Something’s wrong with me, Doc,” said Steve, a thirty-nine-year-old lawyer. “I want a complete urologic workup.”

I asked him what the trouble was. “I met this great woman,” he said. “We had a terrific first date on Valentine’s Day. She invited me in, one thing led to another, and before I knew it we were in bed. But I . . . well . . . I couldn’t . . . you know . . .”

I knew all right. I had heard it so many times before from hysterical patients. Steve was terrified that something had gone wrong with his penis, when in reality his failure to get an erection with his terrific new woman had nothing to do with physiology. He had gone through a bitter divorce. It had taken him some time to get used to being single again. On the ill-fated date, it was the first time in many years that he had even kissed a woman in earnest other than his wife. Steve was not impotent, he was just plain nervous. The high romantic expectations related to Valentine’s Day, the newness of the experience, the excitement of meeting someone he liked, and his eagerness to please her and prove himself a worthy bed partner all conspired to create one of the greatest enemies of penis power: anxiety, or more precisely, performance anxiety.

More penis weakness occurs the first time a man is with a particular partner than at any other time. When it happens, men feel so humiliated that they sometimes find any excuse they can to avoid dating that person again, thereby depriving themselves of what might have been a good relationship. It is sad. I have even met men who, after several embarrassments, stayed away entirely from people who turned them on. They became, in effect, celibate prisoners of penis performance anxiety.

The first time with a new sexual partner can be an exciting experience. For some men, however, that very emotional excitement can lead to temporary penis weakness. It can spiral into a pattern of disaster. My advice is to take your time, be patient, stop pressuring yourself, and stop thinking you are inadequate. Find a partner who makes you feel comfortable and unthreatened. It worked for Steve, and it will work for you. You must be willing to face the challenge with the courage it takes to overcome performance anxiety.

Accentuate the Positive

What can be done if you do have performance anxiety? Let us start with the issue of anticipating the use of your penis. When you begin to feel anxious or fearful, you are programming your mind for failure. Stop what you are doing, calm yourself down, and remind yourself of what Franklin Roosevelt so elegantly and succinctly stated during his first inaugural speech at the depth of the Great Depression: “The only thing we have to fear is fear itself.” Losing an erection, unlike losing your job and home, is not catastrophic. What is the worst thing that could happen? You embarrass yourself? You can only be embarrassed if you let yourself be. If you think that a “real man” cannot possibly lose an erection or ejaculate too quickly, then you will be encouraged to know that these things happen to every man at some point in his sexual life. So why should you be embarrassed if it happens to you? And what if you are embarrassed? How bad is that really? Maintaining this positive point of view will keep you calm and lighthearted. If you feel that way, your penis is likely to behave accordingly. If you develop the ability to laugh at both yourself and that unpredictable appendage of yours, you will both be winners.

Get rid of fearful, negative thoughts altogether. There is no valid reason to entertain them. They are the natural enemy of your penis. Mobilize a battalion of positive thoughts, and let them take over your mind. Penis power is the power of positive thinking applied to your penis.

It is a fact that some men with a deeply rooted fear of penis failure need more than just a pep talk. Perhaps a prescription for Viagra, Cialis, or Levitra is just what is needed to break the vicious cycle. However, the “crutch effect” may result in dependence on these medications. I often suggest that patients talk to a psychotherapist and perhaps explore deeper reasons for their anxieties. In most cases, lack of self-esteem is the underlying cause. Their self-image is so low that it affects every aspect of their lives, not just sex.

Lighten Up, Dude

Okay, you are in bed with a sexy partner, whether it is your wife of thirty years or someone you just met. You feel tense. You start to worry that your penis will not get hard or that you might lose the erection that just popped up. What do you do? Your first reaction might be to panic. You might worry so much about your penis that tension builds. You get clumsy. You try to exert your willpower on your organ. You forget about doing all the things that might excite your partner. You cannot appreciate, or even feel, the kisses and strokes your partner is so lovingly giving you. One of two things is bound to happen next: your partner gets turned off and thinks she is doing something wrong or your penis goes limp. From my experience, it is usually both.

The minute you start to feel any anxiety, stop what you are doing immediately and tell your partner about it. Do not make excuses. Do not try to hide it. Own up to it. Explain openly that you are nervous, that this sometimes happens to you. It happens to all men. Tell your partner you want so much to please her, bring her satisfaction, and that her acceptance means a lot to you. Make sure she understands that it is not her fault, she is terrific, and she has not done anything wrong. Tell her it is all in your head, and it will surely go away.

Honesty is always the best policy in general, but when it comes to your penis, it should be the only policy. Ninety-nine percent of the time, candor will improve the situation by diffusing tension. If you have a healthy relationship, your partner will understand. Your partner will appreciate your integrity and your vulnerability. Most people want intimacy, affection, and closeness in bed, so if you communicate these qualities, your partner will not hold your anxiety against you. She will probably reassure you, calm you down, and take the pressure off. If your partner does not act this way, or if she gets angry, gets resentful, or demeans you in a castrating way, you should ask yourself if you are in bed with the right person.

And if you do fail to get an erection? If you do lose it at precisely the wrong moment? If you do ejaculate too quickly? What then? I say laugh it off! You are probably thinking, sure, that is easy for the doctor to say. But I mean just that. Joke about it. Lighten up! I assure you that “real men” can and do laugh at their own penises. They might say funny phrases to their partners like “Oh well, that rascal pulled a fast one on me,” “I cannot get him to behave sometimes, the unpredictable little devil,” or “Do not take it personally.” Remarks like that, expressed in your own words and your own style, should ease the tension and help your penis rise another day, or even the same day. Medically, I can practically guarantee it.

Your partner should appreciate the light touch and will be pleased to know that you are trying to improve your sexual ability. She might start thinking that something is wrong with her. She might be feeling guilty for failing you. She might know you feel ashamed but not quite know what to say or do about it. You can take the lead and break the ice with a good laugh. Who says sex has to be serious?

When you get right down to it, with all the unstated agendas, the physical clumsiness, and the childlike awkwardness, sex is just as suited for slapstick comedy as fine art or soft-focus cinematography. Many people say there is no better turnon than a good, hearty laugh in bed, and nothing sexier than a partner whose sense of humor is compatible with your own. Just do not take your penis so seriously. That is how the trouble starts in the first place.

If you do not succeed, try again and again and again. Do not shy away from using your penis if it falls down on the job once or twice—or any number of times. Do not give up on it. Practice makes perfect in sex, just as it does elsewhere in life. Perseverance is the only way to get over setbacks and gain the confidence you need to overcome your fear of failure. As a last resort, you can always turn to your urologist for the quick but temporary fix provided by medication.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

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