The Masculinity Myths Surrounding Erectile Dysfunction

Various researchers have offered a variety of estimates on the prevalence of erectile dysfunction (ED) diagnoses in the U.S. One survey from 2018, for example, concluded that it affects one-third of men. Another 2019 global survey estimated that ED affects between 3 percent and 76.5 percent of men.

ED refers to an inability to get erections for penetrative sex or intercourse. It can be traced to several things, including cardiovascular disease, diabetes, hypertension, metabolic syndrome, stress, and poor mental health.

It is important to educate men, particularly young men, about the medical facts related to erectile dysfunction. What is often not addressed when men see their medical providers are the many potentially harmful yet common myths circulating in society about penises and masculinity. These myths are often intersectional in nature—meaning that the racial, religious, and cultural communities in which men are raised tend to have their own unique spin on masculinity myths.

Some myths previously talked about in a previous article in this series include:

• That men are always ready to have sex if it is offered.
• That the size of a penis is important for pleasure among heterosexual women.
• That porn’s depictions of penises and erectile longevity are realistic.
• That any sexual event needs to include climax and ejaculation.

In this article, I'll present a few more myths, then challenge them with facts and research findings. All of these incorrect myths regarding men's penises and sexual preferences can be discussed with a sex therapist and should be taught much more commonly in sex education programs.

Myth #1: Erectile dysfunction is all in your head.

Erectile dysfunction has comorbid origins in medical diagnoses—and at times, it may be the early harbinger of underlying illnesses like MS or cardiovascular disease. Sex therapists should do a thorough assessment that includes psychiatric diagnoses like major depression, anxiety disorders, bipolar disorder, ADHD, and PTSD that can impact erections, they should also do a thorough history-taking of medical issues and medications that can impact a man’s erectile functioning—including diabetes, PTSD, Parkinson's, and past genital injuries. There are also many medications that can have sexual side effects, like SSRIs and statins.

Additionally, there is a recent study by Kevin Chu et al. showing an increased chance of new-onset erectile dysfunction post-COVID-19 infection. In this study, conducted by the University of Miami Urology Department, it was observed that the likelihood of having an erectile dysfunction diagnosis was 20 percent higher if the male patient had a prior COVID-19 diagnosis. This may be due to virus-induced cell dysfunction.

Many people with penises may have wondered recently why they've experienced newfound issues with performance. If a COVID-19 diagnosis is in their past, this data may provide a resolution to the confusion and frustration, and encourage them to seek treatment from a urologist.

Source: Deposit Photos/Photographee

Myth #2: Erectile dysfunction is a man's problem to deal with on his own.

Men are often taught that in order to "be a man," they need to “pick themselves up by their own bootstraps” (which, by the way, is a phrase originally intended as sarcastic due to the impossibility of such a task). Frequently, partnered men come into sex therapy on their own, with the misguided notion that since they are having a problem with their penis, the responsibility lies solely with them to resolve it.

What many of these men miss is that they are part of a relationship system. What's more, there is a relationship feedback loop that can help—or, at times, hinder progress—in healing the erectile issue. In other words, they are better off not going it alone.

Sexual chemistry and well-informed, clear, and compassionate communication (all cornerstones of higher levels of what I call "Sex Esteem") are essential for increased pleasure in partnered sex. They're also a big part of what couples can address in couples therapy with an experienced sex therapist.

I argue that the increasing emphasis on surgical and pharmacological solutions to erectile dysfunction has led to a neglect of the importance that a couple's dynamics, including attachment, must hold in the conversation when trying to identify the cause and appropriate response to erectile challenges. This is true for both heterosexual and LGBTQ+ couples.

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Source: Deposit Photos/photographee

Myth #3: Erectile dysfunction only affects older men.

There has been a notable rise in complaints of erectile dysfunction in younger people, chiefly between the ages of 16 and 35 years old. Many people in this group may be struggling with ED due to comorbid psychiatric diagnoses (anxiety, depression, bipolar disorder, etc.).

Erectile dysfunction is associated with major depressive disorder (MDD), and treatment is associated with decreased rates of MDD. A recent study by Sirpi Nackeeran et al. found that men who received ED therapies had lower rates of depression after treatment than those who did not.

Further, relationship concerns, performance anxiety, technological savviness, and many other issues can be helped or even entirely resolved by ED treatment.

Myth #4: "Natural" remedies for ED sold online are effective and safe.

Due to the heightened prevalence of erectile dysfunction—be it as a result of psychiatric stressors, medical illness and/or medications, relationship issues, or following a case of COVID-19—many men are seeking remedies outside of the medical establishment. Due to increased demand, erectile dysfunction supplements (ED-S) are increasingly featured on online marketplaces like Amazon, often with claims that they "naturally" treat ED.

However, their efficacy and safety are largely debated, which limits the ability to counsel patients regarding their use. Human studies that evaluated the efficacy of ED-S ingredients are limited and have yielded no definitive findings of the effects on ED. This is to say that patients who are considering ED-Ss should receive appropriate counseling from an experienced medical provider and potentially include sex therapy as part of their treatment plan.

Source: Deposit Photos/gpointstudio

The Truth About ED

Men often learn about their bodies and sex through societal standards, often those displayed on TV or in porn. They often absorb the message that they must conform to traditional masculinity in the bedroom—i.e. be strong and dominant—and that they must always be down for sex: get turned on fast, be aroused easily, and finish in the appropriate amount of time (neither too short nor too long).

These notions are not standards—far from it—but due in part to their ubiquity, many more men are being diagnosed with some form of erectile dysfunction. This can manifest in many ways, from difficulty getting and/or maintaining an erection to getting less hard overall, and can occur for myriad reasons—none of which make one less of a man. Stress, relationship struggles, ADHD, diet, and now even COVID-19 can be underlying factors that lead to erectile dysfunction.

There is no uniform way in which sexual activities should be performed, no base rate for hardness, and no timer measuring how long an erection "should" last. The ways in which a man has sex are not able to be generalized, and to perform in a way that does not align with commonly held notions does not necessitate a lack of masculinity.

Each day, someone is discovering that they have erectile dysfunction that could be caused by external stressors. There is no shame in this. Talking with a sex therapist and seeking a diagnosis can be very beneficial to one’s sexual confidence, and in turn, one’s mental health. To find help near you, visit the Psychology Today Therapy Directory.