Umm, that wasn't supposed to happen... So, what next?
Words by Gareth May
The first time it happened, I blamed ‘the drink’. It was late, we’d shared a bottle of rum, it was inevitable. The second time, I was distracted before an exam and my head was elsewhere. The third, tiredness. By the fourth, fifth and sixth times, I had become exhausted, feeling myself getting aroused only to have the flicker of hope snuffed out as my erection subsided and the condom rolled off again. I was 23 years old and not being hard felt like a failure.
I may be older now, and bolstered by the reassurance that my erectile dysfunction (ED) turned out to be a short-lived blip, but the problem is far from unusual for twentysomethings. For older men, the condition is typically related to atherosclerosis (clogged arteries), diabetes or high blood pressure. But up to a quarter of new ED patients are now under 40, and a scroll through online health forums shows an increasing number of young men are seeking therapy for erectile dysfunction. Unless the cause is physiological nerve damage or deep psychological issues, the condition is usually temporary in younger men, but that doesn’t make it any less unnerving.
Urologists and therapists have their theories as to why erectile dysfunction is more prevalent today. Sex therapist Dr Morgan Francis cites an increase in pornography viewing – watching porn three to five times a week can result in a loss of appetite for real-life sexual interaction because the brain’s dopamine reserves are consistently diminished from overstimulation.
A study by the Naval Medical Center in San Diego on the impact of porn on sexual desire found that of the 300 men and women who took part, porn didn’t affect the women’s sex drives at all, but it did for men, with three per cent claiming they would rather watch porn than have sex. Urologist Dr Joseph Alukal from New York University suggests this is due to the unrealistic expectations that porn represents.
What causes erectile dysfunction?
For some men, like 32-year-old Ali, it was an unhealthy lifestyle in his twenties that triggered erectile dysfunction. ‘I was hitting the beers hard every weekend and doing the occasional line of coke. I’d go to bed, get horny, reach down, only to realise my penis had shrunk. This went on for months – years even – on and off. I hardly ever wanked. Then I had a heart scare, gave up the partying and went back to normal.’
The UK has the highest rate of cocaine use among young adults in Europe and this, along with heavy drinking, can cause blood vessels to narrow, preventing enough blood from getting to the penis. Similarly, cannabis smokers should be wary of ‘weed dick’. According to Dr Justin Lehmiller, assistant professor of social psychology at Ball State University in Indiana, daily smokers are three times more likely to suffer from erectile dysfunction compared to non-smokers. Junk food is another culprit, as it increases your blood pressure and cholesterol, which restricts circulation and hardens arteries (not your penis).
It’s not just regular drug dabblers who are at risk, either – a study in medical journal Acta Neurologica Scandinavica found that long-distance cycling can damage the neurological nerve systems required for penile stimulation. ‘Men would have to be off-roading regularly on a bike with a particularly hard saddle to be at risk of perineal or nerve damage – it’s pretty rare – but any trauma to the penis can cause temporary ED,’ says Dr Christopher Parry, practitioner at The Wellman Clinic in London. ‘Even painful sex can give men psychological concerns about getting an erection, which can trigger ED. When I assess a patient, I first want to rule out cardiovascular issues – especially if there’s a family history – but if the basic mechanisms are intact, the issue is usually psychological. I’d recommend Viagra or similar drugs, which increase blood flow to the penis when it’s stimulated, or alprostadil injections into the penis shaft that cause an erection lasting two to three hours.’
Sex therapist Joanna Benfield believes ‘millennial ED’ is almost always the result of psychological rather than physiological issues, particularly if men have no problems getting an erection while masturbating, but are unable to achieve one with a partner. ‘We think about the penis as being disconnected from everything else that’s going on in a man’s life,’ she says. ‘In fact, it’s extremely sensitive to stress. If a man is facing work difficulties or financial worries, it’s likely to affect sexual performance.’ Anxiety dulls the nervous system, which is required to spark arousal, and the hormones released when you are stressed, cortisol and adrenaline, can also constrict the blood vessels.
Treatments for erectile dysfunction
This was the case with Mark, 29, who suffered from ED for six months after being made redundant. ‘I just clammed up in the bedroom, which left me feeling emasculated and angry that it was happening to me at such a young age,’ he says. ‘Not being able to “provide” in more ways than one left me overthinking the problem, which of course exacerbated it.’ In Mark’s case, his erectile dysfunction was temporary and things picked up after he found a new job.
For the partner of an ED sufferer, it can be a huge dent to your confidence, especially as we often take on the responsibility for our partner’s arousal. Benfield says it’s important you don’t interpret erectile dysfunction as a personal slight, as this can lead to you pulling away from each other out of fear of rejection. When treating couples, Benfield focuses on the issues behind erectile dysfunction by asking patients to avoid penetrative sex for a few weeks and reconnecting through non-intimate touch, such as sharing a bath. ‘The problem with ED is that it can overshadow any form of intimacy,’ says Benfield. ‘Removing the necessity of an erection allows the couple to rediscover a sensual bond and rebuild their relationships and sex lives from there.’
A female perspective: ‘I felt I couldn’t satisfy him’
Kate’s partner Pete* experienced ED six months into their relationship after a death in his family. Here, Kate explains how they got their sex life back on track
‘Because we’re told as teenagers that sexual attraction equates to how hard a man is, I couldn’t get my head around the fact that Pete was still sexually attracted to me, even though he didn’t have an erection to prove it. I felt that I couldn’t satisfy him. It took a lot of openness before we accepted it was nobody’s fault. Pete would still get turned on, particularly every time I bent over to pick something up, but that arousal just didn’t manifest itself as an erection. He eventually had counselling to work through his emotional issues and treat the ED. Gradually, over a period of weeks, we focused on cuddling and massage, before moving towards penetrative sex when his erections began to reappear. We don’t have any problems any more, but even if we did, we’ve learned that it’s a passing phase. We now have the coping skills – such as ad-hoc therapy and refocusing on non-penetrative sex – and crucially, we talk more openly than ever before, in and out of the bedroom.’
*Names have been changed