The Best Ways to Overcome Erectile Dysfunction Issues
Ready to enhance your erection? Here is the science and psychology behind your erection and how to overcome erectile dysfunction issues.
Renowned Sex Therapist Mark Goldberg is here to break down every question you could have about erectile dysfunction (ED): What it actually is, how to overcome erectile issues, what your partner can do to be supportive, and so much more.
Whether you are currently suffering from Erectile dysfunction or want to reduce your chances of experiencing erection issues in the future, this episode is a must-listen. Mark and Kirsten discuss the causes and impact of ED, the emotions men experience, and what is causing ED prevalence to be on the rise, especially among younger men. This episode is stacked with clear information and actionable practices to improve erectile performance.
AND…Mark and Kirsten answer some of your questions about ED!
Key Topics:
02:39 Emotional Impact of Erectile Dysfunction
03:44 Causes of Erectile Dysfunction
04:39 The Rise of Erectile Dysfunction in Younger Men
07:43 Impact of Modern Dating on Erectile Dysfunction
11:14 Situational Erectile Dysfunction and Communication Challenges
14:06 When to Seek Help for Erectile Dysfunction
17:52 Supporting a Partner with Erectile Dysfunction
27:35 Practical Steps to Address Erectile Dysfunction
42:13 Dealing with Trauma and Psychological Factors Related to Erectile Dysfunction
Connect with Mark Goldberg
Erectile Dysfunction Radio
https://erectioniq.com/podcast/
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Episode Transcript
[00:00:00] Every single person on this planet can think one thing. For their existence. Erections. And today we are going to talk all about erectile dysfunction. What causes it ways to reduce the symptoms and ultimately how to get yourself. And your penis to a place of having consistent epic erections. Welcome back to the naked connection.
This is the show for driven men to reach sexual mastery and build deep connections. What's up, you guys, it's Kiersten your soon to be licensed sex therapist and. Today. We actually have a renowned sex therapist, mark Goldberg on the show. You guys, mark is an ed specialist who has really mastered all things, erectile dysfunction.
So pull out your notebook. Grab your cock. And let's get some. [00:01:00]
Kirsten Trammell: Mark Goldberg, welcome to the naked connection. We're so excited to have you today.
Mark Goldberg: Thank you so much for having me.
Kirsten Trammell: Just to lay the groundwork for anyone that's tuning in about what [00:02:00] exactly erectile dysfunction is first and foremost.
Mark Goldberg: So I, I like to distinguish between the clinical definitions and some of the experiential definitions because sometimes those could be a bit different. So generally I think from a clinical perspective, when we think about erectile dysfunction we're thinking about a somewhat persistent challenge in either gaining, maintaining, gaining or maintaining an erection, or challenges with maintaining an adequate amount of rigidity.
I believe the diagnostic criteria is that this is occurring more often than not over a period of six months.
Kirsten Trammell: Mm hmm.
Mark Goldberg: And the reason for that is because it's quite common for men to experience erection inconsistencies as part of just normal function. That that's much more of the clinical definition experientially, though you know, there are many men who [00:03:00] long before they hit the 6 month time mark or even if erections are generally consistent, but even at times they're not gaining or maintaining, maintaining an erection.
It could be a very distressing experience and a lot of those men will try to seek out help to try to eliminate the possibility of having erection challenge at all.
Kirsten Trammell: Mm hmm. Yeah. And what would you say when having that experience is really the primary emotion that a guy is Carries as they're moving through that.
Mark Goldberg: That is a great question. Shame is, is one of the big ones.
Kirsten Trammell: Mm
Mark Goldberg: shame. Think during the actual experience of erectile dysfunction, a lot of times it's panic like intense fear, worry from a cognitive perspective, a lot of catastrophic thinking that goes on. But I think the, the aftermath emotion is, is primarily shame.
Kirsten Trammell: mm Yeah. [00:04:00] Yeah. And when I was preparing to talk with you, I was reading some statistics on Ed and it was saying something like, in America, in the US upwards of 24% of men experience or had diagnosed with ed. And so understanding the prevalence of it and just the experience of the panic followed by the shame, what is.
I guess in your experience, like what is causing this? Why is this happening to, to guys out there?
Mark Goldberg: You know, erectile dysfunction is, you know, it's probably oldest time. As far as, as far as we know, there, there is erectile dysfunction is, is at its core, it's a biological issue. And I want to be clear about that.
Obviously I'm a sex therapist and we'll talk about more of the, psychological or psychogenic elements to it. But even when erectile dysfunction is psychologically driven, it is almost always a, a inadequate blood flow, which is, causing or facilitating the erectile [00:05:00] dysfunction. So I want to emphasize that the cause is medical.
Okay, and that will be across the board. As men age, some of those physiological systems don't work as well. There's just, , wear and tear on the body. There's, , a slew of medical conditions that can impact blood flow. If it's okay with you, I, I would maybe ask this question a little bit differently, which is we've seen a tremendous rise in reported cases of erectile dysfunction in men under 40. And I think we can ask the question as to what are the drivers in those cases? What is going on out there that those numbers seem to be on the rise? And whatnot. And I think that that is a a question that I don't think we know quite. Exactly what the answer is. There could be like, again, a number of factors out there.
Um, so just some of the things that I think is worthwhile considering is pornography. That's a big one. And how that's impacting people's psychology. How that's impacting their experience of [00:06:00] erections. The way we date, the way we engage. Expectations in dating expectations and sexual encounters.
That's another factor, which I think is important. There are a number of other possibilities out there that do I think go beyond my area of knowledge and expertise, including you know, what we eat is so much processed food out there. There's so many things that are going on. And I'm not, I'm not a, alarmist about these things, but I recognize that they do matter.
They do make a difference. And there's a lot of things that have changed just about, you know, us as people and our society. So these are again all, you know, different factors that might be contributing to a general rise in erectile dysfunction. The other point that I will make about this though is our reporting has gotten a whole lot better.
So we are starting to see a general, I think, shift towards destigmatization of these conditions. And with the proliferation of online pharmacies that are designed for men who are experiencing erectile [00:07:00] dysfunction, they're collecting data. And they're reporting that data. So it's possible that some of our reporting is getting better.
So what we don't know is that these numbers exist at this level. 100 years ago, we just didn't have any good way of collecting that data. But now we do. So that may also be a factor here. So it's just a blind spot for us in terms of knowing how, how much of the numbers actually going up versus how much better is the reporting getting.
Kirsten Trammell: Yeah. And maybe that might be connected to, with it. Because Yeah. From what I understood was the older that you got the more like the higher the statistic was to have it, but perhaps maybe it's just, that was the social norm. And so now younger men feel more comfortable saying that they are actually experiencing, or maybe it is environmental.
Sounds like there's a lot of potential variables to uncover.
Mark Goldberg: More more. Yes, more than I can count. And I think to a certain extent, more than we ever will know, meaning I don't [00:08:00] think we can account for all the variables. But yes, historically, the perspective has been, and I think it continues to be there are higher rates of erectile dysfunction as men age. I think that continues to be true, but we are seeing a, I think, a disproportionate rise in reporting of cases among younger men.
Kirsten Trammell: Yeah. And you mentioned this piece about the way that we're dating, and I know a lot of guys listening into this show are out there trying to find someone R in the dating space. What specifically do you mean by that?
Mark Goldberg: So what I mean by that is you know, there, there are so many dating platforms out there just online alone. And a lot of times where erectile dysfunction is being reported has to do with partnered sexual activity. There are people that have developed full relationships online before ever meeting somebody in person.
There's a lot of people who maintain, primarily, a lot of their social connections are internet based. I don't think we know enough [00:09:00] about the impact on one's psychology, as well as how one navigates the transition from an online relationship to an in person relationship. That would be one aspect. Another aspect is some of those dating platforms are primarily designed for, for what's called hookup or hookup culture which means that there's an expectation oftentimes that there will be sexual activity.
at that first meetup. So for men who are more relationally based who need to feel like a bit more of a sense of safety and security they're going to be prone to having higher levels of performance anxiety or just being anxious stepping into a scene like that. And it's not, it certainly is not an uncommon presentation that I've seen here in my office where Either a, you know, a gentleman who's exited a long term relationship and is getting re acclimated to what dating looks like in 2024 or younger men who are just discovering [00:10:00] about themselves, that they're more relationship oriented than perhaps they assumed or more relationship oriented than their peers, and they're continuously running into problems specifically with the dating apps that are.
designed for or it's implied that there will be sexual activity early on in the, in the process.
Kirsten Trammell: That's so fascinating. And I could see also perhaps even like that, I know a lot of guys I talk to, there's this pressure to perform and it's like in those sorts of environments where the first time you meet, there's almost like this expectation would increase the pressure to perform. Or if you've never met this person in real life, but you have this whole prolonged connection online, when you meet in real life, there's probably even higher expectations.
Anxiety or higher pressure about how you're gonna interact with one another. Like how to show up as this person that they've built this story around you being,
Mark Goldberg: Exactly.
Kirsten Trammell: yeah. Oh my goodness. Okay. So it sounds like there's a lot of reasons why this is [00:11:00] unfolding . What have you found that's perhaps maybe the most surprising cause.
Maybe from working with a client, or is there something where you look at it and you've been a little taken aback to recognize that that's been a proponent of, of leading to Ed?
Mark Goldberg: It's a great question. And I'm just thinking about like different versions of myself in
Kirsten Trammell: Mm mm-Hmm.
Mark Goldberg: I would say today there's very little that surprises me. I wouldn't say I've seen it all. But I I've, I've seen enough and I've been surprised enough that the element of surprise is no longer there.
In a certain sense. And I'm I think one of the striking drivers that I've seen is a little bit tricky. So let me kind of back up here. There's a lot of men who are reporting erectile dysfunction that are having a much more like a situational erectile dysfunction. They're just not sure how to name it.
Men who are in relationships where [00:12:00] communication is really, really difficult and they know things about themselves. That they are hesitant or just unwilling to share with a partner.
Kirsten Trammell: Mm-Hmm.
Mark Goldberg: those, those situations, I think, you know, continue to kind of strike me. Because here you have, like, all this really important information about yourself.
And you know it. But you're just not willing to say it out loud. And like the problem persists, because whether it's something that you are scared about a partner's reaction, unsure about what they are thinking, you have a particular interest, a fantasy, sometimes even a fetish, but you're embarrassed to bring it up.
And meanwhile, like you're, you know, turning to somebody for help, which already takes a lot of courage, but are unwilling to Bring that back to a partner. That that situation, I think, still is something that I find just really, [00:13:00] really intense and upsetting in certain ways that it's, it's like right there, but, but just, So difficult and so hard to take that next step and actually engage one's partner around it.
Kirsten Trammell: And so I guess how would someone recognize that they have a situational dynamic unfolding versus thinking that they have a diagnosed, prolonged issue? Like, how do you, , face that?
Mark Goldberg: So it usually happens like one of a, one of two ways, primarily one , somebody is engaged in an affair or has been engaged in some type of affair or two, they use their solo sexual activity as a barometer and that, that is a very common presentation that, that guys are not able to gain and maintain an erection with a partner, but on their own, they're doing perfectly fine,
Kirsten Trammell: Yeah.
Mark Goldberg: and oftentimes the erotic material that they're engaged with could be like an indicator and I want to emphasize is [00:14:00] not that, not that, okay.
The material is causing erectile dysfunction. I think that's a big misnomer out there. But the material is never going to judge them or shame them and they're able to engage in more of the things that speak to their wants, desires to the pleasure region, regions of their brain, but getting that to translate into partnered activity becomes a lot more difficult.
Kirsten Trammell: Mm. Yeah. And then I could see how that would go back to the having this, knowing who you are and what you like, and then not feeling like you could share it.
Mark Goldberg: Exactly.
Kirsten Trammell: yeah, interesting. Yeah. I guess at what point should somebody seek help? Where is the kind of tipping point where maybe they've noticed that this is going on for a while or how, how do you recommend someone seek help?
Know when it's time to, to ask for help or to share it or talk about it.
Mark Goldberg: I think this falls into two different categories. So one is if [00:15:00] somebody is experiencing erectile dysfunction, really, really important to go for medical treatment first and for medical assessment. Like I mentioned before, erections work off of blood flow. And while it's not necessarily like overly common, it's common enough that A lack of erection could be like a canary in the coal mine for other circulatory issues that are going on without getting too deep into this, a little bit out of my space, but what we do know is that the arteries and veins in the, in the penis, like a couple other areas of the body, are like the absolute thinnest or the absolute thinnest, but they are among the thinnest, I should say or the most narrow.
So sometimes that's where problems begin to emerge. That you know, when you have wider arteries and other parts of the body, even if they start to experience problems, they oftentimes can allow enough blood flow that you're not seeing anything problematic right now. But in the [00:16:00] penis it could be a, it could be a sign of underlying problems.
So for that reason alone, I encourage everybody, go talk to a doctor, talk to a urologist. That should be your first line of treatment. I also recommend joining for a sex therapist. Really should be careful that these are medical issues, a medical condition, and I don't see anybody unless they've been medically cleared.
Like that, that's my policy because I, I do see it as, as like something that has to be done properly. Now, in most instances, it's not a medical issue. Most instances, there's no blockage, there's no underlying thing, but it does happen. Number one, when we talk about treatment, like medical, that's the first line, okay?
There are situations, though, where even myself, like I would be comfortable to treat, If it's not, even if somebody has not been medically cleared, so to speak, like they're getting erections in a bunch of situations, and they're in one specific situation where it's not happening. Like the body does not [00:17:00] distinguish between those, the mind does.
In those instances, the question is, when should somebody reach out for help? Okay, not getting an erection once is usually not an indication of anything. Like we said, that 6 month that 6 month window is usually a pretty good window. However, that's why I was trying to be careful when you asked me this question in the beginning.
If you are noticing that you are becoming increasingly distressed about this. Waiting for six months to see if it heals itself or clears up or, or whatnot oftentimes is not going to work, and by the time you get to six months the, performance anxiety and anticipatory anxiety that goes along with sexual activity is usually pretty compounded at that point.
That I would say is that you got to know yourself if you're feeling really anxious about this, if you're ruminating about it it's probably time to seek help and start to work on that. If your anxiety profile is one where you're pretty cool and , you don't feel a lot of anxiety, generally speaking, and you're not really panicked about this, I think that you have a little bit of, you have a little bit more [00:18:00] leeway here, a little bit more time before, , I would say it's really, time to seek help.
Kirsten Trammell: Yeah. Yeah. Okay. And I really like that breakdown of, it's almost like kind of a step process of understanding the duration of time, assessing your level of distress about it. First getting medical help then looking at it from a psychological perspective or doing both and and seeing what is Underlining this issue, I guess thinking that there's two people typically in a relationship What do you say to the person that's in a partnership or that's sleeping with somebody that is experiencing ED?
I guess what is first of all the worst thing that someone could do? You If their partner is having erectile issues
Mark Goldberg: the worst thing they can do is leave.
Kirsten Trammell: Okay. Yeah.
Mark Goldberg: than they're like, again, , criticism, shame blaming, like those are [00:19:00] like, obviously things that are not helpful ultimatums demands making the, the viability of the relationship dependent on.
Like erections and sexual activity, these are things that are all not helpful. , the other piece that's really unhelpful in a lot of ways is when partners internalize responsibility for their partner not getting an erection. And. While I will acknowledge that there are some instances where there's an attraction issue, it does happen.
I can't deny that. But I would say in the vast majority of situations that I've encountered, that's generally not what's happening. It's generally not a lack of attraction towards a partner. And I would say that there are way more partners who have reached that conclusion than there are men with ED who are actually thinking, if my partner was just a little bit more attractive.
Or if, you know, he or she lost weight, or it's just, I just don't encounter that very often. It's a [00:20:00] very, it's a very rare presentation.
Kirsten Trammell: Yeah. Yeah. And I, it's so hard just as humans not to, to take that on as our own or intern put it on ourselves. Okay. So what is the best thing that someone can do? Let's say that they're in a situation, they're hooking up and he can't get an erection. What would be the gold standard?
Mark Goldberg: It's interesting, you said, you said hooking up, and, you know, that's a really, no, it's a really, I think it makes a big difference,
Kirsten Trammell: Mm hmm.
Mark Goldberg: There is, again, it goes back to there's a pretense. If we were meeting up to hook up, and you have ED, and you know it you kind of misled me, right?
Because we like, we matched, we went out of our way to make this happen. And I don't love to say it this way, but I understand there's there's an element of a quid pro quo, right? That's why we're meeting up here, right? We don't really know each other, like we're not really well. So if we're talking about like a pure [00:21:00] hookup I don't have high hopes or high expectations that like, beyond just basic human decency that somebody is going to shift into an overly supportive role in that situation.
Kirsten Trammell: I know that makes sense.
Mark Goldberg: yeah, if somebody, if somebody does that I tip my hat to them, they're really a great a really good person, but I, I certainly understand the frustration and feeling misled and feeling like they've wasted their time. So I think human decency, if you're talking about somebody who's in a relationship.
Kirsten Trammell: yeah. Yeah.
Mark Goldberg: And, and they're going to engage in sexual activity and something like this occurs, and I'm assuming you're talking about a situation where this, this has occurred already, like this, we're beyond the initial shock of all of this,
Kirsten Trammell: Yeah. Maybe. Yeah. Like the first couple times or it's been going on for a while. It's starting to become a thing. Mm-Hmm.
Mark Goldberg: yeah. This is going to really vary from situation to situation because, you know, each person, each person listening to this knows a lot more about their relationship than I can [00:22:00] possibly cover. I encourage people to de emphasize the role of an erection in their physical intimacy, just like acutely.
There's a lot of options out there for many people, and I don't want to take away from the fact that for some, for some people Having a full erection generally for penetration is, if you think on the partner side, is like a must have. There are, there are some people out there like that, but again, I think that is certainly the exception, not the rule.
And I think there's a lot more panic about, not having an erection in those moments ready for oftentimes some form of penetrative sex than is warranted. So when these things happen, I think having alternatives and when I say alternatives, I don't mean runner ups or second best. I mean, just another way of engaging, which is fully satisfying, and everybody can walk away with a smile and whatnot.
I think [00:23:00] that's a really important thing to develop. Most of the time it takes some conversation outside of the moment to say, hey, it's no big deal. We're just going to shift over to doing X, Y, and Z, or A, B, and C, instead of, you know, You know, proceeding to penetrative sex or oral sex on him or whatnot. I found that that has been something which I think is generally helpful for a lot of couples and it helps to take the pressure down. Paradoxically, over time, it can just lead to not hitting that pressure cycle in the first place and having more consistent erections as well.
Kirsten Trammell: Yeah. As you're describing this, you know, we've had conversations on the show about what to do if you partner, can't have an orgasm, like in a heterosexual relationship. And this sounds very similar of removing the goal. In that case, it would be to help the partner have an orgasm. This is like to have an erection.
So like shifting the focus into something else that feels and is just as connected and intimate just in a different way. [00:24:00] Yeah. Yeah. Yeah.
Mark Goldberg: kind of piggyback off of that. So like in, in, I make this point to men a lot of times, like in, in like specifically in heterosexual relationships, if your partner does an orgasm through penetrative sex, and I tell you, that's just how I am. Like, that's just, that's how it works.
So I, I do, but maybe it's only like 10 percent of the time. And I'm not sure exactly why that is and whatnot. For some reason, men have a much easier, like they go way easier on their partners than they do on themselves, right? And they have these high expectations that they're supposed to be showing up and delivering every single time, every single experience, okay?
Because they don't want to disappoint their partner, who, , Oftentimes seems to be okay to say look, this is how it works for me. I'm not showing up here a hundred percent of the time. I can't give you a hundred percent guarantee. And like a lot of men are like, okay, I get it. That's how it works for you.
But I, I have a responsibility to show up here 100 percent of the time. So they afford [00:25:00] their partners in many instances, a lot more understanding and care and empathy and support than they're willing to offer to themselves. And sometimes pointing that out to men and letting them just kind of digest that for a moment can be helpful to say that, you know, I don't have to be a machine. Don't have to show up here every time, especially because this is meant to be an intimate experience with this partner who themselves doesn't always show up and they're okay with that. Why do I have to put all this pressure on myself?
Kirsten Trammell: I'm like, why do you think that is? Like why do guys do like, why would someone do that?
Mark Goldberg: Why would somebody put that pressure on
Kirsten Trammell: Yeah.
Mark Goldberg: So I think, you know, some of it is probably societal. Some of it is just again, these expectations creep in. But there, there, there is a lot deeper psychology, I think, that goes into men's experiences. Most men you know, come of age and go through puberty at a time when there [00:26:00] really is no such thing as inconsistency and erections.
There's no such thing. It just doesn't, it just doesn't, it's unheard of. And a lot of this is just like the amount of hormones that are pumping through and they're young and you know, everything is new. And you know, prefrontal cortex underdeveloped a lot of things just not in the way. So I, I do believe and again, I don't have any specific data to back this up besides just anecdotal things, but I think that, that men become accustomed that like the erection is always there.
It's always going to be there. Why would it not be there, right? You just, you just grow accustomed to it. So the idea of having to adjust to this reality, I think, is, is very difficult. I think like female counterparts, a lot of times did not have an experience where it just works every single time, no matter what I do, right?
It's just there. It just always works. So I think that there's a much bigger learning curve. for men to adjust into this because their starting point is very different. [00:27:00] So I think that there's probably again layers to the psychology here of why it's difficult to accept that it doesn't always work as planned or as expected.
Kirsten Trammell: Yeah. Yeah. It's like starting at a hundred percent and then over time it drifts down, whereas women's almost going like the opposite direction.
Mark Goldberg: Yes. Yeah.
Kirsten Trammell: Yeah. Yeah. Oh, wow. That's a really interesting way to look at that. I guess it sounds like a part of this is, there's an element of acceptance. But perhaps like the ability to accept that maybe I'm not going to have a 100 percent satisfaction guarantee like to perform the way I did when I was a little kid. There's a piece of being okay with that.
But then also, I guess, you know, we obviously can't do a full therapy session here with you today, but what are some ways that maybe either questions to ask or some ways to start taking action to reduce or improve the symptoms, what would [00:28:00] you recommend someone do?
Mark Goldberg: Yeah, so that's that's great. So the answer is absolutely there's there's a lot of things that men can do even before coming to see a therapist and I I make this point to people that I speak to on podcasts and whatnot So like number one like recognize that when you experience something like erectile dysfunction or some other challenge there's a tendency to Catastrophize everything like it's all over.
Like I'm aging. It's done. I don't know what's going on. I've lost control of my body. What's happening? And in that panic I think a lot of men lose, lose sight of this was like one time and three other times it worked and whatnot. So one of the recommended recommendations I make is before even going to speak to anybody, start tracking things.
Kirsten Trammell: Mm.
Mark Goldberg: Just start tracking things. Just start noting. Oh, I woke up with an erection. I, just, just jot it down even for yourself. Keep like a, a basic log. Because certainly from a psychological standpoint, and even sometimes [00:29:00] from a, from a medical standpoint, the details matter. A lot of times the work that I do with men has to do with finding the underlying patterns, like finding situations which are more or less anxiety provoking.
So just as like an example I, I have guys that I work with track all kinds of things that might not sound intuitive but they really make a big difference. So one, one that I, that I like because it's oftentimes it becomes more significant than, than often than men appreciate. And then even I appreciate, but who initiated.
Who
Kirsten Trammell: mm.
Mark Goldberg: it? Okay, so and, and, and, and, Either way could have a different outcome for different men. So like for some men when they're thinking yeah, you know, I noticed every time I'm, I'm the one who's initiating, I'm like not performing well. Because I was thinking about it for 19 hours in advance.
Like I planned all my moves, but in, in planning all my moves out, like my mind, like the way it seems to work is that it also starts to get anxious about it. So [00:30:00] as we're getting closer what should be excitation, like an anticipatory excitation. actually is an anticipatory anxiety, and I'm feeding it to myself because I'm planning the initiation.
But, you know, I noticed that at times my partner initiated, especially like with spontaneity, it was just spontaneous. I, it caught me off guard, like before I even had time to think about it. I was already getting an erection and like lo and behold, I was fine. So it's these kind of details that I'm encouraging men like track just see what happens with the details.
So we'll talk about things like, you know, what was the setting time of day, etc. So that's definitely one piece that any man who's experiencing Some inconsistency interactions like this is a worthwhile thing to do because the devil is usually in the details And the solution that you're looking for is in the details for many relationships.
It doesn't take much to say look Temporarily until I understand why i'm so anxious and i'm working on this I just need you to initiate and also don't tell me when it's [00:31:00] coming like I don't need too much of a heads up because it doesn't work for me, right? so like meanwhile, like the couple can protect a lot of the You Subsequent you know, injury that happens to the relationship or even to each of them psychologically by just having some of the details and working with the parts that are working better and not necessarily going down the roads that haven't quite been worked out yet.
Tracking sequencing that's definitely 1 piece of advice that I would, I would throw out there. I don't see any harm in it. Certainly.
Kirsten Trammell: Yeah.
Mark Goldberg: That was one piece. The other thing is that just to kind of be aware that Erectile dysfunction like we're seeing in this, in this episode is multifactorial.
And there's a tendency to look for a singular, simplified answer. Because, like, when things are scary, and they're uncomfortable, and they're worrisome that's our tendency. We want to simplify and get to an answer. For better or for worse, and I really think for better, it is multifactorial.
[00:32:00] Because While the challenges are coming from possibly multiple places, the solutions can also come from
Kirsten Trammell: Mm-Hmm?
Mark Goldberg: There's a lot of ways to address this. as well. So I think recognizing it's multifactorial, it's not always just I'm anxious, you know, sometimes it's, you know, a stimulation issue.
Sometimes it's a physical stimulation issue. Sometimes it's a relational issue. There's so many things that are possibly going on. Don't limit the way you're thinking about this to you know, it has to be, you know, pornography, right? It has to be my partner. It generally is more than one piece going on at the same time.
Kirsten Trammell: Yeah. Wow. Yeah, I really love the, the tracking. I'm such a spreadsheet, so I love being, and you're right, like no information is necessarily bad information, so might as well get it and see what you find. Thank you for that. Okay, so I have some questions. That I thought I would, I would share with you whether it's from men that I've worked with or [00:33:00] men writing in from the show.
So I'll read you the question, the prompt, and then if you want to share any advice or how you would answer this, go
Mark Goldberg: do the best that I can.
Kirsten Trammell: Okay. Okay. Okay, and this is interesting. After we've spoken, I feel like I, some of these things might become, be obvious right away. Sometimes I can still get morning wood, but not during sex.
I recently went on a solo vacation for a month and I woke up with an erection almost every day. Does that mean I'm just not attracted to my partner anymore? It was a relief to know that I could get an erection, but now I'm almost more concerned about why this happens during sex. Yeah,
Mark Goldberg: Yes, I know. I mean, again, I would say like number one, so this is like a really good indicator that there's something psychological happening. When I say psychological, I don't mean necessarily on an individual basis, it [00:34:00] could be a relational piece.
Now, look, if you have to ask yourself, Does this mean that I'm not attracted to my partner? I think you've already answered the question, and the answer should be no. Because if you're not attracted to somebody, it doesn't take much to figure that out, right? We, we, we, it's one of the first things we do from a psychological perspective, is we see somebody and we know okay, this is somebody that You know, fits my general attraction profile.
And we have some obviously we have elasticity with that to a degree, but we generally know that. So if you're saying, does this mean that I'm not attracted to my partner? I, a therapist can't answer that question for you better than you can. I, if, if, if. If you're looking at your partner and you're saying generally I find this person attractive, then yeah, you find them attractive.
What is much more likely going on here, and I think I already alluded to this kind of situation, is that there's a performance anxiety. You're, you're worried about you're up in your [00:35:00] head thinking about is this not going to go well? And You're not pleasure driven when you're on a solo vacation, like number one, when you sleep, like your anxious parts are largely shut off for most people, not everybody, but for most people.
And your body goes through this very natural process. So clearly he can get erections. Number two is there's no, there's no performance pressure. Nobody's watching, nobody's looking, you don't like, and like you can really be a lot more pleasure focused. So I, I would venture a guess that either one of two things.
One, you're asking this question because you know there's some unattractive feature about your partner. That's number one, right? I don't think that's the case. And I would say if it is, try turning the lights off or dimming them, right? Or avoiding that piece, okay? Unless it's like very much in your face.
But again, in all likelihood there probably is a partner based anxiety here that needs to be fleshed out a little bit more. Some of it may come from, you know, a comment that was made. It may come from something, a facial [00:36:00] reaction. It could be a miscue or a misread, or it could have nothing to do with the partner, and it could be something which is more paradigmatic to, I mean, you have a partner based anxiety without the partner being the one who caused that in the first place.
People get nervous about their performance in front of other people.
Kirsten Trammell: yeah, okay. I love it. Okay, next question. Here we go. My ED actually be caused by me masturbating too much or gripping too tightly? I don't like to masturbate any other way, but I'm starting to worry that this is causing issues when I have sex with a woman. Yeah,
Mark Goldberg: Okay, so this is this is a quite a tricky question. So When someone asks could it be my answer is generally like most things could be like I can't I can't rule anything out. So there is there is a A concept that we refer to called idiosyncratic masturbation, which means that there certainly is like a concept that we do habituate ourselves to a certain degree to certain forms of [00:37:00] stimulation, whether that's, you know, visual stimulation, like pornography or like physical stimulation that we do become accustomed to needing a certain amount of stimulation.
So that part of it is true now when we, We're talking about erectile dysfunction. This is where these different categories make a significant difference in my opinion. So if he's not gaining an erection in the first place with a partner, I, I don't know how much of that we really could attribute to masturbation because that initial gaining of the erection usually is not associated with masturbation.
However, if what he's referring to is losing his erection in the middle of sexual activity There is a possibility, I could hear a possibility, that having grown accustomed to a particular form of stimulation that not being replicable, let's say if, I'm assuming his partner is a woman, it's very difficult to replicate a tight gripped, intense, [00:38:00] masturbatory motion in a vaginal canal.
They're just not, they're, they're two very different experiences. Now, can a person like relearn a lot of this. I do believe that's the case. And that, that it is possible that that's what he's experiencing. I would say in my experience of doing this work, it is more common that this type of setup or scenario would lead to a delayed ejaculation, Or an an ejaculation, meaning a lot of instances, there's enough stimulation to gain and maintain that erection.
But a lot of times not enough to get to a point of ejaculation at the same degree or the same time frame as with masturbation. That would be a more common presentation. So all that being said, to the person who wrote this and I would say it is possible. And again, I'm not going to make any particular recommendations of how to go about approaching that.
It is possible. But again, there also is a whole world of like psychology here [00:39:00] because again, there's performance anxiety. There's concern about what the partner is thinking. There's a lot of other things that could be contributing to this as well. There's a, there's a distinct possibility that what the, what the writer says is a factor but there certainly are other factors that could be at play here.
Kirsten Trammell: Interesting. Yeah. It's interesting. Okay. Her next question is, I've been struggling to stay aroused with my partner for the last year of our five year relationship. She wants to try some sexy outfits, role play to help, and even mentioned some sex toys for me. I love how committed she is, but I'm afraid I'll just feel more anxious.
How can we avoid that? Mm hmm.
Mark Goldberg: That's a really great question and it's a more common, it's a more common scenario that people think, but I would say to me it sounds just based on how this question has been, you know, submitted that this person finds themselves caught in a pretty intense anxiety loop already, [00:40:00] which is the things that I would, I know should be working for me.
Right to increase my arousal. What if they don't work? What if they what if it doesn't like you can hear already the anticipatory anxiety of I almost don't want to let my partner do these things for me because if I don't respond, it's going to be so much worse than having not tried it in the first place.
I mean, it sounds to me like this person's already caught in a pretty, pretty intense anxiety loop. I Bye bye. think his intuition is correct, that you probably should not proceed forward, like when you are that anxious because it is a high probability things are not going to yield the results that you want.
Because like you're nervous about this. And this is a, this is a comment I make to a lot of men that I work with and whatnot. Like you can be in, in the most stimulating environments possible. But if, if your mind is, preoccupied and is in a state of panic or worry, it almost doesn't even [00:41:00] see what's in front of you.
It's not like your mind is not really there. When you're anxious, you're in some future alternate world. You're not even present. And some of them that I work with, I'll ask them like, Oh, you're describing this situation. Can you tell me like, what did your partner look like? What was she wearing? And they're totally blank.
They have no clue. No recollection because the anxiety and this is like a hallmark of anxiety. It's a very future oriented type of experience. You're worrying about all these what if scenarios. What if something goes wrong? What if my partner leaves me? What you're not present. You're really, really not here. like, when, when people are that deep in anxiety, All these great efforts to try to increase arousal and increase stimulation and do something new and do something fun. I think it's going to leave the partner potentially in a very vulnerable place. And if this guy is this anxious as he is describing, [00:42:00] it's not going to be effective.
So I'd say first step is you got to address the anxiety loop and put yourself in a position where you actually can be receptive to some of these things.
Kirsten Trammell: Yeah. Wow. Okay. Last question. I have here. I've struggled with ED for many years. When I was younger, I was sexually assaulted. How can I get past the psychological trauma that That this has caused.
Mark Goldberg: So I would say that this, this question I would put slightly, I wouldn't say out of my wheelhouse, but I would say probably, you know, touches on just more of a, it's a broad, it's a broader question just about trauma. I think it's, it's much more of a trauma therapy. Now, I want to be very careful about the following statement, which is, this would be a good example from my perspective of having linked to events that we don't know if they're actually linked.
In other words, like it is possible that. Early [00:43:00] childhood trauma that this person is describing is what is driving the erectile dysfunction, right? But it is also possible that it is not and that's why I would be really really careful and cautious about this I don't like to jump to any conclusions even when it's Oh, this seems really really obvious How could you not see the link between these two?
So I I would say pardon me. I would say to to It's important to address the trauma. That's number one. and the end goal of that should not be, or the measure for processing through trauma should not be whether your erection improves. If it does, great. You just killed two birds with one stone. And you don't have to go through the rest of the work necessarily for addressing the, you know, psychogenic ED. But you should go in assuming that these may be two separate processes. Your end goal is to get [00:44:00] there, right? But you've got to process through the trauma, and you've got to be open and not discouraged that that may not be the answer.
This may be, again, this may be the red herring, which happens a lot. And when I hear it could be trauma, but a lot of people And I think I even fielded a phone call today around this, which is it was the porn that did it to me.
Kirsten Trammell: Mm-Hmm.
Mark Goldberg: in an empathic way, I'm going to ask how do you know that?
Like, how did you come to that conclusion? Because I don't know that. I never know if it's that was the singular cause. So a lot of times, again, it goes back to wanting to make that jump. So I would I would not be able to answer that question here, other than saying, you definitely should get the trauma.
You know, addressed, you definitely should go through that work, and if and again, I'm also like, and this is so hard to describe this, it's hard to say, like, when the trauma is resolved. I don't know if that's a fair Framing of like trauma. I kind of look at it as like it's it was a it's scar tissue, right?
It kind of changes Like a person's life [00:45:00] now, they can live better They can live better than they ever would have before because of that But it's hard to talk about these things like being fully resolved as if human beings get back to some kind of tabula rasa So I want to be careful about That but if one feel like they've processed through that trauma and the erection issues are persisting, number one, it could be that there are other causes.
Number two, many people develop a secondary anxiety to The initial trigger. So sometimes like they, they, you know, hadn't like a trauma or they had some kind of issue occur that acutely caused erectile dysfunction. Even physiologically, it's fully resolved. They're ready to go. But now their mind is like, what if it happens again?
What if it right? So sometimes it's secondary anxiety that kicks in over the years and we have to be able to get to that to really fully resolve the erection issues.
Kirsten Trammell: Amazing. Okay, mark, thank you so much for coming onto the show today. Where can everybody find you if they wanna work with you? I know you [00:46:00] have a booming therapy practice. I You have a podcast share, share away. We wanna know.
Mark Goldberg: Okay first of all, thank you so much for having me on. I, I like being on the other side of the podcast at times. Gives me a lot more freedom to talk and answer questions and think things through. I really appreciate the opportunity to do that.
Kirsten Trammell: Amazing. Thank you so much for coming on this show and yay, erections, you know,
Mark Goldberg: I, I, I'm definitely a big fan and a big proponent. [00:47:00]