Dear Dr Pinhas,
I am in desperate need of help.
I recently got married and lately I have been trouble maintaining my erection. I got blood test results and I found out I had high cholesterol about 2 months ago but still the sex was good and I had hard erections, but over the last 3 weeks I get erect during foreplay but when it comes to sex, I get soft before I start to try to even penetrate. I am very very attracted to her and I don’t know what the problem is. The last few times we tried to have sex it was unsuccessful and its really hurting me because my wife and I just got married 2 months ago and that’s when we started having sex. The first 3 weeks of our marriage the sex was great. Up to before I got my test results for my high cholesterol, I was always getting erect very easily, and they were healthy firm erections. Now I feel like when i do get erect its not as firm as it was a month ago and I cant keep it hard unless I am penetrating inside of her but sometimes i cant even get it in because I go soft too fast. I feel like when I think about getting soft, I do go soft. And i cant get it out of my head no matter what I do. It may be because I am worried for my cholesterol and feel I cant get hard or maintain my erection because of that. Before the last couple times which we tried to have sex which was unsuccessful, we had sex . I had to quickly penetrate inside her without a condom , and after a minute or two, I slipped on the condom and everything was fine. But if i put the condom on after foreplay, I will go soft by the time I get to penetrate. Please please help me, we are newly weds and this is really killing me . Please Please help me. I feel like this can ruin my marriage.
Thank You
Response from Dr. Pinhas
Dear J
You have lost your confidence and you cannot explain it to yourself so it is easy to blame your erectile inhibition on your high cholesterol level. I presume other than your HDL/LDL ratio you are a healthy, vital guy. If there are any other medical concerns, let me know as soon as you can because approximately 10% of erectile difficulties are due to physiological reasons. Most erection dilemmas are in the psychological realm and I believe that your difficulties are psychological, not biological, given the information you have provided. You state that if you think about getting soft you get soft. This leads me to believe you are suffering from performance anxiety.
It work like this…. For whatever reasons, men throughout the life cycle can have difficulty maintaining erections for a number of reasons that are fairly normative and SITUATIONAL. Too much alcohol or drugs; stress about work or lack thereof; financial pressures given the lousy economic climate; distractions and random non-sexual thoughts that manage to intrude; situation anxiety or the “just because” syndrome. These are just a few examples of the reasons why men can’t get it up on a situational basis. None of this is worrisome unless the ED has developed a life of its own…. by that, I mean you cannot accept the lack of erection for what it is– a temporary inability to get it up with a self-accepting attitude that recognizes you are still ok and in no need to focus on worry, anxiety, fear and fret.
If however, you start to fret and order yourself about, internally demanding that a healthy, normal, recently married guy should get it up all the time, you are heading for trouble. You will create a problem for yourself. You already have. Talking to your penis is a notoriously unsuccessful intervention in getting it to rise to the occasion. Your worry about the situation is producing more worry and it is spiraling out of control. This is called performance anxiety and it is the leading cause of ED in otherwise, psychologically healthy men.
Part of your problem may be your approach to sexuality in general. If your wife was not sexually experienced before your marriage you may feel the need to stage and orchestrate a sexual encounter according to your standards of what sexual relations should look like. She may take her lead from you if she doesn’t know any better . Many traditional women are not experienced and usually do not have a voice in their sexuality but prefer their husbands to take the lead. Throughout the years, they hope that sexuality becomes something that they will eventually get to like. You might feel like most men, that it your responsibility and duty to provide your woman with a strong, powerful erection concluding this is what she needs and wants from you. She may want this but it may not be as important to her as you believe it is to you. If she loves you, she wants to best for you and her which means you do not torture yourself with this performance anxiety. Women are far less demanding about erections than you might believe. I guess it goes like this. You are suppose to start the sex by thinking that sexual intercourse is the goal. You erroneously think that she shares your erection and intercourse goal with you. Most women do not. They want a non demanding, pleasurable erotic experience which many of them do not get when their husbands keep their eyes set on the end game of sexual intercourse. This is unfortunately what you are keeping your eye on– sexual intercourse and the troubling side effect of anxiety. Why should you have an erection given your feeling style? The more you think about intercourse the worse things get. If you get an erection and you are afraid of losing it, your penis heads south. This is to be expected given your self-fulfilling anxieties. Do yourself and your wife a favor.
Stop making sexual intercourse the be-all and end-all. Put your efforts on learning how to do what is called a Sensate Focus…. A series of non-demanding, non-goal oriented slowly graduated exercises which put no emphasis on sexual intercourse…. but rather on sensual and sexual experiences that are in the zen-like moment, emphasizing different types of tactile experiences that allow both you and your wife the possibility of luxuriating in sexual pleasure. If you focus on the process of pleasure rather than the end result, you will more than likely achieve greater satisfaction. If you learn to stay in the moment and take your focus off of sexual intercourse your penis will most likely cooperate and head back north.
Read my blog about Sensate Focus. You need to relax and start again without the buzz in your head which is renting too much space and crowding out your natural sexual inclinations. Start naked and do one half hour taking turns. Do not touch each other genitals while you learn to caress your wife’s body in what I call “pianissimo” touch. Concentrate on your desire to caress her . Focus on how you touch her skin, drawing her to you like metal to a magnet. Let her concentrate on how to caress you without touching your genitalia. Let her make your body her own. Communicate to her about the quality of her touch. Let her tell you about the quality of your touch on her body. In the first beginning exercises you are not to touch each others genitals… just learn to experiment in the quality of the touching…. If you get an erection, fine…. if you don’t, that’s fine as well. If she is mildly pleasured and relaxed that’s great; if she is lubricated ( although neither one of you would know because in the first steps of these sexual homework experiences, there is to be no genital touching) good for her, if not, it is of no consequence; if you both fall asleep, that’s ok too…. it shows that you are relaxed and in the moment; if you find yourself aroused, just experience it and stay with it without needing to do anything about it. This is the beginning of learning how to have a sexuality that will eventually give you your confidence back in an advanced meaningful way.
What is critical J, is you need to give up your performance expectations and stay in the sensual moment. A hard thing for guys to do but worth it if you want your penis to be your best friend. Do not fight it for control. Breath deeply and slowly. If you need more help, I think you should give some thought about seeing a psychotherapist that specializes in sexual therapy. Be well.
Dr Pinhas
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