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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John McDonnell interview: "We’re going to destroy Osborne’s credibility"

The shadow chancellor on the Spending Review, Jeremy Corbyn's leadership and why trade unions will have to break the law. 

When I interviewed John McDonnell in March, before the general election, he predicted that Labour would be the largest party and confessed to a “sneaking feeling that we could win a small majority – because I think the Tory vote is really soft”. As the long-standing chair of the Socialist Campaign Group, McDonnell anticipated leading the resistance inside Labour to any spending cuts made by Ed Miliband. Eight months later, he is indeed campaigning against austerity – but as shadow chancellor against a Conservative majority government.

I meet McDonnell in his new Westminster office in Norman Shaw South, a short walk down the corridor from that of his close friend and greatest ally, Jeremy Corbyn. The day before George Osborne delivers his Spending Review and Autumn Statement, his desk is cluttered with economic papers in preparation for his response.

“The message we’re trying to get across is that this concept of the Tories’ having a ‘long-term economic plan’ is an absolute myth and they’re in chaos, really in chaos on many fronts,” he tells me. McDonnell points to the revolt against cuts to tax credits and policing, and the social care crisis, as evidence that Osborne’s programme is unravelling. On health, he says: “He’s trying to dig out money as best as he can for the NHS, he’s announced the frontloading of some of it, but that simply covers the deficits that there are. Behind that, he’s looking for £22bn of savings, so this winter the NHS is going to be in crisis again.”

Asked what Labour’s equivalent is to the Tories’ undeniably effective “long-term economic plan” message, he said: “I don’t think we’re going to get into one-liners in that way. We’ll be more sophisticated in the way that we communicate. We’re going to have an intelligent and a mature economic debate. If I hear again that they’re going to ‘fix the roof while the sun shines’ I will throw up. It’s nauseating, isn’t it? It reduces debate, intellectual debate, economic debate, to the lowest level of a slogan. That’s why we’re in the mess we are.”

Having abandoned his original support for the Chancellor’s fiscal charter, which mandated a budget surplus by 2020, McDonnell makes an unashamed case for borrowing to invest. “The biggest failure of the last five years under Osborne is the failure to invest,” he says. “Borrowing at the moment is at its cheapest level, but in addition to that I’m not even sure we’ll need to borrow great amounts, because we can get more efficient spending in terms of government spending. If we can address the tax cuts that have gone ahead, particularly around corporation tax, that will give us the resources to actually start paying again in terms of investment.”

He promises a “line-by-line budget review” when I ask whether there are any areas in which he believes spending should be reduced. “My background is hard-nosed bureaucrat . . . we’ll be looking at where we can shift expenditure into more productive areas.”

From 1982 until 1985, John McDonnell, who is 64, was chair of finance at the Greater London Council under Ken Livingstone. After vowing to defy the Thatcher government’s rate-capping policy he was sacked by Livingstone, who accused him of manipulating figures for political purposes. “We’re going to look like the biggest fucking liars since Goebbels,” the future mayor of London told him. McDonnell, who later described Livingstone’s account as “complete fiction”, has since resolved his differences with the man now co-chairing Labour’s defence review.

After his election as the MP for Hayes and Harlington in 1997, McDonnell achieved renown as one of New Labour’s most vociferous opponents, rebelling with a frequency rivalled only by Corbyn. His appointment as shadow chancellor was the most divisive of the Labour leader’s reshuffle. “People like Jeremy even if they don’t agree with him. People don’t like John,” one MP told me at the time. Mindful of this, McDonnell has sought to transform his image. He has apologised for his past praise of the IRA and for joking about assassinating Margaret Thatcher, rebranding himself as a “boring bank manager”. But there are moments when his more radical side surfaces.

He told me that he supports workers breaking the law if the trade union bill, which would limit the right to strike, is passed. “It’s inevitable, I think it’s inevitable. If the bill is introduced in its existing form and is used against any particular trade unionist or trade union, I think it’s inevitable that people will resist. We established our rights by campaigning against unjust laws and taking the risk if necessary. I think that’s inevitable and I’ll support them.”

“Chaos” might be how McDonnell describes Osborne’s position but the same term is now daily applied to Labour. The party is riven over air strikes in Syria and the renewal of Trident and MPs are ever more scornful of Corbyn’s leadership.

While Corbyn has so far refused to offer Labour MPs a free vote on Syria, McDonnell says that he favours one and would oppose military action. “My position on wars has always been that it’s a moral issue and therefore I veer towards free votes . . . We’re waiting for Cameron’s statement; we’ll analyse that, there’ll be a discussion in shadow cabinet and in the PLP [Parliamentary Labour Party] and then we’ll make a decision. I’m still in a situation where I’ve expressed the view that I’m opposed to the bombing campaign or engagement. I think the history of the UK involvement in the Middle East has been a disaster, to say the least . . .This isn’t like the Second World War where you have a military campaign – you defeat the enemy, you sign a peace agreement and that’s it – this is asymmetric warfare. In addition to the risks that are in the battlefield there’s a risk in every community in our land as a result of it.”

Would he want any of the 14 former shadow cabinet members who refused to serve under Corbyn to return? “All of them, we’re trying to get them all back. We’ve got Yvette [Cooper] helping us on a review we’re doing about the economy and women . . . It’s an open door policy, I’m trying to meet them all over these next few weeks.”

Livingstone, a member of Labour’s National Executive Committee, recently called for Simon Danczuk, who revealed details of a private meeting with Corbyn in the Mail on Sunday, and Frank Field, who told me that MPs should run as independents if deselected, to be disciplined. But McDonnell takes a more conciliatory line. “With Simon [Danczuk] in particular and the others, it’s just a matter of saying look at the long-term interests of the party. People don’t vote for a divided party. They’ll accept, though, that within a party you can have democratic debate. As I said time and time again, don’t mistake democracy for division. It’s the way in which you express those different views that are important. All I’m saying is let people express their views, let’s have democratic engagement but please don’t personalise this. I think there’s a reaction within the community, not just the party, against personalised politics. It’s not Jeremy’s style, he never responds in that way. It’s unfortunate but we’ll get through it. It’s just minor elements of it, that’s all.”

McDonnell disavows moves by some in Momentum, the Corbyn-aligned group, to deselect critical MPs. “What we’re not into is deselecting people, what we want to try and do is make sure that everyone’s involved in a democratic engagement process, simple as that.

“So I’ve said time and time again, this isn’t about deselection or whatever. But at the same what we’re trying to say to everybody is even if you disagree, treat each other with respect. At the height of the debates around tuition fees and the Iraq war, even though we had heated disagreements we always treated each other with mutual respect and I think we’ve got to adhere to that. Anyone who’s not doing that just lets themselves down, that’s not the culture of the Labour Party.”

In private, the 90 per cent of MPs who did not support Corbyn’s leadership bid speak often of how and when he could be removed. One point of debate is whether, under the current rules, the Labour leader would automatically make the ballot if challenged or be forced to re-seek nominations. McDonnell is emphatic that the former is the case: “Oh yeah, that’s the rule, yeah.”

McDonnell’s recent media performances have been praised by MPs, and he is spoken of by some on the left as a possible replacement if Corbyn is removed or stands down before 2020. His speech to the PLP on 23 November was described to me by one shadow minister as a “leadership bid”. But McDonnell rules out standing in any future contest. “No, no, I’ve tried twice [in 2007 and 2010], I’m not going to try again, there’s no way I would.”

Despite opinion polls showing Labour as much as 15 points behind the Conservatives, McDonnell insists that the party can win in 2020. “Oh definitely, yeah, you’ll see that. I think this next year’s going to be pivotal for us. We’re going to destroy Osborne’s credibility over the next six months. But more importantly than that, we can’t just be a negative party . . . we’re going to present a positive view of what Labour’s future will be and the future of the economy.

“Over the next 18 months, we’ll be in a situation where we’ve destroyed the Tories’ economic reputation and we’ve built up our own but we’ll do it in a visionary way that presents people with a real alternative.”  

George Eaton is political editor of the New Statesman.