Gay men suffer from erectile dysfunction significantly more than straight men. A lot more. While ED is often studied in heterosexual contexts, emerging studies over the past decade have started to highlight how it manifests among queer men, and how much more prevalent it can be.
A 2014 study in the Journal of Sexual Medicine found that gay men are nearly twice as likely to experience erectile dysfunction than their heterosexual counterparts. Among those studied, 12.1% of gay men reported ED compared to 6.4% of heterosexual men.
This same study noted that gay men in relationships were likelier to report ED than single men, which is the opposite typically seen in heterosexual men. Researchers theorized this could be due to greater sexual monotony in long-term gay relationships and higher expectations for frequent and freakier sex.
But let’s theorize further. It’s probably not that surprising, but these reasons can’t be narrowed down to our penises. Our culture is to blame as well. From role-based pressure to body image, to the constant pursuit of hot, hard, and always-ready sex, the expectations we absorb can really mess with us. So let’s break it down.
Erectile Dysfunction Medication
When chatting with folks who confessed to experiencing ED, a trend was quickly evident: Most use medication like Cialis and Viagra as an added assurance that they’ll remain stiff enough for long enough during a sexual encounter.
This 2017 review all but confirms that recreational use of erectile dysfunction medications is significantly more prevalent among gay and bisexual men. Similarly, a San Francisco study reported that 32% of gay and bisexual men (primarily 18–39 years old) had used Viagra in the past year, and this London study found that 83% of gay men who use ED meds do so recreationally and without a prescription.
Erectile dysfunction has long been framed as an “older man’s issue,” but for many gay and bisexual men, that narrative simply doesn’t hold. The numbers don’t lie: a significant portion of those using ED meds are under 40, often navigating performance anxiety, body image pressures, and the sexual expectations that run deep in queer culture.
One man I spoke to, Ethan, 32, told me he uses ED medication “about 80 percent of the time” he has sex. “It’s not that I can’t get hard,” he explained, “it’s that I’m so in my head about performing that I don’t trust my body to just do it on its own.”
Another man, Kevin, 29, put it even more bluntly: “Everyone’s ripped and has a drawer full of toys. If you can’t deliver porn-star sex, you’re going to get ghosted.”
Whether it’s for confidence, consistency, or coping with a hypersexualized environment, younger men are turning to these medications more than we tend to acknowledge. It’s time we stop treating ED as a symptom of aging and start recognizing it as a reflection of the unique pressures queer men face—at every age.
Tops And Bottoms Can Experience Erectile Dysfunction
Unlike many heterosexual encounters, where penetrative sex is typically assumed to follow a certain script, gay sex is less rigid, and with that flexibility comes role-based pressure.
“Most gay men say that they’re ashamed, fearful, and confused when experiencing erectile dysfunction,” Craig Cassey, sex coach and relationship researcher, says. “The last thing they want is to let their partner(s) down by not getting or staying hard, and often fear the social or romantic repercussions of not being able to perform with new partners.”
Tops are expected to get hard and stay hard as if their cocks are machines, whereas bottoms are expected to be relaxed, prepped, and cleaner than a surgical table. Bottoms also feel pressure to be erect during penetration, which can be difficult, and not typically a sign that they aren’t enjoying themselves. This pressure can take pleasure away from the experience and turn it into more of a performance, which can, of course, impact your erection.
“I feel like being a bottom comes with its own kind of performance anxiety,” said Marcus, 34. “If I lose my erection, I start wondering if my partner thinks I’m not into it, or if I’m not ‘doing it right.’ It’s exhausting.”
From what Cassey sees with his clients, erectile dysfunction usually boils down to four big culprits:
1. Stress and medication: Stress and anxiety levels in general are so high that they can impede one’s ability to get or stay hard, or the medications they’re taking to assist their mental health (such as antidepressants) are impacting their ability to get or maintain an erection
2. Unrealistic expectations: They place a lot of pressure on themselves to perform to an unrealistically high level in bed all the time and that pressure, with its accompanying fear of rejection, limits the ability to get or stay hard.
3. Diet and dehydration: Poor nutrition, dehydration, and lack of sleep can mess with blood flow, energy levels, and hormone balance—all key players in getting and staying hard.
4. Pelvic floor issues: The pelvic floor muscles help control blood flow to the penis and support erections—if they’re too tight, too weak, or uncoordinated, things can quite literally get blocked or cut short.
How To Fix It
When Cassey works with clients struggling with ED, the first thing he looks for is where the roadblock actually is. “Is it between their ears, their legs, or both? It’s usually both,” he says. In other words, if your brain’s checked out, your blood flow probably is too.
One key step is helping clients reconnect with their bodies during sex. “Uncovering what pleasurable practices a client enjoys that help them get back into their body while playing with a partner is especially helpful,” Cassey explains. “Simply incorporating more kissing, massaging, or mutual masturbation can go a long way in helping a person’s body relax and get turned on sufficiently.”
He also encourages clients to broaden their definition of sex itself. When partners talk openly about what feels good—and when penetration isn’t the only goal—there’s a lot less pressure to stay rock hard the entire time. Ironically, that lowered pressure often makes it easier to maintain arousal.
For anyone also experiencing groin or pelvic pain, trouble ejaculating, or difficulty peeing, Cassey recommends seeing a pelvic floor therapist.
And when it comes to progress, patience is key. “Working back from ED is less like flipping a light switch and more like physical therapy,” he says. “Learning what turns you on and putting it into practice can feel awkward at first, but the more you do it, the easier it becomes for your body to relax into excitement—and to return to the sex life you want.”
The truth is, ED is more common—and more complex—than we often acknowledge, especially in queer scenarios where performance pressure runs high. ED doesn’t have to define your sex life—or your self-worth. With patience, the right support, and a little less pressure to perform, you can start to rebuild pleasure, connection, and confidence.
If you’ve struggled with ED, you’re not broken. You’re not alone. You’re a product of a system that often confuses pleasure with proof. But there’s nothing wrong with needing a break from the script. Relearning what feels good and what you want—that’s real sex. And it’s where healing starts.
