Why can’t I get or keep an erection?

“It’s not that common, it doesn’t happen to every guy, and it is a big deal.”

The psychology of performance anxiety

- Rachel Green, Friends Season 4, Episode 1

“It’s not that common, it doesn’t happen to every guy, and it is a big deal,” is often how men feel the first time they are unable to gain or maintain an erection with a sexual partner. In fact, this could not be further from the truth. Up to one in five men may experience this at some point in their life and it can affect men of any age. However, many men feel too embarrassed to speak about it or seek support – but help is out there.

Physical or psychological?

The first thing to consider is whether the cause is physical. Conditions such as obesity, diabetes, heart disease and high blood pressure can affect the blood flow to the penis, leading to erectile dysfunction. Low testosterone, drugs, alcohol and tobacco use can also play a part. If you are taking any prescribed medication for blood pressure, anxiety or depression known side effects can include erection difficulties, so it is important to discuss this with your doctor.

If you tend to wake up with an erection in the morning, or can get one when you are by yourself this is usually a sign that things are physically working and may point to a psychological cause.

Fight, flight or flop

Do you remember the first time your penis let you down? Maybe you had a bit too much to drink, were too tired, stressed, anxious, or just not in the mood. The next time you then want to have sex there may be an increase in anxiety that the same thing will happen again. You may be on the lookout to see if you can spot any signs that things are heading south. This hypervigilance can further increase your anxiety. It is perfectly normal for a penis not to remain fully erect during sex, but to harden and soften throughout. If you notice your penis softening this may then fuel your anxiety even further, setting off the “fight or flight” response.

The fight-or-flight response is a survival mechanism all humans have. When we are faced with danger our bodies automatically respond to give us the best chance of staying alive. Our lungs take in more oxygen so we can create more energy, and our hearts race so blood can be pumped into our arms and legs – enabling us to fight better or run faster.

Systems such as digestion slow down as blood and energy are diverted to where it’s needed the most in this emergency. Blood is also diverted away from other areas where it’s less needed, such as your hands (which can make them feel cold and clammy) and... the penis. Less blood flow to the penis means it is physically more difficult to get it up, which can lead to more worries, leading to more anxiety and the fight or flight response keeps going in a vicious cycle. The fight or flight response is all well and good when you are actually faced with danger, but often this alarm system becomes too sensitive and goes off when there is no actual need, but it does not have to be that way.

How can I get better erections?

Psychological therapy can help you get better erections. This may include all or some of the following:

• Gaining an understanding of where the difficulties came from.
• Looking at what is keeping the problem going (e.g. the kinds of thoughts you are having about your erection, any behaviour that may be impacting it, and the way you treat yourself as a result).
• Working through any trauma that may be associated with the issue.
• Improving your relationship with your partner.
• Reconnecting with your body and getting out of your head.
• Dispelling any myths about sex that you may believe.
• Increase your understanding of anxiety and sexual function.

Can porn and masturbation affect my erections?

Like most things in life, porn and masturbation are best when used in moderation. Someone watching a lot of porn may start to become over-reliant on solely visual stimulation, and less in tune with their other senses which can heighten sexual arousal. Masturbation can be an incredibly healthy way to connect with your own body. However, using the same method over and over can make the penis used to only being stimulated in a certain way. Masturbation can also be a great way to relieve stress, but when it becomes someone’s only coping strategy it can become unhealthy and for some people may lead to them feeling compelled or ‘addicted’ to masturbation to regulate their emotions.

How can I reconnect with my body?

Many men that seek psychological support for erection difficulties often say they are too in their head rather than trying to enjoy the moment. They are often thinking about what might go wrong, what their partner might think about them, what their next move is going to be, and trying to get ‘through’ the experience, rather than being present and enjoying it.

Try and bring your attention back to what it is you’re actually doing, rather than being lost in your thoughts. Use your five senses to experience the moment as much as you can. What can you see? Hear? Touch? Taste? What sensations do you notice? Although this may sound simple, putting it into practice can be extremely difficult to begin with, and it is natural that your mind will wander off again. Once it does, notice it and gently bring it back to the present. It is helpful to practice this skill during general day-to-day activities before trying it during sex as a way of building up the skill. Talking this through during therapy can also help you to hone this skill even more.

So in summary, what can i do to improve my erections?

• Try to be more present, and connect with your body and your partner.
• Learn strategies to regulate your anxiety in a healthy way.
• Talk things through with your partner.
•  Do not overuse porn or masturbation, and try to connect more with your body when you do.

Take the initiative and talk to a therapist and work through the issue together. I have online availability and can be contacted here via my profile.