Pssst – I’ve got a secret but you’ve got to pinky-swear not to tell anyone, please. It’s embarrassing! I don’t talk about it.
I’ve started the article like this because the topic is hard (no pun intended) to write and yet in hindsight it's somewhat childish, the way we refuse to speak about it.
We don't admit that it’s an issue for men in general, earth-shattering for gay men, confusing and depressing for all men and especially for those living with HIV. If we do talk about it, it’s either in jest or to discuss the latest Viagra/Cialis commercial.
Erectile dysfunction -- there, I said it.
I’m a black gay man living with HIV and this has been a worsening situation for me over the last few years. I haven’t yet cried over the matter, but boy have I come close. Why? Frustration plain and simple. But worse, according to my medical team this shouldn’t be occurring.
Erectile dysfunction, the inability to develop or maintain a hard-on, is becoming of more concern to urologists (penis doctors) because it’s no longer just affecting older men. It’s affecting men of all ages. Bet you didn’t know that.
Statistically, five percent of men over 40 have ED. In men between 50-65 it’s between 15-25%. Over 65 it’s 40%. For men with HIV the numbers are higher. Let’s not forget that the stats given are based on what people reported. I suspect the stats aren’t nearly close to reality though, due to the very nature of the illness.
I’m sure I don’t have to explain how this erection thing works. See sexy, hot guy/girl, brain goes into automatic, blood flow not passing GO, but going directly to cock and lo and behold – your own, personal CN Tower. Scientifically speaking, they add something about hydraulic activity but I don’t care. I’m not getting or retaining a hard-on when I need it.
Hell, in my youth I got a hard-on if the wind blew too swiftly. My cocksmanship rivaled the swordsmanship of D’Artagnan of the Three Musketeers - or so I’ve been told. And as for jerking off, I’ll quote Louis C. K.: “I found out about it when I was 11 and I didn’t skip a day.”
Now a “fucking” hurricane could blow -- nada. I’m left having to explain to new dates and rely on the understanding of old partners and on not being versatile or else being the bottom in my encounters.
But a partners' enjoyment is heightened by visible signs of the other's sexual arousal. Sex isn’t limited to fucking; blow jobs and kissing are a part of it too. Not getting a hard-on when getting blown and so on can and does impact the scene.
This can be especially devastating for gay men who are used to being the dominant ones in their encounters. It's a change that's forced on them, leading to depression and more. We become reclusive, no longer going out or going to bath clubs, employing apps like Grindr etc. We risk unsafe sexual practices including not using condoms and so heightening the possibility of sexual diseases. We do things we wouldn’t have done before. We use drugs like crystal meth, hoping it will change the situation for the better.
"Many of us in the gay community indulged in recreational drugs and still do. How has the long history of drug use affected my body? Again, the answer is unknown."
But many of us either just lie or else abstain from sex totally.
As they say, it’s complicated. In the gay community, being able to perform is expected. Erectile dysfunction places you in a leper colony. It’s ironic that there are healthy men taking Viagra who don’t need it so they can keep their hard-on for hours.
To be diagnosed HIV positive is traumatic and being on meds makes many of us despondent. To be horny and unable to get it up is depressing. This is the vicious cycle many of us face: lonely, single and friendless, with no explanation as to the causes.
So what happened?
A Google search shows that there are a number of reasons for ED: organic, cardiovascular diseases (multiple sclerosis) and diabetes, neurological (trauma from prostate surgery for instance), hormonal insufficiencies (hypogonadism), decreased testosterone levels. The other causes are psychological in nature; low self-image, relationship issues, performance anxiety, stress, as well as a few mental disorders. Then there’s aging, smoking, kidney failure, poor physical health, dietary habits, obesity, drug side-effects and HIV.
I’ve been taking some sort of HIV medication now for over 30 years. I was on AZT and I think it saved me - but at what cost? They don’t know.
I’ll quote Selina Cockery: “While sexual dysfunction may be a problem for anyone, people living with HIV may be particularly affected. Loss of sexual drive or desire (libido), the inability to obtain and sustain an erection or have an orgasm, or experiencing pain during sex can have a significant impact on quality of life or self-worth…these issues can contribute to emotional problems including anxiety and depression.”-- AIDSmap, 28 June, 2016.
All the meds we take for HIV may have contributed to this problem, as well as all the other drugs to deal with the side-effects of the antiretrovirals, the high blood pressure and depression. Many of us in the gay community indulged in recreational drugs and still do. How has the long history of drug use affected my body? Again, the answer is unknown.
I do wake up with wonderful Towers of Tumescence, which according to my doctors means that the plumbing works. “That really doesn’t help, doc” I’ve been through countless tests. The tests can include duplex ultrasound, penile nerve function or MRA (Magnetic Resonance Angiography).
I saw a psychiatrist and I assume he knew his shit. I suggested that maybe it was my body's way of making sure I didn’t infect anyone with HIV or the guilt that I had before being tested.
His response: “Possibly.” Really?
The diagnosis is always the same: I shouldn’t be having this problem. Hence my confusion.
A number of treatments exist, depending on the cause. Exercise and quitting smoking are among the suggested options. There are creams like Vitaros, injections like Papaverine or Trimex Triple X. There are penile pumps, implants, extracorporeal shockwave therapy, surgery, alternative medicine and of course Phosphodiesterase type five inhibitors (got you) which the public knows as Levitra, Viagra and Cialis.
I’ve found that when you tell your doctor, their solution is to prescribe Viagra which sadly isn’t covered by ODSP and doesn’t always work in my case. Our sexual health isn’t of primary concern to the medical profession though and it should be if the aim is to treat HIV holistically.
I think it should be - especially since I shouldn’t be having this fucking problem.