Last week’s New York Times repeated the popular professional opinion that half of all men over 40 “will suffer from erectile dysfunction at some point.”
And indeed, every week individuals and couples come to my office talking about “ED.” Unfortunately, professionals and lay people alike use the term to describe anyone who can’t get an erection when he wants to—even just once.
This, of course, implies that penises should behave like ATMs—ready to do business 24/7, rain or shine. But that’s not how penises (or any other body part) are designed.
Like eyes, ears, and stomachs, penises need a special set of conditions in order to do what their owners (or their owners’ partners) want them to do. Those conditions can involve emotions, environmental issues, or features of another person. If one of those isn’t quite right, even the healthiest penis will stubbornly stay small and soft and quite calm.
Too many physicians prescribe erection drugs without inquiring about the situations in which a man wants to get erect. If you’re with someone you can’t stand, or you feel terribly guilty, afraid of unwanted pregnancy, or you’re in a big rush, all the Viagra in the world may not help. That’s what often leads docs to send patients my way.
So here are common situations in which people expect an erection, and typically don’t get one. These are examples of unrealistic expectations, not ED.
* You’ve been drinking
How much? As far as your penis is concerned, “a lot” might be as little as a couple of drinks. You don’t have to be drunk in order to be compromised by alcohol. You know how drinking slows down your reflexes for driving? It also slows down your erection reflex.
Many people start their sexual careers at an age when drinking seems glamorous and very adult (and it temporarily reduces anxiety). The confusing, embarrassing, or simply unenjoyable experiences that result can lead to more anxiety, and a lifetime of pairing sex and alcohol.
That can launch a lifetime of believing “I have ED.” And unfortunately, many physicians overlook this when diagnosing someone with longstanding erection issues.
* You don’t really want to have sex with this person
Sometimes it’s a long-term partner you’ve lost interest in, but you have sex in order to prevent conflict. Or to prevent them from suspecting infidelity or masturbation.
Sometimes it’s a casual partner that you’re not that attracted to—but hey, it’s sex, right? Sometimes the hookup is sloppy drunk, or high on pills. It’s hard to feel relaxed and connected with someone in such a state—and penises are frequently turned off by such an undignified (or even unethical) situation.
* The stuff they’re doing isn’t sexy to you
Long, long fingernails where you don’t want them, too much teeth, bad breath, thrusting or bouncing on your penis in a way that scares you—these can all chase away an erection. And a look, a phrase, or underwear that someone thinks is sexy but just strikes you wrong can also get in the way.
Turns out that most men—and most penises–are more sensitive than some people give them credit for. It would help, of course, if most people were better at saying “Um, a little slower would be nice,” or “Wait, that’s not my thing,” or “I usually like that, but not tonight, thanks.”
* They don’t want to have sex
Trying to talk someone into sex—or roughly pushing them into it—gets some men excited, caveman-style. Many men are simply too friendly (or too tired) to enjoy it.
And no matter how desirable they were before, once someone says “no” it’s hard for most men to stay enthusiastic if they keep pushing. And erections usually leave when dignity (or hope) does.
* You’re really tired, or just not in the mood
People of all genders have been told that a man just doesn’t have the luxury of not being in the mood when sex is available. If you’re not in the mood but proceed anyway, your penis may reveal the truth by refusing to participate.
Sometimes sex is available exactly when we’re most tired—and worse, we may fear it won’t be available when we’re rested (or once a potential partner has had a chance to think things over).
In America, many people leave sex for the last thing at night, when they can no longer do anything productive. When we treat sex so disrespectfully, it should be no surprise if our bodies don’t respond as we wish.
* You still haven’t gotten over that recent quarrel
That argument hurt, didn’t it? And even if it didn’t, it made you feel separate from your partner, right? Besides, a productive argument actually gives you something to think about afterwards. If you’re thinking about that, that’s good—but it may not leave much of your attention available for sexual interest.
An argument, or even a friendly disagreement, that has nothing to with sex can affect anyone sexually. Having sex with someone you’re angry with, or disappointed with, or feel separate from, may seem like a good idea, but your penis may have other ideas. This can be a perfect example of unrealistic expectations leading to what some anxiously consider “erectile dysfunction.” But when your penis doesn’t have the circumstances it needs to get erect, don’t blame the penis.
* * *
Why does it matter what we call a situation that can be aggravating, embarrassing, confusing, or shocking?
For one thing, calling something “ED” can raise unfortunate questions about a possible lack of desire, arousal, or affection. For another, yesterday’s lack of erection may be quite temporary; as soon as the right conditions are arranged (an hour later, a week later), an erection may be quite available, making “ED” a mistake. And finally, “ED” invites the solution of erection drugs–which may be the wrong approach to a situation.
As in so many things sexual, honesty with oneself and communication with one’s partner are frequently the first steps toward improving your sexual experience—in this case, getting more reliable and drama-free erections.
So is there such a thing as ED? Like “too skinny,” “fair fight,” “ugly car,” and “pornography,” it all depends on how you define it. Some medical conditions, such as diabetes, prostatectomy, and multiple sclerosis damage or destroy the ability to get erect. Such a condition certainly qualifies as ED.
Some psychological conditions, such as obsessive-compulsive disorder, can make it difficult for someone to get erect even under ideal circumstances. I’d call that ED as well.
But most men who occasionally don’t get erect when they want to, or who only get erect under special circumstances (e.g., they feel loved; they’re at a massage parlor; they’re with a partner of a certain race or age) aren’t suffering from ED. They have a more complicated situation—they’re struggling to integrate their sexuality with the realities of adult life. Penises shouldn’t bear the brunt of that project.
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