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 erec tion
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 - as will do more exercise
and having a low BMI. 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 erec tion 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 the information you need about erectile
problems called
'End Erectile Dysfunction!'. 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
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