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.

Getty
Show Hide image

Not since the Thatcher years have so many Tory MPs been so motivated by self-interest

Assured of an election win, backbenchers are thinking either advancing up the greasy pole, or mounting it for the first time. 

One hears despair from Labour not just about probable defeat, but from MPs who felt they had three years to improve the party’s fortunes, or to prepare for personal oblivion. In the Conservative Party, matters seem quite the opposite. Veterans of the 1983 election recall something similar: a campaign fought in the absolute certainty of winning. Theresa May talked of putting the interests of the country first when she engineered the poll, and one must believe she was sincere. However, for those expecting to be Tory MPs after 8 June there are other priorities. Theirs is not a fight for the national interest, because that for them is a foregone conclusion. It is about their self-interest: either advancing up the greasy pole, or mounting it for the first time. They contemplate years ahead in which to consolidate their position and, eventually, to shape the tone and direction of the party.

The luxury of such thoughts during a campaign comes only when victory is assured. In 1983 I worked for a cabinet minister and toured marginal seats with him. Several candidates we met – most of whom won – made it clear privately that however important it was to serve their constituents, and however urgent to save the country from the threats within what the late Gerald Kaufman later called “the longest suicide note in history”, there was another issue: securing their place in the Thatcher revolution. Certain they and their party would be elected in the aftermath of the Falklands War, they wanted their snout in the trough.

These are early days, but some conver­sations with those heading for the next House of Commons echo the sentiments of 1983. The contemporary suicide note has not appeared, but is keenly awaited. Tories profess to take less notice of opinion polls than they once did – and with good reason, given the events of 2015 and 2016 – but ­imagine their party governing with a huge majority, giving them a golden opportunity to advance themselves.

Labour promises to change the country; the Liberal Democrats promise to force a reconsideration of Brexit; Ukip ­promises to ban the burqa; but the Tories believe power is theirs without the need for elaborate promises, or putting any case other than that they are none of the above. Thus each man and woman can think more about what the probability of four or five further years in the Commons means to them. This may seem in poor taste, but that is human nature for you, and it was last seen in the Labour Party in about 2001.

Even though this cabinet has been in place only since last July, some Tory MPs feel it was never more than an interim arrangement, and that some of its incumbents have underperformed. They expect vacancies and chances for ministers of state to move up. Theresa May strove to make her team more diverse, so it is unfortunate that the two ministers most frequently named by fellow Tories as underachievers represent that diversity – Liz Truss, the Lord Chancellor, who colleagues increasingly claim has lost the confidence of the judiciary and of the legal profession along with their own; and Sajid Javid, the Communities Secretary, whom a formerly sympathetic backbencher recently described to me as having been “a non-event” in his present job.

Chris Grayling, the Transport Secretary, was lucky to survive his own stint as lord chancellor – a post that must surely revert to a qualified lawyer, with Dominic Grieve spoken of in that context, even though, like all ardent Remainers in the government, he would be expected to follow the Brexit line – and the knives are out for him again, mainly over Southern Rail but also HS2. David Gauke, the Chief Secretary to the Treasury, and the little-known Ben Gummer, a Cabinet Office minister, are tipped for promotion with Grieve if vacancies arise: that all three are white men may, or may not, be a consideration.

Two other white men are also not held in high regard by colleagues but may be harder to move: Boris Johnson, whose conduct of the Foreign Office is living down to expectations, and Michael Fallon, whose imitation of the Vicar of Bray over Brexit – first he was for it, then he was against it, and now he is for it again – has not impressed his peers, though Mrs May considers him useful as a media performer. There is also the minor point that Fallon, the Defence Secretary, is viewed as a poor advocate for the armed forces and their needs at a time when the world can hardly be called a safe place.

The critical indicator of how far personal ambition now shapes the parliamentary Tory party is how many have “done a Fallon” – ministers, or aspirant ministers, who fervently followed David Cameron in advising of the apocalyptic results of Brexit, but who now support Theresa May (who is also, of course, a reformed Remainer). Yet, paradoxically, the trouble Daniel Hannan, an arch-Brexiteer and MEP, has had in trying to win selection to stand in Aldershot – thanks to a Central Office intervention – is said to be because the party wants no one with a “profile” on Europe to be added to the mix, in an apparent attempt to prevent adding fuel to the fire of intra-party dissent. This may appease a small hard core of pro-Remain MPs – such as Anna Soubry, who has sufficient talent to sit in the cabinet – who stick to their principles; but others are all Brexiteers now.

So if you seek an early flavour of the next Conservative administration, it is right before you: one powering on to Brexit, not only because that is what the country voted for, but because that is the orthodoxy those who wish to be ministers must devotedly follow. And though dissent will grow, few of talent wish to emulate Soubry, sitting out the years ahead as backbenchers while their intellectual and moral inferiors prosper.

Simon Heffer is a columnist for the Daily and Sunday Telegraphs

Simon Heffer is a journalist, author and political commentator, who has worked for long stretches at the Daily Telegraph and the Daily Mail. He has written biographies of Thomas Carlyle, Ralph Vaughan Williams and Enoch Powell, and reviews and writes on politics for the New Statesman

This article first appeared in the 27 April 2017 issue of the New Statesman, Cool Britannia 20 Years On

0800 7318496