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There are a variety of treatment strategies available for targeting the specific causes of erectile difficulties that I discussed in my last article.
The goals of treatment are not to have automatic erections or to prove one’s worth as a man or a lover by being able to achieve a hard-on and demonstrate Olympic stamina.
The goal is to establish comfort and confidence with erections to enjoy a satisfying sexual life with one’s partner.
The first order of business for any sexual concern or difficulty is to obtain a thorough medical exam from a physician to rule out organic causes.
If there are no improvements after a trial of a prosexual medication like Viagra, Levitra or Cialis, a referral to a urologist will likely occur with further specialized testing.
If a medical illness is causing the difficulties, this condition should be treated. Medications or a penile vacuum device might help bypass damaged neurological systems in the case of physical injury.
Lifestyle factors can be modified via limiting/abstaining from alcohol and drugs, getting adequate sleep and nutrition, becoming involved in a weight loss program, engaging in moderate exercise and implementing stress management techniques into one’s life to reduce fatigue and promote relaxation.
If medication side effects are the culprit, one will want to work with a physician and develop a plan of action.
Some options include stopping or switching to a different medication with fewer side effects, allowing medications time to see if the body adjusts and scheduling sex at times furthest away from the time dosages are taken.
There also are some medical devices, injections and surgeries available for the treatment of erectile dysfunction, but these should be considered last resorts due to potential risk factors.
Vacuum pumps and cock rings also have shown a degree of success for some men.
For all medical treatment strategies, it is extremely important to begin with the least risky approach first and to recognize that any strategy is rarely effective as a stand-alone treatment.
Most require a combination of various approaches, and sex therapy should always be considered as another integrative intervention.
One should always involve their partner in the decision-making process, as he’s also affected by the choices.
Individual, couples, group and sex therapy can all be important components of growth for both sexual issues.
Sex education would be a vitally important component of any psychological treatment.
Metz and McCarthy (2004) advocate for the reinforcement of positive anticipation about sex, pleasure-oriented sexual experiences rather than performance (pass/fail tests) mindsets and engaging in a regular routine of sexual contact.
Resolving and recovering from emotional distress is critical, especially in the area of anxiety reduction and removing pressure and demands. Building assertiveness skills and anxiety management training can be helpful.
“By learning how to replace a performance-oriented
mindset, anxiety will be eliminated.”
Most present-day sex therapists believe ED is best understood and treated as a couples approach, since sexuality is an interpersonal process and both partners contribute to and/or are affected by the realities in their relationship.
Couples can learn how to create a non-demanding sexual ambiance and climate in their relationship, as well as how to invite sexual desire and eroticism into their lives by operating as a cooperative, intimate team.
Couples can learn how to have a healthy relationship and sexuality, improve communication and conflict resolution skills and increase emotional intimacy to heal relationship wounds and promote a positive alliance as a couple (Metz and McCarthy, 2004).
Most of the relationship causes can be directly addressed and worked through in couples therapy and sex therapy.
A technique called sensate focus also is widely used and can be tailored for the unique needs of gay couples.
Metz and McCarthy (2004) cite important goals to accomplish in this area as:
They also advocate countering the tendency to be a spectator (monitoring oneself) during sex and learning how to divert attention to one’s own body and focus on the physical sensations experienced.
They also promote exercises for achieving physical relaxation and comfort with sexuality (being able to talk about sexual feelings, practicing deep breathing and relaxation techniques, strengthening and relaxing the PC muscle).
Famed sex therapist Kaplan (1974) recommends couples first engage in non-demand pleasuring through mutual caress and sexual teasing with an initial “no penetration rule” (if you and your partner are into anal).
This focuses attention on pleasure and the sexual enticing without the pressure to perform.
This also subsequently reduces fear of failure, which actually acts as a major aphrodisiac.
Masters and Johnson (1970) pioneered a technique in which the penis is squeezed at the height of erection to allow it to abate and then resume (wax/wane). This is repeated numerous times to restore erectile confidence.
Distracting obsessive thoughts through the use of thought stoppage techniques, erotic fantasy and learning how to focus on erotic sensations is another strategy suggested by Kaplan.
Lastly Zilbergeld (1999) encourages the use of positive sexual visualizations for success.
He also advocates for the determination of conditions that are necessary for the individual to meet for better erections, such as desire, arousal, anxiety, mental and physical stimulation, time of day, state of relationship and partner’s attitude and behavior.
He also emphasizes the importance of focusing on physical sensations and getting the right kinds of stimulation and to avoid having penetrative sex until erectile confidence is achieved.
Men in top/bottom sexual relationships can learn a desensitization procedure that eventually culminates, in gradual fashion, to happy endings during anal sex.
He highlights the importance of men beginning with solo masturbation sessions to get acquainted with their body and sensations.
A man would first pleasure himself with a flaccid penis and then practice the waxing and waning process described above during masturbation sessions before moving to partner exercises.
Here the couple would begin by recreating the old problem and trying not to get an erection (or losing one). Then his partner plays with his soft penis, works up to stimulating his erect penis and practices the wax/wane process through manual stimulation and then to anal intercourse if desired.
But the prognosis for the great majority is positive.
By learning how to replace a performance-oriented mindset that we’ve been socialized and taught as men with a pleasure-oriented focus, much anxiety will be eliminated and more sexual enjoyment and satisfaction can be derived due to the expanded eroticism that grows from this.
This particular article series has been rather clinical, and this information can seem confusing and overwhelming. It’s also prudent to meet with a professional who can help make sense of all this. You’ll be great!
References: Kaplan, Helen Singer (1974). The New Sex Therapy: Active Treatment of Sexual Dysfunctions. New York: Brunner/Mazel, Publishers.
Masters, William & Johnson, Virginia (1970). Human Sexual Inadequacy. New York: Bantam Books.
Metz, Michael E. & McCarthy, Barry W. (2004). Coping with Erectile Dysfunction: How to Regain Confidence and Enjoy Great Sex. Oakland, CA: New Harbinger Publications Inc.
Zilbergeld, Bernie (1999). The New Male Sexuality: The Truth About Men, Sex, and Pleasure. New York: Bantam Books.