Treating Erectile Dysfunction Starting With Questions About Good Sex
It is well known that many men experience sexual performance pressure. In my practice I often see men who want to become better lovers. These men often come to treatment because something has gotten in the way of the erectile strength they previously enjoyed. Whether it is because of erectile disorder, premature ejaculation, delayed ejaculation, ageing, diabetes, or something else, the final straw that brings these men to break their silence and to ask for help often boils down to what their penis is or is not doing during sex.
What Men Think Makes Good Sex
The first thing I need to do is challenge some of their notions about what constitutes “good sex.” So I ask a few questions, “What makes for a good sexual experience for you? What makes for a good sexual experience for your partner? How do you both feel during good sex? How do you feel after good sex?”
As my male clients respond they often give me a list that starts with body parts and points directly to their perception of the problem, “a hard erection” they might say, or “my partner is well lubricated.” When I redirect them to the subjective experience of the sex that they are describing they eventually shift to the tones of the sexual experience using words like, “hot,” “intense,” or, “passionate.” Usually with just a little more encouragement they can talk about the subjective emotional experience, “powerful,” “desire,” “I feel s/he is open to me,” “connected,” or “merged.” Then I ask the last question to understand their experience or expectation of good sex, “how do you feel after good sex?” The answers are often very similar, “connected,” “close,” “peaceful,” “at ease,” “one.”
Challenging Expectations About Erections
In most cases, I am able to ask some question that challenge all their notions about good sex. Fortunately, I work in Silicon Valley and the vast majority of my clients are liberal and have broadly accepting views of sexual diversity. For those clients, I am able to ask if they think lesbians can have good sex. They invariably say, “Yes.” And then I ask, “but do you think lesbian women can have really good sex?” and again they respond “yes.” So I finish with, “how do you think they do that without an erection?”
The answer of course is that lesbian sex creates good sex by using methods other than a penis. From their frame of reference their sexual pleasure and their capacity to give pleasure has often revolved around their erections. While many of them have considered oral sex or manual sex as receiver or giver, they have often equated really good sex with the functioning of their penis.
From here, I admit that I’m not always able to help men improve their erections the way they would want. For example, sometimes medical conditions or medications prevent improvement. But before we try to find which of the many ways that talk therapy can help improve sexual function, having had this brief conversation, they usually now imagine a future where they can have good sex and can give their partner the experience of good sex even if they don’t experience the erections they would like.
Direct Erectile Dysfunction Treatment
Once this groundwork is laid, I will bring the practical tools for better erections like sleep, exercise, diet, cutting out alcohol, pelvic floor exercises, emotional vulnerability and connection, elimination of goal orientation (for more details see the description of the Sensate Focus Exercise here), and a referral for a medical examination to help the client. One of the beautiful things about having had the conversation I described above about good sex is that now that the man knows that good sex isn’t dependent upon a strong erection (even though it might be his preference), there’s suddenly a lot less pressure and stress about doing this practical work. And less pressure and less stress are good for erections.