Help! My Penis has Fallen & I Can't Get It Up (O.C.)

Every now and then, a relatively young man comes into my therapy office concerned that he’s lost the ability to get an erection.  The events leading up to his visit to see me, might have gone something like this:

It’s Friday night and Mike’s been swamped at work all week.  He decided to cut-out at 5:00p, rather than staying late to get a head-start on next week like he normally does.  Mike goes out and after a few drinks he chats up a hottie at the local bar.  After some conversation he’s invited back to the hottie’s place for what he’s certain will turn into some consensual adult-on-adult fun.  Mike’s pretty excited – it’s been a while since he’s had any action, and it’s been even longer since he picked up a hottie at a bar.  

After a few more drinks on the couch, one thing leads to another and the two start messing around.  And then, about 10 minutes in, Mike goes limp.  The hottie notices and asks if everything is okay.  Mike says he’s fine and that he just needs a minute and he’ll be back to action.  Mike takes matters into his own hands for a few strokes – trying to focus on the hottie in front of him waiting for him to come to attention.  He gets a little movement from the little guy, but he’s still limp.  Now Mike’s getting a worried.  This hasn’t happened to him before.  He remembers he hasn’t had sex in a while and wonders if he’s become impotent from underuse.  Embarrassed and convinced that something is seriously wrong with him or his equipment, he tells the hottie that he’s had too much to drink, gets dressed quickly, and darts out the door.

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Men who’ve experienced a situation similar to Mike’s usually show up to my office on one of two occasions: 1) Immediately following their first failed attempt at achieving an erection or 2) weeks, months, or even years after several failed attempts. The first group of men, so astounded by their inability to bone-up after years of never having a problem, show up afraid that sex, as they’ve known it, is over. The second group of men have secretly been harboring the same amount of terror, but have only recently built up the courage to tell anyone about it. Both types of guys typically show up feeling embarrassed, ashamed, and sometimes depressed.

The first question I tend to ask guys with this issue is “Are you able to get and maintain an erection in other situations, such as masturbating or while asleep?”  In most cases, if a man can achieve and maintain an erection while masturbating and/or notices that his penis is erect in the mornings (i.e. “morning wood”), then the problem is likely a psychological one and not a physiological one. If my client reports that he cannot achieve erection while masturbating or while asleep/waking, his ED may have a physiological cause, and he should speak to a physician about treatment.

However, most of the men who’ve sought my help around this issue are young to middle-aged men, who describes no significant medical history that would suggests a physiological issue – such as poor prostate health or long-term drug abuse. The root cause of ED in these men is most typically related to anxiety. Anxiety is a boner’s arch-nemesis.

Anxiety activates the sympathetic nervous system, which makes it incredibly difficult for any man (young or old) to achieve an erection. The sympathetic nervous system is the part of the nervous system that activates when we experience feelings of “fight or flight.” It most cases it serves an important role in preparing our bodies to take action, such as fleeing a dangerous situation or competing in a sport. The sympathetic nervous system accelerates our heart rate, allows our body to take in more oxygen, and increases blood-flow to our limbs. As a result, other bodily functions are reduced – such as digestion and sexual arousal, which are controlled by the parasympathetic nervous system. For most men, it’s unlikely that they can be fully sexually aroused while simultaneously engaging in strenuous physical activity. Similarly, most men cannot achieve full sexual arousal while experiencing high levels of fear or anxiety.

Some men are quite aware of their anxiety in sexual situations.  In cases like Mike’s, his first experience of ED might have been due to stress related to work or his anxiety about hooking-up for the first time in a long time.  However, in a future sexual situation, Mike may recall his previous inability to get-it-up, causing him to worry about his ability to get-it-up this time, thereby increasing his anxiety, and making it more difficult for him to achieve an erection.  This cycle may repeat itself for days, months, or even years before he seeks appropriate treatment. Men who put a lot of pressure on themselves to perform sexually are at increased risk of this vicious cycle.

For some men, overcoming this cycle is as simple as realizing its cause. Simply by knowing that there isn’t a physiological problem allows them to relax and feel less anxious in future sexual situations. Other men will need to be more patient with themselves in order to reduce their anxiety.

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Here are some tips for those struggling with anxiety induced erectile difficulties:

1. Know that men of all ages can experience erectile difficulties at any point in their lives.

• Just because you couldn’t get/maintain an erection on a few isolated occasions, doesn’t mean it will necessarily continue to be a problem.
• If your difficulty achieving/maintaining erections is limited to certain (but not all) situations, then it is likely caused by a psychological issue, not a physiological one.

2. Anxiety will kill your boner.

• Although things like depression can also make sexual arousal difficult, sexual difficulties from depression are more likely experienced as a loss of libido – a.k.a., not being “in the mood” – rather than as erectile difficulties.
• If you are feeling nervous during a sexual encounter or have more generalized anxiety it will be more difficult for you to achieve an erection.  (I should note: for some men anxiety results in premature ejaculation — but that’s a topic for another article.)

3. Find ways to reduce your anxiety in the moment and in general. 

• If you experience anxiety specifically during sexual encounters, find ways to make the experience more comfortable for yourself.  Such as, engaging in sexual activity in a familiar environment or with a trusted partner.
• If your anxiety is more general or related to other issues in your life, seek psychological treatment, or find a trusted friend or family member to talk out your anxieties.

4. Relax. 

• Try to take yourself and your penis less seriously in these moments.
• Guilt, shame, and embarrassment will only increase your anxiety, making it more difficult for you to become erect.
• If you’re feeling anxious and having erectile difficulties while with a partner, redirect your attention to your partner.  Find ways to engage sexually with them that don’t require you to be erect – e.g. stimulating them orally, kissing, or massage.  By doing so, you can allow yourself to relax and potentially regain your erection.  Focusing on them in this way also reduces the likelihood that they’ll blame themselves for your “loss of enthusiasm.”

The only thing you have to fear is fear itself.