Erectile Dysfunction: Michael Castleman Talks to Men

8/18/11 update: I’m bringing this older post to the top because it answers so many of the questions about erectile dysfunction that my readers are asking. Michael Castleman is also one of the experts in Naked at Our Age and I respect his knowledge and ability to convey important information simply and compassionately.

So many readers–both male and female–have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions. His interview starts here and continues here.

Q: Explain erectile dysfunction (ED) and why it happens.

MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.

Q: What about men who are capable of erections, but they’re less reliable than they used to be and require more stimulation?

MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call “erection dissatisfaction” (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don’t rise as quickly as they used to. They no longer rise from fantasy alone–seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man’s 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.

The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again–IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.

Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I’ve been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don’t have true ED. They have EDis.

Q: Many men fear that they can’t please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?

MC: Of course not. As you know, women’s pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON’T know this.

Q: How did men’s sexual education skip that important concept that women’s orgasms are based on clitoral stimulation, and that most women don’t need penis-in-vagina penetration for their pleasure?

Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they’re “too small.” Mainstream porn includes a bit of massage and cunnilingus, but it’s mostly about sucking and fucking, so that’s what men come to believe sex is all about.

I’ve spent my life as a sex educator and counselor trying to persuade men that they’ll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men’s #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.

Here’s where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You’ll enjoy sex more and have fewer sex problems–more cooperative erection and better ejaculatory control.

Great SexMichael Castleman, M.A., is the author of twelve books, including Great Sex: The Man’s Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife,


  1. Dan on June 19, 2014 at 2:09 pm

    Question on Delayed Ejaculation, also called Retarded Ejaculation. My wife asked to write you, Joan or one of your guest post folk about this trigger problem.

    OK, I don't have to come every time but it's nice to, no? More frequent these days is that I can't. Some guys are 2 pump chumps; I'm a 200 pump chump of late. And that's on a good day!

    Two meds I take-Lisinopril for Hypertension/HBP and Finasteride for BPH, for a slightly enlarged Prostrate. I read that both meds on their own can cause Retarded Ejaculation (really, who invents these names for cock and ball "issues"?)
    a) other meds for HBP and BPH that don't do this? (My lady likes a good pounding but there are limits, no?)
    b) I also take Testosterone for low (148 free now 600) to bump up my aliveness all around; is it this med?
    c) could all 3 the meds be the issue?
    d) should I just be happy coming 2 out of 3 times?
    e)I'm 66, is "normal" for my age anyway and it is not the meds?
    f) I can usually come by hand alone, with more concentration; I'd like to include my wife however!
    Thanks for your help.

    • Joan Price on June 19, 2014 at 4:10 pm

      Dan, please ask your doctor and/or pharmacist about the meds, for two reasons: (1) only they know the answer; (2) we MUST talk out loud to our medical professionals about our need/ desire for continued sexual pleasure through our lifespan. Only if we keep asking will they realize that giving us (all of us, not just those who ask) this information must become a priority. They don't know that it matters, if we don't say, "Hey! This matters!"

  2. Anonymous on August 4, 2013 at 1:25 am

    My fiancé of 3 years; him 72, me 61; has ED, but with the special love we have he pleases me orally so much that that I reach my peak of satisfaction beyond belief. Him not getting an erection doesn't bother us. We just love each other every way we can. I love him so much

  3. Joan Price on June 11, 2013 at 11:42 pm

    I apologize to my readers for a few comments that slipped through with links that tried to send you to ED sites that I do not endorse. I've removed them now. I try to keep those from making their slimy way into my blog. I want you to be able to trust the information presented here, and the links that I or my guest bloggers provide. Thanks for your understanding.

  4. Joe Thomas on June 11, 2013 at 6:32 pm

    I think prevention and a positive thinking could reduce EDis. We should eat real food and do exercise, doing this basic things improve our lives in all aspects. The problem is that sometimes we don't have time and leave this things until a lot of time has passed.

    • Joan Price on June 11, 2013 at 11:38 pm

      You're right that a healthy lifestyle promotes good blood flow which is essential for erectile vigor. But often ED and EDis are due to medical problems that are not within a man's control, unfortunately.

  5. David Pittle on August 18, 2011 at 8:35 pm

    A few comments:

    Joan, your talk at the Center for Sex and Culture was very good. Because of the energy with which you present the subject, even people who normally would be more reticent were able to share.

    I think your own willingness to "let it all hang out"–talking about your bone fragility, wearing revealing clothing, etc., is very helpful. That takes a lot more courage than most of us could muster but it also encourages more candor than usual from audiences.

    Aside from what I've learned about treating ED from courses and books, a lot of it is first hand experience. Sure I "knew" about the effects of diabetes, and other physical issues, had to working with sex therapy clients. When they entered my life, I had to LEARN them. Unfortunately the doctors–even my urologist–were unprepared to really deal with an older man wanting an active sex life. I had already tried Viagra but found, as Michael intimated, that it works for some men but not for all. Even so, I had to push him to prescribe the alternative of the penile injection (Edex-or Caverject). He did that, but added the comment, "haven't had much luck with it."

    For me, the Edex was a very imperfect solution as it requires refrigeration for storage. Very difficult for someone who travels a lot or might not be at home for "the moment."

    Not that I haven't had an active sex life even when not having an erection. One of the commentors had trouble convincing her partner that the erection was more of a problem for him than for her. That is, of course, true, but I've had more problem convincing women that I really didn't need to have an erection even for my own pleasure. Men can and do have orgasms without erections and even without ejaculation.

    The AdamandEve commentor mentioned cock rings and penis pumps as a help. Indeed, I have found these a great help for myself–and for some, though not all, clients. BUT, not the cheap "fireplugs". A good medical grade pump can do an excellent job. The couple needs to pay attention to not overdoing the vacuum–nor the time they keep the erection.

    Your books–and you–are a treasure for seniors who have the itch and don't know whether or how to scratch. LOL

  6. alcwkat on January 29, 2011 at 1:48 pm

    "As you know, women's pleasure organ is the clitoris."
    That's a very limited view. Hundreds of posting in MrG's thread give the bigger picture:

  7. edegra on October 5, 2010 at 6:48 am

    Erectile dysfunction can be cured with a proper balance of food which may involve leaving behind fatty food. smoking and drinking alcohol also provides you some relief. But according to me, as age progresses, the body will resent from being sexually active..

  8. Joan Price on May 18, 2009 at 11:06 pm

    Anonymous, Michael Castleman just sent me a terrific response to your comment, which is a separate blog post titled “He thinks he can’t please her without an erection, so why bother?” at (If this doesn’t hyperlink, it’s listed under “erectile dysfunction” in the label categories listed at the right.)

    I hope you’ll comment on that post, too, and let us know how his advice strikes you. Thanks again for your candid comment.

  9. Joan Price on May 18, 2009 at 12:05 am

    Anonymous, you ask an excellent question. You value love and intimacy (including sex)without his erection, but if he is convinced that he’s worthless sexually, how do you get the intimacy back? I’ll address this as a new post on my blog very soon, and I thank you for your candor in asking this important question.

  10. Anonymous on May 16, 2009 at 2:28 am

    I’ve been in a loving relationship for over two years, its been great. Until now, its taken a complete turnaround. His thinking is because he can’t get an erection he’s a failure in pleasing me. No matter what I say, his comment is “why bother”. I have been completely satisfied with our love making up until now, I am completely confused. Our love and intimacy made our relationship what it was, now what? What do I do?

  11. Gratitude on June 9, 2007 at 7:48 pm

    Last night I was writing a comment to the previous article, which still needs to be shortened before I post it, but part of is is an exploration of this idea that if we want men to learn more about sex, about pleasuring women, we could make pornographic videos and dvd’s showing ways to do that, and have lots of pictures of nude women in any books on the same subject. I was really getting a little silly, but maybe it would work.

    I realize it would take a stretch of many people’s imagination to produce a sex education porno video, but I think that’s what our generation is all about, stretching imagination, pushing the boundaries, and creating new ways of living.

    Michael Castleman, or his publishers anyway, have the right idea, putting a nude woman on the cover of a book about ed and calling it “Great Sex.” My first response to seeing it was indignant. “Oh that lady is so thin! If I were a man I would want a lady with more meat on the bones. Why does there always have to be some skinny young woman’s body plastered absolutely everywhere?!!!” Then I realized, with this image on the cover, lots of men will pick up this book.

    My husband will appreciate the good information written in this post. Thank you!

Leave a Comment