The pills can solve your problem, while not really solving it at all. Photo: Getty
Show Hide image

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.

Warner Brothers
Show Hide image

Nigel Farage's love for Dunkirk shows how Brexiteers learned the wrong lessons from WWII

Film has given Britain a dangerously skewed perspective on World War II

For months now it’s been hard to avoid the publicity for what seems like an epidemic of new World War Two films for 2017. June brought us Churchill (starring Brian Cox), which concerns Operation Overlord and the allied invasion of Normandy in 1944. A month later, in July we were pushed back four years, to Dunkirk, with Christopher Nolan’s film of the evacuation of Allied troops from French soil in the summer of 1940. April had already brought Their Finest, a comedy about making a - let us not let the irony go unacknowledged -  stirring film about the evacuation of Dunkirk in the event’s more or less immediate aftermath and November will bring us Darkest Hour, some events in which will predate all three earlier films, as Gary Oldman’s Churchill struggles through the earliest days of his war premiership.

This glut is peculiar. There are no significant round anniversaries to commemorate (e.g. Dunkirk is 77 years ago, the Normandy landings 73). More, we’re meant to be in the middle of a series of commemorations of the horror and waste of the Great War of 1914-18, but that seems to have slipped away from us in the political turmoil that’s engulfed this country since 2014. Instead, it’s to the Second World War we return yet again. To modern Britain’s founding myth.

It’s a coincidence, of course, that these films should come along together, and at a seemingly odd time. They were developed separately, and films takes so long to conceive and produce that no one could have anticipated them arriving together, let alone arriving in a toxic Brexit Britain where they seem like literally the least useful things for anyone in the UK to watch right now. As works that will inevitably, whatever their own creative intentions and merits, be hi-jacked by a press and political culture that is determined to gloss its opposition to the UK’s membership of the European Union, and its appalling mishandling of the process of exit with garbled references to, the conflict the films portray.

This is an impression that is not exactly dismissed by Nigel Farage posting to twitter of an image of himself standing next to the poster for Dunkirk, along with a statement in which he encourages all young people to see the film. For what reason, we’re entitled to wonder, does he make this encouragement? Does he admire the sound design? Or the aerial photography? Or is he just a big fan of Mark Rylance and Harry Styles? Or perhaps he is, inevitably, indulging in a behaviour that some might call "nostalgic"? Of pining for the past. Except, of course, nostalgia requires an element of pain. The suffix "algia" the same as employed when referring to chronic conditions. For Farage and his ilk there is no pain in this behaviour, just the most extraordinarily banal comfort.

Farage is asking us and asking the young who voted against his chosen cause by an overwhelming majority, and who are are sickened by where he and his ilk have brought us - to share in his indulgence. To enjoy, as he does, those fatuous analogies between the UK’s isolation between Dunkirk and Pearl Harbour with its imminent failures in European politics. To see that "escaping from Europe with nothing is at least better than not escaping at all". Or to believe, once again, in a "plucky little Britain, standing up against the might of a wicked mainland European tyranny, its back against the wall".

All this, confused, indeed nonsensical, as it is, is being invoked, as surely as the anti-EU right have always invoked Churchill. This is despite his own family recognising him, as the EU itself does, as the fervent pro-European he was. Indeed, he was one of the founding fathers of the whole post-war pan-European enterprise.

What Farage and his behaviour demonstrates, yet again, is that British culture, in many ways, learned not merely the wrong lessons from the war against Hitler, but exactly the wrong lessons. It’s a lesson that found its most enduring, poisonous expression in Margaret Thatcher’s breathtaking assertion that the European Union was a "third attempt" by Germany to take over the world.

In contrast to the rush of war films in cinemas, television has recently given us glimpses into theoretical worlds where Nazism did succeed in conquering the planet, in Amazon Prime’s The Man In The High Castle and BBC One’s SS-GB. There are lessons too, in these alternative histories, proper lessons that we have collectively failed to learn from the real one. Which is that fascism or authoritarianism are not diseases to which anglophone countries are somehow miraculously immune due to [insert misunderstood historical fetish of choice].

The Man in the High Castle, particularly in its more subtle first series, goes out of its way to show Americans that their lack of experience of collaboration with Nazi occupation is a result of circumstance, even luck. Not because collaboration is a peculiarly European tendency. SS-GB also worked hard to demonstrate the helplessness of occupation, and how that leads to the sheer ordinariness of collaboration. Both show the understanding that while fascism from the outside is funny accents and funny uniforms, fascism from the inside is your neighbours informing on you and the absence of the rule of law.

That experience of occupation, of subsequent complicity, and humiliation, felt by many other other European nations, is absent in Britain. Farage’s fellow Leaver Liam Fox, without anything resembling self-awareness, asserted that "the United Kingdom is one of the few countries in the European Union that does not need to bury its 20th century history". Fox’s remark summed up, again seemingly unintentionally, the oafishness of the principle Brexiteers. A group who exemplify a culture that boils a vast and unimaginably complex conflict down to the title sequence of Dad’s Army - an animation in which a Union Flag is forced off the European continent by a trio of Nazi triangles, and after returning home bobs around defiantly. A group who, in a strange and witless inversion, have fantasised themselves into a position where they see the Britain’s membership of the European Union as the occupation the country once avoided.

This is the UK’s postponed tragedy. At a timethat European countries experienced national humiliations which fundamentally reconfigured their understandings of their place in the world, the UK got yet another excuse to shout about how much better it was than everyone else.

I’m a child of the very late Seventies. I grew up in a world where (British) boys’ comics were dominated by war stories rather than science fiction or superheroes, where literally everyone knew several people who had fought in World War Two - and almost everyone someone who could remember World War One. That war was the ever-present past. I am, as a friend who teaches history neatly phrased it "Of the last post-war generation." After me, the generations are post-post-war. They are free. The moral clarity of the war against Hitler has, in the end, been a curse on British culture - a distorting mirror in which we can always see ourselves as heroes. 

But, not, of course, all other generations. The war generation collectively (I make no claim that there were not exceptions) understood what the war was. Which meant they understood that the European Union was, and is, its antonym, not an extension of it. Unlike their children and the eldest of their grandchildren, they had real experience of the conflict, they hadn’t just grown up surrounded by films about how great Britain was during it.

The Prime Minister who, or so he thought, had secured Britain’s European destiny had also, as he related in his autobiography, seen the devastation wrought by that conflict, including by shells he himself had given the order to be fired. Like Helmut Kohl, whose worshipped, conscripted older brother died pointlessly fighting for Hitler, and Francois Mitterrand, himself captured during the fall of France, his experience was real and lived, not second hand.

This can be seen even in the voting in 2016 referendum. That the young principally voted Remain and the old voted Leave has been often noted. But if you break that over-65 vote up further, there’s a substantial flip to back towards Remain amongst the oldest voters, the survivors of the survivors of World War Two. After all, someone who is 65 today was born nearly a decade after the war ended. It was their parents’ war, not their own. A war that has been appropriated, and for purposes of which those who fought in it would, collectively, not approve.

Let’s return to Dad’s Army, after all, BBC Two does often enough. Don’t Panic! The Dad’s Army Story (2000) a cheerful history of the sitcom great written and presented by Victoria Wood contains a telling juxtaposition of interviewees. The series' surprising continued popularity is discussed and Wendy Richard (born 1943) expresses a nostalgia for the war years, and how people banded together during them. This is a sentiment which Clive Dunn (born 1920) bluntly dismisses. “Like most people I had a foul war,” he says, and disgust and horror briefly pass across his face.

It’s the difference between those who remember war, and those who only remember war films.