Can't get erection with new girlfriend

Dear Mr. Erection-Less..., 

It seems there is a lot of pressure you’re feeling to not just have an erection, but also to please your new girlfriend. Balancing sexual satisfaction, new relationships, and the two of those coming together (no pun intended), may be a process indeed. And, because of all this pressure, you may be experiencing a form of erectile dysfunction. Learning more and putting a name to what you're experiencing may be intimidating, but it also allows for more concrete solutions.

Your experience isn't uncommon. Erectile dysfunction can affect people at all ages, and the causes could be both physiological and psychological. While many of the underlying causes that result in ED (diabetes, high blood pressure, prostate cancer, heart disease – to name a few) more often occur in older age, research has found that around 26 percent of new cases of ED happen to those with penises under the age of 40. Additionally, studies have shown that psychological causes can account for up to 20 percent of ED cases. It may be helpful to consult with a health care provider in order to determine if your problem with erections is medical. If it is, they can follow-up with the appropriate care. They can also provide a prescription for medication that may address the physiological causes of ED. However, it's worth noting that medications may not treat psychological causes nor aid in pleasure. 

So, what exactly are these psychological causes? If someone experiences stress, anxiety, depression, relationship problems, or performance anxiety, they’re more susceptible to ED. You’ve mentioned that you have no problems with having an erection while masturbating, which provides more grounds for a psychological cause. For performance anxiety, it's concern about how well they will perform on a task (in this case sex) and worry about other people's evaluation of their performance (e.g., their partner). This can lead to being self-conscious, self-critical, worried, tense, and anxious while being sexual; it may also result in other forms of sexual dysfunction besides ED, such as premature ejaculation or difficulty experiencing orgasm.   

If you suspect that your problem may have underlying mental health causes, then seeking support from a mental health professional may help you address it further. They can help you to identify and change patterns of thought and action which may be contributing to your erectile issues. If seeking help from a professional doesn’t seem like the right fit for you, then you may want to try self-guided techniques, even before sex if you want, to help you relax and reduce your anxiety centered around your erections. You may consider the following: 

• Rhythmic breathing: You could try inhaling slowly and deeply over a count of five. Then, hold your breath for five seconds before exhaling slowly over another count of five. You can repeat as much as you like.  
• Meditation: Even 10 to 15 minutes a day can help reduce stress and anxiety. Feel free to check out this response on Meditation from the Go Ask Alice! Sexual & Reproductive Health archives. 
• Guided imagery: The images you decide to focus on are up to you. You can focus on general positive images to provide you with a sense of happiness or calm. Going in another direction, you can also try focusing on sexual images of yourself or you with a partner while you masturbate. It may be helpful to create an image of sex not in the way you most prefer, allowing a visualization of yourself sexually with or without an erection.  

It may take some practice and time easing any of these techniques into your daily life. What’s most recommended is being conscious to gently set aside any critical thoughts you encounter and physically easing any tension you feel in your body while you do so.  

Understanding yourself and the worry you feel can help resolve your problem, but you’ve also mentioned worries with your current girlfriend. Sex is a collaborative experience and doesn’t have to be reliant on an orgasm or erection. Have you talked to your partner about what you both enjoy? Are there ways to have sex that doesn’t involve your penis? Can you and your partner brainstorm ways of being intimate (physical or not) without the pressure or expectation of having sex? Similarly, are there alternative ways to help your partner experience an orgasm? It may be helpful to consider these or bring them up to your girlfriend in addition to the worries you’ve been having about erections. You may even find yourselves trying new and daring ventures that further enhance your sex lives together.  

Here’s to good times coming,