I can’t sustain an erection during sex

PROBLEM: I am 22 and haven't had a relationship yet but have never really had any problem meeting girls. Over the years several have wanted to go out with me, and on a few occasions I wanted the same thing, but I never let it happen. The problem is that during sex I can't keep an erection. I have had several one-night stands, most while drunk. I don't bother any more, as I know the night is going to end literally in a flop. I haven't wanted to talk to anyone, but recently went to the GP, who asked if it worked when I masturbate, which it always does. He did some tests but said it is probably psychological. This has caused me annoyance as I never thought that there was anything wrong with my mind; nothing really bad ever happened me, and apart from this problem I don't really have any other stress going on. So I don't know how it could be psychological. I don't want this to last forever. Is there anything I can do?

ADVICE: Our bodies are complex, and we are often not aware of what they are expressing. That lack of awareness can lead to unintended consequences such as refusal to engage in sex or intimacy. It seems your body is working well sexually, in that you can masturbate successfully, and your GP is not concerned about underlying issues. For older men with erectile difficulties, it can be a symptom of things such as heart problems, diabetes and so on, and it is essential that they have a full medical check-up before using any medication to help with erections.

You say you have wanted intimacy with girls over the years but you never let it happen. I wonder if you had an anxiety or fear of not meeting expectations and this has become your default position when a possibility of intimacy arises.

Fear is a powerful emotion, and our primitive reaction to it is the fight, flight or freeze syndrome. In your case, your body protects you from exposure or possible recrimination by withdrawing and shutting down desire in you. The usual response to this is to try to force your body to do what you want and ignore its signals that you are in danger. But this demand only creates more resistance as your body comes under more pressure to perform. Many men try to deal with this by getting drunk and trying a one-night stand to prove to themselves that they can function, but of course this does not work as the cause of the problem is ignored.

Fear of intimacy or fear of exposure or ridicule are the issues, and if these are to be tackled, it needs to be done in a way that will work with your body and emotions and not against them.

One of the main ways of tackling fear is to be courageous and honest. It is a risk to become involved with another human being, and no relationship can happen without this. There are steps that need to be taken that will all involve courage and require you to begin speaking. It may be that you would like to discover if there is something in your past that has created this mistrust of intimacy, and if you are to explore this, it will involve talking to someone you can trust. Most good friends are open to this and the hardest part is to begin the conversation.

If you can crack this first step, it is likely that you will be more confident in talking to a prospective partner. Intimacy will need to happen slowly so that your body can trust that it will not be pushed too far, too fast.

Letting your body enjoy the sense of touch, taste and smell is the starting point. The danger is that your mind goes ahead, anticipates rejection and the result is freezing or retreating. Train your mind to connect with the senses and let go the idea of judgment. This will require trusting someone to stick with you but this is also the pathway to closeness and intimacy – both things you wish for.

Desire pushes us to reach for another human being, and orgasm is the ultimate letting go; both these things are working in you, but fear and anxiety are holding you back. Find someone you desire and think is trustworthy and ask them for coffee (alcohol impairs judgment). If you judge that to be successful, take the next step and go out again. The question of expectation of sex will probably arise by the third date, and this is where you will need to risk honesty. Be determined to make this happen.

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