Many men find that they sometimes have difficulty getting or maintaining a satisfying erection. This may be more common as they get older, but can occur to men of any age. Sometimes it is related to normal changes associated with aging. Some of it is also due to the fact that older men tend to have more physical health problems that can negatively impact their erections—as can certain medications and treatments for other conditions.
Fortunately, despite all the angst they produce, erectile difficulties often respond quite well to medical and/or psychological treatment. The goal is not simply more reliable or firm erections, but also to help the couple once again create a mutually enjoyable sex life. Some of this will involve working with both partners to help restore the man’s erectile ability, but treatment will probably also involve helping both partners to not tie all of their sexual satisfaction to the presence and firmness of the erection. This has the potential to create a sex life that is more enjoyable than it was before the erectile difficulties began.
Just as a good erection results from a combination of physical, psychological, and relationship factors, so too are erectile difficulties potentially influenced by all of these, so we need to look at all three in order to figure out what is getting in the way.
Physical: Erectile capacity can be negatively impacted by any of the following: diabetes, hypertension, Peyronie’s disease (bent erections), endocrine problems, prostate surgery/radiotherapy, and neurological problems (Alzheimer’s, Parkinson’s). In addition, antihypertensives, antiandrogens, major tranquilizers, and SSRI antidepressants can all play a role.
Psychological: Depression, anger, anxiety, low self-esteem, sexual self-doubt, and poor body image can all interfere with erectile ability, as well as general enjoyment of sex. Of course, erectile difficulties can also cause or worsen all of these. For some men (and their partners), one random bout of erectile difficulty can cause a downward spiral of performance anxiety, where every time after they worry about their ability to get an erection which then undermines their ability to get one, which reinforces that worry, etc.
Relationship: Other relationship or sexual issues can impact a man’s ability to get an erection with his partner, as can his partner’s sexual functioning (e.g., low or ambivalent desire, pain with sex, etc.). Once erectile difficulties begin, they can obviously also impact the other partner and can elicit many feelings, thoughts, and reactions. It is easy for both partners to get over-focused on the current state of the erection which makes sex much less enjoyable for both and thereby makes erections even more elusive.
If you suspect that other medical conditions, medications or treatments are impacting your erectile abilities, then speak with your treatment providers and, if necessary, explore your options. A urologist may test your body’s ability to create an erection to determine what is going on which then helps guide treatment.
Medications such as Viagra, Cialis, and Levitra can help to create more reliable erections for many men. There are also other medical treatments and devices such as tourniquets and vacuum pumps that can be useful, if necessary. If you find that a treatment is not working as expected, then talk with your treatment providers to see if refinements can be made.
Once erectile difficulties begin, it can impact both members of the couple and how they relate to each other, both sexually and otherwise. When some couples do try to have sex, they wind up approaching it with such uncertainty that it is no longer enjoyable. If it becomes uncomfortable enough, some couples may avoid sex entirely. Therefore, a sex therapist can help you sort through this fall-out and rise above it to create a mutually satisfying sex life. This may begin by helping you and your partner to think through the various treatment options so you can make a well informed and well thought out decision, then make best use of the treatments that you do choose.
The goal of treatment, whether with a therapist or on your own, may involve a return to your previous sex life, but it may instead focus on creating a new one. Overcoming erectile difficulties often begins by avoiding the erection killing trap where the more hyperfocused you get on the erection, the more it fades away. Ironically, focusing on each other and the pleasurable sensations and letting the erection do what it will do, makes for more reliable erections.
You and your partner can facilitate this by engaging in a couple straight-forward exercises at home. They are rather simple to do but, like much else, require some practice to do well. For example, sensate focus exercises can help you both learn to focus more on the enjoyable physical sensations and let distracting thoughts go. Stop-start exercises help the man (and his partner) to see that he has more control over his erections than he feared. This helps both members of the couple to feel that they have more control over it and therefore not fear its sudden and mysterious disappearance. You can find plenty of resources on both techniques online, so look around a bit and find one that fits your style.
Improving the quality and predictability of erections is helpful, but the equally important other half of treatment involves learning ways to deal with whatever happens. Instead of hanging all of your sexual success or failure on the presence of the erection, it can be more satisfying to also learn to compensate for any limitations in your erectile capacity. After all, more options tend to lead to better outcomes.
This begins by broadening your definition of a satisfying sexual encounter so that completed intercourse isn’t required in order to call it a success. There are plenty of other fun ways to spend that naked time together and many other ways to help your partner enjoy themselves. Many of these other options don’t require an erection, so then it doesn’t matter whether or not you have one. This greater variety may also help you keep your sex life interesting over the years and decades—which may also help with your erectile abilities.
Ironically, even though these techniques make erections more likely, perhaps the most important thing to keep in mind is to enjoy yourselves and be flexible about your expectations, so that you can still have fun even if the erection makes a temporary exit. If you can do this, you will have learned an important secret of a happy sex life.