Q. Sometimes my boyfriend and I have great sex — but occasionally he struggles to get enough of an erection for penetrative sex.
I find it difficult because it affects my confidence, and of course his. What could the reason be?
A. The cause could be psychological, or it could be an indication of an underlying health problem. Either way, your boyfriend needs to see a doctor.
In men, erectile difficulties are associated with a host of serious conditions, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease and other neurologic and endocrine disorders.
Before you get too anxious, however, I should add that the bulk of research into erectile dysfunction (ED) has been carried out on men over 50 and these conditions also tend to be more common in older men, so there is uncertainty about what is cause and what is effect.
Because erectile function declines with age, when younger men go to a GP with erectile difficulties there is a tendency to presume that the problem is psychological.
However, younger men with ED should always be screened for underlying health problems — a recent study confirmed that in men under 40 ED may be the first clinical sign of the thickening and hardening of the walls of the arteries, which is a precursor to heart disease.
One of the most important clues about the nature of a man’s ED is whether or not he can achieve a rigid erection during manual masturbation.
If your boyfriend can sustain a firm erection during solo sex but he fails when you try to have sex with each other, his problem may relate to stress, anxiety or depression.
If, however, he can’t sustain a firm erection during masturbation and he doesn’t experience nocturnal penile tumescence, the problem is more likely to be related to a health condition.
Psychological ED can often be traced to difficult life events, such as job loss, bereavement, or relationship problems, but it can also be triggered by stressful sexual events.
All men, no matter what their age, experience the occasional uncooperative erection. Hangovers, for example, make it more difficult to get an erection and because hangovers also increase anxiety, they can set up a nasty feedback loop where a failed erection causes performance anxiety, which, in turn, inhibits erection.
Whatever the cause of your boyfriend’s problem, the one thing you need to know is that it is not a reflection of how attracted he is to you.
Try not to take it personally and do your best to encourage him to get a diagnosis as soon as possible. It is very difficult for young men to process the implications of ED, so your support will be hugely important.
Although this might seem like an insurmountable hurdle now, couples who have to deal with sexual difficulties often find that being forced to talk openly to each other about sex establishes much more open and honest lines of communication, and this improves their overall satisfaction within the relationship.
The good news is that there is an ever-increasing range of treatments available to treat ED, so with the right medical or psychological help, he should be able to resolve the problem.
In the meantime, focus on sustaining intimacy in any way you can.