Erectile dysfunction, or erectile difficulty (ED), as I prefer to call it, is something that will affect most penis owners at some point in their life. The reason I say “erectile difficulty” as opposed to “erectile dysfunction” is because a true erectile dysfunction diagnosis requires that the individual struggle to get or maintain an erection during 75-100% of sexual encounters for a minimum of 6 months. There are a lot of people who may not meet that criteria but still struggle from massive disappointment and anxiety due to trouble with erections. 

Because so many penis owners struggle with erections, I think it’s important to talk about it. ESPECIALLY because there is so much stigma around ED. A lot of people believe that strong erections are an indication of masculinity, that you can’t have satisfying sex if there are erection difficulties and many other lies that the world likes to throw at us. Let’s dig into the truth about ED and what we can do about it.

Why Do We Lose Erections?

First, we need to clarify that it is completely normal for erections to soften or go away completely, even during sex. Sometimes we’re stressed, get distracted, or simply aren’t experiencing a lot of pleasure in a moment. If you are worried about how your penis is functioning, let’s first examine expectations. Sometimes there actually isn’t anything abnormal about one’s penis function at all–it’s just that they have unrealistic expectations about how their penis should behave. 

During a sexual encounter, erections wax and wane. Fluctuation is normal! Penises aren’t meant to stay hard for hours on end. In fact, that would actually be a sign that something is wrong and a visit to the ER is recommended. According to the Cleveland Clinic, while there isn’t really good research on how long an erection should last, our best guess is that the average person’s erection lasts about 7 minutes. Again, we don’t have amazing research, so don’t put too much stake into this number. However, I’d bet that 7 minutes is a lot shorter than many people would expect the average to be. And even moreso, it’s sort of a moot point, because there are so many things that affect how penises function. Here are some of them:

• Medical conditions (e.g. cardiovascular disease, neurological conditions, diabetes, etc.)

• Smoking, alcohol, and other substance use

• Anxiety and depression

• Stress

• Certain medications

• Injuries

• Low testosterone

• Relationship issues

• Pelvic floor dysfunction

Treatment

Because there are so many things that can cause erectile difficulties, there are also tons of treatment options. As a sex therapist, I collaborate with other providers to make sure we’re addressing the problem from a holistic, biopsychosocial approach.

My first recommendation is always to speak with your doctor (usually a primary care physician or a urologist) about any concerns. It’s important to rule out and/or treat any underlying medical conditions that could be contributing to ED. Your doctor may prescribe a medication such as Viagra or Cialis. While these meds can be extremely helpful, they’re not always necessary, and most importantly, they’re not your only treatment option!

When I work with clients in my practice, I always give them a thorough assessment so that we can explore potential causes of the difficulty they’re experiencing. This helps us explore whether the problem is medical, psychological, and/or sociocultural in nature (and spoiler alert, it’s often more than one). 

Some things we explore are mental and relationship health, as well as your education, beliefs, and experiences related to sex. As I mentioned above, anxiety, stress, and relationship issues can all contribute to sexual functioning. This is especially true when it comes to ED. We work together to explore how your thoughts, emotions, and behaviors might be contributing to your struggles and how we can make improvements. 

In my work as a sex therapist, I’ve found that more often than not, a person who is struggling with ED is also experiencing performance anxiety (and oftentimes they don’t even realize it!). A lot of times when we work on decreasing the anxiety, the ED symptoms decrease drastically. Don’t underestimate the power of anxiety and self-esteem when it comes to sex! How we think about ourselves matters. 

Lastly, pelvic floor physical therapy can also be incredibly helpful in the treatment of ED. Like I mentioned above, there can be multiple issues that can contribute to ED. An important factor to explore is pelvic floor function. There are A LOT of nerves and muscles in the pelvic floor, and there is a lot that needs to happen just right for an erection to occur. If anything isn’t working properly, this can certainly contribute to ED. A great pelvic floor physical therapist can assess for any possible dysfunction and help treat it through stretches, exercises, and several other physical therapy techniques.

Helpful Tools and Resources

One of my favorite resources to recommend to clients is a book titled Coping With Erectile Dysfunction by Barry McCarthy & Michael Metz. The book is short and easy to read, and it does a fantastic job of covering all the different bases (i.e. biopsychosocial) of ED and how to address them. It’s full of tips and tricks to help manage ED. 

In sex therapy, we’ll discuss coping skills to help manage anxiety and disappointment, communication skills to help improve intimacy with your partner, and tools to help decrease ED symptoms. One of my favorite tools I love giving to clients is something called sensate focus. Sensate focus is a series of touching exercises that you do at home with your partner, which helps decrease anxiety and increase safety, communication, intimacy, and pleasure.

This Isn’t The End

I know it can feel overwhelming and maybe even hopeless, but I promise that ED is not the end of your sex life. ED symptoms CAN improve, and both you and your partner(s) can continue to have amazing, pleasure-filled sex. If you need help navigating this, please don’t hesitate to reach out. I, along with my trusted colleagues, would be honored to help. The therapists at Aligning Intimacy are passionate about facilitating a compassionate and judgment-free environment to answer questions, create a secure space, and partner with you as you create an alignment within yourself and your relationships. We are just an email or phone call away!