In episode 286, I received a question from an individual struggling with their mental health, with particular issues surrounding self-esteem, trust, and erectile dysfunction. In this post, I take a look at this question in detail and offer my thoughts on how you can move forward and overcome these issues.
Hi Dr. Duff,
Back in the fall, my partner of 5 years and I broke up after deliberation surrounding an open relationship—in short, I didn’t want one (and was taken aback when it was suggested that far into the relationship), and it really messed with my self-esteem, trust, masculinity, and mental health as a whole.
However, I’ve been seeing someone new for the past few months, and it’s been great. We have similar interests and personalities, and we support each other with our respective mental health. However, the past few weeks I’ve been experiencing ED with them, which has further been messing with my self-esteem and masculinity.
I saw my primary care physician about it, who suggested that it’s likely psychological and not physical, as I’m young (in my mid-20s) and healthy overall. I’ve also been seeing a therapist since the breakup, which has been very helpful but hasn’t solved this physical problem. I’ve purchased some generic medication for the time being, which seems to work but lowers my self-esteem thinking I have to take it.
What recommendations do you have to work through this with for myself and my partner?
Thank you for writing in. This is a really interesting question and one I haven’t had the opportunity to answer before, so thanks for that. First off, I’m sorry to hear about the breakup. After 5 years, that must have been really hard for you. It seems like it felt like it came sort of out of the left field for you, which probably adds to the difficulty. It’s one thing when you have been talking about opening up a relationship for a while, working through things, communicating in general etc. But it sounds like this feels like it came out of nowhere for you. When that happens, you don’t get the same sense of closure. You are probably left to do a lot of post-hoc interpretation. You are left looking back at the reasons why. There are a lot of legitimate reasons for opening up a relationship that do not reflect poorly on you. They may not even have anything to do with you. But if you never talked about them, then you are just left with your own thoughts.
So you think about what you did wrong, how you weren’t enough to satisfy them, whether everything was a lie to start with etc. That’s understandable, but these are also definitely things that you can process and work through in therapy because your automatic negative interpretations of why what happened did are likely just one possibility among many. There may also be things that you can look back on and re-interpret to better understand how things went that way. I don’t say this to diminish the pain and impact of the breakup and what you experienced. Not at all. It was clearly super difficult for you. That’s valid. However, those doubts that you are talking about probably do have something to do with the difficulties that you have experienced in the current relationship.
Finding the right help
Moving on, I am super happy that you are finding success and closeness in your current relationship. It sounds like you found a good match and that you are good supports for one another. Great job checking with your primary care first. It’s always important to rule out physical health issues first because there are a variety of things that could definitely contribute to erectile dysfunction. You said that you’ve been seeing a therapist since the breakup, which is great. I wonder though if it might be time to go and see a specialist like a sex therapist. This is one of those bread-and-butter issues that sex therapists would be totally used to working with both in an individual context and for someone in a relationship.
Honestly, I think there’s a good chance that you have already started to make some progress on this since writing in. It’s been a few months since you started seeing each other. You may simply need more time to adjust, to grieve the past relationship, and to break some of the negative associations you have to it. You also need to go easy on yourself about using medication. There is absolutely no shame in that. I think your partner should take that as a compliment even. That they are important enough for you to go on medication to facilitate your sexual relationship.
Understanding erectile dysfunction and what you can do
When it comes to why this is happening. ED is most often tied to anxiety. Sometimes it’s performance anxiety. And sometimes it happens randomly and then there is basically a second layer of anxiety where you are so worried about being able to get it up… that you can’t. One thing you can do is work with your partner on this. Do they know it’s been an issue for you or have you kept it pretty well hidden with the meds and such? Being open about it can be helpful both to help them interpret what they see from you and also so they can be on your side and work WITH you on it. For instance, one thing you can do is work to expand your definition of sex. In a lot of relationships, we see a heavy focus on penetrative sex involving a penis. It’s no wonder that performance anxiety can take hold because it’s like you have to get it up, perform well enough for long enough to be satisfying, but also orgasm at the perfect time, etc. That can be a lot of pressure! When I say that you can work on expanding the definition, I mean you can focus more on oral sex, heavy petting, and other forms of intimacy that don’t even require becoming erect.
You also can work on being less perfectionistic. Like if you attempt to have penetrative sex and you find that you can’t get erect that doesn’t mean you have to slump your shoulders and quit the whole session. You can always come back to it. In a situation like this, you could slow down a little, focus more on other forms of intimacy, even if that’s just kissing and cuddling. You may find that when your mind is off the “objective”, you get the happy surprise of an erection. If that happens, then you can go for it. If not, just enjoy the process. Enjoy the company. Enjoy the other sensations.
There is a type of work that is often used in sex therapy called sensate focus where you actually intentionally make the rule that you are not allowed to have penetrative sex at first. For the first whole session, you only focus on what we tend to think of as less intense activities such as kissing and caressing. Depending on how intense the protocol is, they might go through session by session and only add little bits. Like now you can do heavy petting. Now you can remove clothes. Now you can integrate oral. Etc. You slowly work your way up without pressure and work on really getting a lot out of each session. Enjoying the unique experience and sensations. By the end of it, a lot of people are surprised about the issues that can be resolved.
There are certainly guides to doing this that you can find online or in books, but as I said before one of the best things you could do here is to enlist the help of a sex therapist. You are already clearly open to the idea of therapy, which is awesome. This would help with this specific issue.
You can listen to this on Episode 286 of the podcast!
Thank you for the great question!
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