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Psychosexual problems for men

When Viagra doesn't work

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For many men erectile dysfunction (ED) is a serious problem - especially among men of around forty and older. Today, a quick and reliable pharmacological solution is available to manage ED in the form of Viagra. To get the most from reading this page, please first read our page on how Viagra works.


Viagra is a medical doctor's dream (as well as a dream come true for the pharmaceutical companies). It is a quick, cheap and extremely reliable way of giving a man an erection. This is what men with ED have been waiting for. Nevertheless, treatment with Viagra has a high drop-out rate: somehow Viagra ends up not working for 50-60% of men who try it.


Some of this could be due to fears about side effects or lack of knowledge about how to best take Viagra (which is on an empty stomach, 45-60 minutes before sex and possibly up to 8 times on separate occasions before it works reliably and predictably). Still, Viagra is very effective in inducing an erection in a sexually aroused man, so why would men stop taking it?


A case example: Paul


Let's look at a typical example of a man using Viagra: we'll call him Paul. Paul is in his mid 50s and has been married for 24 years. He and his wife love each other, but both of them are leading busy lives even after their children have left home. Paul started to experience problems with his erections in his mid 40s. There was one occasion when he initiated sex because he felt he ought to, but he'd been having quite a stressful time at work for a while. That evening he felt really shocked and disappointed with himself when his erection didn't firm up properly and what should have been a nice evening turned into silence on both sides. Since then he'd always had a worry in the back of his head about whether his erection would be OK or not, and whether his wife would feel angry or disappointed with him if things didn't work out. He always wanted to talk to her about it, but somehow he never quite managed to initiate that conversation and she never brought it up either.


Over the last few years Paul's sex life had fizzled out somehow: he tended to avoid getting into possible sexual situations so as not to feel embarrassed if his erections didn't stand up to task. Over time he and his wife also had less and less non-sexual physical contact as Paul's avoidance grew. He got more involved with work, but also with tasks around the house, as he felt guilty about avoiding his wife when it came to sex. Somehow his wife didn't seem to mind or at least she never brought up their lack of physical closeness either. Paul would have said that his relationship was really very good even though they didn't touch a lot and there was no sex.


Finally, Paul saw a program on TV about Viagra and started to wonder whether it could work for him too. In the end he needed to go to his doctor anyway for a different matter and at the end of the consultation he brought up his ED too. When he left he had a prescription for Viagra in his pocket. Over the next few days Paul started to fantasize about sex again as he felt reassured by the pills. He planned a nice dinner at home with his wife and took the pill afterwards looking forward to an intimate evening hoping to surprise his wife.....As you can imagine the evening didn't work out as planned. You can discover more facts about delayed ejaculation at and about how you can last longer in bed at these excellent blogs on ejaculatory difficulties.


It is easy to imagine many different ways in which that evening could have gone wrong for Paul and his wife. Paul himself might have become very nervous about using the pill or about having sex again for the first time in quite a long while. So despite an erection Paul wouldn't have been able to relax and enjoy the experience. Or it could have been that he had never dealt with his earlier performance anxiety and his insecurities returned with a vengeance despite his use of Viagra. He might also have been so convinced about his own inadequacy as a lover (real or imagined) that he ended up not initiating sex and instead avoided sex the whole evening until the effects of Viagra wore off.


It is also possible that Paul was all ready for a good time, but his wife was far too surprised and shocked that she didn't know how to respond. Paul might have seen her hesitancy as a rejection and withdrawn very quickly into his study to try and forget about this embarrassing episode. Or it is possible that she'd been harboring a lot of anger, disappointment or doubts about their relationship all this time, thinking Paul's withdrawal was because he didn't love her or care about her anymore. Or maybe she was interested in sex, but felt betrayed that Paul had taken Viagra, which she could easily have guessed, without involving her - she might have thought it was just the drug that had suddenly made him interested in having sex with her, and he wasn't really attracted to her.


Social factors in the use of Viagra


Simply taking Viagra and having an erection does not automatically mean that a couple will have a mutually satisfying sexual experience together. Issues for both the man and the woman - and their interaction as a couple - might result in Viagra 'failing to work' or, more precisely, sex failing to be enjoyable despite the use of Viagra. Viagra tends to work the way it was designed to, but the emotional factors in a relationship can be much more complicated.


Using Viagra successfully involves more than simply swallowing the pill. Firstly, it involves working out which aspects of the ED are to do with the man who has the problem. What is his level of performance anxiety or other anxiety about sex, and has he always had this? What kind of anxieties or worries has he developed since his erection problems started? If a man is very nervous he will not be able to relax into the experience of having sex with his partner once again very easily. He may also have unrealistic expectations about how the drug would work or how he might feel during sex.


For although Viagra creates the physical possibility of an erection it is not an aphrodisiac, i.e. it doesn't generate libido, desire, arousal or sexual satisfaction. Also, it is not able to magic away any underlying issues with depression or discomfort with sex or being intimate with one's partner. In short: Viagra does not work if the man who is taking it is not turned on by the sexual situation in which he finds himself. For example, should a guy have a sexual arousal pattern involving sado-masochistic leanings then using Viagra and expecting straight sex with his wife will not result in an erection.


The man's partner (who will be mostly female, but could also be male) will bring her (or his)  own set of variables to the equation. Does she still desire sex with her partner or was she quite glad he stopped wanting sex? Does she have her own physical or emotional resistance towards resuming their sex life, for example not feeling attractive because she has put on weight over the years, and so feeling embarrassed about being naked? Or it is possible that their sex life had been very important to the female partner and its disappearance has left her with many difficult emotions such as disappointment, rejection, aloneness, resignation, and so on? She may not be able to emotionally invest again in being sexual and open with her man until those emotions have been dealt with. She may also worry about how long his change of heart will last and whether it is even worth getting involved again if her hopes are just going to be dashed once more.


There are also some important factors separate from the individuals themselves in a relationship which can lead to the use of Viagra being seen as a failure. Certainly the quality of the couple's overall relationship is extremely important. It must be assumed that the relationship isn't as good as one or both partners believed if the use of Viagra doesn't get openly discussed and negotiated. And how long a couple have avoided sex will also be of great significance, as will any other problems they've had in the sexual relationship. And it's even possible that the use of medication to have sex is not supported by either or both of the two partners because of their moral or emotional beliefs about sex. Finally, many other factors impact the use of Viagra just as they do any other sexual experience - such as lack of time, too many responsibilities and problems with money, children, housework or jobs.


What next if Viagra fails?


So what can you do next if you have tried Viagra with your partner and somehow things didn't quite work out? Well, don't give up on it too quickly! Firstly, it takes time to really get used to taking a drug such as Viagra. Think of the first time you took any alcohol (which is also a drug) There is a good chance that the first time you tried it you didn't enjoy it much or you simply felt dizzy. It takes time to interpret the physiological effects of a drug and to learn to enjoy it. Research shows that the efficacy of Viagra increases from the first to the eighth time of use.


Additionally, it is important to see the use of Viagra as only the first step in addressing the lack of sexual enjoyment for a couple. When you think about it, it's a bit naїve to believe that just by having an erection you will end up having good sex with your partner. This wouldn't have been true before your problems with erections, so why should it be true now?  Rather than seeing Viagra as a magical cure for all that isn't working in your sex life, it is more realistic to approach the use of Viagra as a way of exploring your sex life. 


What that means is that using Viagra will help to show up all the other things, which need to be addressed in yourself, in your partner, in your relationship and in your sex life. It means that if Viagra didn't do the trick for you, it's time to start reflecting on what went wrong. How come you didn't have a good time with each other? What happened for you internally, i.e. how did you feel, what did you think, what did it all mean to you, what did you want to say to your partner about it - but didn't?


The same is true for your partner: What did she think, feel, take things to mean? What is she not saying that she would like to say?  In this way, Viagra is simply the first step at repairing your sex life together as a team by making it physically possible for you two to have sex in the conventionally approved and expected way. But the real work on your relationship starts after that.


When things don't quite work out as you expected in yourself or in your relationship approach the situation as an interesting challenge. Become curious about what is underneath it all and don't be judgmental or disapproving about what you find. You will need to be tolerant and welcoming of whatever your partner has to say about things even if you don't agree with her or like to hear what she has to say. At the same time don't persecute yourself for your perceived shortcomings, we all have them, but work on improving them gently and consistently. It makes much more sense to be kind to yourself, but at the same time inquisitive so as not to let yourself get away with simple truths and avoidance.


Areas which you might find useful to reflect on and talk about with your partner are:

  1. The length of time you and your partner didn't have sex before you used Viagra. What happened during that time and what emotional baggage did either or both of you pick up?

  2. What is it like for the man with the ED to have sex again? What are his fears, hopes, skills and sexual patterns like, and how might they prevent him from having a good sexual experience? What kind of sex does he want with his partner now? What is his role during sex and does it need changing? What was his approach to sex before his ED and does it need developing?

  3. What is it like for the female partner to go back to having sex? Does she want to have a sex life with her partner again or not, and if yes, what kind of sex life? What are her fears, hopes, skills and sexual patterns like, and how might they prevent her from having a good sexual experience? What was her role during sex before the partner's ED and does it need changing? What was her approach to sex before his ED and does it need developing? Is there anything else in the relationship that is bothering her? Is there anything left over from prior sexual experiences with her partner that needs addressing?

  4. What is it like for both partners that there is now a medication involved in having sex? Do both of the partners have enough information about Viagra and do they both endorse its use?

  5. What is the rest of their relationship like? Many women only want to be sexual with a man when they feel supported, heard and respected by him. The overall quality of a relationship will often determine what is possible sexually between two people.


So what if all of this makes sense to you, but it feels too challenging to open these things up? You could always forget about sex and continue to believe that Viagra simply didn't work. On the other hand, you could also reach out for help and go into couple therapy so that you get support and guidance with addressing the issues outlined above. Or you could slowly but surely start addressing the issues together with your partner. The most important thing here would be to start communicating as openly as possible about everything: The ED, what it means to you, how you are doing in general with each other, how you feel about your partner, what kind of sex you would like, .... Click here to get to our page about talking. Once you start talking to your partner, please don't stop. Most things can be worked out by the combined efforts of two committed adults, who work together.


This page is based on the following paper, which is freely available over the internet:

S.E. Althof (2002) When an erection alone is not enough: biopsychosocial obstacles to lovemaking. International Journal of Impotence Research 13, Suppl 1, 99-104


Written by Anna 04.09.09


End Premature Ejaculation!

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