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 www.male-sexual-dysfunction.com 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 naÑ—ve 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:
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?
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?
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?
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?
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:
