Sexual problems in gay men
This is a difficult conversation to have.
Nobody likes to admit they’re having sexual problems. As gay men, our sexuality defines us. Unfortunately, we’re all victims of that definition – our media and magazines say that we’re ready for sex at the drop of a hat and always in the mood. If that doesn’t turn out to be our personal reality, we assume we’re at fault.
Inability to perform leads to acute embarrassment. Acute embarrassment means we never ask for help. We’d ask for help with every other health issue imaginable, and so it’s time we swallowed our pride and talked about the elephant in the room. If embarrassment is hindering our sex lives, it’s time we stopped being embarrassed and did something about it. So let’s face this square on.
Let’s talk about erectile dysfunction
We’ve always heard it said that we think with what’s in our trousers. In truth, erections do seem to have a mind of their own. When we were teenagers, it felt like they were always there whether we wanted them or not. Now we’re a little older, they can sometimes be a little shy even when they really shouldn’t. Here’s a fact for you. Every single man reading this article either has had, or will have, periods where they struggle with erections. Sometimes it won’t go hard at all. Sometimes it’s not quite hard enough to do the job. Most of the time it fixes itself. Every now and then, it becomes a medical issue.
When that happens, it gets a name:- “Erectile Dysfunction”, which from now on we’ll call “ED”. By definition, ED is the inability to achieve or maintain an erection during sexual activity. It falls almost exclusively into two categories: If you literally never have an erection – not even when you’re on your own, or when you wake up – chances are there’s a physical issue. If you’re capable of getting an erection alone, but not with a partner, chances are it’s a psychological issue. Sometimes a physical issue causes a psychological one, or vice versa, which intensifies the problem.
There are a few ways that physical ED can be caused, and they’re often related to other illnesses. Diabetes is one. Multiple sclerosis is another. General circulatory problems are also a common cause – the blood flow to the penis is interrupted with conditions like that, and so erections are difficult to create. Sometimes, ED is the first symptom of a circulatory problem. That’s another reason you should always go to see the doctor when it occurs – you might be saving your life, before the blood flow to the heart is affected. Low testosterone might be the culprit, and especially if you’re an older gentleman. And then there’s the drugs. Both prescription and ‘party’ drugs are frequent factors in ED.
It can be just as concerning to find out your ED is caused by psychological issues, but just because you have psychological ED doesn’t mean your mental health in general is at risk. Most importantly, there is plenty of help available, regardless of the cause.
What are the options for treatment?
There are quite a few drugs and medications targeted at erection problems, some of which you’ll have heard of. The most common ones come in tablet form. Scientifically they’re known as phosphodiesterase inhibitors, or PDE5i. Common variants include tadalafil (branded as Cialis), avanafil (branded as Spedra), vardenafil (branded as Levitra), and of course sildenafil, which is better known as Viagra. For a lot of ED suffers, the problem is solved easily by taking any one of these solutions, although they’re only effective in men who are physically and mentally stimulated.
A weakened erection poses an additional problem; condoms can slip off during intercourse. PDE5i can assist with this by giving you more firm erections, thus making sex safer as well as better.
As with any medication, PDE5i tablets aren’t suitable for everybody. If you’re already taking other medications, there can be negative side effects – for example you shouldn’t go near them if you’re on any medication containing nitrates. As a combination, they can dangerously reduce your blood pressure. You’ll find nitrates in angina sprays, various other heart medications – and ‘poppers’, which are a recreational drug. Poppers can be a particular problem because they can spread in an enclosed environment (a bedroom, or a sauna) and affect people who aren’t directly taking them. As such, PDE5i tablets should only be taken by prescription, after speaking frankly and honestly to a doctor who understand your situation. You have probably seen all of the above listed medication offered for sale online. We strongly recommend that you don’t buy them this way – they’re highly likely to be fake or unsafe.
It’s not all about tablets, though. When you achieve a natural erection, your penis produces a chemical called alprostadil. The chemical can be injected directly into the shaft of the penis, which encourages blood to both flow into it, and to stay there. Success rates in men who have tried and failed with tablets are very high with injection methods. There are two branded solutions currently on the market – Viridal and Caverject.
Similar, but slightly different, is an injection therapy called Invicorp. Containing a blend of phentolamine mesilate and aviptadil, one chemical works on the blood flow into the penis, and the other works on trapping it there. Users who’ve struggled with the other recognized treatments have found success with Invicorp, and some users simply prefer it to the other injection methods because they find it more comfortable.
If you shudder at the thought of injections, hope is not lost. You can also try a pellet called MUSE, which contains alprostadil. The pellet is inserted into the urethra after you’ve been to the toilet, and will cause an erection as it dissolves. There’s even an alprostadil cream called Vitaros, which you can apply directly to the penis yourself. We have an ED fact-sheet at this link which contains further information on all the urethral, topical and injection based treatments out there.
If you don’t like the idea of introducing chemicals into your body to assist with an erection, you might prefer a vacuum pump device. The pump draws blood flow to the penis, and a special ring around the base of your penis holds it there. If that sounds like a simpler solution to you, find out more on our vacuum pump treatment fact-sheet here.
For those individuals who are told that low testosterone is behind their ED diagnosis, testosterone replacement therapy (known as TRT) might be an option. Click here for more information on that.
There are some – but not many – men who can’t be assisted by any of the methods described above. Even in those circumstances, all is not lost. Modern technology means that surgical implants are now available, which create and strengthen erections from the inside.
What about problems with ejaculation?
Controlling ejaculation is a little harder than Frankie Goes To Hollywood would have us believe! There are two common issues here; premature ejaculation (or PE) is when you ‘come’ too quickly. The opposite, therefore, is taking too long. That’s delayed ejaculation, or DE. It was once thought that DE was a very rare issue, but in more recently years it’s been seen frequently at clinics.
The other potential issues are ones you may not have heard of. One is retrograde ejaculation. This is when you ejaculate, but there is no semen or other fluid visible. You may later on notice that your urine is cloudy after sexual activity. That’s where your semen went – with retrograde ejaculation, semen is actually emitted in reverse, and enters the bladder. This isn’t to be confused with an ejaculation, which is where you get the ‘feeling’ of having come, but no ejaculation has physically been produced. Our detailed information sheet on ejaculation problems is available here.
How about loss of sexual desire?
Loss of ‘sex drive’ is commonly termed as having a low libido. Everyone goes through stages of it. However if the problem persists, there may be a physical cause, like low testosterone. That’s an issue your doctor can help you with. They’ll organize for tests to be done and recommend treatment if necessary. If, however, the tests come back and show no issue, the problem may be purely psychological. That’s when sex therapy can help – and involving your partner can be a positive, too.
Sex therapy and what it involves
Simply put, sex therapy is a counseling program where a couple, or an individual, meet with an expert therapist to talk about and find solutions to their sexual or relationship issues. By working together, the root causes of the problems are identified, and individualized treatments are designed to eliminate or at least reduce the burden of the problem.
The method has been found to be significantly successful in identifying the key factors of difficulties with intimacy. Successful sex therapy also fosters more open and healthy attitudes towards sex, giving people back their confidence and encouraging more intimate communication between partners.
Sex therapy can be used as a stand-alone or combination treatment, meaning that you can see a therapist at the same time as trying other solutions. Your GP, or another NHS qualified professional, may well be able to organize a referral for you – although this depends a little on where you live. There are also private therapists available, although you’ll have to pay for their time. Always check the qualifications of anybody you speak to, and ensure they’re registered with reputable professional bodies. All the information you need is available here on our fact sheet.
How do recreational drugs affect your sex life?
You may have heard the word ‘chemsex’ in the media. Concerns are growing about the connection between gay men, party drugs, and irresponsible sexual behavior.
’Chemsex’ is defined in the UK as having consensual sex whilst using psychoactive drugs. It can be taken to mean any drug, but predominantly refers to mephedrone, gamma-butyrolactone (GBL) and gamma-hydroxybutyric acid (GHB). The drugs are used individually or together, acting as fuel for sex sessions that can last for anything from several hours to several days, and involving multiple people.
There are obvious hazards to indulging in such high risk sexual activity. Prolonged drug use can lead to dependence (both physical and psychological). Your mental health can be impacted, and medical intervention may be necessary to treat both the addiction and the effects. There is the risk of overdose. There’s also the risk of the drugs reacting badly with each other, or with alcohol. Sleep deprivation, and failing to eat for prolonged periods of time, both have negative impacts on your body.
Drugs taken via injection significantly boost the chances of a hepatitis C or HIV infection, as does unprotected sex with multiple partners. Even if you avoid those two more serious conditions, there are any number of STIs you could catch.
Guilt can become an issue after chemsex sessions. Often, men will be aware that they’ve done something they shouldn’t, but won’t seek treatment or speak to anybody because they’re ashamed of their behavior. That can be a critical mistake. Many GPs will be aware of the issue, and will have received training on it. Even if they haven’t, they can refer you to a specialist therapy service, or substance misuse clinic. You’re also free to contact such services yourself, and they’ll listen to you without judging. The popular website “Frank” (www.talktofrank.com) offers helpful advice. GUM (Genito-Urinary Medicine) Clinics are used to speaking to people who suspect they have STIs, and testing for them, on a daily basis. It’s far better to be slightly embarrassed for five minutes than to suffer in silence.
Where can you go for help with sexual issues?
In the majority of cases, it’s best to start with your own GP. If you’re not comfortable with this, GUM Clinics are very helpful, and can direct you to whatever service you need if they’re unable to assist themselves. You can find their contact information on the BASHH (British Association for Sexual Health and HIV) website, which is www.bassh.org.
It’s not always easy to find quality care that also advertises as being ‘gay friendly’. If you decide to find help through gay media publications, be sure to verify their qualifications, and the fact that they’re registered with a reputable professional body.
What’s the headline here?
Your sexual health issue may be a warning that something more serious is wrong. Listen to it, and seek medical advice.
Is there any more information available?
We’re here to assist in any way we can. Although we can’t give specific medical advice to you, we are able to answer general questions about sex concerns, and connect you to specialists who are active in your area. We produce several booklets and fact-sheets on sexual problems in both men and women, and you can download them directly from the website, or you can request that we send them to you. We’re always happy to hear from you. Call or email us at any time – our contact information is detailed at the bottom of the page.
Visit www.nhs.uk (the website for NHS Choices) to find lots of great advice and information on a wide range of lifestyle and health concerns.
Contact us if you have any further questions or to arrange for an consultation