Sexual Difficulties In Gay Men

Posted on: 26 March 2008 by Gareth Hargreaves

It is often difficult for a gay man to admit to having any problems with sex.

Introduction

It is often difficult for a gay man to admit to having any problems with sex. After all, our sexuality is part of what makes us gay men. It is a myth that we are all sexual athletes, always ready for sex and always able to perform at a moment’s notice. Because of this false view we tend to measure ourselves against very high sexual standards. If something goes wrong some men feel they are ‘letting the side down’ if they ask for help. Asking for help with a sexual problem is the same as asking for help with any other medical problem, and our needs are as valid as any one else’s.

Difficulties With An Erection

Erections are funny things. When we were sixteen they often came up all the time, even when they weren’t wanted. As we get older they don’t always appear, even when we want one most. Almost everybody has the occasional time when their erection is less strong than they would like but sometimes it becomes a problem. If the erections are fine except with a partner, then it is likely that the problem is largely psychological. If the erection is never OK (with a partner, with masturbation and never there when you wake up), then it is likely that the underlying problem is physical. Often people have a mixture of psychological and physical things which together cause problems.

There are many physical things that can cause problems. Drugs, both ‘prescribed’ and ‘recreational’, are a common reason for difficulties. Other health problems, such as diabetes and multiple sclerosis, may cause problems in some men. Very occasionally there is a problem with the male hormone, testosterone, or something wrong with the ‘plumbing’ of the blood to the penis.

Help is available for both psychological and physical causes

Having psychological problems with sex does not mean that there is anything else wrong with your mental health. A specially trained counsellor can teach ways of strengthening the erections and, if you have a regular sexual partner, they may be asked to come to some of the consultations as well. Although sexual ‘homework’ is often part of the programme of care offered, you will not be expected to have sex in the consultation. Drugs to help with erection difficulties are available. You can be taught to inject directly into the penis to produce an erection which will last for as long as two hours (if it lasts for more than four hours it can cause problems), and many people learn to do this even if they were not keen on needles at first. Another option is to insert a pellet into the urethra after urinating which will dissolve and give an erection which will last between thirty and sixty minutes.

There is currently only one oral drug licensed for treatment and is taken as a tablet one hour before sexual activity. It does not cause an erection unless the man is sexually stimulated. Another oral treatment which is not licensed is yohimbine. It is derived from the bark of an African tree and several studies have suggested it has a beneficial effect in enhancing erectile function. Vacuum devices, which draw blood into the penis where it can be trapped with a special ring at the base of the penis, suit some people and surgically implanted devices which strengthen the penis from inside are available for the very few people for whom producing an erection is not possible in any other way.

Difficulties with coming

Difficulties in controlling when you ejaculate, or come, seem to grow more common. Coming too quickly is called ‘premature ejaculation’, when it takes longer then you would like it is called ‘delayed ejaculation’.

Premature ejaculation can be treated by sexual counselling and homework exercises (if you have a regular partner it can be useful if they go to at least some of the clinic visits). Medical drugs used to treat it include local anaesthetic creams that can be put onto the penis and some anti-depressant drugs that have a specific action of lengthening the time it takes to get to coming.

Delayed ejaculation is traditionally thought of as a rare problem, but it is being seen increasingly in gay men referred to specialist clinics. Drugs don’t seem to help much and sexual counselling with sexual exercises to do at home are usually the preferred mode of treatment. If you have a partner then they may be asked to come to some of the visits to the clinic.

Difficulties with sexual drive

Occasionally ‘going off sex’ has a physical cause. It can then usually be treated by a Doctor. More often the problem has started in the mind and is best treated by sexual therapist. If you have a regular partner it is often useful if they go to some of the clinic visits with you

Getting help

Most people are recommended to seek help from their GP in the first place, but things aren’t that straight forward for gay men. If your GP already knows that you are gay the they are the right starting point. If your GP doesn’t know you are gay then you need to think about telling them. If in the future you apply for life insurance or a mortgage your GP will be asked for a medical statement. If they know that you are gay they have to declare it and doing so can cause problems with the insurance or mortgage application. If you don’t want to go through your GP, many GU clinics [Departments of Genito-Urinary medicine or ‘clap-clinics’] can offer help. They should at least be able to direct you towards whatever services are available.

Finding good quality care that is also ‘gay friendly’ is not easy. If you choose to find a counsellor through gay media, look for someone who is accredited with at least one professional body, BAC and BASRT are the most common for this work.

Further information

The Impotence Association is here to help. We cannot give individual medical advice, but we can answer your questions on all aspects of impotence and put you in touch with local specialist practitioners. Please feel free to write or telephone our Helpline. We have a number of factsheets on impotence and related problems. Please send a large SAE when writing for information.

The Impotence Association, PO Box 10296, London, SW17 9WH.  Telephone: 020 8767 7791 begin_of_the_skype_highlighting            020 8767 7791      end_of_the_skype_highlighting

Alternatively visit their website at www.impotence.org.uk

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