myth of the ever ready, hypersexual male.


3 A man should know exactly what his partner wants and needs during sex

The problem is that many couples don't have an easy or effective way of communicating their sexual needs to each other. Instead, getting sexual satisfaction becomes something of a lottery, with one partner guessing what the other wants. When this burden is placed on the man, together, perhaps, with the burden of giving his partner an orgasm, it's often a load too heavy for his erect penis to bear. He feels like a failure if s/he doesn't enjoy sex or s/he doesn't come; he works hard to give him or her what he thinks s/he want and neither partner ends up satisfied or fulfilled. Fortunately, the answer is easy: talk about it!


4 A man should be erect at all times, come what may!

This is not how sex naturally proceeds, though many a young man might have trouble believing that! Erections come and go through sex as the sexual energy between two people waxes and wanes. A man who believes that he must be erect from start to finish during sex - whether or not that involves intercourse - is heading for self-doubt and anxiety. The fact is that erections can come and go several times during sex, but as long as both partners are actually interested in what's happening, and want to be there, one will always come back again. Even when a man is giving oral sex to his partner his erection may subside - it's natural! But there are a lot of men who don't know this, and suffer great anxiety when they experience transient loss of erection, seeing it as a major problem rather than a normal but temporary thing.

Side note - for men who want an effective premature ejaculation treatment, this may be helpful.

Other perhaps surprising facts  (well, they may be surprising to you!)

  • Some men need to be in a committed relationship before they actually want sex.

  • Many men are turned off by the idea of casual sex.

  • Some men over 30, and most over 40, often need to be physically stimulated before their penis becomes erect.

  • A hard and firm erection is not actually needed to enjoy intercourse. It is possible to have intercourse with a semi-erect penis.

  • Focusing on the physical touch of your partner can reinforce your capacity to get erect.

  • You can read how testosterone declines with age, and what can be done about it, here.

Written by Rod 25.07.07, last edited 22.08.09

How Viagra works
Treatment for erectile dysfunction
Effect of impotence on men
Erection problems - one man's story
Erectile problems in gay men
Erectile dysfunction and women
ED - advice for women - how to support a man with ED
ED - What to do when Viagra doesn't work


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