Understanding the Mind-Body Erection Connection: A Mans 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 betteror 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 physicians assessment was that Geoffs erection problem was not physical. Viagra had been prescribed, and Geoff found it helpful. But because he is a young man, Geoff felt didnt 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 Geoffs 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 didnt 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 didnt work anymore. So I tried to learn to do it the way she wanted, but it didnt work. Sometimes Id start to make love, and shed just flip over and go to sleep right in the middle. I began to feel really depressed and rejected."
Geoffs 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 didnt 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 didnt 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: Janets Response to Tims 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. Tims face looked very sad as he talked, and he reported feeling terrible about himself because he cannot have intercourse. Tims 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. Tims 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 couldnt get an erection with the medication.
Meanwhile, Janet had come from a conservative background too. She wasnt comfortable giving Tim the stimulationhe needed and she didnt like a lot of sexual activities that didnt 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 couldnt stand talking about it.
Of course, since he loved her, Janets 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 "wasnt 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 didnt require an erection. In fact, Janet said that she felt sex was so private that she really didnt 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 Tims 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, Tims problem was not magically resolved. Tim and Janet never came back to see me. Its unfortunate that Janet was so uncomfortable with sexual exploration, because her rigid reactions to Tims 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 dos and dont are summed up in the next installment. (February 2002)
End Part 2 of 3