Ask a doctor on the topic of Urology

Erectile dysfunction caused by anxiety? Effects on normal life

September 28, 2016 | 30,00 EUR | answered by Dr. David Meyer

About myself:
I consider myself to be moderately to strongly introverted. Large groups of people, parties, festivals, etc. make me uncomfortable and drain me of energy. I am happy when I can be alone. It is very important to me what other people think of me, more so than my own opinion.

Regarding my (urological) history:
Due to my reserved, shy nature, I was a virgin until age 25. My first attempt at sexual activity was unsuccessful as I felt no pleasure and had to check if I was actually "inside". It was later discovered by a urologist, after a short 3-week relationship, that I had phimosis which was already inflamed and required surgery (complete removal of the foreskin). After this, due to self-imposed social isolation for about 4 years, I had no chance or attempts at sexual intercourse. I also never felt the reproductive urge towards women that my friends often talk about. This remains true to this day.

At age 30, I made another attempt at sexual activity with similar results - little to no sensation. The partner at the time suggested using a larger condom, which helped slightly. However, the relationship did not last long enough for further experimentation. Since then (another 3 years), I have had no success in relationships or sexual activity.

Generally, my erections have never been very strong, and they tend to fade quickly if there is a delay or lack of stimulation. Previous attempts at intercourse ended abruptly due to this. It took a long time for the erection to return, and the disappointment of my partner was the worst part. I still look back on these events with dread. However, I have no issues with self-pleasure.

Now, at age 32, I live with a significant fear of relationships and the expectation of sexual activity from a partner. I wonder if I have always suffered from a mild erectile dysfunction, exacerbated by my reserved nature and initial difficulties. I once had a complete hormone analysis done (about 2 years ago) which showed high estrogen levels and slightly low testosterone levels. I did not pay much attention to these results at the time, but they came to mind while searching for the cause of my burnout, fatigue, and mild depressive thoughts.

I have extensively researched transgender topics and can identify with certain aspects. I feel more envy than desire towards attractive women. The male impulses that occasionally surface weigh heavily on me, and I struggle to suppress them. I am considering self-medicating with an anti-androgen like Androcur to eliminate this burden, as I see no possibility for a normal sex life. However, I am afraid of the potential side effects and have decided to give my assigned gender one last chance before pursuing medication or hormone replacement therapy (HRT), even though I may be considered too late to start at age 32.

My question for a urologist would be for advice based on my description. Can a known medical condition be deduced from my symptoms? Would it be beneficial to repeat hormone tests to check estrogen/testosterone levels? Is my exploration of transgender identity and desire to eliminate the burden of natural impulses due to past failures, or could it be my feminine side emerging?

Dr. David Meyer

Hello dear inquirer,

I have read your text thoroughly and I can tell you that we often see patients with similar "symptoms" in the urological outpatient clinic at the university hospital.

What you are experiencing is more or less not a physical or medical problem, but a psychological stress situation. Many young men who are late bloomers have trouble maintaining an erection during intercourse for the first time. Due to nervousness, your autonomic nervous system automatically prevents you from getting an erection.

As I mentioned, I know several cases where young men in their mid-twenties had intercourse for the first time, lost their erection while putting on or selecting a condom, or even upon penetration, which was frustrating.

Often, the partners are not aware that their partner has little sexual experience.

I would like to give you some tips that have helped my patients and in cases where a psychosomatic therapist was involved.

1. Talk to your partner, it is not a problem to admit nervousness. Get into bed together in the right mood and eliminate all distractions.
2. Try not to take a strenuous position directly before penetration. I am not a physically oriented sex therapist, but a side-to-side position (L-shaped) can make penetration easier without causing physical stress. As soon as you notice your heart rate starting to rise, take a step back.
3. Take your time to find the right condom. I recommend extra-thin condoms for sensitivity issues.
4. Talk to your partner about alternative contraception methods, such as "Natural Family Planning", so that the stress of the condom may be reduced. Of course, experimentation should not be done here. You will be surprised how important this cliché topic can be.
5. Time, time, time. Do not get frustrated if it doesn't work the first time. Often, it will work after taking a break during foreplay, and your partner will notice that you have overcome your inner blockage. Do you wake up next to each other? Then take every opportunity to confidently embrace your sexuality.

Based on your history, I would consider a hormonal disorder unlikely, as you do not have any issues with masturbation. A psychosomatic therapy may be more suitable for you to help you overcome your nervousness.
If you look at your own "vicious cycle" from the outside, you will realize that you are putting pressure on yourself to achieve a certain sexual satisfaction. A single elevated estrogen level in an otherwise healthy man is certainly not a reason to suspect an organic cause of "disturbed" sexual function.

Consult a specialist in sexual medicine if your situation continues to affect your quality of life.
From my experience, I can tell you that with patience, openness to your own body, and discipline to avoid negative thoughts, the phenomena you described can be resolved.

I wish you all the best and look forward to positive feedback.

Dr. Meyer
(Specializing in Urology)