The pills can solve your problem, while not really solving it at all. Photo: Getty
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What happens when you go to the doctor and say you can’t get an erection

It is estimated that only a third of men with erectile dysfunction seek treatment. This is what happens if you do.

So, what happens when you go to the doctor and say that you are chronically unable to get an erection?

Well, if you have a female doctor, she’ll look sort of surprised, and tell you, very kindly, that you could have requested an appointment with a male doctor; she’ll seem to think that that would have in some way been less embarrassing. In response, you’ll shrug and explain that, by this point, it’s all the same to you, embarrassment-wise.

You’ll learn that most cases of erectile dysfunction (ED) occur in men over 40 (maybe up to 52 per cent of over-40s have suffered from the problem). You’re not over 40. You’ll learn that ED is associated with a portfolio of serious medical conditions, including diabetes, neurological disease, liver disease, kidney disease, testosterone deficiency, low thyroid hormone, urinary problems and coronary artery disease. But you don’t have any of those. Nor do you smoke, do drugs, or drink heavily. “Good for you”, the doctor might say.

These medical conditions, you’ll be told (quite rightly), make it very important that anyone who does experience ED consults a doctor. But, of course, you already knew that it was very important to consult a doctor – because ED, in addition to being a signifier of various lethal illnesses, prevents you from having penetrative sex. Which is a crap state of affairs.

So then you’ll be asked to drop your jeans and pants and get on the couch, and you’ll obediently do so, wondering if you’re supposed to take your trousers off all the way or if it’s OK to leave them, as you have done, around your ankles, and then the doctor will pull aside the curtain and say, “Oh, I should have said, lie down on the couch, please,” because you’ve been attempting a sort of nonchalant lean against the couch instead, which when you think about it is pretty stupid, because it suggests that the doctor is going to either bend double or drop to her knees to examine your knob, and obviously she isn’t, so you climb on the couch and recline, somehow, unbelievably, feeling even more stupid and awkward than you felt thirty seconds ago (you know, when you sort of rolled your eyes and said, ‘Well, I’ve got, um, chronic, erm, erectiledysfunction, basically”).

The doctor will then frowningly inspect your limp member, viewing it from above, lifting it to view it from below, poking interestedly at the surrounding regions, and then sliding your foreskin back and forth like a cricketer adjusting the rubber grip on his bat.

Then she’ll say, “Well, that all seems fine”, and for the first time that day you’ll feel pretty good about yourself.

Why don’t more ED sufferers go in for this diverting pastime? What’s keeping them from confronting the problem?

“Some men just hope it will get better and go away,” says Victoria Lehmann, a sexual and relationship therapist at the Sexual Advice Association (formerly the Impotence Association). “Women attend GP surgeries for contraception and have developed a language to talk about sexual issues. Men, on the other hand, visit doctors less, so going to make an appointment or seeing a doctor for the first time and talking about something so intimate and private can be extremely difficult. The media can still portray men as strong and virile, which makes men feel vulnerable and anxious when they are not being able to engage in successful sexual activity.”

Doctors themselves don’t always help matters. GPs have been given additional training on how to take a sexual history and are broadly aware of treatments available, but – thanks to time restrictions, embarrassment and a lack of confidence in their own expertise – many avoid going into these issues in depth.  

As you hastily re-trouser yourself and the doctor disposes of her rubber gloves, there’s a palpable sense of relief that the worst is over. For the doctor, that’s true. For you, it is not.

The doctor – who is young, and very kind – prescribes (a) bonk-pills, (b) an appointment with a specialist at an out-of-town clinic and (c) counselling. She’s unfamiliar with the NHS’s rules on bonk-pill allocation (they seldom prescribe Cialis or Viagra on the health service unless you have a physical cause for your condition, but, she smiles, in a case like yours – seeing as you are so UTTERLY impotent! – they’ll make an exception). When you take the prescription to the Lloyds round the corner, you’ll find that she’s recklessly over-prescribed; the senior pharmacist, who happens to be a man, will have to usher you into a secret little cubicle to explain that they’re not allowed to give you that amount of Cialis for £7.85 (which could have kept a stud-farm in hard-ons for a year), and amends the scrip to grant you a tenth as much. You leave with the packet in your pocket and dread in your heart. Next stop, the Specialist.

The Specialist turns out to be a very tall, very impressive Dutchman. Again the business with the couch (the frowning scrutiny, the waggling back and forth, the cricket-bat routine, the that-all-seems-fine). He asks you if you’ve been on holiday. You wonder if he’s making small-talk, even though he didn’t really say it like it was small-talk, and you answer, haltingly, with something about a long weekend in York, and he says that it often, you know, helps, a holiday, and you say “oh”, because it’s never helped you. The Specialist sends you off for some blood tests (which will come back a few days later, as you knew they would, clear), and gives you a scrip for more pills, and shakes your hand and says good-bye, and off you go. You’ll later be told that he has written “seems anxious” on your notes. You will respond to this information with a hollow laugh.

Now nothing remains but the Counsellor. Many ED clinics refuse to provide psychosexual counselling on the NHS, forcing sufferers to go private or go without. It’s representative of a generally patchy ED provision across the health service. But you got lucky – so off you go, to your first appointment with the Counsellor. 

Remember, you do all of this on your own – not because you lack kind friends or a supportive partner, but because you know (you insist) it’s your problem, this; it’s your illness, your failing, yours to deal with. It’s not something anyone else needs to worry about. So, quite voluntarily, you do it on your own. You feel lonely, of course, but that’s only fair, because this is all your problem.

Anyway, it’s the Counsellor you’ve really been pinning your hopes on, because you’ve known all along, for these past twenty years, that this, your problem, your impotence, is a form of anxiety – even though you’re not an anxious person, not a real worrier, not uptight or embarrassed about sex (a late bloomer, sure, shy sometimes, yes, but there are later bloomers and shier men, you’re quite sure, who don’t struggle so pitiably to maintain an erection in bed). Somewhere inside you there’s a strung-out little Numskull who just can’t get it together to pull the lever marked “boner”.

There isn’t room in one article to explore the sexual anxieties to which the average man is prey. 

“In general, men believe that they ought to be good lovers and please their partners,” says Victoria Lehmann. “They cannot fake an erection or ejaculations. Men worry about the size of their penis and are concerned if they ejaculate too quickly or not all and whether their erection remains hard enough for their partner to enjoy sex. This puts enormous pressure on a man to perform well.”

You’ve never really been all that aware of this sort of pressure – but that, of course, doesn’t mean it hasn’t been there.

So you go to counselling. And the counselling is fine, and the counsellor is lovely though her office is tiny and dowdy and, you feel, inadequately soundproofed, and you have several hour-long sessions, and you speak openly and frankly and without shame about your erectile dysfunction, and you don’t really learn anything you didn’t already know but it’s still nice to get it all out in the open. She recommends a book by some American MD, and you read the relevant chapter, and it brings you to sorry tears of recognition, even though you never cry at anything, ever - and you think, tentatively, that maybe, if you were to write openly about your experience of impotence, it might help someone out there, and maybe even help you, too.

Then your counsellor transfers to another hospital, far away, and although before she goes she gives you the option of switching to another counsellor, you both sort of feel that this counselling thing has run its course, so you don’t book any more sessions, and the counselling peters out – and you’re left with the pills.

The pills work. Seriously. Those things work.

So your problem has sort of been solved but also not really been solved at all. There’s still prescription fees and awkward appointments, every time, every fucking time with a different GP, for repeat scrips. And there’s still, deep inside, something wrong, something not working.

And the funny and terrible thing is that you can’t tell anyone about this (oh, except the life insurance agents with whom you will have several hilariously painful conversations). You’re not the sort of person who gets embarrassed about this stuff, you’re a liberal and down-to-earth and foul-mouthed person, and you know none of this is your fault, so why should you feel awkward? – and yet you can’t talk about it, because, even if you’re not embarrassed, your friends will think you are, or ought to be, and so they’ll be embarrassed, and so you won’t say anything (once, when drunk with a mate, you’ll mention it fleetingly, testingly, and he’ll tell you, in alarmed tones, that you’re pissed, and that you mustn’t say any more, because you’ll regret it in the morning if you do).

How can this be helped? Can it be helped?

More flexible, accessible health-service support would, of course, be a good start. Advertising and online resources – targeted not only at ED sufferers but at their partners too – would help with the development of the vocabulary and social protocols we need in order to promote more open discussion of the problem. And celebrity endorsement might seem tacky, but it can give men and their partners “permission” to discuss their symptoms. Providing these things shouldn’t be left to pharma companies and their shills (hello, Pelé!); “A pill will make it all better” is not the message ED sufferers really need to hear.    

In the meantime, we remain locked in to the taboo – so much so that, when you do come to share your experiences of erectile dysfunction, writing a wry second-person article on the subject for a magazine with a readership of thousands in a bold bid to normalise psychosexual health problems, you’ll still feel the need to adopt a pseudonym.  

That is what happens when you go to the doctor and say that you are chronically unable to get an erection.

David Vernon is a pseudonym.

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MP Michelle Thomson's full speech on rape at 14: "I am a survivor"

The MP was attacked as a teenager. 

On Thursday, the independent MP for Edinburgh West Michelle Thomson used a debate marking the UN’s International Day for the Elimination of Violence against Women to describe her own experience of rape. Thomson, 51, said she wanted to break the taboo among her generation about speaking about the subject.

MPs listening were visibly moved by the speech, and afterwards Thomson tweeted she was "overwhelmed" by the response. 

Here is her speech in full:

I am going to relay an event that happened to me many years ago. I want to give a very personal perspective to help people, both in this place and outside, understand one element of sexual violence against women.

When I was 14, I was raped. As is common, it was by somebody who was known to me. He had offered to walk me home from a youth event. In those days, everybody walked everywhere - it was quite common. It was early evening. It was not dark. I was wearing— I am imagining and guessing—jeans and a sweatshirt. I knew my way around where I lived - I was very comfortable - and we went a slightly differently way, but I did not think anything of it. He told me that he wanted to show me something in a wooded area. At that point, I must admit that I was alarmed. I did have a warning bell, but I overrode that warning bell because I knew him and, therefore, there was a level of trust in place. To be honest, looking back at that point, I do not think I knew what rape was. It was not something that was talked about. My mother never talked to me about it, and I did not hear other girls or women talking about it.

It was mercifully quick and I remember first of all feeling surprise, then fear, then horror as I realised that I quite simply could not escape, because obviously he was stronger than me. There was no sense, even initially, of any sexual desire from him, which, looking back again, I suppose I find odd. My senses were absolutely numbed, and thinking about it now, 37 years later, I cannot remember hearing anything when I replay it in my mind. As a former professional musician who is very auditory, I find that quite telling. I now understand that your subconscious brain—not your conscious brain—decides on your behalf how you should respond: whether you take flight, whether you fight or whether you freeze. And I froze, I must be honest.

Afterwards I walked home alone. I was crying, I was cold and I was shivering. I now realise, of course, that that was the shock response. I did not tell my mother. I did not tell my father. I did not tell my friends. And I did not tell the police. I bottled it all up inside me. I hoped briefly—and appallingly—that I might be pregnant so that that would force a situation to help me control it. Of course, without support, the capacity and resources that I had within me to process it were very limited.

I was very ashamed. I was ashamed that I had “allowed this to happen to me”. I had a whole range of internal conversations: “I should have known. Why did I go that way? Why did I walk home with him? Why didn’t I understand the danger? I deserved it because I was too this, too that.” I felt that I was spoiled and impure, and I really felt revulsion towards myself.

Of course, I detached from the child that I had been up until then. Although in reality, at the age of 14, that was probably the start of my sexual awakening, at that time, remembering back, sex was “something that men did to women”, and perhaps this incident reinforced that early belief.​
I briefly sought favour elsewhere and I now understand that even a brief period of hypersexuality is about trying to make sense of an incident and reframing the most intimate of acts. My oldest friends, with whom I am still friends, must have sensed a change in me, but because I never told them they did not know of the cause. I allowed myself to drift away from them for quite a few years. Indeed, I found myself taking time off school and staying at home on my own, listening to music and reading and so on.

I did have a boyfriend in the later years of school and he was very supportive when I told him about it, but I could not make sense of my response - and it is my response that gives weight to the event. I carried that guilt, anger, fear, sadness and bitterness for years.

When I got married 12 years later, I felt that I had a duty tell my husband. I wanted him to understand why there was this swaddled kernel of extreme emotion at the very heart of me, which I knew he could sense. But for many years I simply could not say the words without crying—I could not say the words. It was only in my mid-40s that I took some steps to go and get help.

It had a huge effect on me and it fundamentally - and fatally - undermined my self-esteem, my confidence and my sense of self-worth. Despite this, I am blessed in my life: I have been happily married for 25 years. But if this was the effect of one small, albeit significant, event in my life stage, how must it be for those women who are carrying it on a day-by-day basis?

I thought carefully about whether I should speak about this today, and it was people’s intake of breath and the comment, “What? You’re going to talk about this?”, that motivated me to do it, because there is still a taboo about sharing this kind of information. Certainly for people of my generation, it is truly shocking to talk in public about this sort of thing.

As has been said, rape does not just affect the woman; it affects the family as well. Before my mother died early of cancer, I really wanted to tell her, but I could not bring myself to do it. I have a daughter and if something happened to her and she could not share it with me, I would be appalled. It was possibly cowardly, but it was an act of love that meant that I protected my mother.

As an adult, of course I now know that rape is not about sex at all - it is all about power and control, and it is a crime of violence. I still pick up on when the myths of rape are perpetuated form a male perspective: “Surely you could have fought him off. Did you scream loudly enough?” And the suggestion by some men that a woman is giving subtle hints or is making it up is outrageous. Those assumptions put the woman at the heart of cause, when she should be at the heart of effect. A rape happens when a man makes a decision to hurt someone he feels he can control. Rapes happen because of the rapist, not because of the victim.

We women in our society have to stand up for each other. We have to be courageous. We have to call things out and say where things are wrong. We have to support and nurture our sisters as we do with our sons. Like many women of my age, I have on occasion encountered other aggressive actions towards me, both in business and in politics. But one thing that I realise now is that I am not scared and he was. I am not scared. I am not a victim. I am a survivor.

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.