Dear Dr. Milrod:

I am in my early 20’s and am having problems getting fully hard when with a woman. I have no trouble getting hard when watching porn or anything like that. I’ve only been with four women and have only gotten half erect. Is this considered erectile dysfunction? Should I get medicated for it, or are there other options? I have been taking anti-depressants for a few years now, Im sure that might have something to do with it.

Pill Phil

Dear Pill Phil:

If you are in your early 20s and “have no trouble getting hard when watching porn or anything like that,” chances are that you are experiencing some good old-fashioned perfromance anxiety, in addition to the possible effect of antidepressants. It would only be considered erectile dysfunction if you had difficulties getting hard under any circumstances. No responsible physician will medicate you for situational erectile dysfunction, particularly if you’re in your early 20s. If you had nerve damage, were disabled, diabetic, etc. and had dysfunction no matter what, it would be a different story.

I’d also make a call to my friendly psychiatrist and discuss the possibility of the antidepressants possibly interfering with my sex life. This is so common that most physicians don’t think it’s odd or unusual to switch the patient to a different medication if possible, if that indeed is the case.

What you can do is try to relax as much as possible. Do not masturbate or get into a self-stimulating state before your date, in fact, don’t do anything sexual for a few days just to get a little more hyped for the occasion. If you find a nice girl/lady that you connect with otherwise, do set up future meetings with her; sometimes mastery is subject to familiarity and the more in control you feel (of your own responses, not of her, mind you), the easier and more fun your encounter becomes.

The other issue is that some men feel very pressured to do something when engaging in sexual activity with a partner. One thing you can do to take the pressure off yourself is to let her be the aggressor. Another one is to engage in paradoxical intentions, i.e. tell yourself that you absolutely don’t care about getting a hard-on and that you’re only hanging out for the sake of some casual fun. All good relationships tend to evolve over time. The pressure to get something to happen on the first date can feel enormous. Try to spend at least four-five dates without sex and do something fun and non-sexual during that time. It would also be a good idea to work on your social skills so that you won’t just be restricted to searching out women in clubs and bars. Not that there’s anything wrong with it, but it can limit your options for intimacy and emotional evolution. Try to join something where you’ll meet women who aren’t on the prowl. Social activity is good for keeping depressive symptoms at bay, even if you have to force yourself to get out of the house sometimes.

One last caveat – sometimes it’s just easier to masturbate and call it a day instead of getting all worked up to meet with a girl. Bottom line, however, is that many guys end up using porn and masturbation as their chief sexual outlet while still wanting to have intimacy with a woman. And when they finally get it, they don’t know what to do with it, which can create frustration and disappointment for both parties. You’re still young and have life ahead of you. Please try to maximize your non-sexual social opportunities first and foremost.

Christine Milrod, Ph.D.