Erectile Dysfunction: Talking to Your GP and Keeping Sex Good

It happened again. It might've been after a big night, or with someone new, or for no reason at all. Now you're lying there staring at the ceiling, saying "This has never happened before," even though it happened last Tuesday, and you've started to dread going to bed. Erection problems are extremely common, and they become more so with age. You're not less of a man. It isn't a sign that you don't find your partner attractive. And it's very often treatable.

What's normal?

Everyone with a penis loses an erection sometimes, or can't get one. Stress, alcohol, tiredness or nerves can all do it. Our guide to soft penises explains what to do when it happens. Erectile dysfunction, or ED, usually means that you've been having trouble getting or keeping an erection that's firm enough for the sex you want, on an ongoing basis. If it's happening regularly or it's bothering you, it's worth a chat with your GP.

See your GP, even if you're embarrassed

This isn't just about sex. Erections depend on healthy blood vessels, and the ones in your penis are small. So trouble with erections can be an early warning sign of heart disease, high blood pressure or diabetes, sometimes years before you'd otherwise notice. A simple check-up could really matter.

Your GP has this conversation all the time. You can start with: "I've been having trouble with my erections." It's that easy. If you'd like to, write it down and hand it over. They'll ask how long it's been going on, whether you still get morning erections, about your health and medications, and about what's going on in your life. They might do a blood test or check your blood pressure. Healthy Male (healthymale.org.au) is a good Australian resource, with reliable information to read beforehand.

Common causes

• Physical: Heart disease, diabetes, high blood pressure, high cholesterol, obesity, hormone problems, nerve damage, and treatment for prostate cancer.
• Lifestyle: Smoking, vaping, heavy drinking, drug use, poor sleep and not getting much exercise.
• Medication: Some antidepressants, blood pressure tablets and others can have this effect. Our guide to antidepressants has more. Don't stop taking anything without talking to your doctor.
• Psychological: Stress, anxiety, depression, relationship problems and performance anxiety. One bad night can make you nervous about the next. Our guide to sex and anxiety looks at how to break that cycle.

It's often a mix. Even if the cause began as physical, worry about it can soon make it worse.

Treatment options

Your doctor can talk you through what's right for you. Options can include:

• Lifestyle changes. Stopping smoking, moving more, sleeping better and drinking less can really help.
• Tablets. PDE5 inhibitors, like sildenafil and tadalafil, are prescribed in Australia and they help many men. They aren't safe for everyone, especially if you're taking nitrates for your heart. Only buy them from a real pharmacy, with a prescription. Pills from dodgy websites or shops may contain unknown ingredients, and that's a real risk.
• Injections and other treatments that work directly on the penis, when tablets don't do the trick.
• Vacuum devices. A pump draws blood into the penis, and a ring keeps it there. Our guide to penis pumps explains how they work. Ask your doctor before you use one, particularly if you're on blood thinners or have a bleeding condition.
• Counselling or sex therapy. This can be very effective for performance anxiety. Here's what that's like.
• Surgery, such as implants, as a later option.

Be careful with supplements and "herbal Viagra", as some have been found to contain undeclared prescription drugs. The TGA keeps warning about these products. It's your heart, after all.

Keeping sex good in the meantime

A penis doesn't have to be hard to feel good, and sex doesn't have to mean penetration. Many men can have an orgasm without a firm erection.

• Take the spotlight off your penis. Spend time on everything else. A sensual massage is a great place to start, and our guide to non-penetrative sex has more ideas.
• Use your mouth and your hands on your partner. Our guides on oral and fingering might teach you something. You can be very good at sex with no erection at all.
• Try vibration. A vibrator on the underside of your cock can feel great, even when you're soft. The Satisfyer Perfect Pair 1 can be used as a finger vibe, and that's an easy way to try it.
• Bring in toys for penetration, if that's what you both want. A strap-on or a dildo isn't a defeat. It's just more options. Our strap-on guide explains. Hollow strap-ons are also available, and are worth looking into.
• Cock rings may help some men who get an erection but lose it. They aren't a medical treatment. Read our safety guide first, and take it off after about 20 minutes.

Talking to your partner

Going silent's the worst thing that you can do. Your partner's probably worried that it's them. "It's not you. I find you incredibly hot. I'm seeing my GP about it." That's one of the most useful things you'll ever say. Partners, don't make it a big deal, don't take it personally, and don't keep checking on it. Keep touching them, and let them know you still want them.

If this is getting you down, tell someone. Beyond Blue is on 1300 22 4636, and MensLine Australia is on 1300 78 99 78, any time. This is general information, not medical advice. Please see your GP, as they can help.