Hard times: A message of hope for those living with Erectile Dysfunction
There can be hard times when you can’t get hard, but often the stigma and stress that ensue cause far more trouble than a limp penis itself.
To start, erectile dysfunction (ED) is far more common than both the public and those experiencing it tend to think it is. The prevalence was noted 5000 years ago in Ancient Egyptian scripts. A 2011 study in Canada found that the overall prevalence was 49.4%; the same study found that moderate and severe cases of ED affect 5-20% of the Canadian population. While ED is known to most strongly impact middle-aged and aging men, studies show that ED is starting to show up at younger and younger ages across the globe. From this, a moralistic storm of sex-negativity has ensued, pointing the finger at masturbation and porn (neglecting the impacts of limited sex education and other societal factors).
Up until 1992, ED was more widely referred to as, a far more harrowing term: impotence. The medical nomenclature was renewed in an aim to separate difficulties obtaining and maintaining an erection from the rest of penile and reproductive function. But the term still haunts those who experience it with its insistence on dysfunction. The question is, can you still have an functioning and enjoyable sex life with so-called erectile dysfunction? The more pressing question often is: can erectile-function be fixed?
We are all lucky to be living in a time where those living with ED need not necessarily suffer under the stigma and spectre of “impotence”. This is because, all too often, ED has associations to an underlying physical health condition. These include but are not limited to obesity, type-2 diabetes, high blood pressure, high cholesterol, atherosclerosis, Parkinson’s disease, multiple sclerosis, metabolic syndrome, low testosterone levels, post-surgical symptoms, nerve damage, cancer/cancer recovery, and the impacts of poor lifestyle choices and substance misuse. Improving your fitness (especially cardio), cleaning up your diet, quitting smoking, cutting back on substance use, and better managing stress are all go-to lifestyle interventions that – when paired with medical treatment for the more serious diseases and conditions listen above – often improve ED. This is why it’s vital that if you are experiencing ED that you get a physical from your doctor and a referral to a urologist to screen for any underlying health conditions and obtain appropriate medical treatment as required. This can save you heaps of psychological distress from thinking that it’s “all in your head” because sometimes it really isn’t.
Other times, the cause and treatment are, alas, to be found in the psychosocial realm. Depression, anxiety, trauma (sexual or otherwise), addiction (to substances, porn, or other behavioural addictions), and also stress and relationship issues can all impact and sustain ED. While Viagra can certainly short-circuit all of this and help a brother out, a pill often won’t suffice in addressing psychological concerns. As anyone struggling with ED knows, on top of the ED itself, is the cognitive and emotional cost of living with ED. As you start to struggle with your erection, self-criticism, self-consciousness, performance anxiety, low self-esteem, and relationship issues show up, which all bring about more distress, creating a compounded, ‘snowball’ effect that is overwhelming, agonizing and daunting to face.
The thing is… this needn’t be so. Erectile dysfunction is not a death sentence: not for your relationship(s), sex life, and not for your self-worth! Below is some food for thought and tips that we wish to share as a message of hope for those living with ED:
(1) Erectile dysfunction is defined as the “recurring inability to attain and maintain an erection sufficient enough for adequate sexual performance”. But there is so much more to “sexual performance” than penetration! N’est ce pas? Making out, masturbation, oral sex, anal play, BDSM, role play, fantasies, sex toys… oh my! The sky is really the limit; and often it’s the limits of our imaginations as opposed to the limits of our bodies that are the barrier to moving forward. It is possible to reframe the arrival of ED as a gateway to enjoying some of the other options on the tapas menu of sex that usually get sidelined due to our heteropatriarchal culture’s hyperfocus on penetration.
(2) Did you know that erection, ejaculation, and orgasm are all neurologically separate? For many (though not all) it is still possible to have an orgasm despite ED! And some (but not all) can still penetrate and ejaculate with a less-than-erect penis! Often, it’s the anxiety, panic, and crushing painful emotions that ensue from ED that halt us and prevent us from continuing with sexually exploring and connecting with our bodies and our partners. As sex therapist Esther Perel has said: a man with a soft erection is still a man! Sex with a soft penis is still sex, and can still be sexy if all partners share this information, and couple it with a supportive, accepting and playful mindset.
(3) All folks who have penises can experience erectile dysfunction; unfortunately, the bulk of existing literature on causes, prognosis and treatment focuses on cis-gendered men. However, the meaning someone subscribes to their ED (and the resultant internalized stress or successful coping that ensues) can be impacted by different intersections of identity. For example, sometimes younger, gay, cis-men feel a pressure from within their community to be ‘always on’, making ED feel like some sort of failure or source of alienation. As another example, those who are deeply connected to their cultural roots and/or religious affiliations sometimes harbour unquestioned messages from those communities about sex, bodies, masturbation, genitals and pleasure; messages that can impede sexual function and leave you feeling torn and confused. Some folks struggle with internalization of oppressive ideas about sex from the media, which get in the way of what is fun, consensual, pleasurable and/or loving. It can help to unpack, alongside a therapist, the particular meanings that sex, erections, intercourse have for you depending on your life experiences and intersections of identity.
(4) Arousal + relaxation=erection!
Even if anxiety didn’t cause your ED, it is almost always a sustaining factor that perpetuates it. Without some level of ease in your body and mind, your erection won’t stand a chance (except for those rare folks for whom stress and anxiety amplifies arousal and desire!). As sex therapist Joe Kort says: “erections are a relaxation phenomenon, not one of excitement requiring orgasm. They are the result of relaxed arousal, not mandatory equipment a guy has to ‘present’ for sex to happen.” For many with ED, the anxiety around it and the story of being a “failure” causes a performance anxiety that makes ED worse. As one article said: “the fear of failure itself makes failure more likely.” The good news is: there are numerous practical tools for soothing anxiety and getting more in touch with our bodies. Like mindfulness meditation, breathing techniques, and this sensate focus exercise (hyperlink to diff. parts of your website here; where you have guided meditation, the sensate exercise, etc.). When these self-care techniques don’t loosen anxiety’s hold, a therapist may be able to assist you in figuring out what can, and address what deeper matters may be getting in the way.
This blog by no means covers all the potential causes or avenues through which one can treat ED or learn to work with it. Think of this as a small slice, a preview. We hope these tools and perspectives show you just a few of the many inroads that can take you in a new direction, and help you reclaim your body, mind, confidence and sex life.
Coping with Erectile Dysfunction by Michael Metz & Barry McCarthy
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139:161–8.
Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84:50–56