Men's Sex Issues: Erectile Dysfunction and Performance Issues
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It happens to a lot of guys.
At some point, many guys will experience the loss of an erection and research shows that it becomes increasingly common with age. While less than 10% of men below age 40 experience it, the numbers go up with each decade. Up to 15% of men age 40-49 experience it, and for men over age 60, 20%-40%.*
Erectile dysfunction (ED) and performance anxiety around erections can be very distressful and bring up feelings of shame. It can be traumatic because the memory of losing an erection can become intrusive - you may replay the scene over and over in your head or you may begin dreading or avoiding sex altogether because of fear that it will happen again. And just having the thought can make you lose your erection! It can become a painful cycle that leads to less satisfying sex and strain in your relationships.
What causes erectile dysfunction?
There are a variety of causes and this can make addressing the issue more challenging. First, there are a number of biological factors that can contribute. Cardiovascular disease, obesity, and diabetes may all influence the ability to have and keep an erection. ED is also a side effect of a number of medications. Changes associated with the aging body can also play a factor.
Second, a variety of psychological issues can also have an impact on your ability to get and maintain an erection. Depression, anxiety, feelings of low-self worth, body image issues, and strong beliefs about gender roles in sex can all be contributing factors.
What can you do about erectile dysfunction?
First, I think it is important to get checked out by a physician. Are there any biological causes that can be treated? Are you taking medications that have side effects? Can dosages or medications be adjusted?
If you've watched any television commercials in the last 15 years, you already know that there are plenty of medication options for ED. While this is an important intervention to consider, I think a wholistic approach that also addresses the underlying problematic thoughts and feelings, as well as possible conflicts and communication issues with partners, can be more helpful in the long term.
Anxiety is often part of the problem.
Erectile dysfunction often brings up anxiety, and specifically, performance anxiety. You may feel a sense of dread at the idea of having sex or being able to get or maintain an erection. You may feel you have no control over this and have problematic and catastrophic thoughts around your identity as a man, your ability to have sex, or if you'll ever be able to have sex again. And much like other kinds of performance anxiety, the fear can center around what might happen in the presence of others.
How do you manage this? There are a variety of approaches to relate to anxious thoughts and feelings in ways that can be more helpful. Mindfulness is an important strategy that can help you have the anxious thoughts that come up and create space to react to them in a different way. Keeping track of negative thoughts and addressing these directly can also help. Finally, learning some relaxation skills to help you in the moments that anxiety occurs can also be useful.
Shifting focus on what is important about sex can also help. De-emphasizing erections and penetration and focusing more on what feels good for you and your partner can take some of the performance anxiety pressure off and move the focus away from having and keeping an erection.
Talking to your partner can help too.
It can be helpful to consider the role your partner plays in this. Sometimes conflicts in the relationship may be a factor in your ability to have or maintain an erection. Are their issues in the relationship that seem to be getting in the way of you having satisfying sex with your partner? Even if there aren't major issues, are you able to communicate about what is going on for you around this challenge? Improving communication with your partner can be very helpful to navigate ED issues, what causes them, and what to do when they happen.
Ultimately, ED and performance anxiety can be a complex experience that requires a number of strategies to address effectively. Basic mindfulness practices can help, as can talking to your partner about the issue. Both individual and couple therapy can be very beneficial in identifying causes and finding solutions to this challenge.
*Lewis, R.W., et al (2010). Definitions/epidemiology/risk factors for sexual dysfunction. Journal of Sexual Medicine, 7:1598–1607.