Oh my gosh, it’s Valentine’s Day, and I think I’m broken in the bedroom

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Jack is a 48-year-old man who came to me to discuss problems in the bedroom. He loves his wife and thinks she’s very attractive, but lately he just tends to avoid situations that may result in intimacy. After going through the usual list of questions, I asked him about his erections. He admitted to me that he had a “failure” about a month ago, something that has never happened before and he is paralyzed with fear of it happening again. His wife is starting to ask questions about his lack of interest.

Whether Valentine’s Day and the annual focus on love and intimacy or the other 364 days of the year, we’re constantly bombarded with messages and images of the ideal sexual relationship. Jack’s story isn’t unique and he’s definitely not broken.

An erection requires three key components:

  1. Plumbing (blood supply)
  2. Electricity (nerve supply)
  3. A brain without distractions

The inability to achieve or hold an erection to the point of ejaculation is called erectile dysfunction or ED. ED is caused by either a medical condition which is called organic ED, or by something we conjure up in our own minds which is psychogenic ED.

Organic ED is rare, and is almost always caused by medication that men take for blood pressure issues. Organic ED can also be caused by conditions such as diabetes that often cause a reduction of blood flow through important body tissues. Organic ED can also be caused by Testosterone deficiency. These causes for ED can usually be treated medically.

The truth is that the majority of men who see me for ED issues suffer from psychogenic ED. Psychogenic ED is almost always sudden, and is a result of some new major stress in a man’s life. Believe it or not, one of the most common triggers is getting a promotion at work. Typically, there’s a failure during intimacy because of a mental distraction of some sort. Once the failure is noticed, trying harder simply makes things worse! Then Failure can lead to questions from a spouse about whether he finds her attractive any longer, and this simply magnifies the situation. So when the next opportunity for intimacy comes along, a man is even more determined to make things work, which invariably leads to another failure. The harder he tries, the worse it gets. I call it the bedroom death spiral!

Because organic ED has a medical cause, it should be diagnosed at the doctor’s office in order to be identified and treated, if possible. Often, something as simple as changing medications may remedy the situation. However some men may require medications called PDE5 inhibitors, common prescription names are Viagra and Cialis, which help produce an erection. These medicines can be used periodically or might be needed long-term if the physician determines.

Psychogenic ED is relatively easy to fix these days with some patient education and the use of PDE5 inhibitors. These medications “take the brain out of the equation.” Once a man as a couple of successful encounters, everything seems to work out just fine. The spiral is over, and often, medication may not be needed any longer.

What to do if you begin to experience ED:

  1. Make sure you’re getting plenty of sleep.
  2. Avoid any alcohol before engaging in intimacy. Alcohol is a depressant and can make the situation worse, despite reducing inhibitions.
  3. Take things slow – remember the days of kissing and hugging? Expressing love and affection comes in many forms.
  4. Give yourself permission not to be perfect.
  5. If you feel like you need help, a short-term course of medication may be in order. Call your doctor. There’s no reason to panic or be embarrassed.

Here’s to you and yours for a happy, no-pressure Valentine’s Day and more.

About Dr. Chastain

2016 curtis chastain_crop Curtis C. Chastain, MD, FACP, is an internal medicine physician focused on the primary care of men. He is a thought leader and frequently requested expert on men’s health, bringing his personal insights and 25 years of practice experience to this topic. Dr. Chastain is the founder and medical director of the Men’s Health Center at Our Lady of the Lake Regional Medical Center. To learn more about becoming a member of the Men’s Health Center, call 225-765-4400.​
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