index - sex problems -
erectile dysfunction and gay men
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Before we get on to a discussion of erectile
dysfunction and gay men, let's step back and
take a wider view.
One of the
things the gay communities have done
extremely well is to liberate their
expectations and what is considered to be
the sexual norm from a lot of the
restrictive assumptions that inhibit
heterosexual sex. It is really acceptable in
most gay communities to be openly sexual, to
have multiple partners, to negotiate openly for sex, and to enjoy
sex freely with no strings attached. But maybe
this kind of freedom is only possible
between same sex male partners because men don’t
have to worry about biased gender roles
(for example, women might always be stuck with
"what will
he/they think of me if I have sex?") and
issues around contraception.
Even negotiations for safer sex can be based
on an assumed sense of equal responsibility
between two partners who may well be
affected
in similar ways if things go wrong.
Also, gay men on the whole
seem to avoid the heterosexual male’s
hyper-masculine stereotype and all that is
suggested by it, such as an inability to let
go, or to express emotions, or to allow oneself to be
sensual, or to be sexual in a playful way.
Unfortunately, however, the gay community
seems to have developed their own sexual
stereotype, which I would described as
hyper-sexualized.
The image of the sexually
successful gay man seems to be of someone
who is open to and actively seeking many
sexual encounters, enjoying them to the full
and being ever-ready, willing and erect for
whoever comes along. What if a gay man just
wants sex once a month, or wants to have sex
only with men he feels safe with or with
whom he is in love? And what about gay men
with erectile dysfunction (ED)? There seems
to be less permission for gay men to have a
low level of sexual interest, and even for
them to be struggling with sexual
difficulties such as erection problems.
Erectile dysfunction is a
more modern term for a condition which used
to be called impotence. (Our
introduction to the subject of erection
problems can be found here). Erectile
dysfunction is a matter of degree, i.e. most
men have some erectile capacity; and even men
who normally have very strong and long lasting erections
may experience a loss of erection in some
circumstances, for
example, when they are ill or after too much
alcohol. Erectile dysfunction is a common
psychosexual problem for men; those who
experience it are often very impacted by it
since loss of erection diminishes a man's self-confidence and
sense of masculine identity.
Of course erectile
dysfunction affects men who have sex with
men just as much as it affects heterosexual
men. Due to the hyper-sexualized gay
subculture, gay men can experience a lot of
pressure to look attractive, be ever-ready
for sex with have rock hard erections, and
are often expected to be able to follow
through on any sexual opportunities which
arise. It is also much more acceptable and
possible in some gay subcultures to use sex
as a way to feel better when you're sad,
anxious or unhappy, as it tends to be so
much more freely available. However, men who
use sex to feel better even when they are
tired or their bodies are not really ready
for sex can experience problems around
their ability to perform.
One strategy to manage
erectile dysfunction might be for a man to
increase his sense of sexual excitement
and stimulation to
make sure his erection is hard and lasts
long enough. For example, he might do this
by choosing more intense sexual
practices, or by opting for receptive anal sex, or
even by not using a condom. These things may
be exciting because of the associated risk.
In fact, there have
been quite a few research studies into links
between HIV and erectile problems in gay men
and there seems to be some sort of a
correlation between the two (see
references below). It's understandable that
a man who is HIV seropositive may
experience sexual problems due to his
HIV status; what is possibly more challenging to
accept is that a gay man with erection
problems may try to manage the issue by
opting for more risky sex, even sex which
could lead to him contracting HIV.
In other
words, untreated erectile dysfunction may
contribute to sexual risk-taking which can
result in HIV infection (Cove and Petrak
2004). In reality, it is not clear as yet
how often this happens, but what is certain
is that gay men need to think
about what erection problems really mean to them and how they
can deal
with them in a constructive and safe way.
I believe there are two
important aspects in addressing erectile
dysfunction in gay men. Firstly, the medical
and therapeutic community must make no
distinction in standards of treatment for
erectile dysfunction between heterosexual
men and gay men, regardless of their
HIV status and other medical issues. This may already be happening in parts
of the world that have strong and open gay
subcultures, but it is probably not the case in more
conservative areas. Not considering the
needs of gay men with sexual difficulties
seems to be a legacy of the ages past when
homosexuality itself was considered to be
dysfunctional. This state of affairs is not
appropriate to a modern society!
First, all gay men
have a right
to
be prescribed Viagra just like
heterosexual men. Every individual has a right
to sexual expression regardless of health
issues; during shared sexual experiences, it is both
partners’ responsibility to safeguard their
own health. On a practical level, making
Viagra readily available will mean men
with erectile dysfunction can use
condoms more
easily
and thereby protect themselves and their
sexual partners from cross infection. I
believe that not making Viagra available to HIV
positive men is morally wrong as well
as disastrous, and constitutes
a kind of moral persecution of
physically ill people.
Second, I believe that the
gay community needs to address the
issue of erectile dysfunction in an open and
honest way. The hyper-sexual stereotype
may be good fun, but it probably creates a
lot of performance pressure for some men, and
may well leave men with erectile dysfunction
feeling inadequate. Just as heterosexual men
should not automatically equate
sex with rock hard erections and penetrative sex, so
gay men need to accept
flaccidity and sensuality as parts of their
sexuality.
Having problems with your
erections does not mean you can’t enjoy sex
or be the active partner in a sexual
encounter. There is much more to good,
exciting sex than performing in the
conventional, expected ways. Even
sub-cultural norms can restrict individuals.
It’s time we liberated ourselves from all
our standards of sexual perfection, so that
we make space for real individuals to have
real sexual encounters.
Further reading
Bancroft, J., Carnes, L.,
Janssen, E. (2005) Unprotected anal
intercourse in HIV-positive and HIV-negative
gay men: The relevance of sexual
arousability, mood, sensation seeking and
erectile problems. Archives of Sexual
Behavior 34, 3, 299-305
Cove, J., Petrak, J.
(2004) Factors associated with sexual
problems in HIV-positive gay men. Int J STD
AIDS 15, 732-736
Sandfort, T.G., de Keizer,
M. (2001) Sexual problems in gay men: An
overview of empirical research. Annu Rev Sex
Res 12, 93-120
