Q: I have difficulty maintaining an erection during vaginal intercourse, while the same does not happen during masturbation. What can I do about this?
A: Problems in maintaining an erection during sexual intercourse may have several reasons:
1. Behavioural or lifestyle causes may include smoking, excessive consumption of alcohol, lack of physical activity, use of drugs, or lack of sleep.
2. Physical causes may include diabetes, spinal cord injury or nerve damage, cardiovascular disease. Certain medications have erectile dysfunction as a side effect. You could consult your doctor to rule these out.
3. Psychological causes may include high-stress levels, depression, low self-esteem, anxiety, or past sexual trauma.
Working with a therapist you can identify the reason that could be the cause for not maintaining an erection. You should have a conversation with your partner and work towards finding a solution.
In the meantime, you and your partner may like to explore other ways through which you could have physical intimacy which may not require an erection initially but could slowly lead to it once you feel comfortable.
Having an open conversation during sexual intercourse about your likes and dislikes is very important. Sharing physical affection with your partner will help you be at ease. You could also try relaxation and mindfulness techniques to reduce your anxiety about sex.
If you feel the need, you should approach a therapist for additional support.