Reader’s Question

I am a 24-year-old woman having a relationship with a 25-year-old man. We recently got serious about our relationship and decided to take it to the next level by having sex. The only problem is that my partner cannot have an erection — or at least not for long. This has happened 3 times in a row, so it can’t be an erectile dysfunction based on situational factors. (I am a psychology graduate, and I have read the DSM-IV to get a clearer picture.) We have done oral sex before and he has managed to have an orgasm, but not now. So now I’m wondering if I’m the reason for the problem.

Our Clinical Psychologist’s Reply

There are several factors that can influence whether someone is able to have a normal and satisfying sexual experience. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV TR) categorizes a broad range of “sexual dysfunctions,” which are primarily defined by an individual’s impaired ability to experience sexual desire and the physiological and psychological experiences that typically accompany the adult sexual response cycle. The major phases of the normal response cycle include desire, excitement and arousal, orgasm, and resolution. A disturbance can occur in any of these areas and can be a cause of emotional, mental, and psychological distress. Dysfunctions can be lifelong, acquired after a period of normal functioning, generalized, or situational. One of the sub-categories of Sexual Dysfunction is Male Erectile Disorder, which is the inability to attain or maintain an adequate erection in order to complete sexual activity.

Situational factors can influence the various forms of sexual dysfunction, even if they occur frequently. What differentiates a situationally-based dysfunction from a more generalized pattern is that a generalized dysfunction occurs in various settings, with different partners, or in response to various types of sexual stimulation.

Because so many factors (both physiological and psychological) can be involved in sexual dysfunction, it’s important to get a thorough evaluation. Many medications, undetected metabolic and other disease processes, as well as psychological factors can all play a role in such dysfunctions. So, it’s best to start by consulting a physician with expertise in the area in order to begin the process of determining the underlying reasons for the difficulty.