How to Deal with Erectile Dysfunction

Erectile dysfunction (ED), or the inability to get/keep an erection during sexual activity, is a major problem. Estimates suggest it may impact up to 30 million people with penises. It’s an issue that has obvious ramifications when it comes to the mechanics of having penetrative sex, but it is also something that can have a devastating impact psychologically. ED is linked to shame, guilt, depressive symptoms, performance anxiety, and relationship disruption. It can be tough for the person with ED to cope with not being able to “perform” when the time comes and it can be easy for their partner(s) to fall into the trap of feeling that they did something wrong or they are not desirable enough for their partner to get an erection. Recently on episode 160 of the Hardcore Self Help Podcast, I got the following question about ED:

I got divorced a few years ago and I have twin five year old boys. I fought for us to stay together but ultimately she wanted her independence back and so I had to give up control and let her go. I have tried dating a few people but ultimately end everything before giving them a chance. I know a lot of it has to do with my fear of getting hurt again and as a result, I have found that every sexual experience I have had post divorce, I am unable to get an erection when the relationship gets to that point. I have been to a doctor and have determined that it is not erectile dysfunction so I am fairly confident it is psychological. I don’t know what to do and I feel like I avoid relationships now because I know ultimately that thing is going to happen again.

What can I do to get over this?

Get Checked by Your Doctor

This person did a great job of first talking to their doctor. The majority of documented ED cases are due to some biological issue. This can be things like blood pressure issues, hypothyroidism, or medication side effects. About 10% of cases are what are referred to as “psychogenic” erectile dysfunction. This means that the person is having trouble getting or maintaining an erection, but they do not have a physiological reason for the issue. They are physically able to get an erection but psychological issues get in the way when it comes to intimacy with another person. In many cases, there is some combination thereof, where there may be a biological barrier along with psychological difficulties. So, getting checked out by your doctor to rule out the physical aspect is always an important first step.

Stress

When it comes to psychogenic ED, it usually is an issue related to stress and performance anxiety. Whether it’s due to a problematic prior experience or just a symptom of overall strong anxiety, typically people with this type of issue have the feeling that they are on stage and need to perform when it comes to sex. This can also be influenced by unrealistic portrayals of sex in popular pornography. This type of pressure to perform can directly impact a person’s ability to achieve and hold an erection. Sometimes this symptom passes with time and sometimes it lingers for quite a while and requires treatment to address. For this question-asker, it is clear that they are having some difficulties with avoidance. They have had a negative relationship experience, and subsequently developed this psychologically-related ED with new partners. Rather than pushing through, experimenting, discussing, and trying to figure out how to work on the issue, their tendency is to ignore and avoid it. This is super common with anxiety. In fact, anxiety wants you to avoid things to give you the illusion that it is keeping you safe.

Sensate Focus

As with most types of anxiety, rather than avoidance, we want to work toward gradual exposure to the thing that causes anxiety. In this case, we want to back off from sex and gradually build back up to it. A great way to do this is through a classic technique called “sensate focus”. Sensate focus is a classic technique developed by Masters and Johnson that can help with issues such as ED or vaginismus (painful intercourse due to vaginal muscle tension). The general idea is that the person and their partner abstain from having full penetrative sex and instead slowly build up to it through a series of less intense steps. Here’s an example of what sensate focus might look like:

Session 1: Kissing, hugging, talking, and being emotionally intimate are okay but no touching genitals or breasts.
Session 2: All of the above and you are also allowed to touch breasts and touch more heavily. Still no genital touching.
Session 3: Now you are allowed to touch genitals but only with hands.
Session 4: Everything aside from penetrative sex is allowed, including oral sex.
Session 5: No restrictions.

The intention of sensate focus is to help people focus intently on the sensory experience of intimacy. Slowing down and taking things step by step helps to alleviate the massive pressure that people often feel to perform during sex. It also serves as a form of exposure where you are gradually approaching the thing that you have been avoiding due to trauma, problematic relationships, or previous negative experiences. To be clear, it can feel like torture to deny yourself the kind of sex that you want, especially because people often find that they are ready to get into it after the first couple sessions, but that’s actually the point. You want to build the desire and the restraint at the same time. Whenever possible, sensate focus or any other exercises meant to tackle sexual dysfunction are best done with a trained and licensed sex therapist. The description above is just one example of how sensate focus might go. It is important to realize that there are adaptations for LGBTQ+ people, people in polyamorous relationships, and more.

Start and Stop

Another exercise that can be helpful has to do with masturbation. Sex therapists will often suggest masturbating several times per week using the “start and stop” technique. Basically this means that you start touching yourself until you get a full erection (again, this is for non-medical ED). Once you get an erection, you stop masturbating and wait for it to come back down. Then you start again. Repeat this process three or four times and then finish if you want to. The point is to help you get used to the idea that things are more fluid than we think. You can get an erection, lose it, and get it back again. This technique helps to combat the feeling of shame and defeat that comes along with losing an erection in the moment. It’s easy to fall into a pattern of black and white thinking and assume that once you lose an erection during intercourse, its all over and you ruined the experience. That does not have to be the case.

Expand Your Ideas About Sex

Here in the US, we tend to have a very straightforward, linear view on sex. What we see in movies and porn is that you start kissing, have minimal foreplay, jump into penetrative sex, pump away as long and fast as you can, and then magically have simultaneous mind blowing orgasms from intercourse alone. In reality, that’s pretty unrealistic and it can be very helpful to simply expand your mental framework regarding sex. One way that I like to do this is by listening to knowledgeable people talk about it. There are many great sex-related podcasts and Youtube channels out there. I would suggest Sex with Emily, Shameless Sex, Sex Nerd Sandra, and Sexplanations. By taking in this type of content, you can become a little more flexible in the way that you think about sex and you can expand your sexual vocabulary.

In Summary

Challenge your notions about what sex “should be”.
Approach the problem instead of avoiding it.
Expand your ideas and vocabulary by taking in content.
Try sensate focus and stop-start techniques to reduce the pressure in the bedroom.

If you’d like to hear about this in more detail and learn whether it is unhealthy to show off your body sexually over the internet, check out episode 160 of the Hardcore Self Help Podcast!

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question relationships sex

How to Deal with Erectile Dysfunction

Get Checked by Your Doctor

Stress

Sensate Focus

Start and Stop

Expand Your Ideas About Sex

In Summary

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