I have erectile dysfunction

What this looks like

It happened once. You didn’t think much of it. The next time, you noticed yourself watching for it. The watching produced what you were watching for. Now you can’t predict whether it will work, and the unpredictability is making it less likely to work each time. You’ve started avoiding sex to avoid the failure. Or you’ve started using a pill and you’re afraid of going without it.

The mechanics work. The watching is what’s interfering with them.

What you’ve already tried

• A prescription
• Cutting alcohol before sex
• Cardiovascular exercise
• Pelvic floor exercises
• A urologist who said you’re medically fine
• Telling your partner what’s going on
• Telling your partner nothing and dreading the next attempt
• Watching porn alone to confirm it still works there

The watching kept doing its work.

Why this gets worse with attention

You very likely came up with a particular relationship to your performance, sexual or otherwise, that doesn’t allow for the body to fail. You may have grown up with a model of masculinity that treated erections as a measure of you as a man, and any failure has felt like a referendum. You may have lived through an early sexual experience where something didn’t work and you swore you’d never let it happen again, and the swearing has been the system that keeps making it happen. You may have arrived at this stretch of life with stress or relationship tension that’s been showing up in the body, and the body’s response has become its own separate problem.

Erections are involuntary. They run on the absence of monitoring. The moment you start checking whether it’s working, the checking interferes with the system that produces it. This is the “be spontaneous” paradox in its purest form. You can’t will an erection. You can only stop preventing one.

The pill works by overriding the system, which is why it works while you’re taking it. It also confirms that you needed the pill, which loads the next time without it.

For the broader sexual context, see I have a sexual problem and I have performance anxiety in bed .

The watching is what’s failing. The body is fine.

How we work with it

Strategic therapy uses the be-spontaneous paradox in your favour. We ban penetration for a defined period, which removes the test that has been training the watching. Inside that window your body gets to register arousal without being asked to deliver an outcome, and the system that produces erections starts firing without the surveillance that was disabling it.

Take the exam off the table and the body remembers it knows the material.