Erectile Dysfunction or ED is the inability to achieve or sustain an erection suitable for sexual intercourse. Problems with erections may stem from medications, chronic illnesses, poor blood flow to the penis, drinking too much alcohol, or being too tired.
Erectile Dysfunction and the woman suffering from vaginismus
For the vaginismus patient, the thought of transitioning from dilator therapy to intercourse is a frightening thought. Therefore, the last thing a woman with lifelong vaginismus wants is to see is her husband or partner with a strong erection. Nevertheless, this is needed to penetrate residual tightness of the vaginal muscles. A weak erection generally sets the stage for first time failure to achieve intercourse. It would be natural for a woman to blame herself, but actually in these circumstances the burden falls on the male.
Erectile dysfunction affects an estimated 18 million men in the U.S.
In my practice, about 20-25% of the male partners have erectile dysfunction and need to take Viagra or Cialis in the early stages of intercourse. It is my opinion that the years of dealing with vaginismus and the thought of hurting the woman they love during intercourse, has created a situation where the men are suffering to some degree of erectile dysfunction.
Some simple male considerations helpful in understanding erectile dysfunction
In order for a man to feel virile and to be able to maintain a strong erection, he may need to take the lead and be in control, which is sometimes a problem because the woman with vaginismus also feels the need to be in control. The male 
may be the one that needs to set a romantic stage. When the time is right, most men understand that they need to penetrate slowly to help stretch the vaginal muscles. The man needs to be in a comfortable position and it is for this reason that men will often turn their partner into a position that is comfortable for them. Sometimes men will turn their partner frequently into different positions, which may help him with greater arousal and ability to function. When the man strains, because a position is not comfortable for him, it is a setup for loss of the strong erection and he may become soft. Once a male becomes soft it is often hard to get back into the erectile state. “You can’t will a hard on” as the saying goes. Once flaccid, the game is over for most. The loss of an erection can be a problem with the next attempt, because now the man has lost confidence. This creates a bad cycle for the man.
Balancing the needs of the man and woman when transitioning to intercourse
When dealing with the traumas of vaginismus and transitioning to intercourse, careful attention to balancing the needs of each partner will help couples to positively transition to a healthy sex life. It is important to remember the needs of the man to reduce “performance pressure” and the needs of the woman to “practice intercourse”. This is so important to be able to fully overcome vaginismus.
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