|
Understanding the Mind-Body Erection Connection: A Man’s
Guide to Conquering The Fear of Erectile Problems
(Second of a series of 3)
Click here to see part 1
Click here to see part 3
Researchers feel approximately 20% of erectile dysfunction problems
are purely psychologically based. Certainly, there are men with
medical problems, which explain 100% of their erectile problems.
But most sexologists now feel that even some predominantly medically-based
ED has a psychological or a psychological/relational component.
If you are having erectile instability, there are things you and
your partner can change in your behavior, whether or not you use
medications or other medical treatments, which will increase chances
of having more enjoyable sex and better and more reliable erections.
Partnersemotional and behavioral reaction to erectile instability
can make a problem better–or worse!
In my private practice in Lexington, Massachusetts, and in my practice
based at the Lahey Clinic Center for Sexual Dysfunction in Peabody,
Massachusetts, physicians refer me many cases of men whose erectile
problems are partly, or sometimes mostly, psychological. (The cases
described here are based on compilations of cases. To protect the
confidentiality of my clients, no case represents an actual, living
person.)
Geoff: Old Conflicts with his ex-wife, Beth, Affected His Sexual
Functioning with His New Love
A 31-year old divorced man, Geoff walked in to my office one day.
" I certainly never thought I would wind up here, at my age"
hesaid.Theproblem was erectile dysfunction with his girlfriend Donna.
Geoff said he noticed the ED for the first time when he was on a
trip with his ex-wife, several years ago, before his divorce. .
But now he has been dating Donna for the last four months, and he
is having trouble staying hard. Geoff went for help, and the physician’s
assessment was that Geoff’s erection problem was not physical.
Viagra had been prescribed, and Geoff found it helpful. But because
he is a young man, Geoff felt didn’t want to become "addicted
" to it. He wanted to understand the root causes of his erectile
problems and find a non-pharmacological solution.
In order to understand the emotional component of his erectile
problems, we had to review Geoff’s life. He told me how when
he met hisnow-ex- wife, Beth, he fell deeply in love with her. Geoff
was ready to be in a marriage, thought Beth was perfect, and looked
forward to a future, with kids, with her. But after a few years,
his wife, Beth, told him she was not happy. At that point, their
entire relationship, including the sex, began to deteriorate.
Geoff revealed a very upsetting sexual experiences with his ex-wife
Beth about five years earlier. "She really tore me down in
the bedroom and all of a sudden she didn’t want sex. She said
that I had to learn to touch her in the right way. She said that
it used to work when we started out, but it didn’t work anymore.
So I tried to learn to do it the way she wanted, but it didn’t
work. Sometimes I’d start to make love, and she’d just
flip over and go to sleep right in the middle. I began to feel really
depressed and rejected."
Geoff’s first experience with not being able to get an erection
occurred with his ex-wife in Jamaica. In an attempt to somehow save
their relationship in the midst of all this tension, conflict, and
mostly unexpressed emotion, Geoff and Beth decided to take second
honeymoon to a romantic island to try to fix things. Not surprisingly,
with such a lot riding on how this trip worked out, Geoff was very
anxious, although he didn’t consciously realize it. When it
came time to make love to Beth in Jamaica, he could not----for the
first time---get an erection when he wanted to. The rest of the
vacation was ok, but the tensions in their marriage were not magically
cured by the trip. From then on, Geoff suffered from erectile instability
with Beth. She was not terribly supportive. Eventually, they broke
up.
Although he dated some, with some success and some experiences
with ED, he didn’t really get attached to anyone new after
the divorce until he met Donna. Geoff said that he wanted to talk
about sex with me for himself, not because Donna seemed to be upset
with their relationship.
Geoff was amazed that his new girlfriend did not seem to be upset
by his erectile instability. She enjoyed making love with him no
matter what they did. Geoff was lucky that his new girlfriend was
open to lots of different kids of sexual pleasure. She also did
not take his erectile dysfunction personally, as a rejection, because
Geoff was open enough to share that he had had this problem previously
with Beth.
Donna came into sex therapy with Geoff, eager to do whatever I
suggested. Together they constructed a list of mutually pleasurable
activities that did not depend upon Geoff having a firm erection.
Donna reassured Geoff that she was happy sexually and that he was
a wonderful and attentive lover who could give her orgasms and sexual
pleasure in many different ways. Soon, they reported that Geoff
was giving up his dependence on Viagra. Over the ensuing weeks,
his sexual confidence returned, and on follow up several months
later, Geoff and Donna were both happy with their sexual relationship.
However, not every man has a partner who is supportive during periods
of anxiety-caused sexual dysfunction.
Janet and Tim: Janet’s Response to Tim’s ED Made It
Worse
Tim came into my consulting room alone. He was despondent about
his erectile problems. His physician had performed all the tests
on him, and it was clear that his problem was mostly psychological.
Tim’s face looked very sad as he talked, and he reported feeling
terrible about himself because he cannot have intercourse. Tim’s
wife, Janet, was so upset and fed up with him that she refused to
come to the sex therapy.
As Tim told his story, it was clear that his erectile problems
were long standing, and probably existed as a result of an incredibly
sex-negative family upbringing. Tim’s father was a foreboding
and stern man. Premarital sex was frowned upon, as was masturbation.
Tim felt that he would wait until he met the right woman to be sexual,
and he rarely masturbated into his 20s. He had never had intercourse.
When Tim fell in love with Janet, he decided that she was his true
love. Once it became clear to him that it was a serious relationship,
he wanted to finally become sexually active.
But the first time he tried to have sex with Janet, he could not
get an erection. After so many years of feeling guilty about sex,
even after Tim and Janet got married, he still felt unsure of himself
sexually.
Tim struggled with erectile problems from then on. He was put on
Viagra by his physician, which sometimes helped. But sometimes he
was so anxious about performing that his anxiety even overrode the
Viagra, and he couldn’t get an erection with the medication.
Meanwhile, Janet had come from a conservative background too. She
wasn’t comfortable giving Tim the stimulationhe needed and
she didn’t like a lot of sexual activities that didn’t
revolve around his having an erection. She would get so upset about
Tim losing his erection that she would cry in bed after their attempts
at intercourse. She couldn’t stand talking about it.
Of course, since he loved her, Janet’s tears only made Tim
feel more like a loser and more anxious. He desperately wanted to
succeed at sex. I tried to encourage him to show Janet his love
in some other ways, through words and other kinds of touch. Tim
came to see me several times. I suggested that they try sensate
focus exercises where they would touch each other without any expectation
of intercourse. I suggested some books for them to read. I repeatedly
urged Tim to try to talk to Janet about what he was learning in
the therapy about anxiety and erectile problems. But he came in
the next session saying that Janet refused to talk with him about
sex, saying that that "wasn’t romantic." She did
not want to do an inventory of sexual activities which would help
Tim figure out ways to be sexual with her which didn’t require
an erection. In fact, Janet said that she felt sex was so private
that she really didn’t even want Tim to come to talk to a sex
therapist about it.
But Tim did come to see me another time, reporting much the same
pattern in their sexual relationship. Tim felt as if he was torturing
Janet with the ED. She was inconsolable and becoming depressed.
Janet felt so unsexy that she could not tell him any other way that
he could show her her sexual worth except by getting an erection.
I urged him to bring her in to see me.
I finally managed to get Janet to come to see me, but it proved
to be futile to talk with her. She insisted that erections should
be "normal and automatic." She was certain that something
was wrong with her and that that was why Tim was having such problems.
She was upset in the session, because it felt like an invasion of
her privacy to be discussing their relationship with me. She refused
to read any books. She refused to do any touching exercises which
took the focus off intercourse, stating that "sex should be
spontaneous, and these exercises are too planned."
I felt terrible for Janet, terrible for Tim, and not hopeful for
any improvement in their sexual relationship. Janet was miserably
sad, crying as she talked about how badly she wanted to feel Tim’s
penis inside of her. She insisted that the only way she could feel
sexual pleasure was through intercourse. She said that she was a
very private person, that she did not want to discuss their sex
life with another person. She was not comfortable with any discussion
of the specifics of how she could take the pressure off Tim.
Needless to say, Tim’s problem was not magically resolved.
Tim and Janet never came back to see me. It’s unfortunate that
Janet was so uncomfortable with sexual exploration, because her
rigid reactions to Tim’s erectile problems made his problem
much worse.
When you compare Tim and Janet with Geoff and Donna, it becomes
clear that solving erection problems is a couples issue. Understanding
the mind-body erection connection and working together to take the
anxiety out of lovemaking can make all the difference. Some important
do’s and don’t are summed up in the next installment.
(February 2002)
End Part 2 of 3
|
