Question: I have had difficulty getting an erection with a partner since my late teens but no problem by myself. Since medicine became available I've been a regular user, but I just want to be 'normal'. I get paranoid that I won’t get an erection when I’m with a partner and that pretty much spells the end for my sex life without the medication, is sex therapy the only way to get on top of this and will it work?

Answer: Sex therapy is the best way to deal with this issue, because it will be the most comprehensive. From the sound of it, this is hardly a new problem, but in fact has been going on for some time, back to some of your formative years. Not only has the cause of your erectile issues remained unaddressed, but additionally your sexual response has had a good opportunity to really cement patterns to sexual stimuli and emotional responses. So to change your erectile function, both areas must be addressed: why it happens, and then also how to change your well established, conditioned response.

The sexual response is conditioned, meaning for every action there is an effect and the more we do the same thing, the more entrenched the same effect becomes over time. So when you feel fear and paranoia that you won’t be able to get or maintain an erection and then you consistently don’t, you confirm your fear and your brain links it with your lack of response and that makes your need to reach for medication that much stronger too.

If you don’t give yourself a chance to try for an erection with a partner without medication, in a positive way, you will never be able to change your conditioned patterns.

Your fear and paranoia sabotage the way your sexual brain thinks by now. So to change it, you need a series of positive changes that encourage your brain to be reassured and will then quiet voices of fear. Do not attempt to change everything all at once. If you have difficulty achieving and maintaining erection with a partner, start by trying to feel arousal and perhaps a partial erection at the thought of your partner. Since you have no difficulty with erections while on your own, fantasise about having sex with your partner. Start building positive erotic associations with your sexual arousal and the idea of sex with your partner. Once that is successfully stimulating, move to experiencing some sexual play with a partner, without any pressure of whether your penis responds the way you expect or want it to.

The pressure actually creates more of an obstacle to overcome. So if you are pressure free and just observe how your body feels, without the script in your head of fear, paranoia, despair, panic, frustration and everything you have been feeling, you give your body a chance to find a new way of responding.

This is a slow process, and complemented with sex therapy addressing the underlying issues and causes, may actually be able to enable you to enjoy sexual pleasure with a partner, without medication, and without fear. Remember that ‘normal’ is different to different people, at different stages in their life. Strive not to be “normal”, don’t compare yourself to others, or even your own pressured expectations, and instead aim to be happy and satisfied, in your relationship, in every way.