Reader’s Question

I wonder if you can give me some sense of direction about a problem I’m having. I am in a fairly stable relationship. We have been together for 18 months. I say fairly stable because, like many, we argue about issues both big and small.

The most common re-occurring issue we argue about is sex. I am 9 years older than my girlfriend. While I don’t think this is a problem in itself, I do wonder if it contributes to our issues with sex.

I have suffered from occasional erectile dysfunction (ED) in the past and, to an extent, still do. I have consulted doctors about this and because the initial standard blood tests didn’t indicate anything physical, they concluded the problem is psychological. But I have a vein problem in my legs, which to me suggests that circulation issues might play at least some role in my problem — but because my GP has ruled this out I’m hesitant to pursue matters further with the doctors.

My girlfriend has a much higher sex drive than I do, it seems. She is also more experienced than I, having had many more lovers than I. I find I am just not always in the mood. Sometimes I also know when my body is not going to respond, so I don’t pursue any sexual activity. In the times that I am not interested and just go through the motions, it only increases doubts in my mind, and I don’t feel as confident about my abilities. As a result, I do not initiate sexual activity as often as she does.

I am asking for guidance really, as I am unsure whether it’s my lower sex drive that causes my ED, and that in turn stops me from feeling confident enough to initiate sex; or whether it really is psychological, and my negative thoughts are the cause for the ED and the lack of motivation.

Our Clinical Psychologist’s Reply

It’s understandable that you are hesitant to pursue further medical evaluation. It’s also understandable that you feel some frustration and confusion about the possible causes. However, the things you mention strongly suggest that you need more comprehensive evaluation.

Although your erectile dysfunction issues might be related to your sex drive, they are very different things. Often, men who experience erectile dysfunction can experience reduce libido (sex drive) over time. Most of the time it’s not a matter of whether the roots of either problem are purely psychological or biological. In most cases, problems with both sexual drive and erectile dysfunction have both physiological and psychological factors contributing to them. So it’s really important to be evaluated by a physician, psychologist, or specially trained therapist to get an accurate picture.

A vicious cycle of disappointment, apprehension, and avoidance often accompanies erectile difficulty. To break the cycle, you have to be sure not to engage in negative thinking about yourself, but rather persist in pursuing help just as you would any other medical condition. It’s also important not to be too discouraged by the lack of immediate answers and help for the problem. Sometimes, it takes a good deal of time and persistence. But it’s important to take heart in the fact that these days there’s a wide variety of treatment options available.