Can using condoms lead to erectile problems?

Safe sex is the safest mantra, and for good reason. But are you one of those who dreads to put on a condom? Fret not. You aren't alone

ILLUSTRATIONs: Azad Mohan ILLUSTRATIONs: Azad Mohan

Why do some men go soft when they put on a condom? Is it because condoms reduce the sensation or intensity of feeling? Are they unable to maintain an erection because they don’t feel skin-on-skin pleasure? People use terms like condom collapse syndrome or condom associated erectile problems (CAEP) to describe this condition — where a man loses an erection either after wearing a condom or while trying to penetrate. But are these fears real?

Can condoms be blamed for erectile problems?  

The short answer is: No.

But, the long answer is: possibly, but not because of the reasons you imagine.

Dr Kersi Chavda, Psychiatrist Hinduja Hospital, Mumbai, says, “A lot of people believe that they will not enjoy sex if they wear a condom. They hear about how it doesn’t feel good from other people, and if there is even one episode where they can’t maintain an erection long enough, they get anxious. Sometimes, there is anxiety associated with sexually transmitted diseases (STDs) or unwanted pregnancy. So they are worried about the condom slipping or breaking while having sex. All this worrying could lead to loss of erection.”

Apart from anxiety related to using condoms, he adds that many people who have an allergic reaction to latex or wear the wrong size — too tight or loose — may also experience erectile issues when they focus on why it is not feeling right.

So, the solution for not using the condom properly is simple. There are YouTube videos one can watch to learn how to use it correctly. When the right size is used, neither is there a feeling of being constricted nor is there any worry that it is about to slide off. Condoms made with polyurethane can be used by those who are allergic to latex. 

After watching videos and learning to wear one correctly, it is a good idea to practice wearing a condom within 3-4 seconds, so one can focus on the act instead of the right way to use it. Sometimes, the partner can help put it on to make it sexy and continue to feel pleasurable sensations instead of taking a break from foreplay.   

According to Dr Chavda, there is no one-size-fits-all solution and each case is unique. So if a man is worried about a specific issue, say, unplanned pregnancy, then the solution may be to request his partner to use contraceptives for a while to allay his fears and see whether that helps.

condom-sex

If the person is using the condom correctly and there are no other major underlying causes, Dr Chavda admits that in some cases, it may actually be mild erectile dysfunction (ED) that affects the ability to maintain an erection, but he warns that it is not right to generalise.

What if it is Erectile Dysfunction (ED)?

ED is a problem where a man is unable to attain or sustain erections long enough to satisfy his partner. ED can be due to multiple factors. If it is indeed ED, it will happen regardless of whether one uses a condom or not. To understand what is really going on, you need to understand the physiology of an erection first.

Dr Deepak Jumani, Consultant Sexologist, Sir JJ Group of Hospitals, Mumbai puts it very simply, “The sex centre in the brain responds to erotic stimuli like watching someone make love, fantasising, a sensual touch, watching erotic images, some foods and aromas, steamy conversation or indulging in foreplay. When this part of the brain is activated by erotic thoughts, the brain sends a signal to the nerves in the penis via the spinal cord. This leads to a rush of blood to the penis, which makes it erect. When there are no erotic thoughts, or these thoughts are replaced by other thoughts, this centre gets deactivated and there is loss  of erection.”

According to Dr Jumani, more often than not, when a man starts losing the train of erotic thoughts while wearing a condom, he loses his erection. This could happen either because he is fumbling with it or because he is worried about pleasing his partner. When worry and anxiety creep in, the sex centre in the brain is not aroused, so automatically the erection is lost.

Typically, if the man has erections while asleep or nocturnal penile tumescence (NPT), he is not likely to have any physiological causes for not being able to maintain an erection. There are tests to figure out how often these erections occur and for how long, which help the doctor to figure out the cause.

So, before jumping the gun and concluding that the person is suffering from erectile dysfunction (ED), Dr Jumani insists that it is important to rule out the underlying medical issues that could be causing loss of erection such as hypertension, diabetes, low vitamin D, prostate issues, raised lipids or low testosterone. This helps diagnose whether the cause is psychological or physical or both. In most cases, even if there are organic causes, there may be some psychological issues to be addressed. After considering such parameters and running suitable tests, if it is due to ED, there are many options available from the famous little blue pill to modifying the treatments to manage the underlying medical conditions.

But if it is not the condom or ED then what could it be?

The loss of erection is due to psychological causes, one of the main issues could be performance anxiety. Fear of premature ejaculation is among the most common causes of performance anxiety. Dr Jumani says that premature ejaculation usually happens because people learn to masturbate quickly when they are younger as they do it in a hurry in their bathrooms. This is because they don’t have enough privacy and are afraid of getting caught. This becomes a habit and they get it over with quickly even while having sex. If their partner is critical or harsh about their ability to satisfy them, then they get more nervous the next time.

Drinking alcohol to boost morale or courage only worsens the situation. Over time, the anxiety could grow and affect their ability to maintain an erection at all.

According to Dr Chavda, “If the person is concerned about performance or afraid they will climax before their partner is satisfied, they can practice methods like the squeeze technique to delay ejaculation. This involves squeezing the tip of the penis between the glans (head of the penis) and the shaft. With repeated practice, they will be able to maintain the erection for a longer period.” He adds that it is important to learn to relaxation techniques and get the right counselling to overcome anxiety.

Apart from psychological causes, premature ejaculation can be due to certain physical conditions. For example, some men may have a hypersensitive glans which makes them responsive to the slightest touch. Dr Jumani, recommends using a simple anaesthetic cream, which numbs the area, to manage this condition. But, to know whether this is indeed the case they need to go to a doctor and not self-medicate.

Who is the right expert to go to for loss of erection?

According to Dr Jumani, it doesn’t matter who you seek first, whether it is a dermatologist, psychiatrist, endocrinologist or a sexologist. This condition needs a holistic approach and you need be able to have an in-depth discussion with your doctor. The discussion could go on for an hour or more depending on your situation and the doctor may also want to discuss it with your partner.

So we recommend you seek a specialist who will point you in the right direction and one who is willing to spend the time to figure out the cause and then prescribe the appropriate treatment or counselling. 

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