The New Male Sexuality (68 page)

Whatever the future, we have plenty to work with right now. If you are open to and willing to explore different treatments, there is almost certainly a satisfactory solution for you.

CHAPTER TWENTY-TWO

Resolving Erection Problems
with Sex Therapy

I don’t think anyone who hasn’t had the problem themselves can understand what it’s like not feeling confident you’ll have an erection during sex. This has taken over my whole life. I think about it at work and home, at night, during the day, constantly. As my son would say, this sucks
.
—Man, 52

I know I was very reluctant at first, but I’ll be the first to say that the therapy was very helpful. I’ve developed a very different relationship with my penis, which now usually works quite well, thank you, and have come to see sex as much more for pleasure and closeness than just for performance. My wife and I are much closer as a result and having a lot more fun
.
—Man, 40

If there’s no physical reason for your erection problem, the main difficulty may well be in how you think your penis
should
function. A great many men uncritically accept the superhuman standards and myths about penises, then get upset when they discover they are merely human.

A married man of thirty-nine called early one morning and virtually demanded an immediate appointment. When he arrived, it was obvious he was in a panic. While still standing at the door to the building, he started talking with great emotion about his “impotence” and his need to know whether he needed a penile implant. I finally got him into my office, but couldn’t get a word in for fifteen minutes. After he calmed down a bit and I was able to ask some questions, it turned out that the impotence consisted solely of a failure to have an erection with his wife the night before. Then, in response to my question of how last night had differed from other times he had sex with her, he began to sob. The previous day, with
no warning at all, he had lost the job he had held for fourteen years and that meant the world to him. After wiping his eyes and making an obvious attempt to pull himself together, he smiled weakly and said without a trace of humor, “Other than that, everything was as usual. I just don’t understand it.” It hadn’t occurred to him that his feelings about being fired might have affected his sexual functioning.

Nonmedical erection problems are almost always due to one or more of the following: unrealistic expectations, lack of arousal, absence of the proper conditions, and the anxiety generated by the need for an erection. For example:

A sixty-year-old man getting upset because his penis doesn’t jump to attention when he kisses his partner. He’s not taking into account that a sixty-year-old penis differs from a twenty-year-old one and that he’s not getting the direct penile stimulation he now requires.

A man who expects an erection even though he isn’t feeling aroused. He just expects his penis to function regardless of how he feels, as if his penis has nothing to do with the rest of him.

A man who is very tense during sex. He’s been criticized by his partner for his “failure to perform” in the past, and he’s anticipating more criticism. Because of the way men have been trained, it doesn’t occur to him to ask how anyone could get an erection in that situation.

If you are tense or anxious, if you are angry at your partner, if you aren’t getting the physical and emotional stimulation you like, if you aren’t turned on, if you are preoccupied with other matters—if any of these things is true, what makes you think you should have an erection? The answer, of course, is our sexual conditioning, the nonsense I discussed in
Chapter 2
.

Recall the example in
Chapter 19
of Bud and Art, of how they think differently about sex. If you’re having erection difficulties and there’s nothing physically wrong, chances are good you’re behaving like Art. That is, you’re worried about sex even before it begins—you’re focusing on how your penis is doing rather than on what you feel.

In order to resolve an erection problem, you need to start thinking and acting less like Art and more like Bud. I know this isn’t easy—in fact, at this moment it may seem impossible—but it’s necessary and can be done. You need to look forward to sex with positive anticipation, focus on the pleasurable sensations, and accurately judge the signs of increasing arousal.

To increase your sexual pleasure and improve your erections, stop stacking the deck against yourself and start stacking it on your side. This means getting your mind on your side, meeting your conditions for good sex, having sex only when you are aroused, and decreasing your anxiety.

USING A MEDICAL ASSIST IN ADDITION TO SELF-HELP

Some couples going through sex therapy or a self-help program can benefit from also using Viagra, injections, or Muse. Here are two examples.

Siri was ambivalent about going through sex therapy with her husband, Hector. On one hand, she was happy and relieved that he was finally, after years of nagging, willing to get help. On the other hand, she was angry that she hadn’t had intercourse in five years and wouldn’t be able to have it for at least another few months. I suggested Hector talk to his doctor about injections, which he did. This allowed him to get good erections and have intercourse with Siri several times while they went through therapy. Siri was impressed by his willingness to do this for her and by the actual intercourse. This made her much more cooperative and contributed significantly to the success of the therapy.

Using medical aids to get erections is more often than not, as in Siri and Hector’s case, for the partner’s benefit. But since nothing is more important than getting her cooperation, it is well worth it.

Winston and Emma were making progress in the beginning of their counseling for his erection problem when we ran into trouble. He still was not having reliable erections, and the thought that they probably couldn’t have intercourse on their upcoming fortieth anniversary was causing sadness and anxiety, which in turn was negatively affecting therapy. They had celebrated all the previous “big” anniversaries by staying in a romantic resort and having intercourse several times. At my suggestion, Winston talked to his family doctor and got a prescription for Viagra. The sadness and anxiety quickly dissipated. On the anniversary weekend Winston was able to have intercourse one time without Viagra but needed the pill for the second intercourse. They were both pleased with the results. They had sex one more time that weekend, but it was their choice to do mutual oral stimulation instead of intercourse. This weekend was the only time during our four-month therapy that they took Viagra. That one time made them feel better and reduced the anxiety that was getting in the way of our therapy.

If using Viagra or one of the other medical resources sometimes during
your therapy or self-help program will gain your spouse’s cooperation, give you more confidence, or produce any other positive result, by all means speak to your physician.

MIND POWER FOR BETTER ERECTIONS

To derive maximum benefit from sexual activity, you need to get your mind working with you. Starting as soon as possible, you need to frequently imagine yourself as you’d like to be, and spend as little time as you can imagining how you’ve been. You are going to apply some of the information and suggestions contained in
Chapter 19
. If you haven’t read that chapter and digested its contents, now would be a good time to do so.

Mind Power A:
Whenever you’re aware of telling yourself that you’re impotent or inadequate, or having an image that embodies that idea, argue with it and change it. For example: “It’s true, I’ve had troubles getting it up for the last few months. But I’m going to do this program and change that. I’m going to have good erections again.”

Mind Power B:
This is an image, really more like a movie, that you should spend thirty to ninety seconds on every day; doing it several times a day is even better. Imagine yourself having good erections with a partner, which includes several components. Imagine having a good erection, entering your partner, feeling relaxed and comfortable, and just being still inside her for a moment or two. You’re not moving, just enjoying being in her. Then imagine slow movements, just taking it easy, still enjoying the feeling of being in her. Then gradually increase the pace of your thrusts. Now slow down again. Now again increase the pace gradually, until you’re moving almost as much as you want, still feeling calm and easy. Now imagine slowing down and stopping all movement. Stop thrusting and just experience the pleasure. Then gradually increase the movements, slowly building up until you’re moving with abandon, letting your body do what it wants. When you want, and only when you want, imagine a wonderful ejaculation. When you’re done with the movie, be sure to end with a statement to yourself of this kind: “As it is in my mind, so it shall be in reality” or “This is how it’s going to be.”

Mind Power C:
Before you do a physical exercise, spend a few seconds imagining yourself doing it perfectly, exactly as it is supposed to be done.
Be sure to imagine all the parts: for example, asking your partner to participate, attending to your arousal and physical sensations, asking her to stop if you get anxious, asking her to resume stimulation, and so on.