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Ask the Sexpert: Can’t maintain an erection

Do you have a question about sexual health? Submit your own question to our Sexpert

Disclaimer: I am not a medical professional, and it is always best to talk with your primary care provider if you are concerned about your health. To make an appointment with your primary care provider at UHS, call (585) 275-2662.

Submission: I am gay with a low sex drive. I am having trouble maintaining erections during sex with my partner. Everything is fine during masturbation, but I am losing an erection before topping my boyfriend. By the way, I also did not feel good being a bottom. I am wondering whether it is a mental problem and what should I do? Thanks for your patience and time. Looking forward to your reply.

Thanks for your submission! The issues you describe are not at all uncommon. In fact, erectile dysfunction (ED) – being unable to develop or sustain an erection during sex – is estimated by the Cleveland Clinic to affect 1 in 10 adults with penises. Let’s explore a little further what erectile dysfunction may look like –

  • No amount of ED is “normal”, but sometimes it can be caused by factors such as drinking too much alcohol, stress, relationship problems, extreme fatigue, or more. If this is happening only occasionally – less than 20% of the time – it is likely that you will not require treatment.
  • If you are struggling to achieve or maintain an erection more than 50% of the time, generally you will require treatment and should discuss this with your primary care provider.

Other than the factors that may cause occasional ED, there are underlying conditions that could be contributing –

  • Physical causes may include cardiovascular disorders (such as blood pressure issues, stroke, high cholesterol), diabetes, sleep disorders, or kidney disease. There are also some medications that may cause ED, including antidepressants, antihistamines, muscle relaxants, blood pressure medication. Never stop taking your medication or change your dosage without talking with your provider first.
  • Psychological causes may include anxiety, stress, depression, or past sexual trauma.
  • Behavioral causes may include alcohol or drug use, smoking, lack of physical activity, or lack of sleep.

With these causes in mind, it is important that you talk with a doctor about your ED, as there is a possibility it could be a sign of an underlying medical condition. There have been great advances made in the diagnosis and treatment of ED. Some possible interventions may include:

  • Lifestyle changes, such as quitting smoking, limiting alcohol intake, exercising regularly, improving sleep habits, and avoiding drug use.
  • Seeking help for any mental health concerns you may have (stress, anxiety, depressions, etc.). You can make an appointment at UCC by calling (585) 275-3113.
  • Trying an ED medication prescribed by a provider.

In response to your comment about not enjoying being a bottom, know that this is okay! You do not have to take on a certain role during sex if it is not enjoyable or comfortable for you. However, if being a bottom is something that you are interested in exploring further, here are some tips to make the experience more comfortable –

  • Use lube! A water-based or silicone-based lube is great for making sex more comfortable and enjoyable for all involved. Be sure not to use an oil-based lube with a condom, as it can breakdown the latex and make the condom ineffective.
  • Take things slow. Engage in activities to increase your arousal before you try to engage in sex, and communicate any discomfort to your partner! They may be able to change things up to make you more comfortable, or you could work together to do so.

Do not compare your experience to porn or other portrayals of sex in media. Everyone has their own unique experiences, and it is important to do what is best for you and your partner.

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