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
Relationship Survival Tips: How to get through quarantine with your partner
We normally lead very busy lives, only sharing home space for a limited amount of time after work or on the weekend admist chores. Prolonged periods of time at home together can bring up emotions and resentments that have been piling up over time. Add to this the extra effort involved in entertaining the children, working from home, and maintaining sanity amidst uncertainty and global chaos, and we see why divorce rates are predicted to rise after the pandemic. With the COVID-19 crisis, couples and families are being asked to work and live in close quarters, with little personal space and high stress levels. Being aware of how this can have a negative impact on your relationship and putting protective measures in place can help your relationship weather the inevitable ups and downs in the upcoming months. Here are some pro tips of how to engage in relational self-care during quarantine/self isolation:
Steer clear of the four horsemen on the (relationship) apocalypse:
Contempt, criticism, defensiveness, stonewalling – in their research, the Gottman’s identified that these communication patterns were the ones that predicted which relationships would not last. In times of stress we are not usually our best selves, nor the best communicators. But for the sake of the relationship – watch your words and actions. Try to highlight (to yourself and them) your partners positive traits. Make an extra effort to notice good deeds and say thank you. These small acts of kindness will likely be the ones that maintain your relationship.
Be Curious (not furious) and Compassionate
From research, we know that couples that are similarly activated (show similar levels of stress hormones) are more likely to be in distress, fight, and experience rising tension in the household. Likely this occurs because we have a tendency to feed off of each others stress. We see a loved one stressed out and we, often unconsciously, put ourselves in their shoes and feel what they are feeling – leaving us both trapped in the negative emotions. Or, we see our loved one stressed and it triggers memories of a time in which they behaved in a hurtful way in a time of stress, which leaves us on the defensive. Luckily, we can disrupt this pattern by recognizing that our partner is suffering and approaching with warmth. Practice compassion by getting curious about your partners state. Remember, as humans we co-regulate, if you can get into a calm space before interacting with your activated partner, your partners nervous system will respond in kind. For help with this try out the Giving and Receiving Compassion mediation. Also, this Compassion with Equanimity saying from Christopher Germer and Kristen Neff is a good one to keep on hand to repeat to yourself in challenging moments:
Everyone is on his or her own life journey.
I am not the cause of this person’s suffering,
nor is it entirely within my power to make it go away,
even though I wish I could
There are times when this relationship is difficult to bear,
yet I may still try to help if I can.
Know each others stress symptoms:
Everyone reacts to stress differently. It is helpful to know what our own and our partners signs of stress are (i.e. withdrawing, ruminating, compulsive behaviour, irritability, irrational thoughts) so that we can identify when our partner is “in that place” and not take it personally. Sit down and have a chat with your partner about what signs you want to both look out for to know that the other has gone beyond their threshold, and also a self-care plan for how best to regulate that stress. Check out our other blog post for tips on this.
Create a routine:
Structure can be a soothing balm for stress and anxiety. It gives us a sense of control and predictability, which are even more important in uncertain times. This does not need to be a strict schedule, nor does it have to be militantly adhered to (in fact, during this time the more easy we are on ourselves in general, the better). Rather, sit down and try to work out when would work best for you to work, gather for meals, play, take space, etc. This is likely to lower the overall stress levels in the household.
Create space and take space:
If you can, designate separate rooms or areas of the house for each of you to be able to go to when you need personal space. If you don’t have a lot of space you can even designate a spot in a room (i.e. if I am sitting in this chair, it means I am taking space and am not available to interact). Also, make sure to carve out time in the day where you spend time in your personal space.
Schedule in time to connect :
Depending on how you react to stress, connection may be the first or last thing you want. However, we know that relationships are better able to weather life storms when there is intentional time put aside to be present with one another. Schedule in a date night, maybe you put the kids to bed early and watch a movie together, play cards, cook a meal, take a bath, etc. Know that it may take a few minutes to ease into a more relaxed state together so be patient.
This may be the most important relational stress reduction tip. Take 15-30 minutes before bed every few nights to take turns listening and talking. We know that being seen and heard is a basic human need (in fact, part of what makes therapy so effective), and during times of stress we can feel disconnected and misinterpret one another. So take time to speak about your thoughts and feeling – one partner speaking for 5 – 15 minutes and the other just listening and not responding (other than maybe to make soothing vocalization – umm hmm, ahh; or to encourage the speaker – “tell me more” “ go on.”). This is not a conversation, nor it is a time to air grievances. it is just a holding of space for one another in order to help maintain trust and connection. Click here for tips on compassionate listening.
Mindful touching :
Mindful touching is also a good exercise. This is different from sex in that the goal is not penetration or orgasm, but rather to experience giving and receiving touch. Such activities enhance closeness and communication, and help stimulate hormones that regulate our stress response. Click here for more instructions on this.
Laughter and humor are connecting and stimulate positive emotions. Instead of getting tense, lean into the ways that you normally make each other laugh.
Schedule time to argue:
Knowing that you have time set aside to air out grievances can often keep your day to day interaction lighter. It also has the added benefit that by the time you get to speak about the things that are bothering you, some of them may not bother you all that much anymore.
Just do it, its good for your health, it’s good for your relationship. You will fight less, or the fights will have less of an impact, if physical intimacy stays consistent. For an extra boost, try some of the guided sex sessions from the Dipsea app.
Go easy on yourself. You are not perfect, neither is your partner. You will get stressed out, you will act out from time to time, you will fight. Just do your best to take care of yourselves and each other!
Safe Sex and COVID-19
During this time people everywhere are asked to reduce their physical contact with one another and to keep their distance.
But what about sex? We know from current research that sex is one of the two most important health behaviours (i.e. behaviours that improve our mental and physical health; the other one being sleep). Sex has been shown to improve immune function, lower stress levels, regulate mood, and improve cardiovascular functioning. So now more than ever sex something that is worth engaging in. But how do we do it safely? Here are some tips on enjoying sex and avoiding the spread of COVID-19:
1. Know how COVID spreads
2. Have sex with people close to you.
3. Take care during sex.
4. Skip sex if you or your partner is not feeling well.
STAY SAFE AND HAVE FUN.