This is my life: I go to have brunch with some folks and end up in a conversation about dealing with a partner’s erectile dysfunction…. And then I wrote a blog post about it.
What do you do when your partner routinely loses his erection?
Well, the first thing to remember is that sexual responsiveness is a combination of hitting the gas (i.e., giving good stimulation through all sensory modalities, including emotion and imagination) and taking your foot (or whatever) off the brakes (i.e., removing threats of all kinds), right? Right. So almost always erectile dysfunction is NOT about a failure of stimulation but about an overabundance of threats, often in the form of stress, anxiety, depression, or, in this case, a recent history of trauma.
Therefore the solution to ED, assuming it’s psychogenic and not straight-up physiological, is NOT about changing the stimulation. There is no extra-special blowjob trick you can use to get an erection back – at least not in the straightforward sense. It’s not about you as a source of stimulation.
Instead, confronting ED is about removing threats of all kinds. Now, in this dude’s case, it was most likely a temporary condition brought on by recent acute stress related to his lifestyle. So the simple passage of time, accompanied by lots of unconditional positive regard, would set things to rights fairly soon.
This combination of realities – that it’s not about stimulation and it IS about threats – tells us that the WORST thing you can do is to take it personally or judge or blame or worry or sweat it in any way at all. If it’s problematic from your point of view, it becomes a source of anxiety, which is the OPPOSITE of arousal. I know you might feel like a failure or you might be inclined to take it personally. Don’t. Your attitude should be one of bright, optimistic curiosity about the things you can do sans erection.
Penises are like puppies. They respond poorly to commands. They don’t understand. And the more aggressive you get with your commands, the more they’ll just cower and duck and wait for you to calm down. But boy are they glad to see you, as long as nothing in telling them NOT to be glad to see you.
So: imagine you were in the middle of intercourse or fellatio, and things went south. Here is the puppy penis before you, flaccid, attached to a boy who now feels like a failure, ashamed, guilty, self-recriminating. What does the puppy need most?
A balanced combination of affection and being ignored. Stop paying attention to the penis. He goes down on you or uses a vibrator or his hands on you, you masturbate while he watches, you flip him onto his belly and ravish his well-lubricated anus. The possibilities are many and varied.
Alternatively, you can adopt this opportunity to do all the pleasurable things you can do only when a penis is soft. You can put the WHOLE THING in your mouth, draw it out with a long, solid suck, and let it flop down with a pop. You can bury your face in the soft warmth of scrotum and penis. You can tug gently upward with your hands, squeezing surprisingly firmly on the soft shaft. You can rub your genitals against his, noticing and reveling in the unique sensation provided by flaccidity. Soft penises are fun! If your partner starts to get an erection, scold him lightly but firmly: “No, honey! No erection right now!” If he refuses to comply, punish him accordingly.
Either way, keep it really sexy.
In conclusion, erections come and go. People tend to put a lot of cultural weight on them, as if all of masculinity hangs on the flow of blood into and out of the phallus. But that’s all just cultural noise and has nothing to do with you and your lustbunny in bed together. Leave that behind and enjoy the body and the personhood there with you. Relax about erections. If one goes away, another will come along soon enough, I promise. The more you worry about it, the longer you’ll have to wait.
The brunch, by the way, involved some truly excellent banana bread, of which I had three slices with butter. Yum.
Emily–you’re so sex-positive that it makes me 1) smile every time and 2) wonder why you haven’t attracted any trolls or scolds (except when you take on an Establishment scientist). Three cheers for a still-safe space to talk about these things with gusto. Thank you for maintaining this blog.
Speaking of erectile dysfunction: http://www.boingboing.net/2010/12/18/19th-century-erectil.html
This is a really great description of how to respond to garden-variety occasional ED – the sort that I remember from my twenties and thirties. But things change as our partners grow older. It’s much harder (pardon the bad pun) when ED has an organic cause. For instance, my partner had a radical prostatectomy three years ago. He was only 49, far too young to give up on sex. And yet that’s very nearly what he did. Physical problems get tangled up with psychological expectations of “failure.” It’s a toxic mix that often discourages the man from even trying to have sex, no matter how patient their partner and how willing she (or he) is to play in ways that don’t require an erection. (ED drugs are not a magic bullet, either, despite the way they’re marketed.)
I’d love to read a follow-up post on these more complex forms of ED. In our culture they tend to be relegated to the sidelines as “old men’s problems,” as if older men don’t matter! And as if 45 or 50 is already “old”!
I fear this will sound quibbling, but I must say it:
Psychogenic ED *is* the more complex form of ED, compared to physiological ED. If erections are problematic because testosterone has been reduced, increase testosterone with meds.Simple. Viagra and the other drugs aren’t perfect, but they’re head and shoulders above anything a sex therapist might provide, in terms of just improving erections. If drugs don’t give the erections you’re looking for, then apply all the stuff in this post, which is as true for aging penises as it is for young ones.(BTdubs, “Aging” in erections begins between 25-30.) All the psychology of failure stuff is virtually identical.
And if spending less time on intercourse and more time, instead, on manual, oral, and non-penetration forms of stimulation feels like “giving up on sex,” that’s MUCH more of a problem than troublesome erections.
What you want is not a post about physiological ED but rather a post on how the person with ED can himself deal with his cultural/psychological burden around erections. And the advice is the same for 20 year olds as it is for 80 year olds: your penis isn’t your personhood, your erection isn’t a measure of your manhood, and lots and lots of sexual pleasure for your partner happens regardless of how hard you are.
<3
A great post, and lessons that I had to learn… err… the hard way. In my case, I had several physiological causes of ED from my mid-30s, and that resulted in psychological-emotional causes.
I was developing coronary artery disease, and had very thick blood, so blood flow to my penis was significantly reduced, and I developed a bad case of ED before people were talking about it (i.e. before Viagra). I only discovered this AFTER an early-age heart attack. But the psycho-emo damage had been done: my wife had made me feel so bad about “not being a real man,” that I couldn’t get hard for her, even after we more or less reconciled emotionally (post-heart attack, when she was confronted with the reality of me almost dying and decided she actually wanted me to live).
When I dealt with my cholesterol issues, I also discovered that I had low (i.e., none, nada, zip, zilch – there are tests for this) testosterone being produced. Replacement therapy literally made a new man out of me, but I still couldn’t get it up for my wife because of the psych damage – the emergency brake was stuck in the stop position. Some years after we split, I found a partner whose attitude is that a soft penis means potential combined with fun, and with her I learned the hundred-and-five ways to enjoy each other that don’t necessarily involve insert tab A into slot B, and that getting there is most of the fun.
We’re now in our late 50s, and we’re enjoying a full sex life more than when either of us were in our 20s and 30s. Taking care of the physiological problems, and having a healthy emotional relationship with a wonderful partner means lots of gas in the tank, and few stop signs.
No, I don’t think you’re quibbling – you’re pushing toward precision – and that’s a *good* thing.
I noted that men with organic issues also virtually always have psychological issues, too. So there complexity is already there with any ED. What a serious medical condition adds is the fear that they will never regain erectile function. I think that this infinite time horizon is a key distinction between men with physical problems and those without: the second group usually has more hope of recovery unless they’ve never enjoyed unproblematic penetrative sex. In both cases, though, the psychological issues are the thorniest to address, and I’m sorry if that didn’t come through; my point was simply to say that the presence of physical damage makes it hard to hope for rapid improvement, or indeed any improvement, just be taking the pressure off and reassuring one’s partner that fun can be had in many other ways.
But even the physical aspects are much more complex that just adding a drug and hoping for the best. For instance, low testosterone is a fraught issue in the world of prostate cancer. Lots of post-treatment patients are indeed low on T, whether due to aging, some side-effect of the surgery, or (as one M.D. has suggested) some greater susceptibility to prostate cancer among men with low T. Adding to the confusion, a standard treatment for advanced prostate cancer is to use drugs to depress T to “near-castrate” levels (nice term, huh?). Survivors who are at very low risk of occurrence are nonetheless told to stay off T supplements, even if their levels are drastically low. The theory is that testosterone could fuel the resurgence of any microscopic rogue cells that escaped the scalpel. I’ve never seen the logic of this, since following this reasoning to its logical conclusion would imply that all low-risk survivors should be treated to depress their T levels. That just isn’t done.
In my experience, I watched my partner agonize over whether to treat his very substantially low T. His risk profile was pretty good regarding the cancer. He weighed factors like his long-term depressed mood (which in hindsight was at least partly a result of low T), his difficulty building muscle during exercise, his risk of CVD problems – and also his nonexistent libido. Adding T has definitely helped his mood and libido. Very few men achieve erections just by taking T. However, as their libido resurges, they may be motivated to take some risks to reclaim a sex life – be it trying Viagra or a vacuum pump, opting for an implant (remember, some of these men have serious nerve damage, and Viagra cannot help them), trying the shots – or the most radical step of all, experimenting to find paths to joy and satisfaction that don’t rely on an always ready, rock-hard cock.
I’m going a little beyond my personal experiences here and drawing on discussions in online support groups for PCa survivors. My observations aren’t rigorously scientific, as I listened in as a wife, not as a researcher. But they’re also better than mere anecdata.
I wanted to float the idea of another post addressing this other ED constituency (which itself cleaves into different groups – guys with PCa, those with diabetes, men who are simply aging, etc.) not because I personally feel a burning need for more guidance. Of course I’m always open to new ideas and approaches, but my partner and I enjoy a pretty good life now, after a few years of angst and struggle.
I just see a terrible need for more education about what to expect prior to PCa treatment. Patients rarely get this from their caretakers. Doctors systematically inflate their success rates, with some counting a single post-treatment instance of vaginal penetration with Viagra as evidence of perfect potency. (Such BS!!) Patients and partners alike are shocked at how pre-op sex counseling they receive (typically zero) and are not properly educated on post-op rehabilitation, which starts too late and relies on Viagra whether or not it produces an erection. (The point is to get oxygen to the tissues to prevent atrophy. No erection, no health benefit.) Patients lucky enough to be insured routinely lack coverage of Viagra (and its cousins) sufficient for “penile rehab” post surgery. They – and especially their uninsured brethren – buy Viagra from India.
The trickiest part of post-prostatectomy sexuality is that most men really do feel robbed of a great joy and of a central element of their manhood/masculinity. I enjoy PIV more than most women, but I set that aside for a good long time, hoping to explore other paths to pleasure and connection. I told him so. He could not get the memo. In that, he’s typical of most men. He’s more than capable of high-level thinking – he’s trained in continental philosophy and critical theory. He’s logged years of therapy and is quite self-reflective. However much Lacan and Irigaray you’ve read … ideas hardly stand a chance against years of embodied experience that has privileged phallic sexuality. And he’s not alone. Decentering the phallus in sex is well-nigh impossible for most men. (Again, I’m thinking of many conversations in the online support group.)
And erections aren’t just important to sex. Besides the oxygenation I mentioned above (without which tissue literally dies), men grow up with erections as a basic bodily experience. When they cease, it’s like a part of them has died. Even if they’ve got no potential partner, they experience ED as alienating and as a loss of self.
I’m sorry to go on at such length. I’m frustrated at the dearth of frank info available to PCa patients. I did my usual online research prior to his surgery. So did he. We were blindsided by the prevalence and severity of post-op ED. We felt fooled and lied-to. I could go off on a tangent about other forms of emotional fallout, but I think I’ve ranted long enough!
I would publish a more polished version of this comment on my own blog, but my pseudonymity is quite thin, and I’m ethically committed to not exposing my partner’s issues to the entire Internets. Thanks for letting me speak out here.
Lovely and thoughtful response, and I agree with you 100% from my own experiences. However, if you wanted pseudonymity, it probably would have been a good idea NOT to link to your own blog. :
Let me add that, when balanced against my total life, getting erections “normally” is probably way down the list of benefits of testosterone replacement therapy. Anti-depression, cognitive acuity, general physical stamina, improved muscle tone and fitness, alertness and ability to concentrate, lack of fatigue, and probably some other benefits as well were all unexpected, but certainly welcome!
Marconi, I’m not terribly worried about blowing my partner’s privacy by posting this here – it’s unlikely that anyone who knows me or him in real life will read it.
It’s wonderful that testosterone supplementation has helped you so much. It’s *really* not just about sex! I wish you continued good health.
Wonderful blog Emily, Would it be possible to put it in every newspaper, Cosmo, women’s health type magazine? Have you been asked on Oprah? As one who has had flaccid penis syndrome (as a nice girl once jokingly put it) from time to time, your blog was outstanding. It’s almost always related to stress of some type. Often, it was wanting so much to be a good lover that I psyched myself out. I loved your suggestions of what to do if it happens. Women who took the time to enjoy my soft penis gave me the time to relax and enjoy (yes, it still feels good when it’s soft) which generally brought about the absent errection and smiles on both our faces.