Difficulties getting it up?

Erection difficulties are common. Some studies have suggested that around 52% of men experience some form of erection difficulties in their lives however I would find it really difficult to believe that MOST men haven't had some issues with getting hard at some point in their lives. This is because it is completely normal!

There is no way that our bodies and brains are going to be synced up and ready for action 100% of the time when there are so many other things going on for us that take up our attention and cause us distress. So an occasional issue with getting hard when you are tired, stressed, physically unwell, not in the mood, rowing with your partner etc is normal and should be treated as such. Sometimes we can get pulled into the narrative that men should be able to perform whenever and wherever and this just isn't the case. Arousal can be a complicated thing no matter what your gender / sexuality.

However if you (or your partner) find that the problem reoccurs then it's a really important thing to get checked out, not least because problems with getting and staying hard can for some people indicate health issues. So speaking to your GP is really important, particularly if your ability to have an erection before / when waking (good old "morning wood") has disappeared. This factor is really useful because this is an erection that occurs entirely spontaneously and is based pretty much on the bodies physical functioning alone.

When we think about treating this issue we need to separate out what are purely physical causes and what are emotional / psychological causes. Sadly, for many, GP's just dish out medication such as viagra without encouraging people to get appropriate psychological therapy to help really address the issues. If you are one of the (many!) men that I have worked with who has a stash of viagra or equivalent but hasn't told their partner they are using it you don't have to have me tell you what kind of additional stress and anxiety this puts on you sexually and it certainly raises huge questions about honesty and communication in the relationship. These are all things that can be addressed and should be addressed to help you to have a healthy relationship (or maybe help you to leave a not healthy relationship!).

Anyway, erections. If you're struggling to get hard you might be feeling loads of crappy stuff. You might be feeling sad or anxious or frustrated. Maybe ashamed? Your partner (s) might be feeling rejected or hurt and acting in a way towards you that makes you feel more crappy. So a vicious cycle starts where everyone ends up feeling pretty rubbish and sex probably starts to get avoided.

Let's think about this in a bit more detail then. Can you get hard when you are on your own?

If you are able to get and stay hard without a partner then we know that physically things are working. We also know that sexually things CAN work. We might assume in simple terms that there is something about sex with a partner that is blocking you. This doesn't mean that it is your partners fault nor does it mean there is something wrong with your relationship (although there could be).

This could be relationship issues it could be fears about getting pregnant (or not getting pregnant), it could be due to sexual differences or could link back to earlier experiences that may or may not be related to sex. There are loads of things that can occur within a relationship dynamic that can lead to problems with erections (and any other sexual issues).

If not, then we would tackle things from a slightly different angle however we would be again thinking about what your individual blocks might be. We would also be thinking about any medications that you might be on that could be getting in the way of you getting hard.

Are there times when you can get hard and times when you can't? What might the differences be? Are there things that can be changed to increase the times when you get hard (for example changing the times you have sex, focusing less on intercourse, changes to contraception, talking with your partner about what you enjoy and don't enjoy).

As a simple starting point that you can experiment with now I would strongly suggest having a go at some mindfulness exercises (loads of free apps you can download onto your phone). The point of mindfulness is to train our brain to focus on one thing at a time which can be really useful when it comes to sex (either solo or with others) as it allows us to focus on the pleasurable physical sensations rather than thinking about what we have to do at work tomorrow. I'm certainly not saying this is a cure all approach as it is likely to just be a teeny part of the jigsaw however it is something you can start to explore on your own / with your partner (s) to see how you get on.

What might sex therapy focusing on erection issues look like when working with me? You are likely to work through a combination of these

• A really thorough and in depth assessment phase where we explore everything you think and feel about sex in detail

• Psycho-education about how bodies work and what is normal

• Skills to understand and manage emotions

• Self compassion work to reduce shame and self criticism

• EMDR therapy to address any trauma / remove any blocks

• Relationship work to improve communication (and to identify if a relationship is damaging to you)

• Exercises to build sexual confidence

You might notice that I work in a different way to lots of therapists as I focus a lot on the underlying issues and the whole person rather than just focusing on exercises to build confidence. That's because my experience firmly tells me that dealing with the underlying issues gives the best chance of sustained change.

If you are noticing that you are struggling to get or keep your erection AND it's causing you problems (if it's not causing any issues then of course therapy isn't needed however I would suggest a chat with your GP to rule our physical stuff) please don't be afraid to seek help. As with most things, the longer we leave it (and avoid it) the more entrenched things can get. so early intervention is always fab! However no matter how long the issues have been going on for there will be a way of working that will help you get to where you want to be.

Remember, you are not alone with this and it is super common. Don't suffer alone, get the help you need.

Dr Nichola Marchant is a Sex Positive and Kink Aware Clinical Psychologist and Sex Therapist working online . Contact drnicholamarchant@gmail.com for more information on how she might be able to help you.

www.drnicholamarchant.com

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