Making “It” Last
The Causes and Treatment for Erectile Dysfunction
There are so many different ways to feel pleasure and express a sexual connection. Unfortunately for men, however, the emphasis is usually on the erection − presumably for both his and his partner’s pleasure. Yet Ian Kerner, in his book She Comes First, explains how his erectile dysfunction led him to a better understanding of how his wife’s pleasure was not dependent on an erection: he became so good at everything else (toys, tongues, fingers) that erections were no longer integral to her pleasure.
Erectile dysfunction (ED) is a condition where one has consistent problems getting and/or maintaining an erection, thus making intercourse particularly difficult. It is much more common than many people think, affecting one in five men. The prevalence increases with age, as well as for those with a history of diabetes, obesity, smoking, hypertension, surgery and cardiovascular disease. Some medications can also trigger ED. As a health issue, however, many men feel great distress and embarrassment and, unfortunately, are sometimes shamed by others when they cannot sustain an erection.
Impact: The effects of ED are as varied as those who are affected by it. Some avoid sexual connections in order to prevent embarrassment of not performing up to their desired standard. Others focus more on their and/or their partner’s pleasure in other ways in order to avoid the necessity of an erection. But because society claims that one’s “manhood” is defined by one’s erections, the emotional toll of ED on self-esteem and relationships can be quite high.
Psychological causes: Sometimes, ED manifests for psychological reasons. Stress, depression, low self-esteem and professional frustration can all trigger erection challenges. They can also exacerbate any symptoms that stem from a physical impediment to erection. And ED – or the fear thereof- can compound itself.
Imagine a situation where someone’s erection did not happen as desired. Now picture what will go through his mind on the next occasion of sexual interaction: “What if it happens again?” Stressful thoughts and worries make it even harder for an erection and/or orgasm to happen. Our bodies function best in “rest and digest” mode during arousal. But any anticipatory anxiety (about performance, the impact on the sexual connection, what a partner might say or do) puts us into “fight or flight” response where blood flows out of the genitals. This is an evolutionary response based on the presence of perceived danger (e.g. when a bear is chasing you, it’s not the right time to have an erection). Thus, the body loses an erection (or ejaculates quickly in order to get rid of the erection).
In this way, even one or a few episodes where the erection did not respond in the desired manner (slow or no erection, short-lived, soft, rapid ejaculation) can trigger a downward spiral into ED. This is often the case when erections arise in some instances, but not in others. This discrepancy is a result of the anxiety in specific situations (such as with a partner, or at certain times of the day, or with certain activities), but not in all sexual encounters. It can happen, for example, where erections have been responsive during manual pleasure, but not during intercourse. Subsequent situations where intercourse is on the menu would trigger the anxiety and an erection would be absent. But subsequent instances of hand stimulation would generally lead to satisfying sexual performance.
What to do?
See your MD: If you experience any dramatic changes in your ability to get and maintain erections, make an appointment with your doctor. Fear not − you will not be their first patient with this challenge. You will likely do lots of tests that might reveal underlying conditions contributing to your ED. Dealing with those conditions can be beneficial to your sex life, as well as your overall health. Some people may also consider natural remedies through a homeopath, naturopath or Chinese medicine practitioner, but should not do so at the exclusion of a Western medicine approach.
Live healthy: It is no secret that alcohol and smoking affect our arousal response. Cut back on your consumption of those substances, exercise, eat well, and follow other recommendations from your MD. Your whole body will love you for it.
Be present: Notice when you get anxious in anticipation of or during sexual encounters. Breathe through the anxiety and focus on all of the pleasurable sensations. When we place all of our attention on noticing (versus analyzing or dictating) what the body is experiencing, there is less room in our minds to spiral into anxiety. Focusing on the pleasure is much more pleasant and effective in feeling the results you are seeking.
Pumps and rings: Many men use vacuum pumps and/or penis rings to help gain erections. The pump fits over the penis and air is sucked out, creating a vacuum, which is filled by blood rushing into the penis − in turn, providing an erection. A penis ring fits at the base of the penis and allows the blood to flow into the penis, but not flow out. Some men put these on before their erections to maintain them for longer, or after the pump comes off.
Hot Octopuss: The Hot Octopuss is a pleasure device for penises that offers fabulous sensations, whether there is an erection or not. And it can be used with a partner to simulate intercourse, while giving pleasure to both.
Adjust expectations: Bodies and responses naturally change as life changes. We have to adjust to not being able to see as well, dance as long, stay up as late or run as far as we always have. And so with sex, our bodies may need more intensity to feel pleasure and orgasm as we get older and, sometimes, how we have sex needs to change as a result. Take the opportunity to rediscover your body and what pleasure is like to you now. You might learn some new approaches that make it even better!