Erectile Dysfunction affects men of every age, but is more common amongst those of us living with HIV. Today we’re talking to the Havelock Clinic about this often ignored topic.
We know that Erectile Dysfunction can happen at any point in your life, but did you know that it’s more common amongst men living with HIV?
It can be for a number of reasons, including but not limited to: fear of passing on the virus, lack of confidence in sexual performance after diagnosis, trouble establishing intimacy, self-stigmatisation, excess use of alcohol and recreational drugs, other health conditions alongside HIV or even the medications we take to treat the virus.
But if this affects you, don’t panic! We met with the team from The Havelock Clinic, an independent sexual problems service based in central London to talk erections.
So tell us- what causes men to have problems with getting or staying hard?
Jane: In younger men, there’s often not a medical cause, but anything that can affect blood flow to your penis, your hormones, your nervous system, or how your brain and penis are interacting could be contributing.
Ali: We see lots of men about this, it’s really common and can be really distressing. As Jane says, there are lots of causes of erectile problems and medical causes are especially important as men get a bit older. Some men worry about their testosterone level and think if they boost it it might improve their sex life, but boosting a normal level of testosterone is not recommended and can be dangerous to your overall health. Testosterone levels can be affected by all kinds of factors including health conditions such as HIV, or as a side effect of medications.
Jane: Yes we’re increasingly seeing more men who are having significant sexual side effects from drugs taken to prevent hair loss (e.g. Finasteride), internet bought steroids and performance enhancing drugs. What is particularly concerning about these drugs is that people are taking them without prescription, not knowing the potential side effects, and not knowing that sexual side effects can persist, even after stopping the medication.
Karen: One of the things that I see a lot is that men sometimes have an expectation that they should be hard even if the conditions are not necessarily erotic, or even if they’re not attracted to the person. Some men tell me that this can be even more pronounced at a chillout if they feel someone else is having sex with them just because they both happen to be there, for example. When men use Viagra-like drugs a lot (either alone, or in groups) it can also create a bit of a false sense of how hard you should be or how long you should be able to stay hard for. Sometimes this means that the comparison you make when you’re not using these helpers, is that your erections are substandard, when in fact, they might be entirely normal.
Mike: One of the other big causes of erectile problems from a psychological perspective is a combination of being worried about staying hard, or worry about another aspect of sex such as STIs, body image etc, and being focused on this worry rather than what’s going on. A negative cycle can be created over time where the worry affects your erections and this makes you worry more the next time you have sex. This can create a snowball effect of the problem over time. Concerns about erections can sometimes be caused by unrealistic expectations of our bodies. Remembering that all men lose their erection from time to time, and that its normal for erections to come and go during a sexual encounter are important to how we judge ourselves sexually.
OK, so what can someone do about it?
Ali: Lots of people find talking about sex difficult, but in our experience those who don’t identify as heterosexual, cis or binary gendered, might be concerned about talking to their GP about sex or sexual practices due to fear of being judged or not understood. National and international guidelines recommend that all men have a medical assessment of their erectile problems, so we would recommend that first. In that appointment we’d take a full medical history, do an examination and do some blood tests to look at things like testosterone, for example.
Jane: We’d also be wanting to look at risk factors for cardiovascular disease. Increasingly the effects of cardiovascular disease, even for younger men are relevant. Studies have shown that making changes to lifestyle factors such as reducing smoking, alcohol and recreational drug use and increasing exercise can improve your sexual function, so sometimes recommendations in this respect are useful and can reverse difficulties with erections. If we find a medical cause, we’d look to treating the underlying cause or perhaps giving a prescription. If we don’t find a medical cause, and sometimes in addition to medical treatment, we’d be recommending sex therapy or our online erections workshops as something that will help.
Mike: A big part of what we do at that stage is letting people know how talking therapies work, and that they do work! People often think about therapy as talking about your problem while someone else listens carefully and reflects it back to you. This can be the case for some therapies, but it’s not how sex therapy works. Yes of course we are interested to listen and understand how the problem has been affecting you, but we’re much more interested in giving you information about how erections work, how problems can be inadvertently created and reinforced over time, and to give you the skills to overcome it. Men often seem pleasantly surprised by how practical the approach is and how quickly it can work!
Karen: Once we’re able to confidently assure men that there’s no underlying medical problem affecting their erections it’s often a big relief for them, but then its ‘what’s next?’. We offer very short term psychosexual therapy to learn about the complexities of the mind/body interaction when it comes to sex, so that people can have the confidence that the sex therapy techniques we’ll ask them to do in between sessions work really well. Sometimes we build condom use into these, as many men tell us that using condoms is either the cause of their difficulty, or a side effect. If they want to use condoms, even some of the time, we like to ensure they feel really confident this won’t affect their erections. Ultimately, It’s all about helping people get the sex life they want.
The Havelock Clinic provide comprehensive face to face assessment and treatment for sexual problems including erectile dysfunction at http://www.thehavelockclinic.com
You can also register for their next online dysfunction workshop here: http://thehavelockclinic.com/online-treatment/
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