DEAR DR. NERDLOVE: First a little bit of background: I’ m a CIS male, 45. And I’ve suffered from ED since… Well, always. I have been able to complete sexual intercourse with penetration, but is very rare and difficult for me.
I’m the kind of man that has never been successful with women. I have always been the nerdy, big, fat guy with glasses. I’m a shy extrovert (I know it’s a weird combination, but that’s me in a nutshell) and I have always find difficult approach to women.
I don’t know what to do about this. It has cost me some relationships in the past and honestly, I have a lot of fear about how handle my situation with a possible partner. When do I tell her that most probably I will need years of therapy to have sex with her? How do I approach this conversation?
Therapy has not worked for me. I think that the problem is in that I haven’t found the right professional: all the professionals that I have consulted about this, always take the same direction. They give me the blue pill and tell me to do some therapy with that with my girlfriend. When I tell them that I’m single, they take back the blue pill and give me the white pill and tell me to get back in a couple of months. As you can imagine, that doesn’t work.
I feel very lonely and very scared at the same time to try to approach someone. When things get closer, usually I panic and freeze.
The last ten years I have worked a lot in myself: I have been working abroad (a very good personal and professional experience), I have lost 40 kgs (40 more to go), worked in my self-esteem… I feel a better person now and I have decided to give relationships a shot. But still I don’t know how to handle this.
Please help, I’m feeling
Stuck in A Rut
DEAR STUCK IN A RUT: First of all: congratulations on all the work you’ve been putting into yourself, man. That’s really awesome; you should be proud of what you’ve accomplished and how far you’ve come. That speaks a lot to how you’ve been caring for yourself and building an awesome life. So it’s important that you keep this trend going; it’d be a shame to let this hard work get derailed by a treatable condition.
And now, my dude, let’s talk dicks for a second. There tend to be two types of erectile dysfunction: emotional and physical. Physical erectile dysfunction tends to occur because of physical causes, usually either hormonal levels or conditions that prevent blood from going to the spongey tissues in the penis that cause erections. Age, weight, hormone levels, drug use (including alcohol and nicotine) all can cause weak or infrequent erections or even prevent them entirely.
Emotional causes to ED tend to come about because dicks are divas; they often won’t perform if everything is perfect. Feeling nervous or insecure? Say hello to Flacid-o Domingo.
Now here’s my question: you mention that you’ve had penetrative sex before, which means you were able to get it up enough for penetration. Do you have the same problems when you’re on your own? Do you have issues getting erections when you’re in the mood to masturbate, or are you still finding that you have to try to shoot pool with a rope then too? This is an important question to answer because it says a lot about which doctors you should be talking to.
Here’s the thing: I agree that you’re seeing the wrong professionals. If your issues are physical, then your first step should be talking to a urologist and making sure that there aren’t other underlying causes. No amount of therapy is going to help if, for example, you have prostate issues that’re damaging your erections.
However, if the causes are mental… well, you need to be talking to very different professionals than you seem to have. If it is literally as you say — they prescribe you Viagra until you say you’re single and then give you something else (presumably an antidepressant or beta-blocker) then I’m doubting you were talking to a therapist. A psychiatrist, maybe… but honestly, it sounds like you may have gone to the entirely wrong people. You want someone who will work with you on your issues, not just throw pills your way and call it a day. If you’re dealing with long-term low self-esteem or high social anxiety, medication by itself isn’t going to help, especially not a “take this twice a day and come back in a month” approach. In an ideal world — and depending on precisely what issues you have — you would want therapy supplemented by medication, if drugs are warranted. And in fairness: they often are. Despite what well-meaning people will tell you, depression and anxiety disorders aren’t the sort of thing you can will yourself out of, nor can you diet or exercise your way past them; I’ll point you to Naomi Osaka and Simone Biles as proof of this. Antidepressants, anti-anxiety meds and the like are often what makes it possible for therapy to work; easing the symptoms goes a long way towards making it possible to develop the coping skills that help, or to address underlying problems.
That having been said, I’m wondering if you aren’t coloring the way things went a little. Depending on how things shook out, I suspect that you may not have been in the most receptive place when you went to the doctor. While being prescribed medication can feel like you’re being written off, often it can be less of a weapon of first resort and more a “ok, let’s get you to a working baseline, so you’ll be functional and able to work on the other issues.” And frankly, it can take time to make sure you’re on the right medication and the right dosage; not every antidepressant or anti-anxiety medication works the same on every person. Finding the right ones, in the right amounts, can be a time-consuming process, since many have to build up in your system over time.
And again, if you were going to your GP or a psychiatrist… well, I think the assumption is that you would be doing this in conjunction with therapy, not “as a substitute for”.
So I’d highly recommend that you try therapy again… and ideally with the right doctors or counselors this time around. If you don’t have someone you’re already working with or can’t go to, then you may want to look to Psychology Today’s directory to help find a medical professional near you. Similarly, if you feel like much of your issues are around sex and sexuality specifically the American Association of Sexuality Educators, Counselors and Therapists. They also have a referral directory that can help you find a sex-positive therapist who can work with you on your issues.
One thing I would advise you to keep in mind is that therapy is a lot like dating; you want a therapist you have chemistry with (that is: that you get along with) and who you feel understands you and empathizes with you. If you feel like they don’t get you or that they aren’t helping, you can and should break up with them and find someone else. Similarly, not all forms of therapy are going to be right for you and your situation. Some folks do well with what’s known as dialectical behavioral therapy — where you focus on mindfulness and emotional regulation. Others do well with cognitive behavioral therapy, which helps find coping strategies and challenging and correcting distorted or intrusive thoughts and behaviors. Still others do well in group settings vs. a one-on-one scenario and some do best with pure talk therapy. Finding the one that is right for you can be a challenge too; much like with dating, just because one therapist or style didn’t work doesn’t mean that it’s all worthless. It’s about finding who’s right for you and who you click with… that can take time. And, of course, medication helps too.
So give it an honest shot. Be more open and up front about what your issues are, how they’re affecting you and how it’s making your life more difficult. That makes it much easier for them to understand what sort of treatment and therapy you may need to look into. And lead with the social anxiety, rather than the ED; I strongly suspect that the latter is caused by the former, and may have been the source of confusion the last time you talked to a doctor.
Another thing to consider: just because you can’t get an erection doesn’t mean you can’t have sex. Sex is much more than just insert-tab-a-into-slot-b; sex is a holistic act, involving brains and your entire bodies, not just genitalia. In fact, the vast majority of women can’t orgasm from penetration alone; it just doesn’t give them the direct, intense clitoral stimulation they need to get off. But you know what does give them the stimulation they need and never goes limp at inconvenient moments? Your hands. Your tongue. Vibrators, dildos, clit-suckers and a whole host of other amazing sex toys that are readily available. Any and all of these are ways of having incredible, mind-blowing, bed-rocking, headboard-slamming sex… that don’t require you to be able to get hard at a moment’s notice. Getting comfortable and skilled with non-penetrative forms of sex will make you a much better lover — and much more in demand — than Studly Goodnight who thinks that jackhammering away like he’s drilling into bedrock is the way, the truth and the light. And if you encounter someone who thinks that your de-prioritizing penetration is a bad thing? Well, all that’s happened is that she’s self-selected right the f--k out of your dating pool and good riddance.
And one more thing: remember what I said about dicks being divas? Well, this is one of those times when Dumbo’s Magic Feather can actually be useful. While you may not have a physical issue that Viagra could treat, having it on hand and knowing that it’s an option could well make the difference between a failed performance by Flacid-o and a standing O from Pavarotti. It may not be medically necessary, but mentally helpful to have it. That simple act of belief — “I’ve got the sildenafil in my system, there’s no chance of not getting harder than Cantonese calculus” — can make all the difference when the moment comes.
Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, email@example.com