Coping with Erectile Dysfunction

ED is treatable and manageable. A satisfying sexual relationship is possible for any man at any age.

By age 40, 90% of males have experienced at least one instance of erection difficulty (inability to attain or maintain an erection sufficient for intercourse). This is a natural occurrence, not a sign of ED.

The majority of erectile problems (especially for men under 50) are caused by psychological or relationship factors, not medical or physical problems. Nevertheless, it is wise to discuss this condition with your primary health provider for a full medical evaluation to rule out an underlying health problem.

ED can be caused by a wide variety of factors including alcohol abuse, anxiety, depression, vascular or neurological deficits, distraction, diabetes, side effect of medication, hormonal deficiency, fatigue, and insufficient sexual stimulation. As men age, their hormonal, vascular and neurological systems become less efficient, making psychological, relationship and sexual skill factors more important.

The foundation for erectile response is psychological and physical relaxation. Anxiety about erectile performance is counter-productive. View the erectile difficulty as a situational problem. Do not over-react and label yourself “impotent” or put yourself down as a failure. You are not a performance machine. Do not compare yourself with the unrealistic portrayals of sex in pornography.

You cannot force or will an erection. Do not be a passive spectator who is distracted by the state of your penis. Stimulating a flaccid penis is counterproductive. You become distracted and obsess about the state of your penis. Engage in sensuous playful touching. Enjoy giving and receiving stimulation rather than trying to will an erection.

Medical interventions–especially oral medications such as Viagra and Cialis–can be a valuable resource for facilitating erectile function, but are not a magic solution. It is normal and expected that the oral medications will facilitate erections only 40% to 80% of the time.  Sexual stimulation is still required to produce an erection even with medication.  You need to integrate these medications (or other medical intervention) into your couple style of intimacy, pleasuring and eroticism. 

Your partner is your most valuable resource in resolving sexual problems. Do not hamper your chances of success by attempting to solve this on your own.  This is an opportunity for the two of you to build your connection and increase sexual satisfaction.

It is natural for erections to wax and wane during prolonged pleasuring.  Almost all men prefer to transition to intercourse and orgasm on their first erection, but do not make this a performance requirement. In a forty-five minute pleasuring session, your erection might wax and wane two to five times. A crucial exercise is practicing waxing and waning of your erection. Allowing the erection to come and go will help you build confidence and reduce anxiety.

One way to regain confidence is through masturbation. During masturbation you can practice gaining and losing erections and focus on stimulation and pleasure. These skills are transferable to partner sex.

You do not need an erect penis to satisfy a partner. If you have difficulty getting or maintaining an erection, do not stop the sexual experience. Your partner will find it arousing and pleasurable to have your fingers, tongue or penis (erect or not) used for stimulation.  

Some men try vainly to have intercourse with their morning erection before losing it. This erection is associated with REM sleep and dreaming, not sexual arousal. Do not try to use a waking erection for quick intercourse. Remember, arousal and erections are not finite resources.  

Attitudes and thoughts affect arousal. A sexual experience is best measured by pleasure and satisfaction, not whether you had an erection, how hard it was, or whether your partner had an orgasm. Some sexual experiences will be great for both of you, some better for one than the other, some mediocre, and others dissatisfying or dysfunctional. Do not put your sexual self-esteem on the line at each experience. Some “duds” are normal.

Adapted from Coping with Erectile Dsyfunction by M. Metz and B. McCarthy.  Used with permission of the author.

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