Impotence

January 16, 2012 4:56 PM

[Penis filter][Gay sex filter] I'm 24 years old and I can't maintain an erection. This is probably a psychological problem, but possibly not entirely.

I've never been able to top someone (have penetrative anal sex). Email: [e-mail]

More details: About four years ago, my lifelong unhappiness turned into a suicidal depression. Treatment included hospitalization, therapy, many different kinds of medication (including SSRIs, SNRIs, antipsychotics, MAOIs, and others I can't recall), and electroconvulsive therapy. I think the MAOI helped most, but the only real solution to my problem, however, was coming out of the closet. By the time I fully came out to everyone at age 22, my mental health problem was more-or-less solved.

I had never had any sexual experience until 22. When I began to be sexually active, I was on an MAOI (Parnate). It had real sexual side effects, though, including difficulty getting and maintaining an erection, as well as difficulty orgasming. (It is possible previous drugs also had such side effects, but I wasn't in a position to really notice.) Eventually, I tapered off the MAOI, and a few weeks later, when it was all flushed out of my system, I noticed a rather marked and immediate change -- I was getting erections more frequently, more easily, and I ejaculated while with another person for the first time in my life. And yet, I have never been able to top someone. Whenever I try to top someone, I lose my erection and cannot successfully penetrate. However, "erection" may be stretching it -- I never truly get as fully hard as other people I am with, I don't think.

To put it in concrete terms: my erection never goes above the horizontal. I can maybe flex my kegel muscle to force it just up to the horizontal, or really stroke it so it gets slightly harder for a quarter-second but the standard is drooping slightly down. And not pointing erectly and slightly down: drooping slightly down. 80-90% hard. This is enough to pass the stamp test (google it), definitely, but not hard enough to penetrate a man. Perhaps I shouldn't simply compare to porn or to other sexual partners, but EVERYONE seems to get harder than me, and most people seem to point at least a little bit up. Also: multiple times while fooling around with a guy, I get an erection, but then lose it. Sometimes I get it back, but the other guy doesn't generally lose his erection in the middle. Another data point: after ejaculating, my mostly-hard penis generally becomes fully flaccid very, very quickly. Other people seem to stay rather hard-ish for some time after coming.

I am not currently on any medication or seeing a therapist. Once, a few years ago, when I was on the MAOI, I got a doctor to prescribe Viagra for me, but I wasn't really in a position to be able to use it then, and I don't have the pills any more. I'm okay with trying Viagra/Cialis now, though the cost is high, when including doctor co-pay and per-pill cost (or: my roommate has recommended pills you get at 7/11 such as something called StaminaRx, but I'm slightly hesistant about what this would do), but really I'm looking for a solution that would NOT mean taking a pill every time I want to have sex. I have also talked to a therapist about this in the past, but there wasn't much concrete he could offer me, beyond saying that I needed a boyfriend I could be fully comfortable with.

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I anticipate two responses which I don't find helpful. 1st: "You just need to find someone you're truly comfortable with, like a boyfriend." Well, it takes two. (I'm looking.) Anyways, I've recently been hanging out with someone (not quite a boyfriend, but he's very sweet and accepting), and the problem keeps popping up. Or not, so to speak. And, 2nd: "Gay sex isn't just anal sex. Find your fulfillment in oral sex. Statistics that show that the majority of gay sex is oral, not anal." I find those statistics misleading, because while the majority of sex ACTS may be oral, due to spontaneity; the majority of sexual RELATIONSHIPS, on the other hand, include anal at some point in time. Regardless, I want to have anal sex, but I can't. This is the problem that's frustrating me.

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The last thing I'll throw out there: I rather frequently notice that my hands and feet are cold, even when others aren't. Multiple people I have recently touched have commented on my cold hands. I'm not saying my problem is NOT psychological, but I'm just throwing out the possibility of poor circulation. I have no idea if cold extremities = poor circulation = poor blood flow to the "fifth extremity," but I'm just throwing the idea out there.

My questions are:

1) Has anyone else had this problem and then overcame it? How?
2) Is it possible that this is actually a physical problem and not a psychological one? If so, what would doctors do (aside from prescribing Viagra/Cialis/Levitra )?
3) Any first-hand experience with Viagra et al from someone with impotence problems (not someone healthy taking it on a whim)? What about with the OTC herbal stuff you get at 7/11?

posted by anonymous to health & fitness (14 answers total)

2. Cold hands and feet can be a sign of hypothyroidism, which can cause erectile dysfunction. A doctor would run a full thyroid panel (which should include an antibody test).
posted by Iris Gambol at 5:04 PM on January 16, 2012

Do you have these erectile problems when you masturbate alone? If not, stop masturbating for an extended period of time and then try to have sex, if you haven't already tried this.

To rule out it being a physical issue, ask your GP to do a workup on your blood. You may have an endocrine disorder (e.g., low testosterone, type-2 diabetes, hypothyroidism as previously mentioned, etc.) that is causing this.
posted by Houyhnhnm at 5:22 PM on January 16, 2012

Yeah, by all means, go see a doctor. There are lots of medical conditions that can cause erection problems. (Basically anything that messes around with your hormones or your circulation can do it.) Many of those conditions are curable or treatable. So depending on what the doc finds, there could be a straightforward non-Viagra solution to your problem.

On the other hand, if it's not a medical problem ... well, your old therapist is half right. The way to get past a psychological erection problem is to relax and get comfortable and quit worrying so much about it. That doesn't necessarily mean "find a real boyfriend" or "find a new guy to fool around with" or whatever. It just means, you know, do whatever you need to do in order to feel comfortable and less stressed-out or nervous.

Basically there's this horrible feedback loop where the more you worry that your cock is too soft, the softer your cock gets. So once you've ruled out medical causes, the next step is to find a way to quit worrying so much.
posted by nebulawindphone at 5:31 PM on January 16, 2012

I'm not a gay male but I can tell you generally that OTC stuff won't help you if you have a real problem. Anecdotal knowledge, of course, but tons of negative reviews for herbal supplements of that sort probably aren't lying, either. Probably best bet is to get a check-up.

Alternatively: Was your therapist LGTBQ or experienced with/familiar with your background and specific issue? I have a gay guy friend who had a similar issue and found it helpful to talk with an alternative-lifestyle friendly sex therapist (for him it was mostly nerves).
posted by sm1tten at 5:32 PM on January 16, 2012

(Oh, for the ability to answer anonymously!)

First off: Who are you actually comparing yourself to? From your narrative, you sound like you've seen a wide variety of them in action...but maybe have not noticed that this is a reeeeeally common problem among real-life people? And it has a whole lot of possible causes. One of which (surprise!) is worrying about it too much. I mean, if you're sitting there sort of studying yourself while a partner is getting impatient...that's going to have a physical effect.

To get to your questions though, yes, it's certainly possible that it's a physical problem. A doctor would ask you a series of questions, and maybe take some blood--as Iris Gambol mentions above, there is the possibility of hypothyroidism, which can also cause depression, but low testosterone is another possibility. He may check you for diabetes and high cholesterol, as well (you don't mention your weight, but given what antidepressants and antipsychotics can do to you, high cholesterol isn't out of the question!).

I would seriously avoid any 'medicine' that comes from the 7/11. Quality control would be minimal, and who knows what you would get?
posted by mittens at 5:33 PM on January 16, 2012

If your hands and feet are cold, don't forget to get tested for low B12 levels and anemia when you go to the doctor, as others have suggested. Sexual dysfunction/low libido is a side effect for this also.
posted by devymetal at 6:01 PM on January 16, 2012

Another psychological possibility? Perhaps you're more a bottom?
posted by xingcat at 6:07 PM on January 16, 2012 [2 favorites]

Your doctor can probably provide a sample of any of the ED medicines. Just ask.
posted by chazlarson at 6:22 PM on January 16, 2012

From the OP:

Thank you all for the medical notes; I will go see a doctor. I notice via google that lithium can cause hypothyroidism, even long after a patient stops taking it. I took lithium for years; while I certainly was getting blood draws while on it, still -- who knows.

@Houyhnhnm: Yes, I have the same problem while masturbating.

@nebulawindphone and @sm1tten: yes, the therapist was gay, and one of the main reasons I chose him was so I would feel comfortable talking with him about this issue. And I *certainly* know that (particularly if this is at all psychologically-based) the best "fix" would be to find someone I can get fully comfortable sexually with... it's not that easy necessarily to do in real life. It takes two, etc. :-)

@mittens: I guess I'm comparing primarily to about 10 men in real life, plus many more I've seen on video. Obviously the real life data points are more valuable, not just because it's real and not faked and therefore a direct analogue to my situation (though it is that, of course), but also because of being able to touch as opposed to just see. But I think other comparisons shouldn't be totally thrown out the window. For example, I recently saw a making-of special on the Shortbus dvd, and after the orgy scene, when everyone was getting up and leaving, there was a guy doing the same (ie, getting up and leaving, no longer involved in sexual activity) with an erection practically pointed to the ceiling. Obviously in actual porn they cut all but the 15 "best" minutes, they don't show all the erection difficulties that are well-known to be very common on set, but still... the draw-a-line-in-the-sand difference between them and me is that those men have had anal sex >0 times, and I haven't.

@xingcat: Eh, I also anticipated this response. Look, I've bottomed before and haven't enjoyed it. In a long-term relationship, if a guy wanted to top me, I would of course be down, and if he truly knew what he was doing I'm sure it would feel something other than awkward. But for right now, I have zero interest in bottoming.

posted by jessamyn at 6:23 PM on January 16, 2012

The direction it points isn't indicative of anything. They don't all point North.

What kind of exercise do you get?
posted by gjc at 8:58 PM on January 16, 2012 [1 favorite]

From the OP:

@gjc: A month or two ago I started lifting weights three times a week. I'm rather thin: 6'0'' 150ish.

posted by jessamyn at 9:57 PM on January 16, 2012 [1 favorite]

Definitely talk to a doctor about possible physiological causes. ED can have a psychological component, too, in that anxiety about not performing becomes a self-fulfilling prophecy. You might try Viagra for a while to see if it can help build your confidence.
posted by qxntpqbbbqxl at 5:43 AM on January 17, 2012

Hi! First of all, ED is more common than you might think (plus the meds you mention are known for the side efffects you describe), and with patience, good education and a willingness to try different solutions until you find one (or more) that works for you, you can get back to the business of enjoying sex!

In addition to speaking with your doctor, there is one non-medical item you can try to see if it can help you maintain an erection suitable for penetrative anal sex. Have you tried cock rings? There is a lot of misinformation about them and their use out there, but by asking good questions and also checking in with gay sexual health resources you should be able to confidently choose a cock ring that will work well in your situation and help you avoid potential problems as well. Once you choose an appropriate ring, a visual tutorial (NSFW - nudity) is in order to insure it is properly fitted. While not ideal (it's written for a hetero crowd...), here's a good overall review of cock rings and their usage.

My advice, as a sex toy store worker and fellow queer guy, is if you are interested in trying a ring, first go for one that has velco or snaps. They will be the easiest to put on and more importantly to take off in a hurry should they work too well. If after you get used to utilizing a cock ring as part of your sexual health routine, then move up to the silicone stretchy rings or perhaps even a metal one. (I won't link to specific brands, but anyone can find reputable sex toy stores that cater to gay men online very easily).

One last thought, it's based on something I read but can't remember the source to properly cite it, but essentially the way to sort out whether ED is psychological or physiological is this: do you have what is commonly known as "morning wood" or do you get erections in your sleep? If not, then your ED is most likely to be physiological. Of course, I am not a doctor, so this is not medical advice, nor is anything I've mentioned based on anything but several years of working with customers at a sex toy store owned by professional sexual health educators.

Wishing you pleasure and good sexual health! :)
posted by kuppajava at 8:58 AM on January 17, 2012 [3 favorites]

Seconding cock rings. They help my partner with his medication-based erectile issues.

Here's another primer on cock rings from one of my favorite Sexual Health Gurus, Ducky Doolittle:

http://lipstickstainsonyourpillow.com/2012/01/12/duckys-guide-to-cock-rings/
posted by Val_E_Yum at 10:21 AM on January 17, 2012