Nature Quickie: Pressure and "Performance"

with sexual & reproductive health specialist Dr. Justin Houman

Sex Outside Nature Quickies are short, 5-minute dives into a specific, practical topic about our bodies and the outdoors. This one features a conversation with sexual and reproductive health specialist Dr. Justin Houman about why so many of us are focused on sexual “performance” when it comes to erections, how we don’t talk about erectile dysfunction often enough, and some of the ways biological processes, mental health, and pressure from sexual partners can contribute to anxiety around getting hard.

Mentioned in this Bonus Content:

Additional Resources:

photo by Karsetn Winegear / Unsplash

photo by Karsetn Winegear / Unsplash

Hosted by Laura Borichevsky.
Cover artwork by Hailey Hirst.
Music by Calica licensed via MusicBed.

TRANSCRIPT

Note: This transcript was lightly edited and created using a transcription service. As such it may contain spelling errors.

Laura Borichevsky - Narration:

You’re listening to a Sex Outside Nature Quickie-- a short 5-minute dive into a specific, practical topic about our bodies and the outdoors. I’m Laura Borichevsky.

Dr. Justin Houman:

There's no correct way in terms of sexual performance. Like there's no right way of doing it-- there’s tons of right ways of doing it.

Laura Borichevsky - Narration:

If the title didn’t give it away, this Nature Quickie is all about erections: specifically, why many of us are *so* focused on when and how they happen. Because I’m guessing that a lot of folks out there-- both those with penises and those without-- have seen or encountered times when erections don’t go as planned. And there tends to be *so* much shame wrapped up in those moments, right? Both for the person experiencing the less-than-tented pants, and for the sexual partner. Whoever you might be in the equation, it’s easy to center yourself, look for a place to stick blame, and ultimately-- make the situation a whole lot less comfortable than it already might be.

In the world of erections, there seems to be *such* a focus on the word “performance”-- how to have a penis with top performance, sexual performance anxiety, a *wide* variety of overly promissory performance enhancers-- the list goes on and on. 

And it all got me thinking about how when it comes to outdoor sports and recreation, our society expects and encourages top performance, especially from cis gender, heterosexual men. So if something was standing in the way of a better, more enjoyable athletic performance outdoors, you would probably talk to someone about it, right? Maybe even seek treatment if needed? But this doesn’t seem to translate to erectile dysfunction. As many studies show, currently up to 70% of cis/het men with erectile dysfunction aren’t seeking out science-based solutions.

Fortunately, there are folks like Dr. Justin Houman, a men's health specialist, specializing in sexual and reproductive medicine. And he agreed to sit for this Nature Quickie to help shine a light on this whole dynamic, starting with what biological functions support erections to begin with.

Dr. Justin Houman:

You need four things to have an erection. The first thing is you need good blood flow. So what's an erection? An erection is essentially blood getting engorged and stays in the penis. So you need good blood flow, things that cause issues with blood flow or diabetes, hypertension, high cholesterol levels that decreases the caliber of the lumen for blood to go into the penis. A good nervous system: nerves that stimulate blood flow into the penis. So things that could compromise the nerves, pelvic trauma, pelvic surgery; those things could affect the nervous system and basically prevent it from stimulating the dilation of the arteries that supply blood flow to the penis. The third thing that you need: good hormones, you need good levels of testosterone. You need adequate levels of estrogen, and it's this fine balance between testosterone and estrogen. And then finally, the fourth thing is you can't be stressed out, right? So there's a huge psychological component to erections if there's any anxiety associated with or in pressure, any stress associated with erections that does cause a lot of issues with performance and performance anxiety,

Laura Borichevsky - Narration:

Performance anxiety is a huge component in erectile dysfunction. And while life events, chronic anxiety, depression, or post traumatic stress disorder can be mental health factors creating a sense of sexual performance anxiety-- this anxiety can often start with pressure from sexual partners, who potentially have a huge influence on whether a penis-bearer feels safe, sexually confident, and turned on without external expectations. In fact, some studies done on erections have shown that in the presence of external feedback from prospective sex partners, erections could rise or fall significantly.

This is not to say that if your sex partner has a penis and they don’t get or maintain an erection that it’s because of something you did. But it does underline that sexual relationships that contain frequent demands for partners to “get hard” or placing blame if an erection doesn’t happen isn’t likely to create an environment where they can.

All this said, there’s still more to consider. Because as Dr.Houman mentioned, anxiety and pressure aren’t the only factors that can get in the way of erections. Biological processes are responsible for erections in a big way, too-- and less frequent erections, or significant changes to them, could be an external sign that something else is going on. 

In addition to some of the major links Dr. Houman noted, recent studies have shown that even more simple medical conditions like lower urinary tract infections can prevent erections from taking place. Additionally, there are environmental factors to consider, like consuming certain substances, which can impact some folks from having erections due to a change in bodily function under the influence of drugs or alcohol.

You might be listening to this worrying that if you or someone you’ve had sex with hasn’t gotten an erection in the past that they need to rush to the doctor. This isn’t necessarily true, either. 

Dr. Justin Houman:

The thing to remember is erectile dysfunction and sexual dysfunction in general is incredibly common, incredibly common. So 40% of guys, before they hit the 40th birthday, have experienced some form of sexual dysfunction, whether it's premature ejaculation, erectile dysfunction, issues with orgasm. So it's incredibly common. For younger generations. I think it's less of a taboo subject, but definitely for older generations, it's very taboo. Like people never really talked about it, but you know, the thing I want to stress is you're not alone, right? Because so many people are experiencing this.

Laura Borichevsky - Narration:

To underline Dr. Houman’s point, a lack of erection doesn’t immediately mean that there’s something wrong. Far from it. However, it’s important to pay attention to changes in your body, or your partner’s body-- not as a way to rate performance, but to keep in touch with overall health.

Dr. Justin Houman:

Erectile dysfunction and sexual dysfunction truly is a proxy of your overall health. So when you think about it, as I was mentioning earlier, in terms of blood flow, you know, you need that good arterial blood supply. So erectile dysfunction usually is the first sign of diabetes, is the first sign of high blood pressure, is the first sign of elevated cholesterol levels. So if you are experiencing it, the best thing you could do is see consultation with a physician, specialist, whoever-- just to make sure everything is okay, purely from a health standpoint, because the longer you wait this out, the longer you delay it, these conditions could become chronic conditions. You could have chronic diabetes and down the road, you know, if you catch this years later versus sooner, these things can impact different organs and cause further problems. So it requires a simple consultation with a physician just to see what's going on, make sure you're not missing anything or there's nothing anatomically wrong.

And if there's things that are bothering you regarding the sexual quality of life, seek out consultation, whether it's with your doctor, you men's health specialist, a sex therapist, whatever it is, it's so important. It's such a valuable part of our life. There's so many options out there in order to address any issue that people are experiencing. So don't think it's a taboo subject. Don't be afraid to talk about it. There's a lot of good resources out there and a lot of good therapies in order to treat whatever issues are going on.

Laura Borichevsky - Narration:

And for those who have experienced changes in their erection, or their partner’s erection-- even once-- it might feel awkward in the moment but remember, it’s nothing to be ashamed about. It’s common, and it’s something that you can move forward from a whole lot easier if you remember that sex is not a performance with a scripted start and end. And between consenting individuals there’s really a lot of ways to enjoy yourselves sexually, no matter what kind of erection is or is not involved.

Dr. Justin Houman:

Sex is something that's so important to all of us, right? It's literally one of the most important things we all do. And there's no correct way in terms of sexual performance. Like, there's no time limit in terms of how long you're supposed to be able to perform. There's no set regimen in terms of the number of positions you're supposed to engage in prior to orgasm. It's truly a subjective thing where there's no right way of doing this tons of right ways of doing it. And there's no real wrong way of doing it. But as long as, ultimately, what it comes down to is sexual satisfaction. As long as you and your partner are sexually satisfied, that's the key. Ultimately, that's what it comes down to: happiness, sexual satisfaction, and good sexual quality of life between you and your partner. That's the most important thing.

Laura Borichevsky - Narration:

Thanks for joining us for this Sex Outside Nature Quickie, and for Dr. Justin Houman for joining us for this episode. For more information to continue your research, tap the links in our profile and check out our resources. You can find more from Dr. Houman on Instagram @justin.houman.md, and follow along with us @sexoutsidepod for more action between episodes. Music is by Calica. I’m Laura Borichevsky. Thanks so much for joining us. Until next time!

QuickieLaura BorichevskyErection, Penis, SexComment