What Goes Up Must Come Down

One of the sex therapy sub-specialties I treat is erectile disorder (previously called erectile dysfunction for you psych and sex nerds) which is defined as difficulty getting or maintaining an erection and/or decrease in erectile rigidity the majority of the times during a sexual encounter.  Helping men with this issue is always a good portion of my practice - it’s a very common problem and the TV and magazine commercials sure know it.

Most of these adult men say it’s not a new occurrence, they have had this issue for a long time, and they each have their own valid reasons for seeking help now: a new romantic/sexual partner is on the horizon or their long-term sexual partner is getting fed up or they themselves have simply gotten fed up.  Generally speaking, men who struggle with their body’s sexual functioning and come to see me have a similar experience: they’ve tried various ways to “fix it” (including medications prescribed by their doctor) but have only had intermittent relief from the problem.  Some haven’t had any relief from medication.  They also have emotional pain, fears, and anxieties — about past failed sexual encounters, about future encounters, and about the process of seeing a sex therapist just to name a few.  My office is usually their last stop, at least in their minds, and they’re feeling desperate, ashamed, embarrassed, and afraid…while also feeling a sense of immense urgency to get it “fixed” NOW.  Welcome to session #1.

Helping a man better understand his body and getting it to do what he wants it to do when he wants it do it is my goal for him as well.  But it’s so unfortunate how many men become engrained to believe that their manliness, their ability to be a great lover, is completely dependent on one body part performing on demand.  So much hangs in the balance for them.  I can’t help but feel for their plight.

So I do an assessment as there can be many contributing factors to ED.  We identify what could be causing his erectile issues and then we get to work.  He may go see his doctor and get a blood test.  He may begin to make lifestyle changes and then we see how that affects his sexual functioning.  Sometimes there’s a simple solution: “Have just one beer, but not two, if I want to have penetrative sex that night.”  Or “Turns out I had borderline high cholesterol that may have been the cause so I’ll work on my diet.”

Often times, however, the solution is more complex.  Things like learning anxiety reduction and self- and body-awareness techniques.  Changing his (and possibly his partner’s) definition of sex and “being a man”.  Figuring out how his partner can not blame herself, her appearance, or his pornography viewing as the reason for his unpredictable erections.  Identifying things his partner can say that will help, not hurt, his sexual confidence should he have another episode of ED in her presence.  And he may have to learn how to speak kinder to himself and what it means to be sexually resilient.

So that’s the actual work we do in sex therapy.  But inevitably what also happens is we touch upon much larger themes of what it means to be a human being in the 21st century.  It’s fascinating how sex does that.

In particular, what I find so curious about sexual functioning issues is how some people hold tightly onto culturally-determined (and, unfortunately, often porn-informed) ideas about sex when real life sex is showing up differently.  Those tightly-held ideas can be about what “sex” is, how to “have sex” with someone without actually engaging in a conversation about how that person likes to “have sex”, what you “need” to “have sex”, and what it uniquely means to each person if these shortsighted ideas and goals are not met.  There ends up being a difference between what is and what should be and it can create conflict both within the individual and in their relationship.  Folks can go to dark emotional and relational places if they or their partner misses the mark sexually and they experience that conflict.  I’ve seen people end relationships, buy sketchy products online from unknown origins to “fix” themselves or their partners, harm their partners emotionally, and sacrifice their integrity — all when their idea of sex simply wasn’t showing up in their actual lives.  It doesn’t have to be this way and the turmoil is optional.