There can be many reasons why men may need to use Viagra. Photo / Getty Images
Do you have any sex or relationship issues you’d like help with? Send your questions through to our experts at questions@nzherald.co.nz.
I’m in my first serious relationship since my divorce. It’s been going well we seem very compatible and our kids get along fine. However recently he has started having difficulties performing in bed. It’s okay if he uses Viagra but I’m worried it means he’s not really that into me, that I’m not attractive to him anymore. Should I be concerned? - Carolyn
The short answer is that we don’t think it is likely that your partner’s erection issues result from him not finding you attractive enough or that he’s not really “into you”. Many things can impact men’s and women’s arousal, and in our experience, how “into” their partners they are or how physically attractive they find their partner isn’t a very common one. So we don’t think it would be helpful for you to focus on that idea.
It is far more likely (and research supports this) that his erectile difficulties (ED) result from the degree of his investment in his relationship with you and you becoming increasingly important to him. We will explain how this psychological/emotional effect on sexual arousal works in a moment, but there are a few crucial points about erectile issues to mention first.
Men’s erectile functioning has been referred to as “the canary in the coal mine” for many health issues. Erectile problems can be a warning sign of emerging health problems such as heart conditions or diabetes. It is prudent for any man experiencing changes in how their erections are working to talk this through with their GP and get a full health check.
If your partner has recently started taking a new medication, this can also impact their erectile functioning. Examples include blood pressure medication, antidepressants, diuretics, tranquilisers, drugs for irregular heart action, Parkinson’s disease drugs, and muscle relaxants. Heavy alcohol use can also cause ED, particularly as they age. The effect can be quite marked if combined with stress, worries, anxiety and fatigue.
Let us come back to the issue of how anxiety can build as your partner becomes increasingly involved in his relationship with you. The anxiety arises as more caring and investment in you by your partner equals a greater potential threat of hurt. The more he cares, the more vulnerable he may feel, and the more anxiety is likely to accompany being in a vulnerable state of opening up to you.
Women may also experience this, and it can affect their ability to get sexually aroused also. That said, there is a gender bias toward emotional vulnerability being more challenging for men to tolerate without feeling anxious. It is sadly still common to teach boys that being emotionally open and vulnerable is “weak”. Yet we desperately need tender-hearted men, and it takes great strength for men to risk being honest and vulnerable so they can deeply connect with their partners.
So what does all this have to do with ED? When any of us feel anxious, some important things go on physiologically. Our bodies respond to an emotional threat the same way they do to a physical threat. Our physiology goes into flight, fight or freeze mode and our bodies flood with cortisol and adrenaline. There are significant changes to the blood flow in our brains and bodies, with blood retreating away from our extremities, including a man’s penis. This can result in difficulty getting or maintaining an erection.
Of course, losing an erection can induce further anxiety and fear of “performance” failure for men, leading to a destructive negative feedback loop. Your fear that he is “not that into me” will likely lead you to react self-protectively, either in withdrawal or accusation. So there is more and more anxiety and worry in the air. This makes it harder still for the man to get and maintain an erection. Working to reduce these fears and anxieties or handling them better often results in the erectile issues diminishing.
So if you accept that your partner’s ED is more likely to be a sign that the relationship is of increasing importance to him, then why is it so easy for you to believe that someone is no longer “into me”? Assuming that your partner’s erection issues are about you (and many women assume this) may, to some extent, be caused by your socialisation. Most women have internalised the mainstream patriarchal idea that it is women’s role to be the “object” that arouses men, so if a man does not get aroused, it means they are not stimulating enough.
Your assumption may alternatively or additionally point to insecurity about your attractiveness or low self-esteem.
Is there a history of you feeling unwanted, unimportant or not good enough in your upbringing or early relationships? Did you have body image issues as a teen? Were you socially awkward with dating? In your prior relationships, particularly your marriage, were things said or done that invited you to doubt your worth or attractiveness?
These are the kinds of questions we would encourage you to focus on rather than what your partner’s ED means. If you fear you aren’t worth wanting – that’s something you need to look at rather than imposing it on your partner’s sexual functioning.
Some women who feel insecure about themselves attempt to manage that by asking anxious questions of their partners and end up making them feel more uncomfortable about their ED and, hence, struggling even more with their penile functioning. Most men already have enough emotional pressure around their erectile functioning without their partners adding the extra burden of insecurities about their worth or attractiveness.
We are not suggesting you don’t talk to your partner about his ED, but we do recommend you do it in a way that supports him, not about seeking reassurance for yourself. Does he worry about it? Does he fear you will think less of him, think he’s less of a man? Is he aware of the health implications?
Difficulties in our sexual functioning are inevitable as we age, but they can force us to have intimate conversations that we have been avoiding. Talking about how sex works for us, what it means to us, what we desire it to be like and what it might take to get there are challenging topics. But if you’re willing to go there, authentic connection and great sex will likely follow in the long run.
• Verity & Nic are psychologists and family therapists who have specialised in relationship and sex therapy for more than 25 years. They have been working on their own relationship for more than 40 years and have two adult children.
Telegraph: The conditions that affect men at every age – and how to protect against them.