Sadly, indeed. I would imagine that if forced to choose between a reliable erection and a fully functioning heart, the heart wins out. So, it sounds like you’re both doing the best you can with the physical realities of the situation.

I recently wrote about rethinking positioning ever-hard-erections at the center of all sexual interactions in November 11th’s column “How To Have An Erectionless Sex Life” in which I give concrete advice about what a joyfully erectionless sex life might look like. Give it a read!

Cultivating creative sex lives that don’t revolve around an always bangin’ boner is certainly one thing to do. In fact, I think all couples would be having more satisfying and longer-lasting sex lives if they were able to embrace this wider perspective of sex.

It’s also very real that when our bodies don’t show up for us in the way we want them to, it can easily create a negative feedback loop where feeling undesirable and failing to feel desire blur together. I don’t doubt that your boyfriend’s heart medication negatively affects his physical erection abilities. And I can also imagine that having a sex life previously defined by your hard-on now being defined by your how hard it is to get a hard-on is disappointing, frustrating, and depressing, just to name a few resulting, and, unhelpfully boner-killing emotions that he might be feeling.

And then, in the spirit of de-centering The Boner — what about you?? Like you’ve said, you would also like to get laid and not just when a lapse in heart health medication allows for it. Your challenge here, Sexless, will be this: you cannot fix his E.D. nor can you fix his feelings about his E.D. You can support him in coping with this, yes, but you cannot fix it by not talking about it. Avoidance is rarely an effective solution though so many (hello, myself included) would love to think it is.

You can either talk about the E.D. and how it affects your sex life or you can avoid poking his resulting sexual self-esteem but, you can’t do both. I would opt for the first option and, in doing so, push yourself to become more comfortable with his discomfort. Talk about the discomfort, empathize with his feelings, but don’t preserve them by refusing to look them in the eye.

Instead, write a concrete list of what “rejuvenating our intimacy” might look like to you. This will help you be clear about what you’re asking for and will help him succeed in fulfilling some or all of your requests because he’ll know specifically what you’re looking for. Reiterate your de-prioritization of his erection without sweeping his feelings about it under the rug. For more advanced help in undoing the intimacy-killing cycle that can evolve out of E.D., hire a couples therapist if you can.

Yana Tallon-Hicks is a relationship therapist, sex educator, and writer living in the Pioneer Valley. You can find her work and her professional contact information on her website, yanatallonhicks.com.