Ask a Cleveland Sex Therapist: I'm 34 and Dealing With Erectile Issues

Matt Lachman Credit: Photo by Kristine Borns

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’m a 34-year-old dude, and I’ve been struggling with erectile issues for the past year. I can’t figure out what’s causing it—sometimes I’m stressed, but other times it happens when I’m feeling relaxed. It’s really starting to mess with my confidence and my relationship with my girlfriend. I’ve tried to brush it off, but now I avoid initiating sex because I’m afraid of letting my partner down. Is this normal? How can I start dealing with it? Is it all in my head, or should I see a doctor?

– Feeling Deflated

Hey there Feeling Deflated. I wish I could tell you that there was a quick and easy solution to this issue but unfortunately, that’s just not the case. Fortunately, it may not be as dire of a situation as you think! First before we dive into my response, because I do not know how you gender identify, I am going to assume that you are cisgender. If you do not know what this term means, “cisgender” refers to your gender identity matching your genitals assigned at birth. This would be different than those individuals who identify as transgender or gender non-binary. Because you identify as “a dude” and have a penis, I have made that assumption. This is important to note here because individuals who identify as non-cisgender may have a slew of other experiences to be considered in this response. Having said that, what I am going to say should be applicable to all “penis-owners.”

Erectile disorder sucks. As a fellow penis-owner myself, it can feel really debilitating when we want to engage in a sexual encounter and our genitals decide they rather nap. Personally, I do not think sexually related problems should be considered “disorders.” This is not the time or place for me to dive into my reasoning behind this, so let me just say that sex negativity has a big role to do with it. I prefer to call this phenomenon an “erectile disappointment.” I did not coin this term, but first heard of it in Chris Donaghue’s Medium article entitled, It’s No Dysfunction, Your Penis is Fine. Understanding “Erectile Disappointment.” The reason for this reframe is because it is important for cisgender men, straight or LGBTQIA2S+ identifying, to realize that there is nothing wrong with you because your friend down south doesn’t want to show up and “perform.”

Speaking of “performing,” I wonder how much that plays a role in your situation. Do you feel like it is your “duty to perform” when having sex? Do you feel pressure to have an erection, make sure it lasts the whole time, and have an explosive orgasm, all on top of making sure your girlfriend has the best experience every time you two have sex? If so, you are not alone. Due to the aforementioned sex negativity that runs rampant in the world, combined with toxic masculinity, a lot of cisgender men can feel that way. So how do you shed this and actually enjoy having sex again? Well, we have to start rethinking our relationship with sex and intimacy.

Sex is not a performance, but rather a connective dance that two or more people engage with, supporting everyone throughout. Just because you have a penis hanging between your legs does not mean you have to perform and provide. This is a trap a lot of us can fall into and while erectile disappointments may not occur for everyone, when they do, we need to find ways through them. So while you could us a PDE5 inhibitor like Viagra or Cialis to help your sleeping friend show up, we are not tackling the root of the issue.

Whenever I talk to someone who mentions they struggle with erectile disappointment, the first step I tell them to take it to get their testosterone levels checked by a doctor. Testosterone is crucial for sexual desire. A decrease in testosterone can lead to reduced libido, which might make it harder to become aroused and achieve an erection. So, if you have been putting off that doctor’s appointment, this may be a good reason to schedule it. If you discover that your testosterone levels are within normal range, which is considered to be around 300 to 1,000 nanograms per deciliter, this is great news as we can move onto the psychological factors.

Testosterone is not the only hormone that impacts arousal. Cortisol, one of the main stress-driving hormones, can impact arousal levels as well. All of this internal pressure you are putting on yourself to get an erection and to not let your partner down is not providing the motivation you think it may be. You can’t muscle your way through sexual anxiety. Your brain is trying to tell you something and we have to listen. It is like telling someone to not think about a pink elephant. They are going to think about a pink elephant! Did you just think of one? Remember, the biggest sex organ in the human body is the brain. We need to decrease the pressure you are feeling and the way I suggest you do it is through practicing vulnerability.

Brené Brown mentions how vulnerability is one of the most courageous things we can do as humans. Do me a favor, if you are feeling comfortable with your girlfriend, and open to exploring some of your fears, be courageous and open up to her. Explain what is going on in your head and bring it out into the relationship. Vulnerability is the key to deeper intimacy. Intimacy can lead to comfort and ease, which is exactly what we are looking for in this situation. Schedule a time to sit down and talk about what is going on inside of your brain and allow her to be the net to catch you.

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.

Subscribe to Cleveland Scene newsletters.