Dr. Kris Case: Erection Problems When Trying for a Baby

There is one thing a patient said that I remember well: "I've never tried so hard at anything in my life, and I still couldn't do it." This case involved no serious disease, but it is the clearest example I know of how trying too hard can turn into pressure.

Background

He was a man in his late 30s who loved his wife very much and was planning to have a baby. Because of work, they were not often in the same place at the same time, so they had to plan with a fertility doctor, tracking ovulation and setting the times when they should have sex.

He used to exercise regularly, but had let himself go a bit recently and gained weight. When the important day finally came, he couldn't get an erection, even though he really wanted to. After missing once, he became even more afraid of missing again the next time. He was very embarrassed to come for advice, and told me he had almost ordered pills to take on his own.

What I found

• Erections in other situations were still normal, such as in the morning or when there was no pressure about dates and times, which pointed to performance anxiety playing the main role.
• Physical factors to look after. He had gained weight and his waist had grown, so I checked his glucose, lipids and morning testosterone, because obesity is linked to low testosterone and vascular damage. Most results were within normal ranges, with slightly high cholesterol.
• Knowledge about fertility. The couple believed they had to have sex on "one single day" exactly at ovulation, which added a great deal of pressure.
• A semen analysis, because having a baby involves both partners. I recommended a semen analysis to support their planning with the fertility doctor.

1. 1
   Ovulation daySex becomes a mission
2. 2
   Pressure"I have to do it tonight"
3. 3
   No erectionEven though mornings are normal
4. 4
   Fear of failingThe next time is more anxious

Care

1. Accurate information about the fertile window. The days with the highest chance of pregnancy are roughly the 5–6 days before ovulation and the day of ovulation itself. Having sex every other day during that time is enough; there is no need to stake everything on one night. This reduced the pressure straight away.
2. Erection medicine as a temporary aid. A PDE5 inhibitor as assessed by the doctor, to break the cycle of fear of failure. There is no evidence that these medicines worsen semen quality with normal use (read: tadalafil vs sildenafil).
3. No buying medicines or male hormones to use on your own, especially external testosterone, which can suppress sperm production. This is a very important caution for anyone who wants children (read: what TRT is and who it suits).
4. Looking after weight and sleep: returning to exercise gradually and cutting down on alcohol, which is good for both erections and semen quality (read: supporting testosterone with sleep, diet and exercise).
5. Giving sex back to the couple, encouraging intimacy on days that are not "scheduled days" too, so that sex doesn't mean only a mission.
6. Inviting his wife into the conversation, because she was carrying just as much pressure.

Afterwards he said his anxiety had dropped a lot, he was using medication less and less, and they both felt like one team again.

1. 1Correct informationFertile window about 5–6 days before and the day of ovulation; every other day is enough
2. 2A temporary aidErection medicine as assessed, to break the fear cycle
3. 3No self-prescribed hormonesExternal testosterone can suppress sperm production
4. 4Look after body and partnerWeight, sleep, closeness on non-scheduled days, invite his wife to talk
5. 5OutcomeLess anxiety, less medicine, back to being a team

What I learned

• Sex can't be ordered, and can't always be scheduled. It needs the body, feelings and relaxation all together.
• Sometimes there's no erection, sometimes you don't finish together, and that is not failure. It is part of real married life, not life in the movies (read: sex isn't perfect like in the movies).
• If he had bought pills on his own, he might have got fake medicine, used hormones that harmed his fertility, and missed the chance to understand the real cause.
• Good care looks at the couple, not just the man.

If you are going through the same thing

Read more in ED: causes, tests and treatment and Stress, relaxation and erections. At Dr. Kris Clinic, I care for erection problems alongside pregnancy planning, look for the causes, offer individual and couples consultations, and can coordinate with your fertility doctor, at the clinic and online, including in English.