Understanding erectile dysfunction as a gay man

Written with
Silva Neves

Today’s post is an interview with the wonderful Silva Neves, psychotherapist and specialist in psychosexual and relationship therapy.

Silva is an advanced accredited gender, sexuality, and relationship diversities therapist. He has over a decade of experience working with members from many LGBTQ+ communities, and has helped numerous guys overcome the psychological causes of erectile dysfunction (ED).

In this interview, Silva explains:

  • why gay men can have unique experiences with erectile dysfunction
  • the link between our mental health and erections
  • how an understanding therapist can help get your sex life and ED back on track

We use the term ‘gay man’ throughout this interview, but we touch on information that could also be relevant for people who identify as men who have sex with men (MSM), and penis owners who have sex with other penis owners.

Mojo: Hi Silva, before we start, can you clarify what ED is, and what causes it?

Silva: Sure. Erectile dysfunction is where you’re not able to get an erection, not able to keep an erection long enough to feel sexually satisfied, or you’re not able to get an erection that’s hard enough to have the sex you want.

Erectile dysfunction is a common issue which can impact any man. And there are many causes of ED; these can be physical/medical, psychological, or a mix of both.

Physical/medical causes of ED include things like heart problems, diabetes, or even the side effects of some medications. So, if you’re worried, the first thing you should do is talk to your doctor to rule these out.
Once you have the physical all-clear, you might be referred to a therapist who can help you untangle any psychological causes of ED that could be affecting you.

Mojo: What causes of erectile dysfunction are different for gay men?

Silva: As I mentioned, there are many physical and psychological factors that can cause ED for any man. However, there are also some additional, more specific stresses that gay men encounter which straight men don’t.

For some gay men, these stresses can translate into difficult or disturbing feelings, which in turn can become a psychological cause or contributing factor to unreliable erections.

This means the psychological causes and experiences of ED can be different for gay and straight men, and those differences need to be understood for treatment to be effective.

To delve deeper, let’s look at some common themes that come up in my clinic all the time:


There are many influences that impact our erections which come from outside the bedroom.

How we feel about our own sexuality, for instance, is very important. But that doesn’t just come from personal feelings. It’s largely shaped by society and how it treats us as far back as childhood.

No matter what the media tells you, homophobia still exists (even in the most liberal households).

This can fuel deep feelings of insecurity and shame around gay identity and gay sex in lots of people.


Despite a lot of progress, there is still a widespread assumption being straight is ‘normal’, and anything else is considered a less than perfect alternative.  

This is called heteronormativity.

Growing up in a world that holds being straight as the gold standard can lead queer people to develop negative thoughts and beliefs about themselves from a very young age.

Minority stress

As a result of homophobia and a heteronormative society, gay people have to deal with a lot of stresses that straight people don’t even have to think about. These are called ‘minority stresses’, and include things like:

  • not knowing how new people will react when they find out you’re gay
  • thinking about whether you and your partner can hold hands in public
  • researching what destinations are safe to go on vacation

How do homophobia, heteronormativity, and minority stresses impact our erections?

When boys start to think society views them as different, they can develop thoughts like:  

  • There is something wrong with me”
  • “I am bad’
  • “I am not good enough”

If these aren’t challenged in childhood or teens, they can become the core beliefs that shape us as adults.

Our core beliefs have a big impact on our behavior, but as they become further embedded, they get pushed into our subconscious, and we stop being aware of them.

However, they can still pull our strings whenever we feel vulnerable. For some gay men, this means they can feel proud and confident one moment, but as soon an intimate situation arises, the shame comes back, fueling thoughts like:

  • “This is wrong”
  • “This is not OK”
  • “I must be perfect or I will get rejected”

When our deepest beliefs tell us that sex with another man is wrong or simply not the ‘norm’, in the moment we want to have sex, our brain is less likely to spark the signals which tell the body to form an erection.

The ongoing drip, drip, drip of stress and negative thoughts can also provoke a more general feeling of anxiety. This can in turn impact both our sex drive and the ability to get it up.

This is because when we’re feeling anxious, it sets off a false alarm telling the body it’s in danger.

This causes the body to direct blood to the muscles rather than the penis. This state is known as ‘fight or flight’. It’ll leave you feeling ready to run away, and you’ll be unable to physically get it up.

However, you are not alone. I see this all the time. So, if you’re struggling, it’s important to get the help and support you need.

Pressure within the gay scene

While there are many sides to the gay scene that are positive and joyful, some people have told me they find it ageist, full of body shaming, and pretty rejecting.

That’s (at least partly) because it brings together people who have been told they aren’t good enough by heteronormative society.

When people feel like they aren’t meeting society’s expectations, it’s common to try to be perfect to prove others wrong and not get rejected.  

As a result, it can feel like the group’s collective standards are very high.

To fit in, you can feel like you must be:

  • Always perfect: by having a great body, a great job, a perfect partner, and lots of friends (who are also perfect)
  • Always sexual: by having the right size penis, always being ready to go, and never failing to be a fantastic lover

Erection comparison

When two penises are involved, it’s easy to compare yourself with your partner.

This could lead to worries about size, shape, or how long it takes to get hard or to cum.

Feeling like your own erection isn’t perfect, can’t match your partner’s, or that you can’t live up to their sexual expectations can make you wonder:

  • “Does he like me?”
  • “Does he enjoy what we’re doing?”
  • “Does he find me attractive?”

How does the pressure to be perfect impact our erections?

When we look at these expectations on paper, we can see how unattainable they are.

Everyone’s bodies and penises are very, very different. We can’t be perfect all the time, and we can’t be ready to get it up all the time.

Trying to achieve these things can cause too much pressure and trigger negative thoughts that race through your mind.

These can take you out of the moment and into a state of panic. And this kills your erection.

Over time, always trying to strive for perfection can easily send your anxiety levels spiraling, and even leave you feeling exhausted or depressed.

I’ve already mentioned how anxiety can stop your erections, and when this keeps happening it can make you want to avoid sex altogether.

This can even lead some gay guys to feel they aren’t good enough for, or worthy of, long-term loving relationships. This means sadly they can miss out on a deeper level of sexual and emotional fulfillment.

Sometimes just talking about all this pressure is the first step to relieving it.

Mojo: On the subject of talking, how can therapy help gay men with erectile dysfunction?

Silva: Therapy can have a transformative impact on your overall mental health and help you overcome specific problems like psychological ED.

I believe good therapy should meet you where you are and work from there. You can slowly reshape your core beliefs just by learning and practicing a new set of tools.

These can help you:

Learn new ways to communicate and be intimate

Gaining the courage and skills to talk to your partner about your insecurities, fears, and desires can be the key to unlocking better sex and more fulfilling relationships.

This isn’t as scary as it sounds. It can begin by just talking about one feeling, like:

“Sometimes I feel nervous getting undressed in front of someone else.”

Learning these communication skills can help you recognize that a) your sexual partner is there because he wants to be with you, and b) he may be experiencing the exact same worries you are.

Rather than making the other person run away, it’s more likely they will feel relieved and lower their defenses too.

When we don’t have to be perfect we can meet ‘heart to heart’ rather than ’shield to shield.’

Deal with homophobia, heteronormativity and minority stress

In therapy you can learn tools to help you build defenses against homophobia, navigate a heteronormative world, and learn how to deal with minority stresses when you’re faced with them.

These skills can help you to improve your mental health overall as a result. This can help you live a more relaxed life and enjoy sex more too.

Therapy may also guide you in finding a group of people who you feel totally relaxed around, where you don’t have to ‘edit’ yourself or change your behaviors, or hide in order to be accepted and loved. Social support and the opportunity to be vulnerable is a good way to protect yourself against the harsh homophobic world, alongside the help of a therapist.

Address past traumas

Many people in LGBTQ+ communities live with a greater risk of discrimination, violence, abuse, or even death in some parts of the world.

Profoundly negative experiences or trauma can cause unhelpful or harmful core beliefs to get stuck.

Sometimes we have to go back and get to the root of these experiences before we can move forward.

This isn’t something I jump straight into, but when it is needed, my clients and I take on this work carefully within a safe environment.  

Mojo: What if therapy isn’t an option?

Silva: There’s a few reasons why traditional therapy may not be the best option for you, but there are some other avenues out there.

If you want therapy but can’t afford it

Traditional therapy sessions aren’t within everyone’s budget. If you would like to speak to a therapist but are worried about how much it costs, there are some alternative options which may be more affordable:

  • LGBTQ+ charities like Pink Therapy in the UK offer low-cost therapy which is tailored to meet the needs of the whole community
  • Local therapists sometimes offer low cost or free sessions to people in the local area. A good place to start is to look for a therapist who is accredited by Pink Therapy. For sex therapy, look for a therapist who is registered or accredited with COSRT

If you aren’t ready for in-person therapy or it’s not for you

Sitting down in a 1-2-1 environment with a therapist isn’t for everyone. But there’s still plenty of places where you can find support for your mental health that can feel a little more anonymous.

  • Find your tribe: Trust me, there are people out there who will open their arms to you. Their love and support can be a game-changer. Online communities and forums are a great place to start your search
  • Self-help: There are resources online, such as Mojo, that can offer anonymous information and support
  • Be kind to yourself: ED can be a horrible and worrying experience, but it’s also very common and can happen for lots of very understandable reasons. None of them are your fault, so if you find you need help, just know there are people out there who ‘get it’ and are here for you when you’re ready

Thanks Silva for all your words of wisdom today. If you’d like to find out more about his work or contact his practice, you can find Silva’s website here.

Mojo is here for you

Mojo is a safe and supportive space for everyone looking to get better erections. Our courses are created with the help of experts like Silva and cover a wide range of erection-boosting topics.

The Mojo Community is a safe and anonymous forum where guys can chat about their erection issues (if they want) and get support from other members.

Mojo aims to provide useful wellbeing resources to its users; however, you should not solely rely on opinions or advice available on the Website or given by the Community. Always seek advice from a qualified medical doctor or other healthcare professional before acting.

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