Is it psychogenic ED if my boyfriend can get hard and climax through masturbation and oral sex?

Based on the information you have provided you are correct in assuming that there may be a psychological component to your boyfriend's difficulties. You have established that he can achieve an erection and reach orgasm through other means of stimulation. His difficulties during intercourse with you may be related to the differences in stimulation he experiences during penetration or may reflect some emotional issues (for example, anxiety) he experiences during intercourse.

Honest communication with him about your wish to improve this aspect of your sex life is essential. Doing this without blaming will be very important. You may want to identify a therapist familiar with addressing sexual performance issues and then volunteer to make an appt. for the two of you. If he is initially reluctant to go it may be helpful for you to see the therapist yourself for some guidance in this matter.

Rick Wirtz

 There is a significant difference between the amount of stimulation to the penis with oral sex or masturbation and intercourse. Think about it: with oral sex you are directly grasping the penis (head and shaft) with strong, moveable muscle groups including the lips, tongue, jaw, and even gently with the teeth. You are sucking and licking, etc. etc. so these actions cause very direct stimulation. Also with masturbation (by one's self or partner) the penis is being grabbed and stroked with finger and hand muscles (also including pressure from the bone structures in the hand/fingers). Obviously, this also provides very direct stimulation to the various areas of the penis. Both oral and "hand" sex do NOT require the penis to be hard initially, but usually are more easily able to provide enough stimulation for men with mild or even moderate ED to achieve an erection, or at least enough of an erection for a short period of time to "feel" successful and to arrive at ejeaculation.

 With intercourse, however, the stimulation of the penis first REQUIRES the penis to be erect in order to initiate intercourse. Also, whether the woman's vaginal muscles are tight or not, there simply is NOT the same type of intense, direct stimulation to the penis. This is especially true if the penis is not fully erect to begin with, or if the penis loses its firmness after a minute or so. As the penis is the "active agent" in intercourse, whereas in both oral sex and masturbation the penis really RECEIVES the stimulation rather than having to provide the firmness necessary for stimulation, it is totally logical that a man can have a good experience with oral or manual sex, but not be able to initiate or complete intercourse.

 It is VERY EASY for the woman to feel it is HER fault when intercourse fails, when in fact it is NOT. It is not really ANYBODY's FAULT; it just is a fact in that couple's life.

 It can be very difficult for a guy to talk about his inability to have intercourse, especially if he feels like oral sex and hand sex go OK for him. That only reinforces his sense of NOT having to deal with it. The woman can often believe that she is not attractive, or that he would just rather have oral/hand sex and forget about her needs/desires, but the worst part of it is that the man really does NOT feel OK about his lack of ability to have intercourse and usually shows it in other ways: passive-aggressive behavior, picking fights about other things (money, job stress, family issues, etc.) in order to avoid intimacy.

 If he has tried something like Viagra or Cialis and it did not work well or had side effects from it, he needs to go back to the doctor and visit about it more thoroughly. The doctor should understand that oral sex and hand sex provide a different type of stimulation and that it is still possible to find the right medication or the right dosage (sometimes it takes several different tries with a medication) for things to work. There are other alternatives, such as vacuum pumps and surgical implants, but if a guy is able to get hard with oral or hand sex, he probably does NOT need such extreme measures as surgery to be able to have an erection strong enough for intercourse.

 There is also a possible benefit to meeting with a relationship counselor for 4 - 6 appts to have a chance to resolve the communication issues that are probably also involved for both partners in a situation like this. Counseling alone, however, will not relieve the erectile dysfunction issue. Sometimes it takes going to a counselor first, though, to get the man to be able to hear how much the woman can be hurt by the lack of intercourse, and his responses to his inability to have intercourse.

 Hope this helps somebody.