The New Male Sexuality (62 page)

There are a number of ways in which penises disappoint men. Almost all men have had at least a few experiences when they wanted an erection and didn’t get one or when they lost an erection at some embarrassing point. Some men have problems with getting or maintaining erections at the beginning of a relationship. Then, after they become more comfortable with their new partners, erections become more reliable. Because these kinds of difficulties are common and transient, it’s best to view them as a part of life rather than as problems. A man can explain to a new partner that it takes him a few times to get comfortable enough for his penis to join in the fun or, perhaps better yet, he can put off getting into sex until he feels more comfortable with her. And some men are now taking Viagra to help break the ice with a new partner.

There are also more chronic difficulties. Some men usually have difficulty attaining erections, while others have trouble maintaining them. For still other men, the problem is that their erections aren’t as hard as they would like. And there are men who don’t get erections at all, regardless of the kind of stimulation.

There are basically three ways to resolve erection problems. One consists of various medical, pharmaceutical, or mechanical interventions (which are the focus of this chapter), the most recent and best-known of which is Viagra. The second is sex therapy, the kinds of exercises I present in the next chapter. The third is a combination of the first two.

Before getting to these options, however, you need to know more about the nature of the problem. Some erection problems are primarily physical or drug-related in nature, some are primarily psychological, and a majority have both physical and emotional components. The cause does not necessarily dictate the treatment—you can try any treatment you want—but this information can be very helpful. For instance, if your problem is due to a medicine you’re taking or to not having enough testosterone, going through sex therapy would be a waste of time. So please attend to the following questions.

WHAT CHEMICALS ARE YOU PUTTING INTO YOUR BODY?

This includes any and all chemicals, including prescription and recreational drugs, alcohol, and nicotine. There are a host of drugs that contribute to erection problems. For more information, check the Appendix at the back of the book. If you are taking any of the suspected drugs, the first thing you should do is talk to the physician who prescribed them. See
if adjusting the dose or switching to another drug is possible. If you’re taking a recreational drug on the list, you should consider getting off it and at the same time look at the available medical and therapy interventions.

Don’t forget to consider your intake of alcohol. Social drinking or having “just a few drinks to relax” may inflame desire but kill erections. And long-term alcoholism—which can destroy testicular cells, lower testosterone production, and increase the production of female hormones—has serious negative effects on penises and sexual desire.

Smoking tobacco is another risk factor to consider. Studies show that smoking contributes to the hardening and clogging of arteries, including the ones that supply blood to the penis. Smokers have far more potency problems than nonsmokers.

DO YOU DESIRE SEX WITH YOUR PARTNER, YOURSELF, OR ANYONE?

If your appetite for sex is intact, we can assume your hormones are in working order and there is no need to get tested. But if your desire is low or nonexistent—if you don’t notice attractive women, don’t fantasize about sex, don’t want to masturbate or have sex with a partner—it may well be that your testosterone level is deficient. Testosterone is the desire hormone in both men and women. When its level goes below normal, as it can for a number of reasons, desire significantly decreases or disappears. It’s difficult to have a functioning penis in the absence of desire.

If your desire and penis are both in the doldrums, you should schedule an appointment with your regular doctor or a urologist to get a blood test to determine your testosterone level.

Unfortunately, different doctors and different laboratories have different criteria for what they consider normal testosterone levels. And because of the risk that supplemental testosterone can hasten the growth of already existing prostate cancer, some doctors are hesitant to give it. You need to talk openly with your doctor about the test results; if you think you’re getting a runaround, seek a second opinion. Supplemental testosterone is usually given by injection, typically every two weeks. But patches are now also available. Although testosterone can be taken orally, this is not recommended because it is less effective than shots and patches and carries a risk of inducing liver problems.

Although hormonal deficiencies account for only about 5 percent of erection difficulties, they are often overlooked. I once worked with a
seventeen-year-old boy with erection problems, and nothing made sense until I thought to have him get a testosterone test. I should have spotted this earlier, but who would have thought a seventeen-year-old would be deficient in testosterone? It turned out his levels were very low.

When hormone injections or patches are used, the results are often quick and dramatic. “The difference between day and night” was how the wife of a client who previously had no interest or erections put it after he got his first testosterone injection. “In the past I couldn’t get him to have sex no matter what I did,” she continued. “Now he’s the one who says we can be late to work because we have better things to do first. I love it.”

Advantage:

If low testosterone production is the cause of your desire and erection difficulties, testosterone is exactly what you need and will probably resolve the problem.

Disadvantage:

Although there is no evidence that testosterone injections cause prostate cancer, they can speed the growth of a cancer that’s already present, especially in men who do not suffer from testosterone deficiency.

A relative lack of desire and trouble with erections can also be the result of depression. By
depression
I mean a definite sense over a period of at least several weeks that life isn’t worth living and things aren’t going to get any better (other possible signs are increased irritability, diminished pleasure in activities that once were fun, increased or decreased appetite, decreased ability to concentrate on what you are doing, and any kind of sleep problem). One of the signature attributes of depression is a loss of interest in sex and usually other things as well. If you or your partner think you are depressed, you should get yourself to a physician or therapist as quickly as possible. When the depression is treated with therapy or drugs, chances are good your sexual desire and erections will return.

ARE YOU GETTING AND KEEPING ERECTIONS UNDER SOME CONDITIONS BUT NOT OTHERS?

If you have erections (firm enough for vaginal insertion but not necessarily hard as a rock) by yourself but not with a partner, or with one partner but not another, or on vacation but not at home, this strongly suggests
that the problem is not primarily physical in nature but instead has more to do with your feelings about one or all partners or your level of stress. This means you can choose any treatment option that you, your partner, and your physician or therapist agree on.

DO YOU NEVER GET OR KEEP ERECTIONS UNDER ANY CIRCUMSTANCES?

If you don’t get erections at all—while you sleep or on awakening, with your own or a partner’s stimulation—this strongly suggests a physical cause or medication side effect. It would probably be a waste of time to try the exercises in the next chapter. As soon as possible, set up an appointment for you and your partner with your regular physician or a urologist.

A man I saw over two decades ago had a strong bias against medicine. Although his penis didn’t get hard under any circumstances, he refused to believe the reason might be physical. Every time he got involved with a woman, the two of them would go to a sex therapist. I was the fourth therapist he tried and, sure enough, he failed with me as well. Only after continued badgering from me was he willing to visit a urologist. A few tests revealed that the problem was indeed medically based. Soon thereafter he had a penile implant inserted, and his sex life and self-esteem improved considerably. What is sad is that he could have had a functioning penis five years earlier and saved himself considerable time, money, and energy.

If you have already tried one or more self-help programs or courses of sex therapy without substantial improvement, you should also see a urologist.

DO YOU GET ERECTIONS BUT USUALLY CAN’T MAINTAIN THEM?

This could mean the problem is either psychological or physical. One of my clients started losing erections in his early sixties. No matter what the activity, he would get an erection and lose it within a few moments. He and his wife of thirty-five years were both puzzled because nothing else had changed in their relationship or sex life. Medical tests demonstrated that although blood was getting into his penis—hence the erections—it was leaking out faster than it could be replenished. He needed a medical solution.

Another client, Larry, had a different situation. With masturbation or
hand or mouth stimulation from his girlfriend, maintaining an erection was easy. It was only when they attempted vaginal insertion that his erection would disappear. This clearly was not a physical or drug-related problem. The real issue, it turned out, was that Larry had serious concerns about commitment, and for him intercourse was the defining act. As long as he didn’t have intercourse with Joan, he didn’t feel trapped. But deep down he believed that if he had intercourse with her, he would have to marry her. It took several months of therapy before we resolved his fears of commitment. After that, erections were no longer a problem.

BE A WISE CONSUMER

If you’re going to see a physician or a therapist, it’s important to be a smart consumer. Among other things, this means that you should see the right kind of person. Sad to say, many physicians and therapists have little or no training in sexuality and not much skill with sexual and relationship problems. You want to find someone who is comfortable dealing with sexuality and knows what he or she is doing. Your family physician may or may not be that person; the psychotherapist you’re seeing or have seen for another matter may or may not be that person.

Whoever you see, you should review your sexual history, or at least the history of the problem, before seeing the doctor so you can present an accurate and comprehensive picture. And make a list of questions you want answered. Don’t let your fear of looking stupid prevent you from asking all the questions you want. The only stupid questions are the ones you don’t ask. If the doctor doesn’t seem comfortable dealing with you and your situation, isn’t willing to take the time you want to discuss your case with you, won’t talk to you in language you can understand, or won’t answer your questions, go elsewhere.

Whether you see a physician or a sex therapist, I strongly suggest bringing your partner with you
. Even though it’s your penis, your partner is an integral part of your sex life, has important information to contribute, and should be there to hear the pros and cons of various treatments and to ask any questions she has. Another advantage to having her with you is that she can later help you evaluate the doctor’s competence and suggestions.

While you should listen carefully to the doctor’s recommendations, remember they are only suggestions. Every treatment costs money and most require time and effort; some also involve pain and risk. You’re the one
who will have to live with the consequences. You should get the best therapeutic and medical advice you can, and then determine with your partner what course of action makes the most sense.

It’s a good idea to get copies of your test results from your doctor. These can then be shown to any other doctors or therapists you consult. This can save time and sometimes money as well.