So, What Exactly Leads To ED?

Q: What exactly leads to erectile dysfunction? I’m now experiencing it, yet I’ve always been a superstar. I also have the problem of premature ejaculation, where I release immediately after I enter. Is there a solution for that?

A: I would be remiss if I didn’t start with this: You are still a superstar. Your penis is not — or should not — be the only thing you bring to the table during sex.

That said, it is, of course, horrifying, frustrating, heartbreaking, sad, sh*tty, and just plain annoying when your body doesn’t work the way you want it to at any time, but especially during sex.

As cliche as it is to assure you, I want you to know that you are so much less alone than it probably feels like — you’re not some anomaly. According to two doctors I interviewed back in 2020, the percentage of people who experience erectile dysfunction is about the same as the age group they’re in. So about 60% of 60-year-olds and 20% of 20-year-olds, for example. Is that exact? No! Absolutely not. But if you consider this, and we assume that you’re not a 13-year-old writing in, that means that you’re looking at, at least 1 in 5 people with penises having them not work from time to time. (Or always.) And premature ejaculation often follows erectile dysfunction — because why not have your body refuse to cooperate in multiple ways instead of one? Basically, people with ED often get into a pattern of subconsciously trying to come quickly while their erections last, which then trains their bodies to try to come quickly.

Now, what’s causing erectile dysfunction? Well, there are many things that can lead to or at least contribute to erectile dysfunction, and you might have a combination of them. Despite the prevailing wisdom that ED is about performance anxiety, doctors have found that erectile dysfunction is more often caused by organic factors — think cardiovascular issues, diabetes, or medication — rather than psychogenic factors like anxiety or depression. In fact, a new case of erectile dysfunction is very important to get checked out by a doctor for this reason. A lot of instances of erectile dysfunction are caused by vascular (blood flow) issues, which can portend something more serious, healthwise. I don’t say that to scare you, but to let you know that as uncomfortable as you might feel about it, this is something to actually talk to a doctor about.

Outside of it being a sign of a potential health problem, I strongly, strongly urge (am begging) you to see a doctor because both erectile dysfunction and premature ejaculation are treatable. Is it going to be an easy fix where you never have problems again? No, probably not! But there are tons of things you and your doctor can try, most of which are at least somewhat successful at addressing the issue and almost all of which are incredibly safe. For erectile dysfunction, first-line treatments are usually lifestyle changes (booo, we all hate this!) and then pills like Viagra or Cialis — ​​PDE5 blockers for the chemistry nerds out there. For premature ejaculation, again, your doctor is going to look at your lifestyle and medical history and then from there probably make some suggestions, but you can also use products like delay sprays and wipes, which are incredibly safe and pretty easy to get over the counter.

There’s not much downside to bringing this up with your doctor other than minor and momentary discomfort at talking to a stranger about your bits. Please keep in mind that you’re trading that annoyance of having to talk to a medical professional about something for the annoyance of dealing with ED and premature ejaculation. A pretty good trade-off, IMO! (If you’re not the kind of person who feels nervous about talking to doctors, then great! You’re ahead of the game!)

To circle back to the beginning, I want to remind you that while you absolutely should see a doctor and address this because of the aforementioned health risks, you can still be an absolute virtuoso in the sack without the focus being on what your body does or doesn’t do. The more honest and upfront you are with your partner or partners, the better. Certainly, it’s not a fun conversation, but it’s going to lead to better times for both of you. You can say something like “Sometimes my dick doesn’t cooperate with exactly what I have in mind, but these things feel really good…” or simply ask for what you want — “Can we try this position?” “Can I go down on you?” “What if we try this?” The good Lord invented mouths and hands for a reason! You might not be able to come when you want or stay hard for as long as you’d like, but sex isn’t only about that. It’s about feeling good. Do what feels pleasurable and try your best to leave any shame or self-doubt at the door.

It’s A Pleasure appears here every Thursday. If you have a sex, dating, or relationship question, email Sophia at BustleSexAdvice@gmail.com or fill out this form.