“Women need a reason to have sex, but men just need a place.” This old inaccurate trope about men’s and women’s sexualities is a nice jumping off point to take a closer look at how sexual issues can impact men, their partners, and their relationships. The point reflected in that quote reflects a common stereotype about men, which is that they’re all thinking about sex nonstop and are ready go anytime, anywhere. However, a variety of factors including cardiovascular health, normal aging, problems in the romantic relationship (**spoiler alert** men commonly experience erectile dysfunction (ED) issues when they don’t feel emotionally intimate), mental health concerns such as anxiety and depression, and certain classes of medication are all potential points to consider when trying to understand the physical and the emotional elements of this common issue.
What is erectile dysfunction?
Erectile dysfunction is an inability to achieve or maintain an erect penis which can get in the way of your overall satisfaction with sex. For many men, erectile dysfunction remains the most common side effect after prostate cancer treatment, with up to approximately 80% of men coping with erectile dysfunction as a side effect of prostate cancer treatment. Other conditions including hypertension, diabetes, and cardiovascular disease have also been associated with increased rates of ED. The prevalence of ED increases dramatically with age. Although ED can occur at any age, it is more common in older men and it is treatable at any age!
It is not uncommon for men with erectile dysfunction to feel sad, angry, frustrated, ashamed or insecure. Such feelings, if not dealt with, can sometimes lead to clinical depression in men. You may ask, “Is there a link between depression and ED?” The research says YES. Many men with erectile dysfunction also report symptoms of depression. Having troubles with sexual health has been shown to worsen feelings of worthlessness or other symptoms of depression such as feelings of sadness, hopelessness, loss of energy, loss of pleasure in things you used to enjoy, and difficulty concentrating or sleeping. Generally speaking, the more severe the depression you have, the more likely you are to have problems with your sexual health. As a result, many men may find themselves in a vicious cycle of sexual dysfunction and worsening depression.
According to Healthline, sexual desire is cultivated in the brain, and sex organs rely on chemicals in the brain to promote libido as well as the changes in blood flow needed for the sexual act. When depression disrupts these brain chemicals, it can make sexual activity more difficult. Depression itself may not be the only thing that interferes with sexual health. In fact, many medications used to treat depression (i.e., antidepressants) can often have unwanted sexual side effects that impact your desire for sex.
It is also important to note that ED does not just affect men! ED can also have a real impact on the emotional and physical intimacy you experience with your partner. You may feel quite frustrated about not being able to achieve an erection or even an erection on demand and this can be very demasculinizing, as you may see an erection as a symbol of your manliness or fertility. You may feel your masculinity was lost or diminished and may notice thoughts “I am no longer a man” or “I’m not a whole man” or even recognize feelings of shame. Research suggests that when this occurs this can be a source of anxiety, depression and/or embarrassment, which lead many men to feel disempowered, to question their self-worth, and/or to fear that they would be stigmatized. Also, for many men who cannot get or maintain an erection during sex, may actually result in you feeling anxious that this will happen again. This anxiety can at times be strong enough to prevent you from getting an erection next time, which leads to feeling even more anxiety. Additionally, your partner may worry that they’re not attractive enough, that something is wrong with them or that they fear you are having an affair because you are not having an erection due to having sex elsewhere. This may cause conflict in your relationship thus impacting the emotional and physical intimacy you experience with your partner. Of course, ED can be a difficult problem for couples to discuss. However, talking about what is going on is much better than pretending that ED problems are not happening or just avoiding sex with or without providing your partner with a reason. Talking openly can help you identify underlying causes and may be a way to resolve stress you are experiencing.
It’s time to check in with yourself! Do you notice having any of these common beliefs? Are you having thoughts that you will not be, or are no longer a man, or not a whole man, as a result of your erectile dysfunction? Are you experiencing any feelings of anxiety, depression or embarrassment regarding your ED diagnosis, treatment or side effects?
Remember you are not alone! Many men experience shame around their ED and the feelings they experience can impact their ability to seek help. ED is treatable and there are a variety of treatments ranging from medication, mindfulness, and even sensate focus therapy.
What treatment options are available for ED?
- Oral Medications
- These typically include phosphodiesterase type 5 inhibitors (PDE5i)—Viagra—which are taken to increase the flow of blood to the penis to induce an erection
- Vacuum Erection Devices (VEDs)
- draws blood into the penis. A constriction band around the base of the penis keeps the blood inside the penis to produce an erection
- Intraurethral suppositories
- Delivery of medication as a small pellet using an applicator (suppository) into the meatus of the urethra to induce an erection
- Intracavernosal injections (ICIs)
- Delivery of medication by injection directly into the penis to produce an erection
- Penile Prosthesis (pross thesis)
- Surgically implanted device within the penis
Typically, in hospital or medical settings, it is customary practice for physicians treat ED in a stepwise fashion, starting with pharmacological therapy options and then proceeding to surgical treatment. However, many individuals with ED are including therapy as part of their treatment or turning to it as an alternative treatment option. More specifically, many men will often have adjunct therapy (e.g., use of appropriate medications) at the same time as sex therapy and sensate focus.
Many men find ED to bring many changes and challenges. Understanding your ED and how you manage it can help you increase your confidence in changes you make to improve and maintain your health. Additionally, ED is a very sensitive topic for many men to discuss, but remember, YOU ARE NOT ALONE! Thanks to Masters and Johnson (1970), many sexologists and therapists are trained in sex therapy around the world and are ready to help with a specific type of sex therapy called sensate focus.
What is Sensate Focus?
Sensate focus is a series of structured touching and discovery suggestions that actually provide opportunities for you to experience your own, and your partners body in a non-demanding exploratory way without having to read each other’s minds. Part of the sensate focus experience is to avoid evaluating or judging what is happening, but rather to focus or concentrate on the sensations of temperature (cool or warm), pressure (hard/soft or firm/light) and texture (smooth or rough). By noticing and focusing on these sensations, you are focusing on what is happening in the present moment by using these touch sensations as a way to ground and relax you, and then your body knows what to do.
You might notice thoughts or distractions that occur and the most common are: “am I going to get aroused,” “am I doing this right,” and “is my partner doing okay.” When these thoughts occur, it makes it difficult to focus on the sensory experience. However, in our culture, Linda Weiner explains that the focus is typically on being a good lover, and revolves around the notion that “I’m supposed to touch you to turn you on, and you touch me to turn me on.” This places a goal-oriented, pleasure mindset (e.g., “in order for sex to be good, we both need to orgasm) which can create stress or anxiety regarding performance or with connecting with your partner sexually. The idea behind sensate focus is that we cannot get rid of these performance or anxiety provoking thoughts, but we can always turn our attention to the tangible sensations of temperature, pressure and texture. When we are able to do this, touch becomes a powerful gateway to arousal and relating sexually with your partner.
There is evidence suggesting that many men are able to utilize sensate focus to reframe their experience of ED and their definition of sex. However, for many men this can be a challenging task as many men may define sex or relate it to their virility or sexual prowess which can make it difficult to manage or cope with the impact of the ED on not only themselves but also with their sexual partners.
Remember, YOU ARE NOT ALONE! There are many trained sexologists and therapists ready to help!
Contact us here for a FREE consultation!
Also, check out these helpful resources:
- To find a sex therapist https://www.aasect.org
- To find a psychologist https://www.psychologytoday.com/us
- San Diego Sexual Medicine
- Us, Too—National http://www.ustoo.org/ (800)808-7866
- TED Talk of an individual sharing their experience of living with ED: https://www.news-medical.net/health/Sexual-Dysfunction-History.aspx
Burnett, A. L., Edwards, N. C., Barrett, T. M., Nitschelm, K. D., & Bhattacharyya, S. K. (2020). Addressing Health-Care System Inequities in the Management of Erectile Dysfunction: A Call to Action. American journal of men’s health, 14(5), 1557988320965078.
Bianco Jr, F. J., McHone, B. R., Wagner, K., King, A., Burgess, J., Patierno, S., & Jarrett, T. W. (2009). Prevalence of erectile dysfunction in men screened for prostate cancer. Urology, 74(1), 89-93.
Chambers, S. K., Chung, E., Wittert, G., & Hyde, M. K. (2017). Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment. Translational andrology and urology, 6(1), 60.
Cuevas, A. G., Trudel-Fitzgerald, C., Cofie, L., Zaitsu, M., Allen, J., & Williams, D. R. (2019). Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research. Cancer Causes & Control, 30(5), 443-456.
Linschoten, M., Weiner, L., & Avery-Clark, C. (2016). Sensate focus: A critical literature review. Sexual and Relationship Therapy, 31(2), 230-247.
Rose, V. L. (n.d.). Cancer Facts and Figures. American Family Physician, 59(6). 1697.
Weiner, L., & Avery-Clark, C. (2017). Sensate focus in sex therapy: The illustrated manual. Taylor & Francis.
Wittmann, D., Foley, S., & Balon, R. (2009). Effective sexual response after treatment for prostate cancer: The role of grief and mourning. Society for Sex Therapy and Research 2009: 34th Annual Meeting, April 2-5, 2009, Arlington, VA [Abstracts], 80-81.
The culture of masculinity and its negative impacts on men [Video file]. (2019, September 8). Retrieved February 17, 2021, from https://www.pbs.org/video/the-culture-of-masculinity-and-its-negative-impact-on-men-1567960454/