Kaylee Wolfe is a sexuality educator, advocate for survivors of sexual and relationship violence, clinic escort, and birth doula. She thinks you should get tested.

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Dear Kaylee,

I recently started seeing someone new, and while we’ve been having a lot of fun together, there are some issues in the sex department. The biggest thing is that he seems to have a difficult time getting and staying hard. Sometimes he can’t get it up at all, and even when he can he loses it as soon as we try to put on a condom. He always apologizes and is very generous with oral, but I can’t help but feel a little insecure. I don’t want to embarrass him by bringing it up, but it’s definitely putting a strain on our new relationship. Is there something that he or I could be doing to make things better?

Thanks,

Anonymous

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Dear Anonymous,

I don’t know if this is comforting to hear, but you and your partner are not alone. Despite the fact that many people are understandably embarrassed to talk about it, erectile issues are much more common in the US than most probably realize. It is estimated that more than 18 percent of men age 20 and over experience some level of erectile dysfunction, which works out to around 18 million people. Still, there’s a lot of mystery around it.

To understand the problem (and some potential solutions), let’s pull back the curtain with a quick lesson on boner anatomy.

Getting and maintaining an erection is all about blood flow — the body has to be able to get enough blood to the penis to engorge the spongy erectile tissue inside of it, and then that blood needs to stay put until further notice. Arousal starts in the brain, which sends signals to the arteries that carry blood to the penis and the veins that carry it away. When the brain decides it’s boner time, the arteries relax and open wide to allow blood to flow freely into the penis and the veins constrict to keep it there.

There are many, many factors that can affect a person’s ability to have and hold onto an erection. Some are situational and may only cause temporary issues, the most common culprit being alcohol use in the lead-up to getting freaky — whiskey dick is not a myth. Anxiety is another biggie. When we feel stressed, our body releases cortisol, a hormone that causes blood vessels to constrict. That resulting decrease in blood flow can make erections a no-go.

Other factors that can affect erectile function are more long-term. Because blood flow is so critical to making a hard-on happen, conditions that negatively impact general cardiovascular health such as high blood pressure and heart disease are also likely to have an impact on a person’s sex life. Folks with diabetes also experience an elevated risk of erectile issues. And on top of being no good for your lungs, the nicotine in cigarettes can hamper blood flow in the short-term and damage blood vessels in the long-term, including the veins and arteries that make erections happen.

Talking about erectile issues can certainly be awkward, and I understand your anxiety about embarrassing your partner or hurting his feelings. But if it’s negatively impacting your sex life and he won’t bring it up, then unfortunately it’s on you to start the conversation.

I would start by asking if this is something he’s been dealing with for a while, or if it’s a newer issue. If it’s new, then what’s different? Have his drinking habits changed? If so, you can try experimenting with drinking less or not at all before sex. Does he smoke? Then cutting back or quitting may help. Is he feeling nervous about sex, or are there other stressors in his life that are keeping him from being able to focus in the bedroom? If yes, you can work together to address his anxieties to help him feel more comfortable and relaxed.

Sometimes, having trouble getting hard becomes its own anxiety feedback loop. It happens once, which causes anxiety that it will happen again, which increases cortisol in the blood, which impedes future erections, and on and on. Talking about it and being willing to work on it together may help ease some of those feelings, enabling your partner to get out of his head and back into his body and the present moment with you.

Additionally, some people who want longer or stronger erections find that using cock rings can help. Cock rings are flexible bands that help constrict the veins of the penis from outside the body, supporting an erection by helping to keep blood from flowing away. Some just slip over the head of the penis to rest snugly (but not too tightly) at the base of the penis, while others go over the penis and under the scrotum, too (hot tip: use lube to help get cock rings into place). You can find them in local sex toy stores or online.

If this is an issue that’s been long-term or recurring for him and the suggestions above aren’t helpful, then I would recommend gently encouraging him to explore that with a healthcare provider. Because erectile function is so intimately tied to overall cardiovascular health, issues getting and staying hard can be indicative of other conditions that need addressing, too. If appropriate, a healthcare provider can also talk to your partner about pharmaceutical methods of supporting his ability to get hard, like Viagra or Cialis.

Thanks for writing in, and best of luck with finding a solution that works for you and your partner!

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