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How to enjoy sex with erectile dysfunction

A hard penis is not strictly necessary for satisfying sex

"More difficult than learning to enjoy a limp dick physically is changing your attitude about how sex must be experienced," writes Dr Pega Ren. Credit: Thinkstock

Ever since I was about 20 (I’m over 40 now), I’ve had difficulty getting an erection. I know all about the anxiety connection, but I have trouble even solo with masturbation. Viagra helps but not for long, and the headache is so distracting I hate using it.

My boyfriend is patient and understanding and assures me he’s less concerned than I am. Still, I’d like to be able to count on a firm and lasting erection at least sometimes. Barring this, what can I do to boost the sensation during sex with a . . .
— Wilted Wiener

Dear Wilted Wiener,
I hope it helps you to know that only about 10 percent of men never experience erectile dysfunction (ED). Your penis is not bionic, you know. It represents more than an indicator of sexual desire. It is, in fact, a pretty fair barometer of how things are going physically, emotionally and interpersonally.

ED can be caused by anxiety or other negative psychological emotions, including worrying about that erection! If you are happily coupled and generally content, let’s examine physical causes, which many researchers say account for about 85 percent of ED. Even if the cause is beyond your control, your emotional response to the situation exacerbates the problem.

First of all, you need a proper evaluation. Start with a physical exam and proceed to blood work (heart disease, diabetes, low testosterone levels) and urine tests (diabetes and other underlying conditions). This may be followed by an ultrasound to check on blood flow to the penis and then an “overnight erection test” in which you put paper tape around your dick upon retiring. Tape ruptured in the morning? You’ve had an erection!

Regardless of whether you find an organic cause, evaluate how else you may be contributing to the ED. Do you smoke, drink or take meds? (Alarmingly, up to 25 percent of cases are attributed to drugs: prescribed, illegal and over-the-counter). All can make your phallus flag.

If you want to concentrate on getting an erection, there are myriad things for you to try.

You might ask for a prescription for yohimbe, sold under the name of Yohimbine. (Over-the-counter dosages are ineffective.)

You might consider surgical implants, or try (one of the many types of) cockrings to maintain any boners that appear, or fluff with a mechanical pump prior to needing an erection; there are injections and intraurethral tablets.

You can likely find some combination of all that is available that will help you, even though you may always need to use some form of treatment rather than expecting a cure.

And while you continue to strive for firm erections, you can lower your performance anxiety and improve your sex life by “boost[ing] the sensation during sex with a . . . Wilted Wiener” as you suggested.

The point of sex is pleasure; a hard penis is not requisite to satisfying and exciting sex. Indeed, a soft penis, rather than remaining a source of embarrassment and disappointment, can provide you with delicious sensation and encourage extended lovemaking sessions.

More difficult than learning to enjoy a limp dick physically is changing your attitude about how sex must be experienced. Once you quit demanding your penis be erect to be sexual, you will notice the sensations you would otherwise discount or ignore altogether. Bernie Zilbergeld explains soft penis exercises in The New Male Sexuality (excuse his heterosexism). Fun homework!

Given the longstanding and unremitting nature of your ED, and the fact that it occurs regardless of your situation, you may not be able to correct it completely. Some can’t. Regardless, address this proactively and sex-positively. You deserve a comprehensive assessment, robust and varied remedial options, and the chance to enhance your enjoyment of your penis, whatever its state.