Given that it’s June and peak wedding season begins this month, I invited my associate Lauren to contribute a blog about the erectile issues that might cause havoc as a straight or gay couple ready themselves to walk down the aisle. 
With the peak of wedding season approaching for the spring and summer, heterosexual and homosexual couples that are getting ready to tie the knot may begin reflecting more on their relationship and their issues within it. Some feel like it’s crunch time and instead of avoiding these concerns, couples might want to finally tackle them before taking on married life. Sexual issues such as erectile dysfunction (ED), which is the difficulty to attain or maintain an erection or remain firm enough for penetration can frequently be put off by a couple and/or a groom because it is a vulnerable and sensitive subject for most partners to address. This procrastination can also lead to avoidance of intimacy in general, which is not a beneficial way to begin a marriage.
What I have found in my clinical work providing sex therapy at Center for Love and Sex is that ED is a common presenting problem for younger men as well as older men. Research has shown that 26 percent of men 40 years of age and younger are effected by ED, with half of them having severe ED. Given that men are getting married at older ages, the fact that a quarter of these men (and their partners) may be secretly suffering from ED is a concern and one that we see frequently as couples are in the throes of planning their weddings. Men are also well known avoiders of getting an annual physical. As part of the CLS model we ask our patients to get a physical, as medical conditions can be a factor in the persistence of ED. The following medical conditions have been associated with ED: high blood pressure, kidney disease, diabetes, obesity, Parkinson’s disease, multiple sclerosis, side effects from medication, and treatment of prostate cancer. 
The young men I see coming in struggling with ED usually discuss performance anxiety, low self-esteem, relationship problems, anxiety, depression, stress, guilt, fear of intimacy, difficulty transitioning between porn and masturbation to partnered sexual experiences, as well as excessive alcohol intake. Other contributing factors may include questioning their sexuality, having had a negative sexual experience, childhood trauma or worry over the lack of control they feel with their climax. It has been shown that ED and PE (premature or rapid ejaculation) often are presented together and that “ED is increasingly being recognized as the single greatest risk factor for PE”
Many young men who come in for help at Center for Love and Sex report that when they first begin talking about the problem, they feel vulnerable and at times worried about what their partner thinks of them, they feel a lower self-esteem. However once I let them know these are common feelings that most men have when confronted with ED and that I will guide them slowly on how to address the issue, they begin to open up about the consequences this issue has had on their relationship. Having sessions with both partners is critical to allow for the partner w/o ED to express their own concern, ask for guidance from the therapist and offer support to their fiance. 
Helping a client track their thought patterns during the sexual scenario with their partner can be extremely helpful. Here are some thoughts that frequently occur before or during a sexual experience: “I’m not a man if I cannot get an erection,” “I am disappointing my partner because I cannot give them pleasure,” “this is all my fault that our sex life isn’t good,” or “my partner must want someone else because I cannot get an erection.” It is also common in gay relationships for the partner who identifies as the top to have more pressure to obtain and maintain an erection more than the partner who identifies as the bottom. The anticipatory anxiety (the anxiety leading up to an event) can be just as stressful as the anxiety a man experiences during a sexual experience because it is setting oneself up for failure before anything even happens.
American society in general contributes to many of these negative thinking habits. For most straight teenagers and more recently gay young adults the dream of your wedding night, honeymoon, and marriage is presented like a Hollywood movie, complete with endless love making, excitement and passion. There is a lot of pressure on getting every detail down for the ceremony, ensuring your relatives get along, making sure the first dance goes off without a hitch that thinking about the penis responding properly can be overwhelming. Given that many young men are now growing up with porn available at any time, comparing oneself to the exaggerated bodies and pharmaceutically assisted behavior of porn actors can only offer more heartache since one can never live up to one’s own and one’s partner’s expectations. In films and porn men are presented as totally in control, exuding confidence and pleasuring their partner, at times for extended periods of time.
When you come into Center for Love and Sex, ED will be initially be addressed with both members of the couple if this is possible. This is important because sometimes there is unresolved anger or conflict, and difficulty in communication that could also being playing a role in sustaining the problem. It is also important to realize what effect each person has on what is going on in the couple’s system. ED can be the symptom that hides or exacerbates other behaviors, such as the non-symptomatic partner rushing to orgasm very quickly before their partner’s erection is lost. Therefore, not only does this put pressure on the man with ED, it also puts pressure on the partner to rush through their pleasure.
Lastly, ED could also be masking a lack of sexual desire that one of the partner’s may have, so the man expressing the erectile issues may be in fact reacting to insecurities he feels around his partner’s lack of sexual desire towards him. In order to address these issues, we would discuss and evaluate the feelings each person has around ED, how they feel about their sex life as a whole, and help each partner understand the relationship between their anxiety and the symptom of ED. It is easy to forget that the partner usually also exhibits anxiety during sexual experiences wondering if things will work out this time or thinking about how the partner with ED is feeling. So the couple must become more mindful of the pleasure of the sexual feelings, instead of putting themselves in a negative thinking pattern which diverts their focus away from the sexual arousal. In addition to that, it is important that when given home exercises to practice between sessions, they do it together in a non-judgmental, relaxed atmosphere where the couple learn to be better intimate partners and use the home exercises to increase pleasure and decrease anxiety as a team. So CLS and I invite you to a place of better understanding, more intimacy, and better communication that can help you not only on your honeymoon but for years to come.