About Last Night: is the problem in my head or my hydraulics?

Q: At 44, I sometimes have difficulty getting or keeping an erection, which freaks me out. On the other hand, I wake up most mornings with an involuntary hard-on. Does this mean the problem is in my head rather than in my hydraulics?

A: The human body is a complex system, and its functions are not purely mechanical. A tip truck will tilt every time it is activated, unless a component is broken. Our ability to perform can be affected by the context, our beliefs about what we are doing, and how safe we feel.

Victoria Cullen is a sexuality educator and researcher working within the area of sexual rehabilitation post prostate cancer treatment. She is the founder of a useful website, atouchysubject.com, where you can buy online courses and physical products for sexual recovery after male cancer treatment.

Maureen Matthews: learn to engage.Credit:Simon Schluter

Cullen says all men will experience a certain level of erectile difficulty at some time in their lives, and they should always start by consulting a doctor.

“I've heard urologists call the morning erection 'the canary in your pants' because it is often the first signal of an underlying organic problem such as nerve damage, cardiovascular issues, or even diabetes. If the erection difficulties only occur during arousal-induced sex, having morning or nocturnal erections suggests that psychological causes are more likely the problem.”

Stress hijacks the mind, and all erections start in the mind. When the mind goes into an alert state because something needs to be addressed, our "fight or flight" mechanism floods the body with adrenalin and cortisol. After all, you do not want a rock-hard erection if you are running away from a sabre-toothed tiger. As Cullen says, "in a sexual state, adrenaline is a literal cock-blocker".

So, what can you do to counter this? Cullen offers a couple of practical tips that might help.

"Move the focus from thinking about your erection and onto feeling the pleasurable sensations from your body, and on witnessing your partner's experience. Your erection needs feeling, not thinking … when you can sense your body is moving into a stress response (shallow breathing, tensed muscles, thinking rather than feeling), take a deep breath imagining the breath coming all the way into your deep belly and pelvic floor and out," she says.

Cullen also points out that you do not need a strong erection for penetration, or sexual enjoyment.

“If what you are concerned about is not being able to perform ‘penis in vagina’ (PIV) sex, then try entering your partner soft, with lots of lubricant, or try oral/hand massage while soft, just focusing on the sensations. This also requires you to communicate what is happening with your partner, which, in itself, can reduce stress by fostering feelings of connection and closeness. Working on feeling safe helps reduce the stress response.”

Try to eliminate the sources of stress. “Are you concerned about privacy because your children are at home? Get a lock for your bedroom door or plan a hotel trip so you're away from being primed by your environment. Is work very stressful at the moment? Find a strategy to complete the stress cycle before meeting your partner, such as a gym workout, yoga, or deep breathing.”

Finally, Cullen says: “It’s very important to know that erection, orgasm, and ejaculation all exist on different nerve pathways and physiological systems – like the Christmas tree string of light bulbs that do not cut off the circuit when one blows. It’s the same with your sexual system and erections. This is often the biggest (and most welcome) surprise for my clients, post-prostate surgery. There might not be an erection when they are aroused, but instead they often have a more intense and stronger orgasm than before (the researchers in this space still do not know why).”

If there is one realisation that can help men to enjoy their sexual journey, it is that the ability to get a hard penis does not define you as a man, nor is it a prerequisite for being a wonderful lover who enjoys great sex.

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