DEAR DR. NERDLOVE: First a little bit of background: I’ m a CIS male, 45. And I’ve suffered from ED since… Well, always. I have been able to complete sexual intercourse with penetration, but is very rare and difficult for me.

I’m the kind of man that has never been successful with women. I have always been the nerdy, big, fat guy with glasses. I’m a shy extrovert (I know it’s a weird combination, but that’s me in a nutshell) and I have always find difficult approach to women.

I don’t know what to do about this. It has cost me some relationships in the past and honestly, I have a lot of fear about how handle my situation with a possible partner. When do I tell her that most probably I will need years of therapy to have sex with her? How do I approach this conversation?

Therapy has not worked for me. I think that the problem is in that I haven’t found the right professional: all the professionals that I have consulted about this, always take the same direction. They give me the blue pill and tell me to do some therapy with that with my girlfriend. When I tell them that I’m single, they take back the blue pill and give me the white pill and tell me to get back in a couple of months. As you can imagine, that doesn’t work.

I feel very lonely and very scared at the same time to try to approach someone. When things get closer, usually I panic and freeze.

The last ten years I have worked a lot in myself: I have been working abroad (a very good personal and professional experience), I have lost 40 kgs (40 more to go), worked in my self-esteem… I feel a better person now and I have decided to give relationships a shot. But still I don’t know how to handle this.

Please help, I’m feeling

Stuck in A Rut

DEAR STUCK IN A RUT: First of all: congratulations on all the work you’ve been putting into yourself, man.  That’s really awesome; you should be proud of what you’ve accomplished and how far you’ve come. That speaks a lot to how you’ve been caring for yourself and building an awesome life. So it’s important that you keep this trend going; it’d be a shame to let this hard work get derailed by a treatable condition.

And now, my dude, let’s talk dicks for a second. There tend to be two types of erectile dysfunction: emotional and physical. Physical erectile dysfunction tends to occur because of physical causes, usually either hormonal levels or conditions that prevent blood from going to the spongey tissues in the penis that cause erections. Age, weight, hormone levels, drug use (including alcohol and nicotine) all can cause weak or infrequent erections or even prevent them entirely.

Emotional causes to ED tend to come about because dicks are divas; they often won’t perform if everything is perfect. Feeling nervous or insecure? Say hello to Flacid-o Domingo.

Now here’s my question: you mention that you’ve had penetrative sex before, which means you were able to get it up enough for penetration. Do you have the same problems when you’re on your own? Do you have issues getting erections when you’re in the mood to masturbate, or are you still finding that you have to try to shoot pool with a rope then too? This is an important question to answer because it says a lot about which doctors you should be talking to.

Here’s the thing: I agree that you’re seeing the wrong professionals. If your issues are physical, then your first step should be talking to a urologist and making sure that there aren’t other underlying causes. No amount of therapy is going to help if, for example, you have prostate issues that’re damaging your erections.

However, if the causes are mental… well, you need to be talking to very different professionals than you seem to have. If it is literally as you say — they prescribe you Viagra until you say you’re single and then give you something else (presumably an antidepressant or beta-blocker) then I’m doubting you were talking to a therapist. A psychiatrist, maybe… but honestly, it sounds like you may have gone to the entirely wrong people. You want someone who will work with you on your issues, not just throw pills your way and call it a day. If you’re dealing with long-term low self-esteem or high social anxiety, medication by itself isn’t going to help, especially not a “take this twice a day and come back in a month” approach. In an ideal world — and depending on precisely what issues you have — you would want therapy supplemented by medication, if drugs are warranted. And in fairness: they often are. Despite what well-meaning people will tell you, depression and anxiety disorders aren’t the sort of thing you can will yourself out of, nor can you diet or exercise your way past them; I’ll point you to Naomi Osaka and Simone Biles as proof of this. Antidepressants, anti-anxiety meds and the like are often what makes it possible for therapy to work; easing the symptoms goes a long way towards making it possible to develop the coping skills that help, or to address underlying problems.

That having been said, I’m wondering if you aren’t coloring the way things went a little. Depending on how things shook out, I suspect that you may not have been in the most receptive place when you went to the doctor. While being prescribed medication can feel like you’re being written off, often it can be less of a weapon of  first resort and more a “ok, let’s get you to a working baseline, so you’ll be functional and able to work on the other issues.” And frankly, it can take time to make sure you’re on the right medication and the right dosage; not every antidepressant or anti-anxiety medication works the same on every person. Finding the right ones, in the right amounts, can be a time-consuming process, since many have to build up in your system over time.

And again, if you were going to your GP or a psychiatrist… well, I think the assumption is that you would be doing this in conjunction with therapy, not “as a substitute for”.

So I’d highly recommend that you try therapy again… and ideally with the right doctors or counselors this time around. If you don’t have someone you’re already working with or can’t go to, then you may want to look to Psychology Today’s directory to help find a medical professional near you. Similarly, if you feel like much of your issues are around sex and sexuality specifically the American Association of Sexuality Educators, Counselors and Therapists. They also have a referral directory that can help you find a sex-positive therapist who can work with you on your issues.

One thing I would advise you to keep in mind is that therapy is a lot like dating; you want a therapist you have chemistry with (that is: that you get along with) and who you feel understands you and empathizes with you. If you feel like they don’t get you or that they aren’t helping, you can and should break up with them and find someone else. Similarly, not all forms of therapy are going to be right for you and your situation. Some folks do well with what’s known as dialectical behavioral therapy — where you focus on mindfulness and emotional regulation. Others do well with cognitive behavioral therapy, which helps find coping strategies and challenging and correcting distorted or intrusive thoughts and behaviors. Still others do well in group settings vs. a one-on-one scenario and some do best with pure talk therapy. Finding the one that is right for you can be a challenge too; much like with dating, just because one therapist or style didn’t work doesn’t mean that it’s all worthless. It’s about finding who’s right for you and who you click with… that can take time. And, of course, medication helps too.

So give it an honest shot. Be more open and up front about what your issues are, how they’re affecting you and how it’s making your life more difficult. That makes it much easier for them to understand what sort of treatment and therapy you may need to look into. And lead with the social anxiety, rather than the ED; I strongly suspect that the latter is caused by the former, and may have been the source of confusion the last time you talked to a doctor.

Another thing to consider: just because you can’t get an erection doesn’t mean you can’t have sex. Sex is much more than just insert-tab-a-into-slot-b; sex is a holistic act, involving brains and your entire bodies, not just genitalia. In fact, the vast majority of women can’t orgasm from penetration alone; it just doesn’t give them the direct, intense clitoral stimulation they need to get off. But you know what does give them the stimulation they need and never goes limp at inconvenient moments? Your hands. Your tongue. Vibrators, dildos, clit-suckers and a whole host of other amazing sex toys that are readily available. Any and all of these are ways of having incredible, mind-blowing, bed-rocking, headboard-slamming sex… that don’t require you to be able to get hard at a moment’s notice. Getting comfortable and skilled with non-penetrative forms of sex will make you a much better lover — and much more in demand — than Studly Goodnight who thinks that jackhammering away like he’s drilling into bedrock is the way, the truth and the light. And if you encounter someone who thinks that your de-prioritizing penetration is a bad thing? Well, all that’s happened is that she’s self-selected right the f--k out of your dating pool and good riddance.

And one more thing: remember what I said about dicks being divas? Well, this is one of those times when Dumbo’s Magic Feather can actually be useful. While you may not have a physical issue that Viagra could treat, having it on hand and knowing that it’s an option could well make the difference between a failed performance by Flacid-o and a standing O from Pavarotti. It may not be medically necessary, but mentally helpful to have it. That simple act of belief — “I’ve got the sildenafil in my system, there’s no chance of not getting harder than Cantonese calculus” — can make all the difference when the moment comes.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: I’ve been with my boyfriend for almost 2 years now. We generally communicate well and approach each other with problems and work together to solve them, in regards to both life and our relationship together. We have a healthy sex life and see each other for at least a couple hours usually once a week. When we spend time together we watch TV or movies for the most part and sometimes play games also, as we are both into gaming. We text every day. Sometimes very rarely we will go outside for an hour or so to do something different. With covid being the reality, I don’t have any issue with what we do together right now. However…

My boyfriend’s career is tech and writing focused and social media is a big part of his life, specifically Twitter. We have had multiple discussions in the past about how, since we don’t see each other as often as either of us would like, I would prefer if we could focus on each other when we spend time together and not be focused on phones or social media. He says his phone is important to him and that he has to check it frequently so he is in the know about current media. I understand that, but we only spend time together outside of work hours, and since we sit next to each other I see that he’s texting his other friends or just doing personal stuff. I don’t mind this to an extent, however it is constant. I try to let him pick shows we watch and games we play so that he will be interested in it even if I’m not really, and focused on our experience together rather than his phone and his friends he is texting.

It especially irks me because his friend he texts most often, without fail 100% of the time we get to spend time together, is one of his best friends who he used to date only a few years ago. I think being friends with an ex is possible and can be done in a healthy way for everyone involved and have no problem with he and she being such good friends, but it bothers me when we are having a discussion and he will ignore what I am saying to respond to his best friend, his ex, VERY often, at least once every time we are together. He will pretend to listen by nodding his head or agreeing, but if I ask him what I said he admits he doesn’t know and wasn’t listening.

He doesn’t try to hide his phone from me and I don’t try to look at it unless it’s right next to me in front of my face and he’s using it, so it’s not that I don’t trust him, I just want to feel like a priority. I feel like I fall far behind Twitter, his ex, and his other friends at this point. I have a lot going on in my life right now as well, my parents relationship is on the rocks, and I’ve ended a friendship recently because a friend told me he had feelings for me and that I deserved better than the relationship I was in, and honestly I felt he was right and was tempted, though I would never cheat on my boyfriend. I love him dearly. I don’t know what to do at this point, please help.

Sincerely,

Not a Priority

DEAR NOT A PRIORITY: … well s--t, this one hits a little close to home, NAP. I am admittedly, one of those folks who is almost permanently attached to his phone. This has been the subject of a lot of… well, let’s be generous and call it “serious discussions” about when I’ve been paying more attention to my phone than most things, up to and including shows I enjoy. And if you asked me, back in the day, I would’ve told you something similar to what your boyfriend said: that I needed to keep track of things, because work!

(Work taking up 75% of my time and attention didn’t help either, I might add.)

It didn’t help that notifications, badges, bings, etc. would catch my attention immediately. I used to joke that anything that I was like a t-rex; movement or noise at the edges of my vision would catch my attention like the apex predator I was…

Now this didn’t mean I wasn’t aware of how much my partners were (rightfully) irked by this… but it was still something I had a hard time managing.

And then last year, I found out that I have ADHD and suddenly a whole lot of things made sense. Up to and including why my phone was so goddamn addictive. One of the issues with ADHD is that your brain restricts your dopamine production — the chemical that it produces when you receive a particular reward or accomplishment. Novelty, in particular, is a huge source of dopamine; new experiences, information, etc. causes an increase in dopamine production. And as it turns out, smartphones — with all of its notifications, constant streams of new information and hordes of apps that promise constant stimulation — is a dopamine factory for folks with ADHD. And if your brain is usually starved for pleasure and stimulation, that constant stream of novelty and stimulation is like heroin.

Now to be clear: this doesn’t excuse my behavior and how much I’d let my phone (and before smartphones, books) get in the way of my relationships; it just changes the context of it all… and what needed to be done.

I share this information not because I think everyone has ADHD now or that it’s eternally relevant, but because it can provide some examples of just why folks get hooked on their phone. That constant stream of stimulation and novelty is a reward of sorts… but it’s also as much a way of avoiding things like boredom or troublesome thoughts or anxieties. Ironically enough, doomscrolling on Twitter and Facebook is much the same way; it’s oddly soothing to realize that your anxieties are justified and not just random s--t that your brain decided to invent for no reason.

So while I don’t think that your boyfriend necessarily has ADHD or ADD (though it’s certainly a possibility), I think it’s more likely that he’s addicted to it because it fills a particular need. Whether that need is a lowered tolerance for boredom, avoiding difficult or complex emotions or even just a way of avoiding being alone with your thoughts, he’s getting something from this behavior. The problem is that while it’s fulfilling a need, that doesn’t mean that the way it’s doing so is particularly good or useful; just because something is a solution doesn’t mean that it’s a good one. Especially if, and I’m just spitballing here, it’s coming at the expense of your relationship and making your partner feel devalued or taken for granted.

So what do you do about this?

Well, outside of addressing any mental health issues (which are outside the scope of this column; remember, Dr. NerdLove is NOT a real doctor…), one of the things to do is to make it clear that the way he’s using his phone is hurting you. You may have told him that you want to prioritize time away from social media or screens when you’re together, but you don’t say that whether you’ve told him how this behavior is making you feel. It’s one thing to say “hey, when we’re together, I want to spend more time doing things that don’t involve phones.” It’s another entirely to say “you are making me feel disrespected and that I’m not as interesting or engaging as literally anything happening on Twitter right now.” Driving home that this is hurting you is going to be important; an annoyance is the sort of thing that can be written off as “ah, we all have quirks that the other doesn’t like.” Finding out that no, this is doing demonstrable harm to your partner and you’re relationship changes those numbers and — hopefully — encourages him to reconsider his use.

And no, “I need to be up on the latest whatever” isn’t an excuse. As someone who has the same goddamn problem, I can promise him that anything going on right this second on Twitter (or Facebook or Instagram or…) will still be going on hours later or easily findable. Hell, if he’s especially worried about “missing” something, he can set up Google alerts, saved hashtag searches and lists to make sure that he has those posts all collected in convenient places. And, likewise, unless he’s specifically waiting for something time-limited like a Mondo drop or a pre-order to open, there’s not a need to be on his phone right that second. And he can set up alerts for things that actually do need his attention right then and there.

I would start with telling him that you want him to put his phone away when you’re doing $DATE_ACTIVITY together. And not just “in his pocket” or “face down on the table” but out of easy arm’s reach… ideally with Do Not Disturb turned on. This will minimize the notifications and alerts that keep drawing his attention and ping the dopamine production centers of his brain, while still allowing for actual important calls or texts to come through, rather than just farting around in the group chat. You can even schedule a brief phone break every couple of hours or so that he can get a quick fix and clear any outstanding messages.

Again: make it clear that his behavior is affecting you and how it makes you feel. He should understand that this isn’t just you being jealous of his ex, or what have you,  it’s that you are being treated like a lower priority than everyone else. And if you’re not a priority for him… then you aren’t sure why he’s even there with you. Again: this has nothing to do with jealousy and everything with the fact that his actions demonstrate that he’s putting Twitter or texting ahead of you… and there’re few things that will curdle a relationship faster than being taken for granted. Would he have acted like this when you first started dating? If the answer is no… well, then he shouldn’t be acting like this now.

With that having been said: I will say that one of the conversations to have is about exactly what it is he’s feeling and whether he’s trying to hide from those feelings by being on his phone. But those are questions that he should be asking himself; a little mindfulness and emotional intelligence goes a long way towards understanding why he’s feeling the way he feels. And recognizing that makes it much easier to get a handle on things, rather than mindlessly going back to the dopamine factory. And if he legitimately struggles with this — by which I mean “makes a good faith effort, not just enough to get you to shut up for a while” then he should seriously consider talking to someone about possible issues like ADHD. Because honestly, no amount of self-discipline makes racing thoughts or anxiety go away, nor does any amount of willpower change how your brain works on the physical and chemical level.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com

DEAR DR. NERDLOVE: My husband suggested recently we move to a cheaper city so we could buy a house in cash, free and clear. He also detests this area for a number of reasons, homelessness, high cost of living, etc. But the way I look at it, it would disrupt a pretty good situation we have right now, and there are other options that he refuses to consider.

We rent in a major west coast city with our adolescent daughter and two dogs. Cost of living is exorbitant and since I started my own firm it’s been a struggle to survive financially, but we have a very large reserve to tap for a few years. Also my firm is starting to show success and I’m seeing life at the end of the tunnel.

My husband has a decent contract with local government, loves his manager and has a good opportunity to get a full time job with excellent benefits. Finding a job he likes has been a major struggle the 14 years we’ve been married so the fact he loves management is huge.

Our daughter is thriving at her middle school where she’s one of the top students and beloved by many there. The school navigated the pandemic very well and our daughter made some very close friends.

So I was stunned when my husband became committed to leaving this area ASAP because he “hates what this area represents”, seeing how many people struggle with housing (he works with the homeless). I’ve tried my best to come up with alternatives:

Move later, once my firm is stable enough to make a decent monthly income. He says that may never happen and he doesn’t trust that I’ll move if it is successful.

He moves first, buys a house, either a) with our daughter or b) without our daughter and we’ll move later. That would require my finding a cheap apartment. Again he says we should stay together and he doesn’t trust I’ll move and/or having two homes defeats the purpose of saving money.

I move first to establish my firm and he stay with our daughter here. Again we’re split up and two locations.

Find a cheaper place here but it would not be as nice as we could get in another city. But this doesn’t work because he hates the area.

My husband says I’m unwilling to compromise because his true dream is to move to Europe where he’s from but will stay in the US since I can’t run my firm from there for regulatory reasons (otherwise I’d explore it). Since I don’t want to close my firm, his compromise is staying in the US. He’s furious with me for not making a definitive answer quickly and I admit I’m all over the place, saying maybe it would work and then changing my mind when I think about how:

He’d have to quit and get a new job which he’s not good at doing.

We have limited health insurance due to his contract situation but we’d have no health insurance if we move.

He only has a network in our current home city and that took him ages to cultivate since he’s introverted

His distrusting me, saying I’m not working with him and that I won’t “prove my love to risk” a move.

That he has sacrificed too much by moving here to be with me and now it’s my turn.

My issue is not the moving part, it’s the timing and his attitude—all or nothing but seems to be characterizing me as the selfish one.

Do I risk it? Am I being too fearful? The ironic point of it is that he’s recommending towns where I have lots of relationships and could possibly build a client base (although premature). I’m likely to be the best off after a move but adding an unemployed, angry husband who doesn’t trust me and a teen who is totally against moving makes it less interesting.

He’s flipped out since our discussion that went really wrong since he won’t believe I’m willing to compromise and because I throw out different options he sees that as stalling. It ended with some really awful things said.

What do I do? I don’t want to split and we are in the best financial shape now so moving out for either of us would make things even worse. I said let’s make a decision next year and he said no it has to be in 3 months.

Torn to Pieces

DEAR TORN TO PIECES: I’m not entirely sure  what’s going on with your husband, TTP, but I’m betting that where you live isn’t the real issue he’s having.

Now there are a lot of causes or issues that are potentially in play, but I suspect that a key one is a classic: “I am not happy with some part of my life, so if something were different, everything would be better.” This is something that I’ve seen a lot, often from (but by no means exclusive to) people Of A Certain Age. The underlying belief is that one’s satisfaction is due to current circumstances, so if you make a significant change — usually something suitably dramatic like changing careers without warning, buying a luxury car, ending your marriage, redecorating your apartment, moving to an entirely different town etc. — then everything would be better.

The problem, unfortunately, is that this is often an article of faith, rather than one of experience. It’s the sort of thing that feels like a decision borne out of careful consideration, but in reality is usually a snap judgement that folks will cling to like a drowning man to a log in a river… usually unware that he’s about to go careening over Dead Man’s Falls and onto the rocks below. And, again, because it’s more of an article of faith, the person who comes to this decision will often want to act on it NOW NOW NOW NOW because it’s very clearly the solution to all of their life’s problems.

In practice, however, the reason why folks often will want to act on this as quickly as possible is because they want to act on it before further consideration causes the bloom to fade on this particular ill-conceived rose. If they stop to think about it, then they’d realize that no, this is actually a really bad idea and is only going to make things worse. In fact, more than a few folks have had moments like this before and have either seen their dream wither and die if they hesitate, or they’ve done it before and it didn’t help. But like someone convinced that the slot machine is finally about to pay out, they want to believe that this time it’ll all work out exactly as they’d hoped.

Unfortunately, what folks often find out is that while surface may have changed, the underlying causes of their dissatisfaction haven’t. You can’t run fast enough to get away from yourself, not when the call is coming from inside the house. So all that has happened is that their solution means that now they have two problems.

There’s also a potential side issue here: a lot of times, this sort of impulsive behavior can be the result of conditions like ADHD. With ADHD, one’s hyperfocus may engage on a concept or an idea, rather than a particular activity or interest and it takes up all the available bandwidth in your mind. This means that folks will lock onto that idea like a pitbull on unattended rashers of bacon and get incredibly pi

y if people don’t help enable them with this.

Under other circumstances, what your husband wants isn’t entirely unreasonable. Finding a place where your money goes further, especially with a lower or more sustainable standard of living isn’t the worst idea in the world. The potential benefits of a less stressful lifestyle or a region where you’re a better cultural fit can be immense. And depending on whether it is possible for you to run your business remotely, it wouldn’t necessarily be too disruptive to your career in the process.

Where this all goes off the rails is his insistence that not only does this need to be done in three months, that any resistance is tantamount to a personal insult and the fact that he has apparently done absolutely no prep-work to make this a feasible option. Any one of these would be a red flag. ALL of them at once isn’t just a red flag, it’s more red flags than the Running of the Bulls in Pamplona. And this is unreasonable. It’s one thing to take time to consider the possibility of moving, to weigh the pros and cons and do some preliminary legwork to see how feasible it would be. It’s another to demand that everyone up stakes with no warning, like he’s Pa Ingalls and y’all just got kicked out of the Kansas territories.

The part that most sets off my Spidey-sense is his absolutist, all-or-nothing/with-me-or-against-me stance he seems to be taking. That… really isn’t good. Under the most generous interpretation, those ultimatums and insistence that you’re being selfish or unsupportive comes across as the result of long-simmering resentment about something. Under less generous interpretations… it comes across as quasi-abusive. His framing this as “you’d do it if you really loved me”, downplaying both your sweat-equity investment in your firm and the growing success and his getting hostile and abusive about any resistance to his plan is disturbing. His not trusting that you’d move to join him after things were settled is even more so. That might speak volumes to how he views your relationship… and not in a good way.

If this is a sudden change — something completely out of character for him — then I’d be worried that it’s a sign of an emergent mental health issue. If this has been building over time, then I’d be more worried that it is a “frog in a boiling pot” scenario, where everything seemed fine until it wasn’t.

I think that moving just to placate him would be a horrible idea. The potential disruption to your life, your career and your kid’s life would be immense, on top of the financial drain that would come from losing your health insurance and your husband’s income. Moving with no real plan in place and no groundwork (like a professional network, a job offer in hand, etc) is a hell of a risk under the best of circumstances. When your partner is throwing tantrums over it? That’s not just no, that’s a HELL no. That’s a very good way to ensure that your marriage won’t make it through the move. It may not die as soon as you get there, but you’d almost certainly be condemning it to a long, slow and lingering death, like an inoperable emotional tumor.

Honestly, I would suggest a cautious approach. Agree to consider the move (not agree to, consider) under two conditions: first, he has to have the preparations laid out in advance. That means at least a solid job prospect for him, investingating the housing market and availability, the infrastructure that would make it possible for you to run your business remotely and so on. That may also mean finding a way to let your daughter finish out middle-school where you currently live and then join you when she’s ready to start high-school.

Second: you go to couple’s counseling. That part has to be non-negotiable. The way he’s acting has damaged the relationship, and if you want your marriage to survive the stress of uprooting your entire lives to go back east, then he needs to put in the work to help fix things. And to be clear: that’s on him. He’s not acting rationally or reasonably, and his being this aggressive and hostile about it is reason to be concerned. And hopefully, couple’s counseling would encourage him to go to solo counseling, so he can get to the root of just what it is that makes it so vital that he flee the west coast.

If he fights you on either of those conditions, then the answer is an automatic “no”; you’re not going to be bullied or browbeaten into moving when the potential costs are this high. And if he continues to be this aggressively antagonistic about it? Then it’s time to put some very serious thought into whether you and your daughter can safely stay in this relationship with him. If it gets to that point, I’d say it’s time to tell him to get the hell out; maybe, maybe he can come back once he’s fixed whatever’s eating at him, but not a moment before.

And even that would still be under probation at best.

It’s a s--tty situation to be stuck in, TTP. I hope you can resolve this happily and safely.

Good luck.

Please send your questions to Dr. NerdLove at his website (www.doctornerdlove.com/contact); or to his email, doc@doctornerdlove.com