Qualified psychosexual therapist and relationship counsellor Julia Cole gained experience counselling for Relate – the relationship counselling charity. Julia recently became Development Director with the Pennell Initiative for Women’s Health – a new charity aimed at championing the health rights of women during the menopause and beyond. She now writes and broadcasts widely on relationship problems. Julia’s currently Agony Aunt for Candis magazine and BBC Wiltshire Sound – and has contributed to Essentials and Best magazines, the BBC Education Web Site, New Woman, The Mirror, The Daily Mail, and The Express. She’s also written a number of books and regularly contributes to national radio and TV programmes.
Erectile Problems (sometimes also called impotence)
Erectile problems are usually broken down into two categories – primary and secondary. A man suffering from primary erectile dysfunction will never have experienced an erection. This condition is extremely rare but it is possible for a man who has a severe psychological problem – perhaps a profound aversion to sex – that leads to a primary erectile problem.
A man suffering from secondary erectile dysfunction will have experienced an erection at some point before he experiences a loss of erection. For instance, a man may have had erections with his partner for several years before experiencing a loss of erection, either on just one occasion or on several occasions. Secondary erection loss is extremely common, and can be caused by a number of factors.
Some common causes of loss of erection:
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Tiredness or stress – a busy time at work or at home can prevent a man feeling sexually aroused. This is natural, and is often easily resolved if the tiredness or stress is relieved.
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Anxiety – worry about daily life can prevent a man from feeling sexual. For instance, a fear of being made redundant or concern about a sick child can diminish sexual drive and prevent erections.
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Alcohol – bingeing, or long-term daily consumption of alcohol, can lead to an inability to achieve an erection.
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Smoking – long-term smoking can gradually damage a man’s ability to have an erection.
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Some kinds of disease – disease can cause loss of erection as a symptom of the disease. For instance multiple sclerosis, heart disease, furring up of the arteries (atherosclerosis) and diabetes can all lead to loss of erection.
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Some drug treatments – the side effects of certain drugs can occasionally cause erectile problems. Always check with your GP for any side effects of drugs – especially those used to treat blood pressure problems.
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Relationship problems – men who are in relationships where there is conflict, lack of trust or communication problems may also find that their erectile functioning is affected.
Erectile difficulties can take different forms. Sometimes the man is unable to achieve an erection at all, can achieve an erection during foreplay but loses it just before penetration begins or loses the erection shortly after penetration.
Treatments
There are several treatments for loss of erection. It is important to get any problems in achieving erection checked by your GP, as it may be a symptom of a disease. Your GP will also be able to advise you on the most suitable treatment for you.
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Viagra This is a small tablet that the man takes before commencing sexual activity. It will not produce an erection unless the man is sexually stimulated, and is effective in approximately 75–80% of men with erectile problems. It must be obtained from a medical doctor, who has taken a medical history, as it can be dangerous to men with heart conditions. Never buy these over the Internet or from some other source as you could be risking your health if you have an undiagnosed health condition that the tablet may worsen. In the UK you can only obtain Viagra with a prescription.
- Injection therapy It is possible to use an injection into the penis to create an erection. The erection occurs with or without sexual stimulation. It is essential to receive guidance from a medical doctor on the use of this therapy because misuse can cause severe difficulties. This form of treatment is only available in the UK with a prescription.
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Mechanical Aids. A vacuum device, into which the penis is inserted, can produce an erection. Other kinds of mechanical help are available, but it is advisable to seek the help of a medical professional before purchasing these because misuse can harm the penis. Avoid buying from sex magazines or newspapers. See web site for Owen Mumford
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Psychosexual Therapy Psychosexual Therapy can be extremely effective in the treatment of erectile problems. Therapists are trained to recognise physical causes of erectile difficulties (and refer to a GP where needed) and to investigate the psychological issues that may have led to the loss of erection. A combination of behavioural tasks undertaken at home and couple counselling can often resolve erectile problems. Therapy can also be used in conjunction with the treatments listed above to allow the couple to integrate the treatment into their relationship.
Premature Ejaculation
Premature ejaculation, an extremely common sexual difficulty, simply means that the man ejaculates before he wishes to. Sometimes the man will ejaculate before penetration – perhaps during foreplay, or in extreme cases, before lovemaking has properly begun – or ejaculates so quickly after penetration that it ends the sexual encounter before the couple is ready to finish. Premature ejaculation is likely to be caused by psychological issues but it is important to check with a GP that there is no medical cause before assuming this is the case.
Common causes of Premature Ejaculation (PE) include:
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Nervousness Starting a sexual relationship for the first time or with a new partner can lead to the experience of PE. A desire to please, the exciting experience of arousal and intercourse and natural concerns about a new partnership can all lead a man to experience PE.
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Inexperience in sexual technique A man who is just starting out on a sexual partnership may need time to get to know his partner and the style of sexual arousal that they wish to share. Until this happens, the man may experience PE because of the uncertainty of the new relationship.
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Rushed sexual experiences Couples who rush through sex may find that the man does not learn how to delay orgasm and ejaculation, which can lead to PE as the relationship develops.
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General problems about sex Occasionally the man who suffers from PE has a more generalised difficulty about sex. He may feel guilty about lovemaking due to a strict upbringing about sexual matters, feel unsure about the relationship or feel unready to start a sexual relationship.
Treatments
Most men who experience premature ejaculation repeatedly do so because they fail to recognise the ‘moment of inevitability’ – that is, the moment at which they realise they are about to ejaculate. Successful treatments centre on helping the man to recognise the ‘moment of inevitability’ and learning to communicate this to their partner.
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Psychosexual Therapy PE responds extremely well to a course of psychosexual therapy. Men (and usually also their partner) are taught graded exercises undertaken at home that help the man to recognise when ejaculation is imminent. See Relate web site.
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Creams and lotions Often advertised in magazines or newspapers, these are usually unhelpful and sometimes dangerous. Most act as numbing agents and work on the principle that the man’s penis should be desensitised. These do not resolve the real problem, and can spoil the sexual experience for the man. They can also cause problems during intercourse as the woman may get some of the lotion in the vagina. This can cause stinging or numbness which subsequently ruins lovemaking for both.
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Condoms The use of condoms can lower the sensation of sexual arousal, allowing a man with PE to feel less excited and thus delay ejaculation. This method may be suitable in the short term, but does not usually deal with the real causes of PE (see above). See web site for fpa.
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Frequent sex Generally speaking, the more frequent the sex, the less likely it is that PE will occur. This is because sex after a long gap may be more exciting and stimulating – subsequently producing the unwanted PE. But, if PE is present in regular sexual relations, help from a Psychosexual Therapist is the best choice in these circumstances.
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Medication Some medications - like certain drugs used to treat depression - delay ejaculation when taken about an hour before sexual intercourse. Always check with your GP before taking such drugs.
Retarded or delayed ejaculation
Perhaps the least common of male sexual problems, this term means that the man is unable to ejaculate when he wishes to. He is usually able to achieve an erection and penetration but fails to ejaculate, even after sustained and lengthy stimulation. Occasionally the man may not be able to ejaculate during masturbation, but this is a rarer form of the condition. Most couples who find this happening to them feel distressed about the event because it may prevent the couple having a family or leave them feeling that their sex life is ‘incomplete’. The female partner may also complain of soreness and discomfort if the man attempts intercourse for a long period of time, and this can lead to dyspareunia (see below).
The following are the most common causes of retarded or delayed ejaculation:
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Some drug treatments The side effects of certain drugs can occasionally cause retarded or delayed ejaculation. Always check with your GP for any side effects of drugs – especially those used to treat depression.
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Alcohol abuse Sustained drinking can damage the nervous system, leading to this problem. Again, consulting a GP will help the man decide if this has contributed to the problem. Sustained use of recreational drugs, like cannabis, may also affect retarded ejaculation.
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Surgery Some forms of surgery, especially those in the pelvic area, can lead to retarded ejaculation. See a GP if the man experiences retarded ejaculation after surgery.
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Back injury or surgery Some kinds of back injuries or surgery can damage the nerves supplying the genitals. Consult a GP if retarded ejaculation is experienced after any form of back problem.
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Psychological problems Previous traumatic sexual experiences – including rape and childhood sexual abuse – can lead to extreme anxiety about ejaculating, even when the man is subsequently in a secure relationship. A lack of commitment or ambivalence about the relationship can also cause problems with ejaculating, as the man (literally) ‘holds back’ from giving himself completely to the partnership.
It is important to distinguish retarded ejaculation from retrograde ejaculation. This occurs when the man ejaculates, but instead of exiting through the penis, the ejaculate goes into the bladder. This syndrome can be associated with prostatectomy so a check with a GP is recommended.
Treatment
Psychosexual Therapy Unless the retarded ejaculation is related to a medical condition (see above), therapy is the best route to resolve this problem. The therapist will guide the man (and usually also his partner) through a graded series of sexual exercises, undertaken at home, with the aim of helping the man to feel more psychologically comfortable about ejaculating with or into a partner. Intensive couple therapy is also usually needed to help the couple understand and take action on any underlying relationship problems that may be blocking their sexual partnership.
Loss of desire
A sexual problem experienced by both men and women. Loss of desire for sex is fast becoming one of the most common sexual difficulties experienced by both men and women. Tiredness, stress, anxiety and the fast pace of life for couples and families can all contribute to a loss of interest in sex. It is possible to regain an interest in sex by taking time to relax more as well as making an effort to put time aside for sex rather than going through the motions of an intimate relationship late at night when both partners are exhausted. Psychosexual therapy can help to boost sexual libido by encouraging the couple to spend quality time together as well as offering new ways of enjoying sex.
