Or maybe Paul had leftover feelings for his previous partner, and was ambivalent about the new relationship with Lorenzo, who could be “bossy” (we all have heard of the “Bossy Bottom” syndrome, which can make a Top partner feel demanded-upon, and creates performance anxiety in the Top). Perhaps Paul was having trouble penetrating Lorenzo because he had an unconscious resentment that Lorenzo was “making” him do a sex act he just wasn’t that into. This goes back to what I discussed in the previous article about cognitive aspects of ED. However, Paul felt pressure (verbally) from Lorenzo, who liked to “really get it on” and considered Paul’s sexual repertoire “under-developed”, which left Paul feeling insulted by his new boyfriend when he and his previous partner “didn’t have anal sex, and never missed it.” Gay men with erectile dysfunction need help to get out of their own head. He and his previous partner had been perfectly satisfied with oral sex, cuddling, mutual masturbation, kissing, and massage/touch. He also thought about how in his last (very long) relationship, Paul and his previous partner generally avoided penetrative anal sex, and had opted for oral play for nearly all of their life together.
When we explored what he meant by “psyched himself out”, he explained how he “gets in his head” about whether he can sustain his erection long enough to satisfy Lorenzo, who had a long-reported history being an enthusiastic bottom. In the case of Paul, his complaint was that using a common ED medication, “ Cialis” (Tadalafil) helped enough for him to have that initial erection, but he “psyched himself out” on trying to penetrate his relatively-new boyfriend, “Lorenzo.” A general practitioner MD had prescribed Paul the Cialis. Or, can you penetrate and get “inside”, but not sustain the erection long enough for you or your “bottom” partner to achieve orgasm, for however “reasonably” (key word: reasonably) a time enjoying intercourse together? Or is it more that you can get partially erect, but the erection is short-lived, and not sufficiently “sturdy” enough to penetrate the mild resistance posed by the closed anal sphincter muscle of your partner? Do you have problems in the early stages, such as feeling sufficiently horny with sex drive and desire? Do you have any initial erectile response on arousal? Or is your penis flaccid even if you have some sexual desire, but it doesn’t respond to visual, situational, mental, or physical stimuli? If you are experiencing erectile dysfunction, try to “break it down” into a more precise self-understanding of what’s going on. (In a previous article, I discussed erectile dysfunction and its related cognitive causes and cures, as well as separate articles on gay men and the fear of topping, or the fear of bottoming.)
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Medical doctors and other medical providers might discuss these phases as well, such as an endocrinologist or urologist, and sex therapists often collaborate closely on client cases with the client’s MD, because erectile dysfunction can have both a medical (blood flow, hormonal balancing, free and total Testosterone levels, estradiol (estrogen) levels, circulation, etc.) component and a psychological component. In working with Paul, our exploration of what was going on brought to mind these three phases, or points in the process, where erectile dysfunction can occur. It was staying hard enough to penetrate his partner, and to sustain that erection long enough to complete anal intercourse, ideally to (mutual) orgasm. For Paul, “getting hard”, or the initial erection, was not a problem for him. Recently, in the case of my client, “Paul,” (names and other details are changed for confidentiality reasons), we explored in sessions how “erectile dysfunction” in general is not quite as precise a discussion as we might need. While it’s important to remember that many gay men don’t like anal intercourse (and that’s fine!), another proportion do, and want to be able to engage in the “Top” role and the related sexual pleasures therein for both partners.Įrectile dysfunction can be thought of in three phases: 1) Getting Erect Upon Arousal or Stimulation 2) Getting Erect Enough to Penetrate and 3) Staying Erect Through Intercourse.
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In my long (28 years) career as a specialist in therapy for gay men, and my relatively recent emphasis on sex therapy for gay men, perhaps the most common complaint I hear from my clients is about erectile dysfunction, which is really just the ability for a (cisgender) man to get “hard” and stay that way enough to enjoy a full cycle of either oral or anal intercourse. Erectile dysfunction in gay men is not limited to older men. Gay Men’s Sexuality: Three Types of Erectile Dysfunction and Their Interventions