⚠️ Content Note: This article addresses erectile dysfunction, stigma, and mental health in gay men. Sensitive themes are discussed—please proceed with care.
Erectile dysfunction (ED)—difficulty getting or keeping an erection firm enough for sex—is common in men, and it can happen even when you’re healthy, attracted to your partner, and genuinely in the mood. The condition is rarely purely physical or psychological. In most cases, it’s multifactorial, shaped by biology, stress, relationship dynamics, self‑image, and context.
For many Black gay men, there is also a hidden, psychological culprit that is often overlooked: the pervasive impact of stigma and minority stress. This is not just everyday stress, but the chronic pressure that comes with living in a world that constantly treats you like an anomaly. This pressure can quietly follow you into the bedroom.
This article explores how internalised stigma, stress, and hypervigilance can interrupt arousal and offers pathways to rebuild safety, pleasure, and authentic connection.
The Hidden Block — Stigma.
Stigma is the unfair judgment, labelling or treatment of an individual or group as inferior because of a particular identity, trait, or experience. It is an undeserved social mark of disapproval imposed on someone who has committed no wrongdoing.
These negative messages result in shame, exclusion, or discrimination, ultimately causing harm to the person being targeted.
Internalised Stigma:
Internalised stigma occurs when the person experiencing the stigma unconsciously absorbs and accepts these negative messages about themselves as truth. This acceptance then begins to influence their life and behaviour.
Stigma and minority stress—the chronic pressure of living in a world that treats queerness as inferior and something to be shameful about — are deeply interconnected. In fact, scholars often treat stigma as the primary mechanism that generates minority stress.
Minority Stress: Why your body can’t relax during sex
The Minority Stress Model explains how sexual and gender marginalised groups experience chronic stress from both external and internal factors—such as discrimination, rejection sensitivity, concealment, and microaggressions—which accumulate over time, leading to poor health outcomes (Meyer, 2003)7.
People with multiple marginalised identities often face compounded issues due to the intersection of multiple stressors, e.g., Black gay men, where pressures of racism may intersect with homophobia to create unique troubles.
Sexual arousal greatly relies on safety, presence, and a properly regulated nervous system. When your body is stuck in “alert” mode—scanning for judgment or danger—arousal can malfunction.
This malfunctioning often shows up as:
- getting erections when alone but struggling when with a partner (situational ED),
- losing erections during condom application, position changes, or penetration,
- feeling mentally “outside your body” during sex,
- Anxiety increases under certain conditions.
Research with young men who have sex with men (16–29) found that while overall sexual functioning was high, some 13.9% reported having some difficulty with erections. In adjusted analyses, internalised stigma was found to be negatively associated with global satisfaction with one’s sex life (Li et al., 2019)4.
Internalised stigma: when the critic lives inside you
Internalised stigma (also called internalised homophobia or internalised homonegativity) happens when one assimilates (often without realising it) negative societal messages about being gay and instead of actively countering them, starts believing them.
Deep-seated internalised homophobia is consistently associated with poorer mental health outcomes in gay men, including higher rates of depression and anxiety (Newcomb & Mustanski, 2010)8.
In sexual situations, internalised stigma can show up as:
- Shame scripts: “This is wrong,” “I’m dirty,” “I’ll be judged.”
- Masculinity panic: Pressure to perform a certain version of “manhood.”
- Performance monitoring: Focusing on how you look or measure up instead of what you feel.
- Erection‑as‑worth thinking: Interpreting one “soft” moment as proof you’re inadequate—the self-judgement heightens anxiety, making the situation worse.
When erections become a test of your desirability or masculinity, anxiety spikes—and anxiety is a well‑documented disruptor of sexual response (Barlow, 1986)2.
Why gay men may feel increased performance pressure
Performance anxiety affects people of all orientations, but gay men often face community‑specific amplifiers, including:
- Hyper‑visibility and comparison:
- App and social media culture can make desirability feel measurable (through likes, comments, and follower counts).
- Role expectations (“top/bottom” as identity signals):
- When sex roles become status markers, sex can feel like a test of one’s status rather than a shared experience.
- Fear of social consequences (Reputation pressure):
- In smaller queer communities, a “bad hookup” can feel like a drop in image. Tying sexual performance to social status can lead to “spectatoring”—self-consciousness and anxiety triggered by the fear of gossip—which further impairs performance.
Qualitative research with young gay men shows sexual roles are often driven by gendered expectations and power dynamics, not just personal desire. Johns et al. (2012)3 found that this pressure can force conformity to masculine stereotypes, highlighting how social norms and stigma impact sexual behaviour, satisfaction, and authentic expression.
Breaking the cycle of pressure: evidence‑based ways to heal
If erectile dysfunction is happening repeatedly or causing distress, think whole‑system approach:
Body + Mind + Context.
1. Rule out physical and medication‑related causes
ED can be an early sign of medical issues (e.g., cardiovascular risk factors), and it can also be linked to alcohol, substances, sleep problems, depression, and many common medications. A basic check‑in with a clinician can help clarify what’s going on and reduce uncertainty (Lowy & Ramanathan, 2022)6.
2. Use ‘low‑demand’ intimacy to retrain your body
A classic sex‑therapy approach is sensate focus—structured, pressure‑free touch that shifts attention from performance to sensation and connection (Linschoten et al., 2016)5.
A simple version:
- 20 minutes of touch (non‑genital at first),
- No goal of erection or penetration,
- The win is staying present.
3. Work with an LGBTQ+‑affirming therapist
Therapy can target:
- internalised stigma and shame,
- anxiety loops and sexual self‑monitoring,
- communication and consent confidence,
- trauma (if relevant).
Evidence shows that psychological interventions—especially when paired with medical treatment when appropriate—can improve outcomes for psychogenic ED (Atallah et al., 2021)1.
4. Redefine what ‘sex’ means
When “real sex” equals “hard penis + penetration,” anxiety has more power. Broadening your definition of intimacy—oral, hands, toys, kink, sensual touch—reduces pressure and often makes erections more likely to make a natural return.
5. Build shame‑resistant community
Minority stress is social. Healing is often social, too. Moving away from hyper-sexualised, performance-competing spaces to find supportive, positive-minded queer community spaces focusing on honest conversations and shared vulnerabilities can reduce isolation and anxiety, which helps normalise fluctuations in sexual functioning (Meyer, 2003)7.
The bottom line
For Black gay men, erectile difficulties can be a body signal—not of failure, but of stress, shame, pressure, and hypervigilance finally showing up where you can’t “logic” your way out of it. When you address minority stress, internalised stigma, and performance pressure alongside any physical factors that may be present, ED becomes treatable—and intimacy becomes easier, softer, and more satisfying.
References
- Atallah, S., Haydar, A., Jabbour, T., Kfoury, P., & Sader, G. (2021). The effectiveness of psychological interventions alone, or in combination with phosphodiesterase‑5 inhibitors, for the treatment of erectile dysfunction: A systematic review. Arab Journal of Urology, 19(3), 310–322.
https://doi.org/10.1080/2090598X.2021.1926763 - Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. https://doi.org/10.1037/0022-006X.54.2.140
- Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). “Butch tops and femme bottoms”?: Sexual roles, sexual decision‑making, and ideas of gender among young gay men. American Journal of Men’s Health, 6(6), 505–518. https://doi.org/10.1177/1557988312455214
- Li, D. H., Remble, T. A., Macapagal, K., & Mustanski, B. (2019). Stigma on the streets, dissatisfaction in the sheets: Is minority stress associated with decreased sexual functioning among young men who have sex with men? The Journal of Sexual Medicine, 16(2), 267–277. https://doi.org/10.1016/j.jsxm.2018.12.010
- Linschoten, M. G., Weiner, L., & Avery‑Clark, C. (2016). Sensate focus: A critical literature review. Sexual and Relationship Therapy, 31(2), 230–247. https://doi.org/10.1080/14681994.2015.1127909
- Lowy, M., & Ramanathan, V. (2022). Erectile dysfunction: Causes, assessment and management options. Australian Prescriber, 45(5), 159–161. https://doi.org/10.18773/austprescr.2022.051
- Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674
- Newcomb, M. E., & Mustanski, B. (2010). Internalised homophobia and internalising mental health problems: A meta‑analytic review. Clinical Psychology Review, 30(8), 1019–1029. https://doi.org/10.1016/j.cpr.2010.07.003
