Forget Big Dick Energy. We're in the Era of Big Dick Injury

Erectile dysfunction is rife, testosterone levels are falling, sperm is weaker than ever and meds are making matters worse.
A bruised banana on a hospital stretcher
Illustration: Cathryn Virginia

When it comes down to it, there’s something inherently funny about The Penis. We compare it to sausages, snakes and sea creatures; it can do The Helicopter; it’s a disconcertingly disembodied, semi-detached part of the body; it can stand to attention and turn a duvet into a tent; it pisses and jizzes; it can be comically large or small. Sure, it can be sexy. But, boy, can it be diabolically unsexy too, a gawky, garish, gangly, gauche gherkin of a thing.


And the penis, when it comes to pop culture, is on the up. Over the last couple of years, the cock has popped up everywhere. For decades, we barely got a glance at the glans on TV, but thanks to the likes of Euphoria, Pam and Tommy, Normal People, White Lotus and Succession, penises have been put on screen for our viewing pleasure. Fashion, too, has gone full prick-up-artist thanks to penis-themed pieces from fashion designers like JW Anderson and Rick Owens. Five years since Kyrell Grant’s neologism first went viral, we’re still feeling Big Dick Energy.

Here’s the thing, though: when it comes to public health, we’re living in the time of Big Dick Injury. While the penis might be solid in terms of pop culture, it’s never seemed so physically fragile IRL. A concoction of cock issues – erectile dysfunction, poor sperm count, low testosterone, snapped penises, genital numbness and STIs – are all on the rise. Seen together, it’s a full on crisis, and while it  might seem easy to laugh it all off, it’s genuinely really, really sad for all those suffering. 

International Andrology, a chain of men’s sexual health clinics that treat 3,000 men a year, have noted a rise in total cases. “In general, there is an upward trend across all the issues that we treat,” says Marinos Alexandrou, the director. Worryingly, too, patients are getting younger. “We have also seen the average age of people seeking help coming down,” he confirms.


Of course, many of these sexual health conditions are obviously not unique to those with penises (and many of us also swerve worse ailments). Those with vulvas face poorer healthcare, a pandemic of sexism and a giant lacuna in vagina academia. Gynaecological conditions such as endometriosis are often dismissed, leading to a half-a-million-strong waiting list on the NHS. On the whole, people with penises have it easier.

Perhaps though, people talk about the penis less, and in a less serious way. “In my opinion, men generally do not talk about their health in general and especially genital health. Many of the men I see have been suffering in silence for many years and were embarrassed even to seek help from the health system,” says Amr Raheem, consultant andrologist at International Andrology London. 

Let’s start with erections. People are finding it hard to get hard. For decades, Erectile Dysfunction (ED) was almost solely discussed in terms of geriatrics popping Viagra; now, though, the issue has become understood as something far more widespread. One report from the Co-Op Pharmacy, at the highest end of the spectrum, suggests that as many as 50 percent of men in their thirties suffer from erectile issues, with 33 percent of these keeping the issue to themselves and only 9 percent ending up speaking to another man in their family. 

Angus Barge, co-founder of men’s sexual wellbeing company Mojo, bucked this trend. He started the app with his cousin Xander after they both spoke about their issues with ED. “When I was 27, completely out of the blue I started having erection issues and I couldn’t get it up,” he tells VICE. “My whole life crumbled. I didn't just withdraw from dating – I'm a big extrovert and gained lots of energy from going out – but I withdrew from my social life too.” Galvanised by the statistic that 85 percent of ED cases among men under 40 are psychological, Mojo draws on the expertise of psychosexual therapists and doctors to offer video courses, exercises and a community of 100,000 fellow fellas. 


ED, though, isn’t the only example of our dicks being dicky. Our sperm strength, too, has never been limper; the amount of swimmers in our semen has fallen by more than half in the last 40 years. “I think this is another signal that something is wrong with the globe and that we need to do something about it,” Hagai Levine, author of a 2022 report on the decline of semen quality, wrote, warning that it could be a major moment in the history of male fertility and cause an irreversible crisis. 

Plus, while Toblerones might be swelling in size, testosterone is as low as it’s ever been recorded, dropping by 1 percent every single year across the globe and contributing to reduced sex drive. According to brand spanking new research from men’s healthcare platform Numan, around two million men in the UK are impacted and 44 percent of us have low awareness of its symptoms. 

Plus, for those of us with penises who are still having sex, it’s also more likely than ever that they’re infected: STIs have gone wild in the UK in the last two years, with gonorrhoea diagnoses the highest on record. Or, broken: While only 46 fractured members were treated by the NHS in 2020, a heftier 169 (ahem!) were reported in 2021.

Many facing these issues are turning to a silver bullet: medication. This includes Cialis and Viagra, which work, in simple terms, by inhibiting the PDE5 enzyme to increase vasodilation and pump your penis full of plasma. It’s seen by many as a rock-solid solution for ED; it is proven to help those with penises achieve higher-grade erections, and anyone who has popped one or two can likely testify to its superhuman effects. Since it became an over-the-counter drug in 2018, sales of Viagra have sky-rocketed to artery-popping levels; Viagra Connect sold seven million tablets in the UK between 2020 and 2021, and 60 percent of buyers were under the age of 55.


There is, though, a literal counterargument, one that’s equally firm. While Viagra might be a short-term fix, it doesn’t actually grasp the issue at hand. “It makes zero difference if you have performance anxiety,” Barges explains, because the fight-or-flight state you’re in means all your blood goes to the brain and skeletal muscles anyway. If it does work, often due to placebo, it can become a crutch for your crotch. “Next time you're like, I need my Viagra, and suddenly you're hooked. It doesn't have a chemical hook like an opioid, but there is a risk of psychological dependence,” Barge says. 

The side effects, too, can be troubling; common knock-on symptoms include dizziness, headache and hot flushes. “Those looking to use Sildenafil (Viagra) should always seek advice from a trusted medical provider beforehand, as there are risks associated,” Luke Pratsides, lead GP at Numan, advises, warning that it can lead to lower blood pressure and make someone more susceptible to collapse. Even if severe side effects are rare, it isn’t a penis panacea. 

It’s not just Viagra: A whole host of other chemical cures are being proffered to anxious penis-wielders. Forums online are awash with possible treatments for ED, low T and decreased libido. “Lots of guys say they're into a particular root or have found this animal extract, and there's part of me that's like, Placebo is a really powerful thing,” Barge says. While he concedes that there’s no point “bursting the bubble” for those experiencing success with certain meds, they still don’t deal with the actual problem, often causing full-on obsession and other offshoot ailments.

Posts on Reddit read like a witch’s Holland and Barrett shopping list; remedies include zinc, magnesium, cyclodextrin, longjack, kegel exercises, herbs, redwood, nitric oxide, ashwagandha, maca root, beetroot juice and – yes – Vitamin D, trialled by desperate men turning themselves into guinea pigs at the expense of their health and wallets. The level of dysphoria is dystopian.

But why is Big Dick Injury a thing right now? There is, of course, no single factor in all this discourse, but one is often bookmarked and kept tabs on: Porn. “The availability of pornography is a problem,” Pratsides says. “Porn can give people a heightened, fantasised depiction of sex that is extremely arousing. Having this unrealistic expectation can make it much harder for people to get an erection in real life.” It’s such an issue, that there’s now a term for it, PIED (Porn Induced Erectile Dysfunction) — while it’s still a hot topic for debate, one 2015 study found 71 percent of heavy porn users experienced some kind of dysfunction.


Porn is also likely a factor in cosmetic surgery's rise; Raheem says it’s an all-time-high in his 20-year career. On the subject of upwards curves, International Andrology offers treatment for bent penises; plus the increasingly popular penile enhancement and the more niche scrotoplasty (basically, making your balls look nicer).

Regarding low T and sperm count, lifestyle changes might be to blame. “Men's health issues are increasing due to poor diet, lack of exercise, chronic stress, lack of sleep, smoking and drug addictions,” Raheem says, adding that an ageing, sexually active population leads to more issues. Diet is key; Pratsides notes that “sugar has a damaging effect on blood vessels” and diabetes also can lead to ED and low T. When it comes to weaker sperm, theories are more diverse; Pratsides cites a belief that microplastics might be to blame, something many recent reports have concluded.

Mentally, too, we live in an age of unprecedented stress and stimulation, making matters worse. “Millennials and Gen Z are the most anxious human beings ever to have walked the planet,” Barge says clinically. “And it's not only the way that we watch porn and masturbate. It's changed how we date, meet people, live, work, communicate. All of it has changed,” he continues.


Perhaps the most nefarious cause, though, is the one that we’ve just explored as a fix: medicine. Over 8 million people in the UK are currently on antidepressants, an increase of 35 percent in just six years. For many, sexual side effects are part of the script; for decades, pharmaceutical companies have tried to cover up the huge risk of sexual dysfunction caused by SSRIs (SSD), but increased awareness has led to reports that around 50 percent of those on antidepressants could face issues. There’s a whole smorgasbord of ruined orgasms on offer: anorgasmia, ED, penile anaesthesia and delayed ejaculation. (Delayed ejaculation is such a common side-effect that people who suffer from premature ejaculation often get prescribed SSRIs to treat this one issue.)

Scarier still is the spectre of PSSD (Post SSRI Sexual Dysfunction), a disorder that sees those on SSRIs experience sexual side effects even after they’ve stopped taking the pills, often more severe than in the first place. It’s defined as suffering persistent genital numbness for more than three months after ceasing SSRIs, but it also can cause many other symptoms, including a loss of libido, anorgasmia, erectile dysfunction and emotional numbing.

Thanks to academics, including psychiatrist David Healy, a recent documentary from Panorama and the work of the PSSD Network, more is finally being done. “The fact is that PSSD has been reported for 30 years. Why did we not know about it? Why would we not want to know about it?” says Luke, head of the UK PSSD Association and a representative of the PSSD Network, who provide a summary of the condition. (His name has been changed to protect his privacy.)

Luke’s own story is harrowing; since stopping SSRIs, he’s suffered from PSSD and also experiences severe anhedonia, finding it difficult to experience happiness, excitement or even love. “A lot of people with PSSD describe it as like the kind of connection between your brain and your genitals is gone,” Luke explains. I can emphasise with him; while I’m still on my SSRIs, I experience similar side effects, often feeling like I’m permanently wearing a pack of extra-safe condoms. The stories shared on the site are genuinely heartbreaking; people liken it to chemical castration, irreversible impotence and being robbed of their humanity entirely. 

Other pills can cause similar effects. Finasteride, a hair-loss treatment that slows down the process of testosterone turning into dihydrotestosterone, has been linked to low sex drive and delayed ejaculation (known as PFS). “In very rare cases, Finasteride can also have an impact on libido and sexual dysfunction,” Pratsides says, but adds that “stopping treatment will cause issues of sexual dysfunction to go away within 10 to 14 days”. The acne medication Accutane, as Luke points out, has also been linked to erectile dysfunction and sexual numbness (surprise, surprise, that’s PAS). There’s something even crueller about the fact that all these meds are taken in the first place due to anxiety and insecurity but, ultimately, can put us even more on edge when it comes to sex.

Basically, Big Pharma is making big bucks from our Big Dick Injury. It’s an endless loop of sexual dysfunction, where the treatment may give birth to a new cause. Luke likens seeking help to a game of Russian roulette. “You go to a doctor and often you're told you're depressed or making it up. You end up with people attempting to treat themselves with drugs, supplements and research chemicals, all kinds of crazy stuff. It's really terrible,” he says.

Hope, though, spunks eternal. Big Dick Injury might actually partly point to something more optimistic: that we’re discussing penile health more. Perhaps it’s only natural that the more conversation and awareness opens up, the more people report their own cases, leading to a sense that the issue has increased when really it’s been latent all along. “A lot more men are talking about their penis health. The rise in digital healthcare and online consultations is driving this shift,” says Pratsides. “Digital healthcare platforms (like Numan) are motivating men to take control of their health and treat undeserved, stigmatised conditions.” 

The real acid test may be how we speak about dicks, not just how often. The jury’s still very much out and deliberating on whether humour, for example, is useful. Numan is quite happy slapping chicken heads labelled with “Pecker” on billboards across the UK to promote ED medication, which has undoubtedly sparked conversation. Others, though, are less sure. “I don't think a load of aubergine emojis is going to make me feel good about an issue which is life-shattering,” Barge says. Luke is also adamant that humour can stunt true progress. 

Perhaps, the penis simply isn’t as funny as I thought it was. For years, I’ve been making jokes about my own delayed orgasm, about finding it easier to finish Crime and Punishment than finish in bed. But while humour might be an important entry point into the conversation and break stigmas – and, don’t worry, there’s nothing wrong with a hen-do cock straw – being at least a little bit more serious about the penis could prove helpful, a seminal moment in healing our Big Dick Injury.