WORRIED ABOUT STAYING HARD?

WORRIED

ABOUT

STAYING

HARD?

BETTER SEX BETTER SEX BETTER SEX BETTER SEX BETTER SEX

for men and

their partners

SAFER SEX

Using condoms for penetrative sex is the best way to

protect yourself and your partners from Sexually

Transmitted Infections, including HIV. Condoms also

offer good protection from unwanted pregnancy.

In the text of this booklet, we have chosen not to

refer constantly to the use of condoms. Instead, we

encourage you to make your own decisions about

protecting yourself and others in each instance of

sexual activity you undertake.

“Sexual health is a state of physical, emotional,

mental and social well-being in relation to

sexuality; it is not merely the absence of disease,

dysfunction or infirmity.

Sexual health requires a positive and respectful

approach to sexuality and sexual relationships, as

well as the possibility of having pleasurable and

safe sexual experiences, free of coercion,

discrimination and violence.

For sexual health to be attained and maintained,

the sexual rights of all persons must be

respected, protected and fulfilled.”

Definition of sexual health, World Health Organisation

IS IT REALLY A PROBLEM?

Having difficulty maintaining an erection (sometimes

referred to as erectile dysfunction) is also commonly

called impotence.

Most men experience occasional difficulty getting or

maintaining an erection, usually as a result of

tiredness, temporary stress or excessive alcohol

consumption. Temporary loss of erections every now

and then might feel stressful or embarrassing, but is

not something to worry about. Difficulty getting and

maintaining erections is more common among the

over-60s, but it can affect men of any age.

However, if difficulties getting or maintaining

erections becomes a long-term problem which

interferes with your sex life, you might want to do

something about it.

FREQUENTLY ASKED QUESTIONS

Does it mean I have lost interest in sex?

No. In most cases men who have difficulty staying

hard are still interested in sex, but their worries

about staying hard can mean they begin avoiding

sexual activities.

Is it inevitable with getting older?

No, not inevitable. Minor changes in frequency and

strength of erections are natural as men get older.

Significant changes in your ability to get and

maintain erections may suggest a difficulty related

to something other than ageing.

Does it affect ejaculation and/or orgasm?

Not necessarily. Most men who have difficulty

staying hard are still able to have an orgasm and

ejaculate.

I lose my erection when I put a condom on.

Should I stop using them?

No. Condoms are still the best protection from

sexually transmitted infections and HIV. It’s not the

condom that causes you to lose your erection. It’s

the fact that you put it on just before penetration.

If a man is experiencing loss of erections, the point

of penetration is often when it happens.

Although many men find using condoms tricky at

times, the more you use them the easier it

becomes. Using condoms can be built into the

exercises described in the booklet

How to

Increase Your Enjoyment of Sex

, which you can

pick up from the clinic. Ask a clinician to give you a

copy if you can’t find it on the leaflet racks.

WHAT CAUSES ME NOT TO GET HARD OR TO LOSE

MY ERECTION?

Difficulty getting or maintaining erections can be

caused by a range of physical and psychological

factors. A gradual onset of symptoms is more likely to

point to a physical cause. The most common physical

causes are:

l vascular disorders (problems that interfere with

blood supply to the penis) such as diabetes, high

blood pressure and atherosclerosis (hardening and

narrowing of the arteries);

l lifestyle factors, such as smoking, alcohol and

recreational drug use, poor nutrition;

l neurological disorders such as multiple sclerosis

and stroke;

l surgery (e.g. for prostate cancer) and radiation

therapy;

l drugs prescribed to treat high blood pressure,

depression, heart disease and cancer.

A sudden difficulty in getting and maintaining an

erection may have a psychological cause. Typically, if

the problem is psychological, men continue to have

erections while they sleep or when they wake up in

the morning — demonstrating that their penis is able

to become erect and remain so. Common

psychological causes include:

l not being aroused by the situation;

l feeling bored sexually;

l worrying about sexual performance;

l relationship problems;

l guilt about sexual practices/partners;

l stress;

l being tired;

l having other things on your mind;

l hang-ups about using condoms;

l fears about transmitting or contracting a sexually

transmitted infection (STI); and

l unresolved feelings about living with an STI or HIV.

WHAT CAN I DO ABOUT IT?

If you think your difficulties have a physical cause, ask

your doctor to explore this with you further. S/he may

want to refer you to a specialist who may carry out

some tests. If there is a physical problem, you may be

offered some medical treatment such as prescribed

drugs. If there are no medical problems, then it may

be useful to consider psychological factors and how

they can affect erections.

HOW ERECTIONS WORK

It is important to remember that you don’t have to do

anything to make your penis hard. Erections are partly

a natural automatic reflex and partly under your

control (a bit like blinking). Erections happen when you

are sexually excited, or ‘turned on’ — blood flow to the

penis is increased, tissues inside the penis fill up with

blood, and the penis expands and becomes hard.

This process is controlled by a part of the nervous

system called the parasympathetic nervous system

(PNS), which is an involuntary, or automatic, system.

Because it’s involuntary, it has nothing to do with

willpower — in fact, it’s the opposite: the harder you

try to get an erection, the less likely it is that you will.

The reason for this is that there’s another system in

the body, called the sympathetic nervous system

(SNS), which cannot work at the same time as the

PNS — when one is in control, the other closes down.

The SNS controls the body when we feel stressed,

anxious, or in danger — it’s responsible for what is

known as the ‘fight or flight’ response. It speeds up

the heart rate, sends blood to the muscles in case we

need to run or fight, and shuts down all non-essential

functions — which includes erections.

When you’re anxious or worried (whether about being

in a sexual situation or about anything else), your body

switches into SNS mode — which makes it almost

impossible for you to get an erection. You have to be

relaxed in order to become sexually aroused and erect.

Men can and do get erections (including first thing in

the morning, in situations of danger, or when their

penis is being physically stimulated) without

necessarily being sexually aroused in the sense of

feeling desire. But if you’ve been having problems

getting erections, you may feel you need to use any

erection you get as quickly as possible, before it

disappears again. This is usually a mistake — it puts

you (and your penis) under pressure, which can set up

patterns of performance anxiety and problems getting

erections.

Some men feel bad about not having an erection

because they feel as though they should reward their

partner’s efforts by having one. However, no-one

‘owes’ anyone an erection or an orgasm, just as your

partner isn’t obliged to ‘deliver’ an orgasm when you

stimulate them. If either or both of you come, great —

but sex is about pleasure, not about having erections

and orgasms to please someone else.

If you think there might be psychological factors

involved in your difficulties with getting or keeping an

erection, there are some simple techniques that you

can learn to help you overcome the problem.

SOME GENERAL TIPS

Spend some time thinking about times when you have

really enjoyed sex. Make a list of the factors that

make the difference, for you, between ‘good’ and ‘bad’

sex. (If you aren’t having any good experiences at the

moment, use your memory or your imagination to

help you list the things you think would be necessary

for you to have good sex.) Try to be specific about

what you need — it’s important that you feel able to

ask for what you want sexually. Your list could

include, for instance: having privacy, not feeling

rushed or under pressure, not being angry with your

partner, being able to have the kind of sex that turns

you on.

Try not to use morning erections for sex. Morning

erections are more often the result of a full bladder

and a need to urinate than a sign of arousal. You

might be tempted to try and use your morning

erection before you lose it, but you could be putting

unhelpful pressure on yourself.

If you have a partner, consider talking to them about

your concerns about staying hard — they might want

to be involved in finding solutions. Read the booklet

How to Increase Your Enjoyment of Sex

, which you

can find on the leaflet racks at the clinic, or ask a

clinician for a copy. It contains practical exercises that

you can do (alone or with a partner) that will help you

get more pleasure from sex.

Some men find wearing a cock ring helps them stay

hard, because it restricts the flow of blood out of the

penis. Cock rings can be bought from sex shops or on

the internet.

“ Writing is like making love.

Don’t worry about the

orgasm, just concentrate

on the process.”

Isabel Allende

EXERCISES YOU CAN DO ON YOUR OWN

For the following exercises (except the first one) you

should make sure you have plenty of time. The times

given in brackets for each exercise are only

suggestions; you may need less or more time for them.

The important thing is that it should all be private,

uninterrupted time. You need to be able to relax, switch

off from other things, get into the mood and make sure

you don’t feel rushed or under pressure.

If you don’t have enough time to do the exercises

properly, or if you’re worrying about what you’re about

to do afterwards, it might be better to wait till you

have more time. If you have difficulty finding time to

do the exercises, it might be helpful to plan time for

them in advance.

EXERCISE

a few minutes a day

KEGEL EXERCISES

One method of enhancing your sexual experience is to

use exercises to strengthen the pelvic muscles that,

through their contractions, produce orgasm and

ejaculation. Regular practice also improves the

circulation of blood in the penis, which is necessary

for getting erections. Men who do these exercises

regularly report improvements with getting hard as

well as stronger and more pleasurable orgasms and

better control over when they ejaculate.

You can feel these pelvic muscles if you contract your

anus as though you’re trying to hold back a bowel

movement, or by stopping and starting the flow of

urine when you’re peeing. At first you might find

you’re contracting your stomach or thigh muscles as

well, but with practice you can squeeze just the pelvic

muscles.

Start off with squeezing and releasing these muscles

fifteen times, a couple of times a day. You can do this

without anyone noticing, for instance while driving,

watching TV or waiting for a bus. Continue doing the

Kegel exercises every day, gradually increasing the

number until you can do 30 - 50 twice a day. At this

point, instead of releasing the muscles immediately,

you can start holding the contractions for a few

seconds. You can do both the long and the short Kegels

a couple of times a day, or alternate between them.

Most people don’t notice any improvement until after

about a month or six weeks, but if you practise them

consistently you will feel the difference.

EXERCISE

15 minutes

PLEASURING YOUR PENIS WHILE IT’S SOFT

The goal of this is to get more comfortable with

touching your penis and discovering different

sensations from different touches. It’s better not to

start off with an erection for this, but good to get

yourself feeling sexy, for example by remembering a

good sexual experience, thinking about a fantasy, or

looking at arousing pictures or literature. Use

lubricant (lube) if you like, and use one or both hands

to touch your penis in ways that feel arousing, trying

out different kinds of strokes and touches, and

focusing on the sensations these produce.

Don’t try to get hard, but if you do, pay close attention

to the sensations you experience as your penis

hardens. If your penis gets to what you reckon is

about three-quarters of its full erection, stop touching

it, and allow it to go down. Repeat this exercise two or

three times until you:

l are more comfortable touching your penis when

it’s soft; and

l feel that you’ve improved your ability to focus on

the pleasurable sensations produced.

EXERCISE

15 minutes

MASTURBATION WITH FOCUSING

The goal of this exercise is to practise focusing on the

sensations in your penis as you play with it, and to

discover what types of touch and stroking feel best. You

don’t need to have an erection in this exercise,

although it’s OK if you get one.

Spend a bit of time getting yourself aroused, for

example by remembering a good sexual experience,

thinking about a fantasy, or looking at arousing

pictures or literature. When you feel ready, start

stroking your penis slowly and gently, concentrating

your attention “inside” your penis so that you are aware

of the sensations the stroking is producing. Use

lubricant if you like.

Experiment with different strokes. For example, try

stroking the whole length, just the head, just the shaft,

using a circular motion, different pressures and speeds

(but not too fast). There are many nerve endings in your

penis that respond to stimulation, with sensations that

may differ depending on how excited you are, how hard

or soft you are, and what kind of touching you’re doing.

Take your time — it’s not about speed or reaching a

goal. Spend about 15 minutes exploring the sensations

you’re feeling, playing with them and enjoying them.

If you feel close to coming before the 15 minutes is

up, stop masturbating and wait a minute or two until

the urge to come subsides before continuing. After

the 15 minutes, if you want to come you can do, but

keep going slowly and keep focusing on the

sensations. Remember, you don’t have to come at all,

so only do so if you want to — the point of this

exercise is to explore masturbation while being

focused on the process, not on having an orgasm.

You can do this exercise several times a week.

POSSIBLE PROBLEMS

You don’t feel any sensations in your penis, or they

don’t feel very interesting.

This probably means you’re not focusing very

strongly — or you may be expecting something

unrealistic. Try just being curious about the

sensations and notice what there is, rather than

wondering whether they’re “good enough”.

Your mind keeps wandering.

This is natural; just keep bringing your attention

back to the exercise.

You can’t relax or focus on the sensations.

It’s important that you aren’t tense, in a hurry, or

very preoccupied with something else. If you are, it

might be better to leave it till another time. If

you’re worrying about not being hard enough,

remind yourself about the purpose of the exercise,

and try again to focus on the various sensations.

EXERCISE

15 minutes

LOSING AND GAINING ERECTIONS

Stroke your penis, using lube if you wish, and focus

either on the sensations or on an exciting fantasy.

When you get an erection, enjoy it for a moment, and

then stop the stimulation by taking your hand away.

Let your erection go down — this may take a few

seconds or a few minutes. When it’s soft again, go

back to stimulating it and focusing on the sensations

and/or the fantasy. Usually, you will get another

erection — at which point, stop the stimulation again

and let yourself get soft.

Two cycles of this exercise (i.e. stimulation, erection,

stopping and losing erection; stimulation, erection,

stopping and losing erection) is enough for any one

session.

If your erection doesn’t return within a few minutes of

going back to stimulation, check whether you’re

comfortable and relaxed, and if you’re not, take a few

deep breaths and try thinking about a different

arousing fantasy. Look at stimulating pictures if you

like. If this doesn’t produce an erection, don’t worry —

just return to the exercise another time.

Do this exercise every other day or so, until you reach

the point where you’re fairly confident that you can

regain your erection by using physical and mental

stimulation.

NB You may find that you don’t always get your

erection back. If you do most of the time, that’s fine.

Most men have grown up thinking that they should

always get erections easily, but all men have times

when their penises don’t respond to stimulation, and

this is nothing to worry about.

Most often, it’s the pressure we put on ourselves, and

our anxiety about whether we’ll be able to get one,

that makes erections less likely. Once you accept that

occasionally it just won’t happen, it will become less

of a problem.

EXERCISE

20-25 minutes

MASTURBATION WITH FANTASY OF SEX WITH A

PARTNER

Step A: Masturbate (with lube if you like) while

fantasising about a sexual experience with a partner

(this could be a previous partner, someone you know,

or someone imaginary). Start the fantasy with the first

touch or kiss, and slowly imagine all the activities

which might occur in this imaginary sexual encounter.

For instance, you might want to include kissing,

hugging, removing clothes, playing with their genitals,

them touching your penis, oral sex, anal sex, them

penetrating you, being inside without movement,

moving slowly, and moving more rapidly. (Of course,

not all of these have to happen, or in this order, in real

sexual encounters — this exercise is about imagining

all the possible sexual activities you might encounter.)

It may be that particular activities or parts of this

imagined sequence will make you feel anxious or

uncomfortable. If this happens, slow down or stop

masturbating and take some deep breaths to become

more relaxed and reduce the anxiety, and in the

fantasy visualise doing something with your partner to

make you feel more comfortable. For example,

imagine yourself telling them you’d like them to slow

down, or asking them just to hold you for a while, or

picture yourself turning your attention to pleasuring

them to take the focus off yourself, or explaining to

them how you’re feeling — whatever helps you to feel

less anxious. Then go back to masturbating and in

your fantasy go back to sexual activities.

If you find your anxiety rising again at the same point,

go to Step B. Otherwise, continue with fantasising all

the possible activities you might encounter. It’s

important to do this fantasy slowly and thoroughly, so

you may well not be able to get through all of them in

a single session, but you can begin your fantasy at a

later stage when you come back to the exercise (for

example, already being undressed).

Step B: Most men find that one or more fantasised

activities (for example, being touched, or penetration)

cause difficulty. These activities are likely to make you

feel anxious in reality as well, so if you find one that

doesn’t get easier after a few repetitions, devote more

attention to it.

Get yourself feeling relaxed and sexual first, and

slowly begin masturbating. Then imagine the difficult

activity in stages (a bit like freeze-frames on a video)

and don’t move onto the next stage until you feel

comfortable with the one you’re on.

For example, suppose it’s having your partner touch

your penis that feels difficult. You might start by

imagining their hand just lightly brushing past your

penis, and stay with that image until your anxiety drops.

Then you might see them resting their hand against

your penis, and when you feel comfortable with that,

imagine them holding it. Only then move onto imagining

them stroking you, and gradually build up the length of

time you can fantasise about this comfortably.

You’ll need to repeat this exercise as many times as it

takes to be able to go through it without feeling

anxious. When you can do that, go back to Step A and

incorporate the activity into a wider fantasy.

If you find another scene that gives you difficulty, use

Step B again. Continue until you can go through your

entire fantasy in Step A while continuing to feel

relaxed and sexy.

It’s better if you don’t come during this exercise, as it’s

very important to explore the fantasy fully, so take your

time. You’ll probably need to stop a number of times to

get relaxed, and may need to do Step B a few times as

well, so it will take several sessions at least. However,

learning how to feel relaxed while imagining activities

that previously made you anxious and uncomfortable

will make a huge difference.

It can be a good idea to imagine all the possible

things that might happen in a real sexual encounter

too, such as not being able to get or keep an erection,

or losing it on penetration. Again, get yourself

relaxed, and imagine possible ways you could deal

with these things that would relieve the pressure and

anxiety. The more you do this, the less likely you are

to worry so much about those events happening,

which in turn makes them less likely to happen.

EXERCISES YOU CAN DO WITH A PARTNER

Before starting any of these exercises, both you and

your partner should read and discuss them. Talk

about your feelings about doing the programme and

sort out any issues that are raised. It’s common for

couples to have some disagreements, but if you sort

them out as soon as they appear, you’ll get more

benefit from the programme.

These exercises are like a training programme. You

won’t have to do them forever, but how long you need

to do them depends mainly on how often you do them,

so you need to work out an agreement about

frequency. Don’t plan to do more than one exercise

per day — a couple of times a week is a good starting

point.

You also need to agree that neither of you will push

the other faster than they want to go. For example, you

might agree that you are happy to satisfy your partner

with your hands or mouth when they want, but not

with your penis until you feel ready to (or vice versa).

It’s important not to rush through the programme, as

this just puts pressure on you both. The point of it is to

allow yourselves to enjoy taking things at the pace that

feels right for you, not to push yourselves into doing

what you think someone else expects.

Don’t make these exercises the only contact you have

with your partner, either physically or emotionally.

Make sure you also have mutually satisfying time

when you’re not restricted by the programme, and

that you can express affection physically without

needing to end up having sex. For ideas about how to

do this, pick up a copy of

How to Increase Your

Enjoyment of Sex – for men and their partners

from

the clinic.

The basic principle is that you do the exercises only at

your own speed. If you start feeling anxious or

uncomfortable, stop and do something that helps you

to feel more comfortable, and only go back to the

activity when you’re more relaxed. It’s a good idea to

agree together beforehand what you will do if you

want to stop — this could be cuddling, talking,

stimulating your partner instead, or doing something

non-sexual together.

You might want to do the exercises both ways round,

so that it feels fair, or you might prefer to focus on the

partner who would benefit most from them — it’s up

to you to decide together how you use them.

EXERCISE

15-20 minutes

SEXY BODY RUB WITHOUT TOUCHING GENITALS

Have your partner arouse you by touching your body,

not including your genitals, using their hands, mouth,

hair or anything else — be as creative as you like!

Give feedback and suggestions, without being critical.

Your job is to focus on the sensations and feelings

which develop from different kinds of touch — this

includes feeling sexually aroused but also other

sensations, such as ticklishness. If you find your mind

wandering, bring it back to focusing on the

sensations.

EXERCISE

15-20 minutes

PARTNER PLAYS WITH YOUR PENIS WHILE IT’S SOFT

This exercise is designed to help you feel more

comfortable about being touched when your penis is

not erect. Many men believe they should be hard

before being touched, or that they should get hard as

soon as a partner touches them, but these can be

unrealistic expectations.

It’s very important that you learn to be comfortable

with being touched when you’re soft, as this allows

you to learn to enjoy stimulation that can get you

erect. Even if you don’t get hard, it will still feel good,

and the more comfortable you become with your

partner touching you when you’re not erect, the more

enjoyable it will feel — and thus the more likely it is

that you’ll get an erection.

Get yourselves relaxed and comfortable, and allow

your partner to play with your penis while it’s soft.

Don’t try to get an erection; if you do, stop for a while

until you become soft again. Your partner can explore,

caress, stroke, and just generally play with your penis

in whatever way they like (but nothing that’s painful or

uncomfortable). Try to keep your attention on the

sensations you experience.

Do this exercise as many times as it takes for you to feel

completely comfortable being touched when you’re soft.

POSSIBLE PROBLEMS

You find yourself trying to get an erection, or

feeling bad for not having one.

This is understandable. Try to let go of your

worries about your erection and make sure that

both you and your partner know that the point of

the exercise is that your penis should be soft.

EXERCISE

15-30 minutes

SEXY BODY RUB WITH GENITALS

Another way of developing a good relationship

between your penis and a partner is to gently rub it on

their body, whether it’s hard or soft. You can rub it

anywhere on them, including, when you’re

comfortable, rubbing against their pubic hair and

between their thighs and buttocks. Again, stop and

get more comfortable if you find yourself becoming

tense. Go slowly, keep your attention on your penis,

and allow it and you to explore your partner.

EXERCISE

15 minutes

PARTNER STIMULATION OF YOUR PENIS

This time your partner is to touch and stroke your

genitals, with a lubed hand if you like, as you direct

them. It’s the same as the sexy body rub, but focusing

on the genitals this time. Some men prefer to begin

with kissing and touching.

The goal is to get as turned on as possible, but it’s

about arousal, rather than erection — if you get an

erection, that’s fine, but the exercise works just as

well if you don’t. Concentrate on the sensations you

feel, not just in your penis but all over your body.

Give feedback and directions in words that turn you

on, and allow any sexual images or ideas to emerge.

During the exercise, you can touch your partner in any

way you like that excites you, but only for your

pleasure — you’re not to try and turn them on at this

point. This is difficult for many men, as they are used

to being active, and/or they want to return the favour.

However, the point of the exercise is to focus on one

person at a time. You can always do the exercise the

other way around afterwards if you like.

If you become aroused and keep focusing on your

sensations, you will probably get an erection for some

of the time. If you want to ejaculate, that’s fine, but it’s

not necessary. Men vary hugely in how often they

need to do this exercise before they become

comfortable with it and get good at focusing on

sensations, re-focusing when the mind wanders, and

giving good directions to their partner to provide the

best possible stimulation.

POSSIBLE PROBLEMS

You never get an erection in this exercise, or don’t

keep it for long.

It may be that you can’t get your partner to

stimulate you in the way you like, in which case

you need to talk about what’s going wrong, and

perhaps go back to one of the earlier exercises. If

your mind keeps wandering, especially to negative

thoughts or anxieties, you need to practice turning

it back to the sensations and concentrating on

these. It may help if you can share your anxieties

with your partner, or with a supportive friend.

If you can usually get erections when you

masturbate, but not with your partner, then there

may be something in the relationship that’s getting

in the way. You might need to think, alone or with

your partner, about what this might be.

Your partner wonders why you don’t get an erection

Some partners may take your lack of an erection

to mean that you’re not attracted to them, that

they’re not attractive enough, or that they aren’t

doing the right things to turn you on or stimulate

you. Of course, it could be true that you’re not

really attracted to them or that they’re not giving

you the kind of stimulation that excites you. If

you’re not attracted to them, it may be unrealistic

to expect yourself to get an erection. If they’re not

stimulating you in the ways you like, perhaps you

could let them know what they could do differently.

If neither of these are the case, you need to find

a way of explaining what’s happening and making

it clear that it isn’t their fault. But it’s also a

good idea not to apologise — you haven’t done

anything wrong and there’s nothing to be

ashamed of. Apologising in this situation may

mean you end up putting yourself down and

believing it’s your fault. All you need to do is tell

them what’s happening, as honestly and directly

as you can — this is respectful to both yourself

and them.

Below are some examples of how other men have

successfully explained it — they may help you

decide what you would say in this situation:

“I don’t exactly understand what’s going on but I

can tell I’m not going to get an erection at the

moment. I like you and I’m really turned on by you,

and you’ve been doing everything I could want. I

think it’s because I do like you and I want to be a

good lover with you, so I’m trying too hard, and

when I do that my penis goes on strike. I’d like to

leave it alone for a while. But if it’s OK with you I’d

like to go on touching you some more.”

“I’m going to level with you — I’ve been having

some problems getting erections. I’m getting

some help with it and I hoped that it would be

different with you. But I know that I’m still quite

nervous about it and that’s getting in the way of

me getting hard. I’m pretty sure I’m not going to

get an erection tonight, but I’d love to do

something to give you pleasure.”

It’s fair to say that some partners may be put off by

you not having an erection, whatever you say. That

may be because of their own insecurities about

their attractiveness or sexual competence, or for

some other reason that means they find it hard to

deal with any problems.

If you’re with someone like this, there’s not much

you can do, and staying in the situation will

probably only make you feel worse about yourself

and increase the pressure you put on yourself to

perform. Unless they can accept your situation and

what’s going on for you sexually, you may not get

very far, and you might consider whether it’s worth

staying in the situation. If you find someone who’s

interested in more than just a rigid penis, who is a

bit more understanding and supportive, you’re

likely to get erections more easily.

All the same, it’s worth remembering that you

won’t always get erections when you think you

should, you’ll lose erections sometimes, and

sometimes your erections may not be as full or as

hard as you’d like. This is true for all men at some

point in their lives. And there will be times when

you just don’t feel like sex — your sex drive can be

affected by tiredness, by stress or worries, by the

state of your relationship, and by some

medications, for example.

EXERCISE

15-20 minutes

ORAL STIMULATION OF YOUR PENIS

This exercise is identical to the previous one, except

that your partner stimulates your penis with their

mouth rather than with their hands. Use whatever

position is comfortable for both of you, but resist the

temptation to stimulate them at the same time — just

focus and give directions.

By now you should be becoming confident of getting

an erection most of the time when you have the proper

conditions and stimulation. You now need to learn that

it is really OK to lose your erection with your partner

— usually you will be able to regain it, and even when

you don’t, you can both still have a good time.

EXERCISE

15-20 minutes

LOSING AND REGAINING YOUR ERECTION

Have your partner stimulate your penis, with their

hands or mouth, in ways that you like. Your goal, as

always, is to focus on the sensations and get as

aroused as possible. When you have an erection, enjoy

it for a moment, then ask them to stop and allow your

erection to go down. You can do whatever you want

while you wait (chat about other things, give your

partner a back rub or a sensual massage), but take as

long as you need for your penis to go soft. Then get

your partner to begin stimulating you again. When you

get hard, get them to stop again, as before. Do two or

three repetitions (stimulation, erection, stopping

stimulation, erection fades) in one session.

You won’t always regain your erection and you won’t

always get one in the first place. When either of these

happen, try being open about it — you could say

something like, “I guess it’s not going to get hard

today. I’d like you to stop.” Then discuss what you’d

both like to do instead. They might want you to

sexually stimulate them, or you might want to talk

about what’s happening, or you could go and do

something else together.

POSSIBLE PROBLEMS

You never get an erection.

This usually means you haven’t yet mastered the

earlier exercises and need to go back and spend

more time on them.

Your erection doesn’t go down very quickly.

This isn’t really a problem, it just increases the

length of time it takes to do the exercise properly.

Make sure that what you’re doing while you wait to

go soft isn’t arousing you, and if it is, do something

different to help you get soft again. Just walking

around the room can be enough.

Once you lose your erection, you don’t get it back.

The problem here is usually anxiety about getting

the erection back. In other words, you’re forgetting

how to focus on the sensations and are worrying

instead. Remember, you don’t have to actually do

anything to become hard, it’s an automatic

reaction which has nothing to do with willpower —

in fact, the more you try, the less it happens

automatically. Just keep concentrating on your

sensations and arousing thoughts.

EXERCISES FOR PENETRATION

These exercises apply to both anal and vaginal

penetrative sex with men or women. For more

information about anal sex, pick up the booklet

Anal

Play – for men and for women

in the clinic. Check out

with your partner beforehand that they understand

the point of the exercise and are willing to follow your

pace, and remember that the keys to pleasurable

penetrative sex are communication, relaxation and

lubrication — you can’t have too much of any of them.

EXERCISE

usually less than 10 minutes

GRADUAL INSERTION OF PENIS

This exercise needs you to have an erection (though

not necessarily a very hard one), so it’s important that

you don’t feel under any pressure or anxiety to

perform. If you do, leave the exercise for another time

and do something else enjoyable with your partner.

You can use spontaneous erections or those that

occur during other sexual activities.

The goal is for you to insert your penis gradually, in

stages. Firstly place your erect penis just at the

opening of your partner’s vagina or anus. Use a

position which is comfortable for both you, and check

that your partner is feeling aroused and relaxed.

Spend a few seconds getting used to having it there.

When you feel comfortable, move it in a little bit.

Again, take a few moments to get used to the feeling.

Continue in this way until you are fully inside, and stay

still for a few minutes and focus on the sensations in

your penis when it is surrounded by your partner’s

body.

If you want to ejaculate and it’s OK with them, you can

do so, but move slowly and stay aware of what’s

happening with the sensations in your penis and body.

If at any stage you feel your erection starting to go

down, stay focused and see if you can enjoy the

sensations of your penis going down.

Do this exercise until you can stay inside your partner

for about a minute without moving but keeping your

erection. If your penis gets softer, and you’re wearing

a condom, take care when you withdraw.

EXERCISE

15 minutes

PENIS INSIDE WITH MOVEMENT

If you are the one penetrating your partner, a good

position for this exercise is you lying on your back and

your partner sitting on top of you — this allows you to

fully relax with the bed supporting your weight.

However, find the position that works best for you

both— it needs to be comfortable enough for you both

to stay in it for 5 or 10 minutes.

Step A: This is similar to the previous exercises,

except that one of you moves slowly. It doesn’t matter

which of you it is, and will depend on what position

you’re using — whoever’s on top will do the moving.

Whether it’s you or them doing the moving, it’s your

job to be in charge of how much movement, when to

stop, and when to resume. The point is for you to

focus on sensations and get as aroused as possible.

It’s important that your partner doesn’t start thrusting

to satisfy themselves — that will come later.

Start at a very slow pace and make sure you’re

comfortable with it before increasing the pace. Then

go a little faster, and when that feels OK (no anxiety

or negative thoughts), increase the pace again.

Continue until the person who’s active is moving at a

good pace, but not all-out — say around 80% of what

would be typical in a non-exercise situation. It will

probably take more than one 15-minute session to get

to this point, but you will find that over several

sessions you can build up the pace more quickly than

previously. When you can do that, move onto Step B.

Step B: This is the same as Step A except that you

take it in turns to move during the thrusting, one at a

time for a few moments each. Start with very slow

movements and only increase the pace as you feel

comfortable. Use as many sessions as you need.

Step C: As before, but with you and your partner both

moving during the thrusts. Start at a pace which is

very comfortable and build up gradually. Stay focused,

and if you become anxious or start to lose your

erection, stop and relax before resuming at a slower

pace, gradually increasing the pace again when you’re

comfortable. If you do this consistently, you’ll become

able to tolerate and enjoy more and more movement.

When you’re comfortable with uninhibited movement in

one position, you can try other positions. You don’t need

to do this as part of a formal exercise, but remember

that at first any new position can be a bit awkward

and/or uncomfortable. When you first try out a new

position, start moving slowly, and only when you’re

comfortable work up to a pace that suits you both.

POSSIBLE PROBLEMS

You lose your erection during penetration.

This happens once in a while for most men, but if

it’s a real problem, there are some things you can

try. Make sure you’re relaxed — if you’re not, take

some deep breaths and focus on arousing

thoughts and images. If you’re already inside your

partner, you can stay there and try to get the

stimulation you want — for example, by moving in

certain ways or getting them to squeeze their

pelvic muscles. Or you can withdraw from them

and use whatever stimulation works well for you,

and go back to penetration when you’re hard

again.

You always lose your erection at a certain point.

If this happens at a similar point during sex, for

example when your partner starts moving quickly,

you can try this out when you’re alone. Take a few

moments to get relaxed and imagine your partner

moving slowly during sex. Continue to relax and

imagine them moving a little faster. Continue with

this, slowly increasing their speed in your

imagination, until you can calmly imagine them

moving at full speed and still keep your erection.

Then do the same thing for real with your partner

— relax and have them move slowly during sex,

and only let them increase the pace a little at a

time, making sure that you stay relaxed. If they

reach a speed that makes you begin to feel tense

or anxious, have them slow down immediately to a

pace where you feel relaxed (even if this is

stationary), and don’t increase the pace until

you’re completely comfortable with the speed

you’re at. If you do this consistently, you’ll become

able to tolerate and enjoy more and more

movement.

What if I still have problems?

You might find it helpful to read other booklets in

this series (see back cover). You can pick them up

from the booklet racks at the clinic, or ask a

clinician for a copy. Or you could ask your doctor

about getting referred to a psychosexual

counsellor or therapist, or contact one of the

organisations listed overleaf.

OTHER LEAFLETS IN THIS SERIES: