May Soo is a Sydney-based psychologist who specialises in relationship counselling and sex therapy. Visit May at RWA Psychology in Beecroft.
Ask any man and if he's being honest, he'll admit that erectile dysfunction (ED), commonly called "impotence" is one of his major fears. A well-hidden fact is that by age 40, about 90% of men have experienced a problem with achieving or maintaining an erection adequate for intercourse at least once. By age 50, more than half of men report mild to moderate erectile difficulty. So a man's major fear is in fact an almost universal experience.
In Western culture, males have been socialised to function in a sexually autonomous manner. For the adolescent and young adult male, desire, arousal and orgasm are easy and almost automatic. Sex becomes a race towards intercourse and ejaculation. This easy, automatic and autonomous approach to sex pose vulnerabilities when sexual function becomes less predictable, setting the stage for sexual problems when men age. By their mid 30s or early 40s, most men find that arousal is no longer autonomous. They need partner involvement and stimulation. About one in three men find this transition difficult and develop arousal (erection) problems.
For many men, their self-esteem and sense of masculinity are tied to their penis. The myth-based performance criterion of the ability and willingness of a "real man" to have sex with any woman, anywhere, at any time puts tremendous pressure on the man, especially on his penis. The focus on performance rather than on pleasure makes the male vulnerable to dysfunction.
A 50 year old man is not the easy, automatic, autonomous sexual functioner he was at 20. Sexual response becomes less predictable. Beginning in the mid 30s, there is a gradual decline in the efficacy of men's hormonal, vascular and neurological systems responsible for adequate erectile response. These systems remain functional when men get older but are no longer at optimal efficiency. Furthermore, stress, anxiety, distraction, fatigue, and negative emotions are also factors interfering with sexual functioning.
Not understanding the impact of age related changes and other factors to his body and sexual response, many men start to panic. The man feels embarrassed and humiliated because he cannot meet the rigid performance demands he grew up with. He retreats into blaming himself, blaming his spouse, and sexual avoidance. Sex is now a source of anxiety, frustration and angst instead of pleasure, eroticism, and satisfaction.
Since 1998 when they came onto the market, an increasing number of men have been using Viagra or Cialis to improve erectile functioning. These medications have two advantages. First, they enhance blood flow to the penis and allow retention of the erection. Second, they serve as a positive psychological stimulus (a placebo response) to reduce performance anxiety.
Medication can serve as a resource in restoring erectile comfort and confidence but it is not a miracle cure. They are most effective when used in conjunction with learning psycho-sexual skills and incorporated into a couple's sexual style. However, if used as a stand-alone intervention, especially if kept secret from one's partner, it is likely to backfire and cause hurt feelings and sexual alienation.
If you can relate to the above information, then it's important to recognise that sexuality is about intimacy and pleasure, not pressure and individual performance. Sex is more than the penis, intercourse and ejaculation. The key to change is to adopt a broad, flexible, pleasure-oriented approach to sexuality. Sex is a team sport. You are part of a sexual couple, not a perfectly functioning sex machine. Psychological, relational and psychosexual skill factors become crucial for erectile response after 35-45 years of age. You can learn to value intimacy and partner involvement rather than automatic, autonomous functioning
As with other sexual problems, seeking the assistance of a sex therapist is more effective than trying to make changes on your own. Couple sex therapy facilitates the change process by assisting the couple to communicate and work as an intimate team.
May Soo is a psychologist who specializes in relationship counselling and sex therapy. Material taken from Rekindling Desire by Barry McCarthy and Emily McCarthy.