Stephanie Livingston–Psychologist

GET YOUR HEAD TOGETHER
Psychological approaches to male sexual dysfunction
Every night we are bombarded with commercials pushing drugs that claim to improve a man’s sex life. We see a middle aged couple sharing a moment together in a bathtub, on the beach, with running water everywhere. The good looking aging baby boomer, who has taken one of these sexual enhancing drugs, is comforted by the notion that when the moment arises, will be ready to perform in the bedroom. He is guaranteed an erection to meet his partners’ needs. But let us not forget the disclaimers (eg, you may have an erection for several hours, numerous side effects, contraindications). These commercials play on the fears of men who are growing older and fear not being able to have a satisfying sex life.
Are you taking one of these sexual enhancing drugs, used to address erectile failure, or are you considering taking one of these drugs? Before you make this decision, first discuss with your physician non-medication approaches to this problem. Erectile Dysfunction (ED) is defined as the inability of the penis to maintain and full and firm erection sufficient for penetration during intercourse. ED can include premature ejaculation and erectile failure. ED can be caused by a number of different things such as: the side effects of certain medications (eg, anti-hypertensives, narcotics), disease (high blood pressure, diabetes), depression or anxiety. Your doctor will help you to rule out any medical reasons for having this problem. If your doctor says that there do not appear to be any physical ailments that seem to be causing the problem, then you might consider psychological explanations. In fact sometimes ED can begin as the result of a medical issue, such as side effects from medication, but later be maintained because of psychological reasons, even after the medication has been stopped. For example, I once treated a 45 year old male in the Hypertension Clinic at The University of Chicago Hospitals for sexual dysfunction. He complained that the high blood pressure medication that he had been given was causing him to lose his erection. He had become very anxious about having sex, for fear that he would not be able to maintain an erection sufficient for intercourse with his wife. His wife was supportive and encouraged him to see his family doctor, but for many months he refused because he was too embarrassed. Finally, she made the phone call and he had a check up and told his doctor about the problem he was having with the medication. His doctor, changed his medication to a drug that had fewer sexual dysfunction side effects and sent him on his way. Unfortunately, this change in medication did not solve the problem, because by this time his performance anxiety was so high that he was afraid to try sex for fear of failure. The medication issue had resolved, but now it was the anticipatory anxiety that triggered the problem. At this point he agreed to try psychotherapy to address this problem.
He and his wife were evaluated, and it quickly became apparent that anxiety was playing the predominant role in his ED. After several sessions of treatment using cognitive-behavioral therapy, relaxation training, and biofeedback he was able to manage his anxiety and was able to perform sexually without difficulty. Those ED problems that are organic in nature (eg, prostate cancer, uncontrolled diabetes) will not likely be resolved with these psychological approaches alone. However, there are many options available to those with disease that has affected sexual functioning, including penile implants and sexual enhancing drugs, such as those previously mentioned. If you have discussed your problem with your doctor and he/she has recommended these approaches, then proceed. Otherwise, psychotherapy and marital therapy can be helpful in treating the patient and/or couple cope with diminished sexual functioning. There are also good self-help books that can step you through dealing with this problem.
With the prevalence of sexual enhancing drugs, that we see on television commercials almost every night, many men are falling into the belief that there sexual functioning should be enhanced even if they are not middle age or older. Some men in their thirties, who are healthy and have no disease processes are taking these drugs because they feel they need a boost. Chances are their issues could be resolved with psychotherapy. Oftentimes, these are men who have issues of self-confidence or they merely want to increase their sexual desire and performance, even if it is at a normal level. Those who seek out these drugs need to be aware that all drugs have side effects and the risks of taking such drugs should be discussed with your doctor. But more importantly, if there is another way to achieve sexual satisfaction without medication, why not give it a try. In the absence of disease, sexual desire and orgasm is 99.999999% psychological. Focus on getting your head together. That is, the one on your shoulders.
GET YOUR HEAD TOGETHER
Psychological approaches to male sexual dysfunction
Every night we are bombarded with commercials pushing drugs that claim to improve a man’s sex life. We see a middle aged couple sharing a moment together in a bathtub, on the beach, with running water everywhere. The good looking aging baby boomer, who has taken one of these sexual enhancing drugs, is comforted by the notion that when the moment arises, will be ready to perform in the bedroom. He is guaranteed an erection to meet his partners’ needs. But let us not forget the disclaimers (eg, you may have an erection for several hours, numerous side effects, contraindications). These commercials play on the fears of men who are growing older and fear not being able to have a satisfying sex life.
Are you taking one of these sexual enhancing drugs, used to address erectile failure, or are you considering taking one of these drugs? Before you make this decision, first discuss with your physician non-medication approaches to this problem. Erectile Dysfunction (ED) is defined as the inability of the penis to maintain and full and firm erection sufficient for penetration during intercourse. ED can include premature ejaculation and erectile failure. ED can be caused by a number of different things such as: the side effects of certain medications (eg, anti-hypertensives, narcotics), disease (high blood pressure, diabetes), depression or anxiety. Your doctor will help you to rule out any medical reasons for having this problem. If your doctor says that there do not appear to be any physical ailments that seem to be causing the problem, then you might consider psychological explanations. In fact sometimes ED can begin as the result of a medical issue, such as side effects from medication, but later be maintained because of psychological reasons, even after the medication has been stopped. For example, I once treated a 45 year old male in the Hypertension Clinic at The University of Chicago Hospitals for sexual dysfunction. He complained that the high blood pressure medication that he had been given was causing him to lose his erection. He had become very anxious about having sex, for fear that he would not be able to maintain an erection sufficient for intercourse with his wife. His wife was supportive and encouraged him to see his family doctor, but for many months he refused because he was too embarrassed. Finally, she made the phone call and he had a check up and told his doctor about the problem he was having with the medication. His doctor, changed his medication to a drug that had fewer sexual dysfunction side effects and sent him on his way. Unfortunately, this change in medication did not solve the problem, because by this time his performance anxiety was so high that he was afraid to try sex for fear of failure. The medication issue had resolved, but now it was the anticipatory anxiety that triggered the problem. At this point he agreed to try psychotherapy to address this problem.
He and his wife were evaluated, and it quickly became apparent that anxiety was playing the predominant role in his ED. After several sessions of treatment using cognitive-behavioral therapy, relaxation training, and biofeedback he was able to manage his anxiety and was able to perform sexually without difficulty. Those ED problems that are organic in nature (eg, prostate cancer, uncontrolled diabetes) will not likely be resolved with these psychological approaches alone. However, there are many options available to those with disease that has affected sexual functioning, including penile implants and sexual enhancing drugs, such as those previously mentioned. If you have discussed your problem with your doctor and he/she has recommended these approaches, then proceed. Otherwise, psychotherapy and marital therapy can be helpful in treating the patient and/or couple cope with diminished sexual functioning. There are also good self-help books that can step you through dealing with this problem.
With the prevalence of sexual enhancing drugs, that we see on television commercials almost every night, many men are falling into the belief that there sexual functioning should be enhanced even if they are not middle age or older. Some men in their thirties, who are healthy and have no disease processes are taking these drugs because they feel they need a boost. Chances are their issues could be resolved with psychotherapy. Oftentimes, these are men who have issues of self-confidence or they merely want to increase their sexual desire and performance, even if it is at a normal level. Those who seek out these drugs need to be aware that all drugs have side effects and the risks of taking such drugs should be discussed with your doctor. But more importantly, if there is another way to achieve sexual satisfaction without medication, why not give it a try. In the absence of disease, sexual desire and orgasm is 99.999999% psychological. Focus on getting your head together. That is, the one on your shoulders.