A good candidate for sex therapy is someone interested in finding out more about himself. Therefore, he is somewhat intro- spective, has some insight into himself and wants to learn more. He will have functioned well sexually in the past, and his problem will have developed recently. This is particularly important, because men with erection problems may become extremely depressed, and solving the problem early can help men avoid the cycle of rejection and despair that can develop overtime.
Some therapists require that a man with an erection problem already have a partner in a relationship. The reason for such a rule is that because sex is something which concerns both partners, both should participate in any resolution of a sexual problem. The two partners don’t have to be married or to have been together for a long time, but it’s important that they feel good about each other. Other therapists will work with men who do not have a steady partner, or don’t have a partner at all.
Perhaps most important of all, a good candidate for sex therapy is someone who is motivated: He wants to improve his sexual functioning and his sexual relationship and learn more about his body. He is willing to do the homework the therapist assigns; he wants to change.
There are also key characteristics a good candidate does not have. He doesn’t suffer from persistent, long-term, low sexual desire, even though the erection problem may have recently reduced his interest in sex. He’s not seeking help just because he’s being pressured to change by his lover. He doesn’t have very restricted and firmly fixed ideas about what is “normal” sex; he will consider sexual behavior besides intercourse, and he’s willing to experiment. He does not carry within him a strong prohibition against sex. For example, a man who says, “I avoid sex until I can’t stand it” will need to spend additional time in sex therapy examining and reconsidering his attitudes.
Along the same lines, someone who remarks, “I masturbate only when I can’t stop myself” isn’t going to be comfortable stimulating himself as part of a sex therapy program. Working on his attitudes toward self-pleasure would be an important first step, and a good sex therapist would be able to help him examine and possibly change those feelings.
Just as the wife or lover plays an important role in diagnosis and treatment, she can be crucial to successful sex therapy. In the best situation, the partner is interested, involved and sup- is that you and your partner honestly share your feelings and concerns with the therapist.
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Until very recently, most doctors thought that veins, which carry blood out of the penis, weren’t important culprits in erection problems. Doctors thought that the amount of blood leaving the penis didn’t change much, whether a man was erect or not. The arteries were the main concern. The fact that some veins in the penis could be abnormal and sabotage erection all by themselves wasn’t recognized.
That view has undergone a radical shift in just the last few years. New research has demonstrated that abnormal veins in the penis can sabotage erection. They do this by letting blood flow too rapidly out of the penis, thus preventing a man from getting or maintaining an erection. Normally, when a man becomes erect, the veins partially shut down, restricting the blood flow. Leaky veins, however, don’t get the message, and keep the blood flowing out of the penis.
In fact, some experts now think that a significant percentage of men with physically caused erection problems may have leaky veins. Doctors are continuing to study the problem and new research should soon tell us even more.
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You know that the penis itself contains no muscles, but exercise still might be able to help your sex life. We’re not sure exercise helps, but some sex therapists suggest that Kegel exercises to strengthen the pelvic muscles may help you prolong intercourse. (Kegel exercises have for years been recommended to women who want to increase their sexual enjoyment.)
In order to exercise the pelvic muscles you first have to find them. There are two ways to do this, according to sex therapist-Bernie Zilbergeld, Ph.D., the author of Mate Sexuality. You can pretend you are holding in a bowel movement; the muscles you squeeze are the pelvic ones. Or, when you are urinating, stop and start your flow several times; when you stop the flow, you’re squeezing the muscles you want.
Once you know where the muscles are, you can try squeezing and relaxing the muscles 10 to 15 times, twice a day. Dr. Zilbergeld suggests you gradually increase your workout to 60 or 70, twice a day. And once you’ve mastered that, you can try holding the squeeze for a bit longer and then relaxing. However, it’s important not to overdo it and to increase gradually, because, as with any exercise, too much too soon can make you sore.
Some therapists say that strengthening these muscles can help you last longer and control your ejaculations more easily. If you tighten these muscles just before you ejaculate, you’re doing a kind of internal squeeze technique.
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The second type of prostate operation is done when a man has cancer of the prostate. Called a radical prostatectomy, this procedure involves the removal of the entire prostate and the seminal vesicles, always through an incision in the body. It’s much more common for crucial nerves to be injured during this type of procedure. Because surgeons have now identified the exact location of these nerves, however, new methods have been developed to save them, and the odds that potency will be maintained are much better. Using these new techniques, popularized by Patrick C. Walsh, M.D., Chairman of the Department of Urology at Johns Hopkins University, the surgeon can preserve the nerves next to the prostate that control erection. The results are striking: One year after having their prostates removed, 86 percent of men who were potent before surgery retained their ability to get an erection. Previously, the vast majority of men who had such surgery were physically incapable of getting an erection. It does take some time to regain potency following prostate surgery; less than a third of the men were potent after just three months, but after nine months about 60 percent had regained potency. Younger patients were faster to recover their erectile abilities, and the smaller the cancer, the better the odds for preserving the nerves and the ability to get an erection. The nerve-sparing technique is now widely known, and any man contemplating prostate surgery should discuss the methods to be used with his doctor.
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Always ask your doctor or pharmacist if a medication can cause potency problems—even if the problem occurs after you’ve been taking the drug for a while. And remember to ask about how drugs interact with each other and with alcohol. Doctors differ in their approach to the drug/erection problem. Some believe that volunteering the information that a medication may cause impotence just sets the patient up for performance anxiety. Others strongly assert that a well-informed patient is in a much better position to report any difficulties, and that patients can be saved needless anxiety by knowing what might happen. We favor the second approach. In any case, you can protect yourself by always asking if a medication can affect your potency. If you ask directly for the information, the physician should provide it.
Many patients do not connect medications with potency, and neither do their wives. Think how differently William and Sharon would have felt if, when the first erection problem occurred, William said, “Well, it might be the blood pressure pills. I’ll call the doctor in the morning. Maybe he can switch me to a different medication, or change the dosage.” A lot of pain and anguish might have been avoided.
Recreational drugs, like marijuana, amphetamines and narcotics can also cause erection problems. As with medications, responses to these drugs vary: Some men find that even small doses leave them unable to get an erection, or maintain one, while others have a higher tolerance.
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