Welcome to Ask a Cleveland Sex Therapist. Want to ask Matt a question that could be tackled in a future column? Click here. Now, onto this week’s topic.
Hey Matt,
I can’t seem to get hard when I want to have sex with my girlfriend. Now she thinks I don’t find her attractive. I have an appointment scheduled with a urologist to talk about options. Any advice would be appreciated.
- Ben
Hey there, Ben. First, let me say that I am sorry you are dealing with this. As someone who has a penis myself, it can feel really frustrating when the one thing we are taught is critical to heterosexual partnered sex just stops working. But before we go any further, I want to challenge the language we often use around this topic. The medical term is erectile dysfunction, but I have never been a huge fan of that phrase. Honestly, if I can be vulnerable, I absolutely hate it. Dysfunction makes it sound like something is broken. Like your body is failing you and you are somehow defective. While it may feel like that, your body is perfectly healthy. If I had to choose a term, I prefer calling it “erectile disappointment.” I did not come up with that phrase, but I appreciate the way it reframes the experience. Your penis is not broken, it is just communicating something, and the challenge is figuring out what it is trying to say.
One of the first questions I find myself wondering is how much pressure you are putting on yourself when sex happens. Do you feel like it is your job to get hard, stay hard, satisfy your partner, have an orgasm, and make sure the entire experience goes perfectly? If so, welcome to the club. Many men grow up believing that sex is a performance and that their value during intimacy is measured by what their penis does or does not do. That is a tremendous amount of pressure to carry into a sexual encounter. The problem is that sex was never meant to be a performance. Sex is a shared experience. When we start treating it like a test that we have to pass, our bodies often respond accordingly. Anxiety enters the picture, we start monitoring ourselves, and we become hyperaware of every sensation. Suddenly we are no longer experiencing sex. We are evaluating it, and I don’t know about you, but I don’t want to be grading myself while I am trying to have an orgasm.
While most, if not all, erectile disappointments are psychological, the first step we are taught to tell our clients is to recommend talking with a medical provider. Since you already have a urology appointment scheduled, you are ahead of the game. Testosterone levels, cardiovascular health, medications, sleep quality, and a variety of other medical factors can influence erections. Getting those things checked out is important because it helps us rule out potential physical contributors. But be careful: there is usually no need to hop on Viagra or Cialis just yet. Those medications just increase blood flow to the penis and do not treat the shame or anxiety that you may be experiencing.
If everything comes back looking good medically, that is often when I start exploring what might be happening emotionally. Cortisol, one of the body’s primary stress hormones, can have a major impact on arousal. The harder we try to force an erection, the more pressure we create. The more pressure we create, the harder it becomes to relax into pleasure. It is a frustrating cycle. Imagine me telling you not to think about a pink elephant. What are you thinking about right now? Exactly. The same thing happens when we become fixated on whether or not we are going to get an erection. Well, unless pink elephants turn you on and then in that case, have at it, buddy.
This is also why I often talk with clients about their masturbation habits. Many penis-owners become accustomed to masturbating with a very firm grip and little to no lubrication. The mind/body connection and strong, and over time, the body can adapt to that specific type of stimulation. Then partnered sex can feel different by comparison. One simple intervention is introducing lubricant into masturbation. Lube can decrease the amount of grip needed, increase pleasure, and help your body become more responsive to a wider variety of sensations. It sounds simple, but sometimes small changes make a bigger difference than people expect. Follow this link to check out my favorite silicone-based lube, Uberlube.
I am also a huge fan of mindful masturbation. Most people masturbate with a goal in mind: orgasm. They rush from point A to point B as quickly as possible. They also turn to porn, and while porn can be fun, it pulls us outside of our bodies instead of inside. Mindful masturbation asks you to slow down and become curious instead. What sensations do you notice? How does arousal build in your body? What happens when you stop focusing on the outcome and start focusing on the experience? For many people struggling with erectile disappointment, this can help retrain the brain to associate sexuality with pleasure rather than pressure. Fantasize about your girlfriend and the positions you want to have sex and see how quickly your body can adapt to being mindful.
Finally, I would encourage you to have an honest conversation with your girlfriend. Brené Brown talks about vulnerability being one of the bravest things we can do, and I think she is right. Let her know what is happening. Share your fears. Talk about the pressure you are carrying. So often people try to handle erectile disappointments alone because they are ashamed. In reality, bringing those fears into the relationship often creates the exact thing that helps most: connection. Intimacy thrives when we stop hiding and allow ourselves to be seen. I tell my clients all of the time, if you can’t be vulnerable with your partner, then why are you in the relationship? Ben, remember this: your worth is not determined by your erections. You are more than your penis. You are more than your sexual performance. Be patient with yourself, stay curious, and please, listen to what your body may be trying to tell you. Chances are, this is not the end of your sex life. It is simply an invitation to approach it differently.
Matt Lachman is a Licensed Professional Clinical Counselor and Supervisor, AASECT Certified Sex Therapist, and owner of Cleveland Sex Therapy, located in the heart of Gordon Square. Since opening Cleveland Sex Therapy in 2019, Matt has been dedicated to promoting sex positivity and inclusivity in his work with individuals, couples, and polyamorous relationships. When he’s not helping clients navigate their sexual and relational journeys, you can find him enjoying a cold brew at Gypsy Beans, sipping a cocktail at Luxe, or relaxing on his couch watching reruns of Happy Endings. Ask a question of your own here.
Disclaimer: The advice provided in this column is intended for general informational purposes only and should not be considered a substitute for professional therapy or mental health treatment. Each individual’s situation is unique, and the insights offered here may not address the complexities of your specific circumstances. If you’re experiencing challenges related to your mental health, relationships, or sexuality, I strongly encourage you to reach out to a licensed therapist or mental health professional for personalized support. You’re not alone—help is available.
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