index -  sex problems - erectile dysfunction treatment




End Your Erectile Dysfunction NOW!

Many cases of erectile dysfunction can be solved at home using the treatment methods of professional sex therapists. Click on the link below to see how you might solve your ED problems with this simple and effective treatment program!


Psychosexual problems for men

Treatment For Erectile Dysfunction (ED)


Related pages:

The treatment of erectile dysfunction tends to be very mixed up with emotional issues: a man's erection is a fundamental symbol of his masculinity and without it, he may well feel shame, anger, grief, rage and anxiety - none of which are likely to be helpful in solving the original problem of the loss of his erection.


Having stated that psychological issues are closely associated with all cases of erectile dysfunction, it is always important to see a medical doctor for a complete physical examination. This will allow you to rule out any more serious issues such as hyperlipidemia, neuropathy, hypertension and nerve damage. For example, a simple test of glans sensitivity or perineal sensitivity can indicate any abnormalities in the nervous system. As an aside, it's worthwhile recalling that up to 50% of men who are prescribed Viagra are found to have high levels of cholesterol which is, to some degree, occluding their arteries. Therefore, if you are experiencing erectile difficulties please get your cholesterol levels checked. Your erectile problems may be a warning sign of a possible heart attack.


There are many men who have been told by their doctors that treatment for erectile dysfunction due to physical causes such as high cholesterol or diabetes is impossible. And yet I have had some success with men in all categories of erectile dysfunction - and the reason, I think, is that much of modern medicine overlooks the emotional aspects of this undoubtedly traumatic condition.


There may be nothing around sex quite so subject to anxiety as a man's erection, and yet few treatments address the fear that surrounds erectile failure: specifically, the fear that once you've had one episode of erectile failure, another will inevitably follow. So it's my view that any treatment for erectile dysfunction should try to take away the pressure to get and keep an erection that all men feel during sex. (And that's true even though an erection is usually never even given a second thought; it's only when it goes away that men wonder how they could ever have taken it for granted.)


Treatment for erectile dysfunction - the background


Because of the aging population, more and more men will need help with erection issues as time goes by. It's likely that one of the major avenues of approach will be Viagra and its counterparts, which have been described on another page: using Viagra. But there are some objections to the use of Viagra - one is that it doesn't work for all men. In such cases there may be a physical problem causing the absence of a response, or there may be psychological issues at work. We'll look at this in a moment. And Viagra does not act as an aphrodisiac, a stimulant for sexual desire. Additionally, if a man's loss or failure of erection has its origin in a relationship problem, all the Viagra in the world may be of no use in making him hard again.


The fact that Viagra can produce rock-hard erections makes it all too easy to assume that the little blue pill is a magic solution for the problem of ED. However, it does nothing to address any relationship issues which may be at the root of a man's ED, nor does it produce sexual desire where there is none. In cases where deeper issues between the couple are at work, it's well worth thinking about how you feel towards your partner and reflecting on what gets you aroused in the first place. Having said that, Viagra can be very useful in many cases of ED, including those where a lack of sexual confidence, perhaps caused by a single episode of erectile failure, is at the root of a man's loss of erection, or where a man loses his erection during sex.


Sexual arousal as manifested by an erection is the product of  mental, emotional, and physical arousal. In younger men mental arousal is sufficient to produce an erection suitable for intercourse. Many men rely on fantasy to become sexually aroused, and spend a great deal of time wishing, imagining and speculating about sexual experiences, sometimes to the exclusion of a full awareness of the sexual situation that they are actually taking part in in the moment. This may not matter if a sexual fantasy is sufficient to maintain their level of arousal, and therefore their erection. However, as a man grows older his body tends to be less responsive to fantasy and thoughts of sexual activity, and more responsive to physical touch.


If an older man has not made a shift from expecting to be aroused by fantasy to being aroused by physical touch from his partner or himself, he may find that he has difficulty sustaining an erec tion during sex because he is too engaged in the processes in his head and not enough in the processes in his body. The consequence of this, naturally enough, is that his erection will become unreliable and fail just when he wants it most. If he is not aware of this process and a change in the nature of his arousal, he's likely to develop both stress and anxiety about the loss of his erection: this may or may not be remedied by Viagra.


One way of getting out of this challenging situation is to use the Sensate Focus exercises, which have the effect of bringing the partners in a sexual relationship closer together, both emotionally and physically. The pleasant, sensual feelings which result from the gentle caressing of each other's body will become associated with sexual arousal and lowered anxiety. This is because the Sensate Focus exercises encourage caressing while not allowing full intercourse; this lowers anxiety and performance pressure. A greater connectedness with your own body is achieved through focusing on what is happening in your body in that moment; you're not thinking about needing to satisfy your partner or spending time focusing on sexual fantasy. Sensate focus also helps to reduce anxiety about loss of your erection because the whole process is soothing to the physical body and calming to the mind. This allows you to have an intimate connection with your partner without the need for an erection.


None of this means that sexual fantasy is wrong! Far from it. Many people rely on fantasy a great deal to add excitement to their sex lives, and to provide the motivation to be sexual. The problem is that when sexual  fantasy becomes your sole source of sexual arousal, to the exclusion of everything else, you're setting yourself up for erectile failure in a big way. And nowhere is that more true than in a relationship where a man is in fact not attracted to his partner, but is relying on the fantasy in his head to sustain his sexual arousal during sex. In addition, any distraction from the fantasy -- such as worrying about whether your erection is going to disappear -- can immediately cause the loss of your erection because your level of physical arousal is not high enough to maintain your sexual excitement.

How does this fit in with the treatment for erectile dysfunction?


It's certainly true that some men have a problem accepting touch from their sexual partner. Somehow, the touchy-feely image of people caressing each other during sex seems very feminine to some men. The reality is that touching is an essential part of emotional, physical, and even spiritual health for both sexes. Sensate focus is a methodology of treatment that allows a man to get back in touch with his body and experience its capacity for sexual arousal to the full. It is the primary treatment of choice, perhaps in combination with masturbation and Viagra, for most men suffering from psychologically caused erectile dysfunction.


It is also possible to use the spirit of the sensate focus exercises to guide sexual exploration and healing on your own. Instead of working with a partner this would mean taking time for masturbation as a mindful exercise, and then focusing on your body rather than on your fantasies so you become more attuned to your own sexual sensations and develop an embodied sense of your sexual arousal.


It is important to consider any relationship issues which need to be resolved; it's probably true that in cases where Viagra fails to produce an improvement in erectile capacity there are significant relationship issues to be dealt with. From our experience this is often true even when a medical condition has been diagnosed as the primary cause of a man's erectile dysfunction.


There may be many causes of erectile dysfunction


Because erectile dysfunction is often multifactorial, including vasculogenic factors, neurological factors, endocrinological factors, psychological factors and even recreational and prescription drugs, it is usually necessary to take a multi-disciplinary approach to the treatment of the condition.


From a physical point of view the most common precipitating factors in erectile dysfunction are of vascular origin, meaning physical occlusion of the arteries of the penis. Either arterial insufficiency or leaking veins may contribute to erection difficulties; these problems can originate in hypertension, smoking, diabetes and high cholesterol levels. Often vascular problems are created through lifestyle choices, which can be compounded by age.


Similarly, neurological problems can be a very common cause of erection difficulties. Any injury to any part of the nervous system that is responsible for the initiation of the biochemical sequence of erection may render a man unable to become erect. This damage is most often caused by diabetes, prostate surgery, and neurological problems such as multiple sclerosis or spinal injuries.


When it comes to hormonal factors, there is a huge body of evidence which suggests men over 50 often have low free testosterone levels, and that this plays a significant role in erectile dysfunction. It isn't enough to measure only the absolute level of testosterone in a man's blood stream: it is the level of free testosterone which is important, since this is the only bio-available testosterone. If this is low, erectile failure is likely to follow, along with a low level of sex drive and lack of interest in sex. The concept of the "andropause" - the male equivalent to the female menopause - is used to describe how a man's hormone levels can fall in middle age, resulting in, among other things, erectile difficulties.


Many prescription drugs including SSRIs, stomach medication, antihistamines, anti-hypertensives, sedatives and antidepressants, are possible factors in loss of erection. (See also our introductory page on ED.)


Even though conventional wisdom suggests little can be done about the physical causes of erectile dysfunction, it's always wise to start from the assumption that the man has more erectile capacity than he has, or believes he has, since anxiety is bound to be playing a large part in diminishing the erectile capacity he does actually possess.


Physical treatment options


Vacuum devices

Vacuum devices work by creating a partial vacuum in a cylinder into which the penis has been inserted. A seal around its base permits blood to enter the penis but not to leave. Although  this is a passive process whereby blood is drawn into the body of the penis through lowered external pressure, it is still an effective means of obtaining at least a partial erection. This can be sustained by the use of a constricting ring around the base of the penis once it has been withdrawn from the cylinder, allowing enjoyable intercourse for both the man and his partner. The advantage of vacuum devices is that they are reliable, easy to use and do not need surgery.


Penile prostheses

A penile prosthetic device is an inflatable device which can be implanted inside a man's penis in place of his corpora cavernosa. This operation is obviously irreversible and rather drastic; it really is the treatment of last resort, not least because there is a high failure rate. Only very experienced surgeons and those with a great deal of experience and wisdom in the field can be considered competent to conduct this operation. Penile prostheses may be an option for men with spinal injuries where the partner fully supports the procedure.


A penile support sleeve

A much less drastic option is to use a support sleeve of some kind which will mimic a degree of penile rigidity and allow the intimacy of sexual connection.


Although psychological issues are extremely important in erectile dysfunction, it is still worthwhile seeing a doctor for a complete physical examination. This will allow you to rule out any more serious issues such as hyperlipidemia, neuropathy, hypertension and nerve damage. For example, a simple test of glans sensitivity or perineal sensitivity can indicate any abnormalities in the nervous system. As an aside it's worthwhile recalling the observation that up to 50% of men who are prescribed Viagra are found to have high levels of cholesterol which is, to some degree, occluding their arteries.


Another way to improve your erections might be to improve your lifestyle and to work at getting fitter and healthier. Cutting out alcohol, cigarettes and illegal drugs will do wonders for your erections and also keep in mind more exercise and having a low BMI will help as well.. Your penis is like the rest of your body: it needs a lot of care, self-discipline, exercise, relaxation, and good food. And just like any other function of your body it really is a case of "use it or lose it"! The more often you have sex or masturbate, the more exercise your penis gets and the better it will work for you in old age.


Pharmacological treatment options


Viagra has revolutionized the treatment of ED. As it is important to fully understand how it works and why it may not work for all men, we have devoted a separate page to Viagra, which you can access through this link: Viagra and how it works.


Psychological treatment options


When the root of erectile dysfunction lies in deep seated emotional trauma caused by childhood abuse, the help of a therapist will nearly always be needed to bring about a cure. But most erection issues are not so serious, and they can be tackled with a self-help behavioral program.


If you were to see a therapist for treatment, they'd almost certainly check that your expectations about sex are in line with reality. For example, men who rely on fantasy to get aroused are often astonished to learn that as they pass forty, they will probably need to be aroused physically before they get an erection. This means they will need to manually stimulate themselves or be stimulated by their partner for their penis to get hard. They often simply do not know this, and think that the failure of their penis to leap to attention when they are naked with their partner in a sexual situation is a major problem. It is not - it is one small aspect of aging. One of the reasons this happens is because men's testosterone levels fall as they get older.


A behavioral treatment program for all forms of erectile dysfunction is set out on a specialist website devoted to providing all home based treatment for erectile problems End Erectile Dysfunction Now!"

The advertisements for it are displayed on some of our web pages in the side column and in our online shop. Sex-and-Relationships recommends this program as it is a clear, step by step behavioral treatment program. It is based on the original Sensate Focus exercises, which are still the mainstay of behavioral psychosexual treatments today.


In summary, the basis of all behavioral treatment programs for erectile dysfunction is: first, to take a man away from his fantasy and thoughts, and get him back into the physical sensations of his body; second, to alleviate anxiety and performance pressure through realistic thinking and relaxation exercises; and third, to resolve any relationship problems with his partner.


Written by Rod 20.07.09, last updated 04.08.09

How Viagra works
Treatment for erectile dysfunction
Effect of impotence on men
Erection problems - one man's story
Erectile problems in gay men
Erectile dysfunction and women
ED - advice for women - how to support a man with ED
ED - What to do when Viagra doesn't work


All material copyright, 2014 Sex And Relationships