Problems with hard-ons

Can't get it up? Come too quickly? Can't come at all? Taking the bottom role because you can't get hard?

Hard-on and orgasm problems can have a physical cause but often it's rooted in the mind. Or it can be a mix of the two.

If physical causes can be ruled out, our problems are often a sign that we don't like the sexual situation we're in. This can be caused by feelings of fear, worry, anger or guilt. Sex therapy/counselling is a good way to get to the bottom of what's really bothering us and of learning ways to get back erections or improve ejaculation.

Finding help

GPs often aren't too knowledgeable about sex problems, especially those of gay and bisexual men. But they can refer you to a sex clinic and/or sexual counsellors or therapists. Make sure that the person you see is gay-friendly and knows about gay and bi men's sex issues.

Sexual health clinics can refer you without involving your GP.

You can also use our list of contacts to help you find a sexual counsellor.

Hard-on problems

'Impotence', 'erectile dysfunction' - whatever you call it, it's difficult to talk about. But erection difficulties are very common, whether it's not getting hard at all, only sometimes or getting erections that aren't as hard or long lasting as you want.

Sooner or later, every man experiences being unable to get it up at least once. But men this happens to regularly might deny to themselves that there's a problem or be too embarrassed to get help. And if they do go for help they often want a quick fix for what can be a complicated problem that's taken a long time to develop.

Causes

Physical causes of impotence can be:

• tiredness or feeling ill
• recreational drugs or alcohol
• side effects of medicines, including some anti-depressants, blood pressure pills or HIV drugs
• circulation or heart problems, maybe related to ageing, diabetes, smoking or being overweight
• problems using condoms
• lack of the male hormone testosterone - some men with HIV can have low levels of this.

Psychological causes can be:

• our feelings about ourselves or who we're having sex with
• fear of getting or passing on HIV
• depression, stress or anxiety, possibly connected with sexual experiences in the past
• sexual boredom.

It's very common for worrying about getting a hard-on to stop you getting hard. This sets up a vicious circle of anxiety and erection problems. If you still get a hard-on in your sleep, on waking up or when wanking, that's a sign your problem's probably likely to be more psychological than physical.

And it's important to know that losing an erection during sex - especially when getting fucked - is perfectly normal.

Solutions

Straight men can't easily hide their erection problems because women expect a hard-on, but gay men can hide it by getting fucked instead of doing the fucking. This can mean men living with the problem for years without getting it sorted out.

Sex therapy/counselling can be useful but these may help with hard-ons:

• stopping smoking as smokers are twice as likely to have hard-on problems
• aerobic exercise as running, swimming and cycling, make your heart better at pumping blood to your dick
• a low fat diet to help keep your arteries from being clogged with fat and less able to get blood to your dick
• cock rings stop blood leaving the dick once an erection happens, helping to keep you hard
• gripping the base of the cock has the same effect if you need some short-lived help with a hard-on
• vacuum pumps
• if condoms interfere with your hard-on it can help if you get the other person to put it on you
• using larger size condoms or a Femidom as an extra big condom.

Even if it's not strictly needed medically, some doctors prescribe Viagra-type drugs to boost a man's performance and confidence, helping to break the vicious circle of anxiety and erection problems. Check out our section on Viagra and similar drugs.

Counselling can also help as you can learn techniques to lower performance anxiety and develop intimacy and stimulation with a partner. You can pay for private services or get a referral for free treatment from your doctor or from a genito urinary medicine (GUM) clinic if you prefer. Find one by using our list of places to get counselling or therapy.

Want to know more?

You can get more information from these organistions and websites:

• Sexual Dysfunction Association
• British Association for Sexual and Relationship Therapy