Erectile Dysfunction: Causes and Solutions for Couples

Erectile dysfunction during sexual intercourse?

Dr.
Hsu, I would like to ask you a question.
I have been in a relationship with my girlfriend for several years, and we are preparing to get married, but I have been troubled by erectile issues.
At the beginning of our intimate encounters, my erections were normal, but when it came time for penetration, my girlfriend would experience pain and struggle.
After trying for a while, I would lose my arousal, and my penis would become soft.
Now it seems that my erection duration is even shorter.
When I feel good, I can still get hard, but I still can't penetrate.
I'm not sure if it's due to incorrect technique or if her vaginal opening is too tight.
In any case, after trying for a while, I also end up softening.
When I don't feel good, I experience erectile dysfunction, where I can't get hard or my erection isn't firm enough, which is really embarrassing and makes me feel bad for my girlfriend.
However, when I watch adult films and masturbate, my erections are normal, and I get aroused easily.
Am I masturbating too much? A few years ago, I was masturbating quite frequently, about once a day, but now it's less often.
I have tried abstaining from masturbation for several days, and my performance in bed is better, but it doesn't guarantee that I will achieve a successful erection.
Please help me understand, do I need to see a doctor? I am considering seeing a doctor and thought about taking Viagra to help me penetrate the hymen, hoping that penetration would be smoother afterward, and then I could stimulate my penis to maintain its hardness.
Is this line of thinking feasible?

A Ken, 20~29 year old female. Ask Date: 2010/07/30

Dr. Xu Weikai reply Urology

Hello, sexual activity is inherently a product of mutual cooperation between both parties.
If the female partner is unwilling or there is insufficient lubrication, it often leads to a quick loss of erection in males.
It seems that this may not be a physical issue with erection, but rather a need for further communication with the female partner.
Extending the duration of foreplay to allow for vaginal lubrication and relaxation before engaging in sexual intercourse may lead to a higher chance of success.
If there are any unclear points, feel free to ask again, and we can discuss and research further together.
This response is from Dr.
Hsu Wei-kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2010/07/30

More Info

Erectile dysfunction (ED) is a common issue that can affect men of all ages, and it can be particularly distressing for those in committed relationships, especially when preparing for marriage. Your situation, where you experience difficulty maintaining an erection during intercourse while still being able to achieve an erection through masturbation, suggests that the issue may not solely be physical but could also involve psychological factors.

Understanding the Causes of Erectile Dysfunction
1. Physical Factors: ED can be caused by various physical conditions, including cardiovascular disease, diabetes, hormonal imbalances, and neurological disorders. However, in your case, since you can achieve an erection during masturbation, it is less likely that a severe underlying medical condition is the primary cause.

2. Psychological Factors: Anxiety, stress, and performance pressure can significantly impact sexual function. The fear of not being able to perform, especially in a new sexual situation, can create a cycle of anxiety that exacerbates the problem. This is often referred to as "performance anxiety." Since you mentioned feeling embarrassed and guilty about your performance, these feelings could contribute to your difficulties.

3. Relationship Dynamics: The dynamics between you and your partner can also play a role. If your girlfriend experiences pain during intercourse, it may create a psychological barrier for you, leading to anxiety about the act itself. Pain during intercourse can be due to various reasons, including insufficient lubrication, anxiety, or anatomical factors.

4. Masturbation Frequency: While excessive masturbation can lead to temporary desensitization, it is not typically a direct cause of ED. However, if you find that abstaining from masturbation improves your performance, it may be worth considering a balanced approach to sexual activity.

Solutions and Recommendations
1. Communication with Your Partner: Openly discussing your concerns with your girlfriend can help alleviate some of the anxiety surrounding sexual performance. Understanding each other's feelings and experiences can strengthen your relationship and create a more supportive environment for intimacy.

2. Consult a Healthcare Professional: It is advisable to see a doctor or a urologist specializing in sexual health. They can conduct a thorough evaluation to rule out any underlying medical conditions and provide tailored advice. They may also recommend counseling or therapy to address any psychological factors contributing to your ED.

3. Consider Counseling: Individual or couples therapy can be beneficial in addressing performance anxiety and improving communication about sexual health and preferences. A therapist can help you develop coping strategies and build confidence in your sexual relationship.

4. Medications: While medications like Viagra (sildenafil) can be effective for some men, it is essential to consult a healthcare professional before starting any medication. They can help determine if this is a suitable option for you and discuss potential side effects and interactions with other medications.

5. Gradual Approach to Intercourse: If your girlfriend experiences pain during intercourse, consider exploring other forms of intimacy that do not involve penetration initially. This can help both of you feel more comfortable and reduce performance pressure.

6. Focus on Foreplay: Engaging in extended foreplay can enhance arousal for both partners and may help ease the transition to penetration. This can also help your girlfriend feel more comfortable and reduce any pain associated with intercourse.

Conclusion
Erectile dysfunction can be a complex issue influenced by various physical and psychological factors. Your experience is not uncommon, and many couples face similar challenges. By fostering open communication with your partner, seeking professional advice, and exploring different approaches to intimacy, you can work towards overcoming these difficulties together. Remember, sexual health is an integral part of overall well-being, and addressing these concerns is a positive step towards a fulfilling relationship.

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