After years of being the top during unprotected, anonymous sex, I was told I was HIV+ (3 years ago). Since then, I have systematically lost my ability to sustain an erection when asked to penetrate my partner whether it be a trick or a long-term relationship. Unfortunately for me, the people I attract are bottoms who love being penetrated as much as I have grown to (now that I don't seem to have a choice) and I fear their needs may cause them to look elsewhere... not to mention the stigma of always being a bottom is killing me psychologically. Is this something any of you have heard of or dealt with before and do you have any suggestions. I'm about to loose my mind, my self-respect and possibly my relationship (whether he leaves or I get so insecure and worried that I force him to go). and YES, I have been to several therapists over the years and I guess I have bad taste in attracting one than can help. Your time, thoughts and response are GREATLY appreciated!!

You are in the company of Bob Dole and others in having a common problem for men, that is difficulty maintaining an erection, often formally called erectile dysfunction (ED).

Before I get on to talking about causes and treatments, let me make an observation. You became infected by having very risky sex in a period when you should have known the risks. I wonder whether that has something to do with your problem now - you may at some level be upset enough at yourself that it interferes with your sexual functioning. Maybe that is too much pop psych, but check out whether it could be true.

I hope you are protecting yourself and all of your partners EVERY time at this point. After 20 years of the epidemic, I don't want to see anyone else get sick.

Sexual functioning is fairly fragile. The things that disrupt it are psychological, hormonal, drug induced, circulatory, and neurologic. Men with HIV often have low testosterone levels and this should be checked. Alcohol and many recreational drugs can eventually lead to ED. Circulatory problems are often helped by Viagra (sildanefil).

You should talk to your doctor about this. Whether it is psychological, biologic, or usually, a combination, there is good treatment available. If your doctor is uncomfortable with the subject, urologists are the docs who often specialize in male sexual function. Many (but not all) are gay friendly, but get a referral for someone you can talk to.

ATP

Andrew T. Pavia, M.D.