Ask Sex Coach Leigh: Erectile dysfunction

Q: I’m a 41 year old male having issues with erectile dysfunction. I’m dating a very attractive 23 year old woman. I’ve taken Viagra in past encounters, but it’s not working with her. There is plenty of kissing, touching, and oral sex. She turns me on and I want to take that next step, but I have yet to get an erection with her. When I masturbate, I’m always thinking about her. I don’t use Viagra to masturbate, though I did try using it again with her the other day and still didn’t get an erection. Any suggestions?

Hi lovely! Erectile issues can be frustrating and confusing, especially when they feel unpredictable. But I want to validate something for you: difficulty getting or maintaining an erection does NOT mean that you’re not attracted to your partner, or that you are not enjoying your sexual interactions. Erectile dysfunction, or ED, is common, and there are a number of things that can contribute to it. So let’s look at the different possibilities, and what can be done about them.

You say you don’t use Viagra to masturbate, which I take to mean that you don’t have difficulties getting solo erections. But if that’s not entirely the case – if you also find yourself having trouble getting it up when you’re alone, or your erections are not as strong as they used to be, or your sex drive seems to have decreased – get thee to a physician. Low testosterone can be a difficult thing to determine, but it can be one (treatable!) explanation for ED. And, as with most things in life, it becomes more likely as we age. (Cue the sad trombone.) Another possibility that could require a trip to the doc is a change in medication. Antidepressants, blood pressure meds, antihistamines, and other prescriptions can all be ED culprits. The good news is that there are many alternatives (including natural remedies), so if one medication causes sexual side effects, something similar might not.

Erectile dysfunction is not always a medical concern, though. Here’s where I get all Mama Bear on you: Are you getting enough sleep? Are you drinking enough water? What does your diet look like? Do you exercise? How do you manage stress? How do you feel about your job? How much alcohol do you drink? How do you feel about your body? I know how hard it can be to cultivate self-care, especially if it is not a practice you have prioritized in the past. But if you are out of balance in one or more of these areas, your body will try different ways to get your attention, including lowered immunity, fatigue, and erectile issues. Changing habits can be daunting, but I would suggest starting small: adding an hour of sleep or an extra glass of water to your daily routine can be surprisingly effective. So can introducing something that encourages mindfulness, whether it’s meditation, yoga, hiking, or journaling. Strengthening your mind/body connection in an intentional way can not only help with erections, but it can improve the overall enjoyment of sex for you and your partner.

Speaking of your girlfriend: I wonder if her age has anything to do with it? You didn’t share much information about your relationship, but you did reveal an almost 20 year age gap. Maybe that’s totally irrelevant, or you regularly date younger women – both of those things are super okay. But it did get me thinking that you could have some insecurity. Most men I work with have experienced some type of performance anxiety, whether it results in ED or an inability to “get out of their heads” in sexual situations. I think this comes from the narrative, especially for hetero couples, that men are supposed to be the ones who get things started and finish things up. If you are coming from of place of sole responsibility: for your erection, for your orgasm, for your skills, for her orgasm, for not taking too long or coming too fast – that can make it incredibly difficult to feel relaxed enough for your body to respond accordingly. And if you have internalized messages about younger women and older men, that just adds to the expectations you are putting on yourself. It’s possible that what you really need to do is take a step back, remind yourself that this woman has chosen YOU, and reframe what sex is “supposed” to look like.

Lovely, I feel your frustration, and I hope you can get to a place where you’re having the erections you want to be having. But I want to leave you with this: you said that there is plenty of kissing and touching and oral. Keep that going! There are as many ways to have sex as there are couples. If you can imagine a sexual experience that doesn’t have a static beginning and ending, if you can slow down and focus on pleasurable sensations without the expectation of erections or orgasms, and if you can tap into your own sense of creativity and wonder, you will find that there are so many more ways to take the next step. I wish you the best of luck!

If you have a sex or relationship question you would like me to answer (anonymously), please contact me.

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