We’ve all known boys or young men who insist they can do it all. That confidence, of course, often extends into the sexual arena, where some can experience arousal to the point of erection (or beyond) without help, or even active cooperation, from a partner. Until they can’t.
A college senior lamented to me about problems he was having: “I used to think that erections were easy, automatic, and most important, autonomous—but not anymore.” The women he was dating were confident, experienced, and, he felt, had high expectations he suddenly felt ill-equipped to measure up to.
Such fearful preoccupations with sexual performance aren’t necessarily testosterone-driven. Many boys grow up learning that they need to “suck it up” and deny any neediness or vulnerability they might feel. By the time they hit adolescence, they’ve become experts at repressing insecurity—and what teenage boy feels secure about sex?
When boys hit puberty, all those repressed emotions suddenly assert themselves below the belt. The often voracious sexuality that drives boys and men can feel impersonal and even cruel to many girls and women, but at its core, it’s generally a well-disguised expression of the same yearning we all have: to connect with another person.
The growing popularity of male performance-enhancement pills illustrates many men’s misalignment with their sexuality as they age. As a middle-aged male friend recently told me, “We expect the libido of young studs long past the time when our bodies can keep up the pretense.”
I’m now seeing many couples who have bought into the myth of 100% “successful” sex. And how are they measuring success? Vaginal intercourse in which both participants are fulfilled and satisfied. Uh oh.
Please believe me when I tell you that all loving couples experience lackluster sex occasionally. This flies in the face of media myths, films, and male braggadocio that sexual ecstasy is certain if only the guy can “keep it up.” Men who haven’t moved beyond the equation of sex = erection = intercourse become vulnerable to what some sex therapists call “inhibited sexual desire.”
I’m now seeing many couples who have bought into the myth of 100% “successful” sex. And how are they measuring success? Vaginal intercourse in which both participants are fulfilled and satisfied. Uh oh.
Once the “plumbing” fails to function a few times like it reliably had, confidence in the usual cycle of positive anticipation, enjoyable sex, and a regular rhythm of sexual intimacy typically suffers. Instead, a pernicious cycle takes its place: anticipatory fear, tension, and “failed” intercourse, leading to shame and sexual avoidance. Any desire to engage his partner withers as he becomes a fearful and passive observer of his genitals—a state of mind that’s the very antithesis of eroticism.
Issues like this aren’t limited to middle age and older; witness the college senior I mentioned earlier. By a certain age, however, men need to learn what most women already know and trust: satisfying and pleasurable sex, particularly as we age, is more a matter of intimate teamwork than of physical hydraulics.
I highly recommend Barry McCarthy’s book Rekindling Desire, which he wrote with his wife Emily. In it, he talks about “good enough sex,” reinforcing the need for loving couples to work together to move past the inhibitions that performance anxiety throws in the way of loving intimacy.
Sex therapy, of course, can be a boon for couples who seek a more customized approach to mutual sexual healing and enhancement. I utilize an approach that involves both couples and individual sessions. I learn about each person’s psychological and sexual background and make suggestions for building bridges to sexual desire, discovering cues, settings, and scenes that are inviting for each partner. Sexual healing can be fun!
I encourage single people to consider therapy as well. A man I worked with in the therapy room who’s now married recently emailed to say he didn’t think he could have “stayed in the game” long enough to meet his wife if he hadn’t faced his embarrassment and let go of his “pass-fail” approach.

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