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Bongani’s (27) Question: I am a gay male and identify as a top. I am unable to keep my erection as soon as the sexual play moves to anal sex. I do not have difficulty maintaining an erection with other activities, e.g., oral sex. Could this be a psychological matter? I am quite sensitive to hygiene issues.

Dr Dick’s response: It seems that your current difficulty might be caused by psychological factors. However, always clarify possible biological factors with a medical doctor. Sometimes, being nervous, tired or not sufficiently horny, you may find that you lose your erection while engaging in foreplay or once one starts anal sex. This may happen to a person who is just starting as a top or even to someone with lots of sexual experience. If this happens, take a deep breath, remove all pressure to perform, and consider continuing foreplay / other sexual play a bit more before attempting anal sex again. Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20% of inability to maintain an erection. I cannot say for certain that your difficulty is due to psychological factors as a full assessment needs to be done. I can however recommend that you visit a psychologist / counsellor to discuss your concerns and receive guidance. They can also provide you with guidance on sexual health and anal sex. Always remember to play safe and use condoms and water-based lubricant, especially during anal sex. Condoms, if used correctly and consistently, can reduce your risk of contracting HIV and STIs by up to 85% and offers protection during oral and anal sex. Using lube makes sex smoother (because it decreases friction) and gives you added protection. Regarding your sensitivity to hygiene issues, don’t be too concerned. Anal hygiene and hygiene in general is an important factor. You are welcome to read through the anal hygiene section on the men2men website.