TLDR: broke up from a 12yr relationship 1.5yrs ago, ED issues for a year or so now. Possible causes: psychological, need to build trust w new partners; bad anxiety; maybe unknown physical issues? Confused.
Hey everyone, 37yo queer cis male. I am physically very fit and healthy (recent measurements taken by doctor all spot on), I exercise a lot and have a strong athletic body. I have great cardio, and I don’t drink or smoke and never have. I don’t watch porn. People generally tell me I look 10 years younger than I am. However, I have been experiencing ED issues for the last year or so.
My erection issues have come following a very difficult and protracted breakup from a 12-year relationship, in February 2023. Prior to this I had a high sex-drive, and, though said relationship was complicated and often strained, sex when we had it was amazing, and I rarely had any issues with maintaining erections. On the contrary, it would often be difficult to not have one: I would think about sex very frequently (too much, I would sometimes feel) and just a kiss or a hug from my partner would be enough to make me hard. This sexual vigour was, silently, a big part of my sense of health and wellbeing, and sex was a big source of physical and mental vitality in my life. Partners throughout my life have told me that I am very sexy, sexual and amazing at giving pleasure, and this became part of my identity and sense of self-worth.
A few months after the breakup I distinctly remember quite suddenly (in the space of a week or two) noticing decreased libido in general and not getting as hard anymore (morning erections still happen but less hard; masturbation less frequent and again erections less hard). By September 2023 I began to be intimate with other people, and this is where I really noticed the erection issues. While there were moments of it seeming fine, there were various incidences of having no erection at all, which is where the worry set in. It got into my head a lot and I now have quite an anchored sense of impotence. I have still managed to have penetrative sex unaided by meds a few times: this seems to be when I have gone a while without sexual activity or ejaculation and allowed the libido to build. This has felt great and given me hope. But then there have come other times where I can’t get hard and the confidence diminishes again. I often only stay hard if I masturbate myself and hold the base of my penis. When I let go and leave my partner to pleasure me, I often lose an erection.
For the last two months, for example, I have been seeing the sexiest person I’ve ever been with; she is stunningly pretty and also incredible in bed. Yet there are times where I can’t maintain or sometimes even get an erection. This is especially the case when we are having sex for the second or third time in a day. We spent two weeks together recently where we were having sex multiple times every day, and I find my ability to maintain an erection just seems to run out quite quickly. In a sense this is fine, we have other kinds of sex, and I firmly embrace the queer view of penetrative sex as just one, and not the ultimate, form of sex; however it also worries me, as I am only 37 and am struggling to understand this rapid shift (too rapid and too early to feel like a natural part of ageing?). It also is of course less satisfying for partners when I don’t have an erection for them to enjoy sexually, and there have been frequent difficult conversations where I have to explain and persuade them that I am still very attracted to them even if my body doesn’t seem to express it. I often come away feeling insecure, worried that they feel insecure too, and worried that they will feel undesired /insufficient, lose interest, or both. This all ends up becoming quite a psychological burden.
I was diagnosed with anxiety and depression in 2022 and have seen various therapists since then. I feel that this is definitely part of the equation; I especially notice these days that being in very anxious states kills my libido a lot, and erection feels particularly difficult, if not impossible. However, it confuses me that for a year and a half before the breakup I was going through this anxiety and depression (both conditions were actually at their worst at this time, they have since become less severe, albeit more longstanding) without any erection issues.
Important to note is that in the first two serious relationships I had in my early 20s, I initially had erection difficulties too. I have struggled with low self-esteem since my adolescence, and I get nervous about being with attractive people, experiencing clear performance anxiety. The solution with my 12-year relationship ended up being to go very slowly and patiently, and after a couple of months, once I felt trust, acceptance, understanding and love, we slowly were able to have penetrative sex and built from there to it not being a problem (again, quite the contrary, we had an amazing sex life). Feeling love and connection became a very key part of my libido. A frequent phenomenon was that whenever we would be open and vulnerable with each other, even in an ostensibly non-sexual way- crying together, holding each other when making up after an argument, having deep emotional conversations-, I would either get hard, produce precum, or both. I used to feel this was strange and something to be ashamed of, but then learnt about oxytocin’s natural role in arousal, and understood that this was a natural response to the love and connection I felt. I have seen my ex a few times over the year and a half since our breakup, and we have been sexual a couple of times; my erection and libido all felt completely as before, very strong.
So this makes me think my current issues are most probably psychological, and I often think the solution will have to be similar, going slowly and building trust. However, I still worry that there is something more at play, as there has been a clear decrease in erections, libido, and masturbation even on my own with no partner, nervousness or performance anxiety involved.
Also possibly of note is that I had a vasectomy in 2017. After a swift recovery from the operation my sex life was completely unhindered, so it seems unlikely but I wonder if there could be some late impact from this.
I have tried various supplements: gingko biloba (no improvement at all noticed), ashwagandha (good for anxiety but no improvement in bed), and maca root (increased desire and feeling sexy, but erection difficulties remained). I spoke to my GP here in London about all this over the phone in March, but only having a cursory telephone assessment meant I described things very briefly. He initially prescribed me a blood test to check testosterone levels. This came back all fine, so he then prescribed counselling for the anxiety and depression, and a repeat prescription for Sildenafil 100mg. The counselling has been good, but is obviously slow progress. I have used the meds and they work well; however, they of course inhibit the spontaneity, and I am not comfortable with the idea of them being the norm from here on, and that my natural erection is a thing of the past.
Voilà ! If you have persevered all this way I thank and salute you; if you have any thoughts to offer I’m all ears, and thank you even more.
J