The dating partner is on the way, or a sex party beckons. Now it depends: The main thing is that „he“ stands, whether out of pure lust or with sexual enhancers. But do you really need Viagra, Tadalafil or other sexual enhancers to have good sex?[1] to have an erection? Hannes Ulrich, sex therapist at Charité Berlin, explains in an interview with Jörn Valldorf why an erection is much more than just a stiff penis. How stress and pressure to perform can kill desire, and why it is sometimes more important to tame the lions in your head rather than treat the symptoms. A conversation about sexuality, self-optimisation and intimacy.
Why more and more men are using Viagra and other sexual enhancers
JV: Studies show that quite a few young men nowadays turn to sexual enhancers.[2] such as Viagra, Tadalafil or Sildenafil. What is behind this?
HU: These drugs are actually widely used. They are easy to obtain - via the internet, sometimes also from a trusted dealer. And they are also often readily prescribed in medical practices to ensure „functioning“ erections. You get the impression that if you are not permanently ready and have a stiff penis, you are not functioning sexually. But of course it's not that simple.
How an erection develops and what role Viagra plays
JV: How does an erection actually work?
HU: Many people think that sexual arousal means that your pulse increases, your blood pressure rises and you get excited. Sounds logical, doesn't it? Surprisingly, this is almost the opposite of what an erection needs. The penis has so-called erectile tissue, which is largely made up of blood vessels. In order for it to become erect, the arterial vessels must be wide open so that blood can flow in and the veins must be closed at the same time so that it doesn't flow back out - a natural cock ring, so to speak.
JV: So it's actually a pretty clever system.
HU: Exactly! The whole thing is controlled by the autonomic nervous system - the part of our body that runs automatically without us having to think. There is the sympathetic nervous system, which activates us, and the parasympathetic nervous system, which keeps us calm. Surprisingly, it is precisely the parasympathetic nervous system that has to be active for an erection to occur - hence also during sleep, which explains the well-known morning wood.
Why stress and pressure to perform trigger erection problems despite Viagra
JV: But then I ask myself: when I'm aroused, everything should be „activated“. Why doesn't that go together?
HU: That's exactly the point! When the sympathetic nervous system is active - i.e. during stress, anxiety or pressure - it contracts the blood vessels. The enzyme PDE-5 is released, which prevents an erection. In evolutionary terms, this makes sense: if a lion suddenly appeared in front of you, you wouldn't need an erection, you would need to be ready to flee.
JV: Okay, but most of the time there's no lion in front of us...
HU: That's right, luckily! But there are often little lions lurking in our heads: pressure to perform, fear of failure, worries about appearance, thoughts like „my penis is too small“. These inner lions trigger the same reaction. The sympathetic nervous system takes over, the erection disappears - and we feel like sexual failures, even though our body is actually doing exactly what it should.
Why Viagra and sexual enhancers are not a long-term solution
JV: And this is exactly where PDE-5 inhibitors in sexual enhancers come into play, isn't it?
HU: Exactly. They inhibit PDE-5, the blood vessels remain open - the penis can become erect. But the medication doesn't just work there, it also affects the whole body. Heart palpitations, red head - a whole bouquet of possible side effects[3]. Medication is therefore more of a crutch. They treat the symptoms, not the cause.
JV: What would be the more sustainable solution?
HU: Taming the lion in your head. If we create relaxed situations in which we can let go, the sympathetic nervous system doesn't have to kick in and the erection happens almost by itself. It is important that we realise this: What thoughts, beliefs and inner demands are putting me under pressure? How can I, my partner or myself help to make the encounter more relaxed?
JV: Sounds like it's about much more than just the penis.
HU: Exactly. PDE-5 drugs can help, but the real question is: Is sex about encounter or performance? Function or pleasure? Sex shouldn't just be a test of our masculinity, but an opportunity to experience closeness, intimacy and fun. If you reflect on this, you can sometimes save yourself the pill - and get much more out of the experience.
JV: To summarise: We should recognise the lions in our heads, relax, reflect - and then it will work without pills.
HU: Absolutely. And if a little support is needed, that's okay. But the pill is no substitute for what really matters: clearing your head and enjoying the encounter.
Sexual enhancers should never be used in combination with poppers.
https://www.drugscouts.de/lexikon/poppers
„Erectile dysfunction (also commonly referred to as impotence) is the inability to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse. If these problems last longer than six months, doctors assume that the patient is ill. In this case, you should consult your family doctor or a urologist. Recurrent erection problems can be a sign of a serious illness or psychological problems.“ (https://www.aok.de/pk/magazin/familie/liebe-sexualitaet/erektionsstoerung-was-ihnen-jetzt-hilft/)
[1] Link here to Hannes„ article “What is actually sex"
[2] https://www.aok.de/pk/magazin/familie/liebe-sexualitaet/erektionsstoerung-was-ihnen-jetzt-hilft/
[3] „Erectile dysfunction (also commonly referred to as impotence) is the inability to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse. If these problems last longer than six months, doctors assume that the patient is ill. In this case, you should consult your family doctor or a urologist. Recurrent erection problems can be a sign of a serious illness or psychological problems.“ (https://www.aok.de/pk/magazin/familie/liebe-sexualitaet/erektionsstoerung-was-ihnen-jetzt-hilft/)
More from Hannes Ulrich: The psychology behind lust
Once we have clarified why the body sometimes goes on strike, our author asks the all-important question: What is „sex“? Hannes Ulrich sheds light on the psychological constructs and clinical experiences that characterise our sexuality. A must-read for anyone who not only wants to function, but also wants to understand.
FAQ about sexual enhancers & desire
Here you will find the most important answers about erections, the use of sexual enhancers and the question of how the mind and body interact during sex.
Often there is no physical problem behind it, but pure Pressure to perform. Dating apps and porn create the feeling of having to „function“ sexually all the time. The pill then serves as supposed security to fulfil one's own (or other people's) demands.
Potency drugs such as Viagra or Cialis are so-called PDE-5 inhibitors. They block the enzyme that causes the penis to relax. As a result, the blood vessels remain wide open and the blood is „locked“ in the erectile tissue - just like a natural cock ring.
Because biology is working against you. When you are under extreme stress or afraid of failing, your body releases adrenaline (the Sympathetic nervous system becomes active). This „escape mode“ contracts the blood vessels in order to channel the blood into the muscles. Even the strongest pill is often unable to counteract this.
Yes, absolutely life-threatening! Both substances dilate the blood vessels extremely strongly. If they are combined, blood pressure can drop so dramatically that it can lead to heart failure or a stroke. If you take sexual enhancers, poppers are taboo.
Hannes Ulrich describes them as „Crutch“. They may help you in the moment, but they don't cure the cause - especially if it's psychological. In the long term, it is more effective to tame the „lion in your head“ (anxiety, pressure) rather than just treating the symptom.
If the problems persist over a period of more than six months occur regularly, this is medically referred to as erectile dysfunction. In this case, you should consult a urologist or GP to rule out organic causes or serious pre-existing conditions.
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