Bach, the Piano, and Erections

Last fall, this guy (let’s call him Sanjay) came to see me with erection problems. He was referred by his urologist, who said he was physically fine. Sanjay had spent a lot of time online, researching supplements, diet changes, kegels, etc.. “I don’t know much about sex therapy,” he said. “Please tell me specific things to do.”

An early-30s engineer, he had met a woman (let’s call her Devi) using an app that matched Indian singles in India and in America. After three months of texting and FaceTiming, they decided they were a good fit. He would fly out to Mumbai to meet her. Barring big surprises, they planned to get engaged, and to bring her out here so they could live together and prepare to marry.

Sanjay had never had sex with anyone.

Here’s what happened:

After flying across the ocean last month to meet his new girlfriend/would-be wife, they had sex. Or tried to; each time they began to have intercourse, he lost his erection. For days, they tried and tried—she used her hand, etc. Two, three times a day for almost a week (yes, really), they tried to have intercourse. “Each time,” Sanjay said mournfully, “I failed.”

Finally, Devi told him that she really likes sex, but if they can’t “do it right,” they should just forget about sex. She sees the whole thing as his problem, and she doesn’t want to help fix it. She just wants to come here, get married, and have their life together. As they both want children, she said they could use IVF.

Sanjay returned to California and is now freaking out. Hence, the urologist and the urgent appointment with me.

The Piano

Knowing that basic story, I asked him about the rest of his life. He mentioned that he used to play the piano as a hobby, but that he hadn’t done so in years—he’d been busy, had changed jobs, felt kind of isolated, and thought his peers would think it "nerdy."

I asked what kind of music he used to play, and he quickly replied Bach. Ah, The Master. A musician myself, I figured I could work with this.

So I said, “You haven’t played in years, right? If you sat down to play today, you wouldn’t do very well, would you? And let’s say you told me the problem is that your hands are small, so you were searching for exercises to make them bigger, looking for books on playing Bach with small hands, or even contemplating surgery.” He nodded and smiled, although he didn’t know where I was going with this.

“But,” I continued, “If I then asked you a few questions, maybe I’d find out that you just don’t like playing the black keys. And you don’t like the whole sharps and flats thing. And you get bored trying to keep a steady tempo, and you don’t understand Baroque rhythms. And you don’t have a decent light on the sheet music, and instead of a proper bench, you use a kitchen chair, whose arms constrict your mobility.

“If you kept blaming your small hands, you’d never get anywhere,” I continued, “because in this example, the problem isn’t your hands—it’s your relationship to the music and to the piano.

“Sanjay,” I said, “The erection problem isn’t in your penis—it’s about your relationship to sexuality, your body, and her body.”

I let that settle with him a bit, and when he looked at me and nodded, I continued.

“Here’s how I imagine your sexual encounters with Devi went last month: you fly across the ocean, you arrive exhausted. You’ve never met in person. You’ve never had sex with anyone. According to you, she expects sex that very evening. You do it in the dark, you can't see a thing, right? You’re not sure what to do. The whole thing feels rushed and awkward, right? She expects you to be erect quickly, you do, too, and you’re wondering how to satisfy her. Meanwhile, there’s little or no talking, right?”

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He looked at the floor sadly. But he also looked up at me, wondering how I knew so much about his experience—an experience that, as I told him, is terribly common all over the world. Too many people have first sexual experiences that are rushed, or awkward, or scary, confusing, aggravating, or painful.

Like Any Good Engineer

Like any good engineer (and I’ve seen hundreds over the years here in Silicon Valley), he wanted to know what to do.

“First,” I said, “Stop thinking you have E.D.. Your penis responded in a reasonable way to very challenging circumstances. Second, stop thinking about sex as a performance you have to deliver to Devi or anyone else. Third, slow down, forget about intercourse, and discover what you enjoy about being with this woman when you’re both naked--do you like how she looks? Smells? Tastes? Touches you?”

And what about her suggestion that they couple up and just forget about sex if they can’t “do it right?”

I asked him straight out: “Do you want to spend the next half-century married without sex?” He was clear about this: “Definitely not.”

Then it was time he spoke equally clearly to Devi about this. I said, “You might want to talk about the kind of partnership you want to have with her if you’re going to be married. You might want to tell her that you want to re-set the sexual relationship, start more slowly, make it more relaxed and playful, change your expectations, and explore each other's bodies. See if she’s interested in that kind of connection with you. If not,” I said as gently as I could, “You might want to think about what kind of marriage lies ahead for you two.”

“So,” he summarized, “You don’t want to suggest treatments for better erections--no exercises, supplements, nutrients, or even kegels, or masturbating less, right?”

Yes, that was accurate.

And because he was still not used to discussing feelings and relationship issues as directly relevant to sex and erections, I returned to the metaphor of the piano.

“That's right," I said. “After you're willing to play the black keys, after you learn how to keep a steady tempo, after you understand the basic rules of Baroque rhythm, after you get a good piano light and comfortable piano bench, after you see that playing the piano is a wonderful privilege and a chance to have fun, rather than a miserable opportunity to fail, and once you don’t feel inept every time you don’t get it perfect, and once you see Bach as your partner in creating beauty, rather than your adversary who wants to shame you…then we can work on hand exercises. If," I added with a smile, "It's necessary, which it might not be at all."

"I think I understand," said Sanjay. "This is not a penis problem, this is a person problem. That's what I need you to help me with."

And that’s how Bach helped Sanjay with his sexual problems.