Dr. Saransh Jain's Burlington Clinic Pvt Ltd 

Sexual problems in gay men

Dr. Saransh Jain

Important Things

It may be very 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. But because this false view exists, we tend to measure ourselves against it.

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 important as anyone else’s.

What is erectile dysfunction?

Erections are funny things. When we were sixteen they seemed to happen all the time, even when they were not wanted. As we get older they don’t always appear, even when we want one most. Almost every man experiences a time when their erection is less strong than they would like, but sometimes it becomes a problem.

Erectile dysfunction (ED) is when you are unable to get or keep an erection suitable for sexual intercourse or another chosen sexual activity. If your erection is never OK (either with a partner or with masturbation, and is never there when you wake up), then it is likely to be a physical problem (in the body). If your erections are fine except with a partner, then it is more likely to be a psychological problem (in the mind). Often people have a combination of physical and psychological issues, which together cause problems.

Physical causes of ED include diabetes, multiple sclerosis and problems with the blood supply to the penis (importantly this may mean the blood supply to the heart will also be affected in the future, so if you have ED, it is wise to see your GP for a general health check.) Occasionally there is a problem with the male hormone, testosterone, especially

in older men. Drugs, both ‘prescribed’ and ‘recreational’, are a common cause of erectile difficulties (see our factsheet ‘Erectile dysfunction’).

Having a psychological problem with sex does not mean that there is anything else wrong with your mental health. Help is available for both the physical and psychological causes of sexual problems.

What are the medical treatments for ED?

There are drugs that can help with erection difficulties. Oral treatments (tablets) are called phosphodiesterase (pronounced phos- pho- di- es- ter- ase) inhibitors (PDE5i). They include sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) and avanafil (Spedra®). They work for many men but will not cause an erection unless the man is mentally AND physically stimulated (see our factsheet ‘Oral treatment for erectile dysfunction’).

Men who have less firm erections may find their condom slips off. A PDE5i may help prevent this (and make sex safer) by producing a firmer erection.

You should not take a PDE5i if you are taking a medicine that contains nitrates, because this combination can cause the blood pressure to drop too low. Such medicines include sprays for angina, some tablets for the heart and the recreational drugs known as ‘poppers’ (Amyl nitrite)). Because ‘poppers’ may be used in a confined environment (such as a sauna) by someone other than the PDE5i user, the effect of the chemical spreading through the environment could potentially affect the PDE5i user. PDE5i should only be prescribed by a doctor who will take your health and other medications into consideration. Do not buy medicines online – they may be fakes!

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