SEX PROBLEMS IN MEN: PROBLEMS WITH ERECTION

An erection in the presence of a woman is a biological compliment to her but both men who want to have intercourse and those who unconsciously want to avoid it can have problems. Sometimes no erection is possible or it may be insufficiently strong to be of any use for penetration. Some men find that their penis becomes very hard during foreplay but that they then lose their erection before intercourse starts or soon after insertion. In some cases the man ejaculates whilst his penis is less than fully erect and, because of the poor orgasm resulting, may scarcely know that he has done so.

The word impotence is often applied to these problems but this is only partially correct as the term also covers and includes problems with ejaculation too. Probably the word is best dropped from use and, like the female equivalent ‘frigid’, should never be bandied around loosely nor used to attack a partner.

Erection problems can have physical causes. More than twenty types of drug, especially antihypertensives, tranquillisers and antidepressants, can cause impotence, as can alcohol and even excessive cigarette smoking. Diabetes eventually produces impotence in a third or so of affected men, probably by damaging the nerves. Diseases and injuries of the nervous system and diseases of the arteries supplying the pelvic region are also causes of impotence. Disorders of the hypothalamus and the pituitary gland, under-functioning testes and an over-functioning thyroid gland can result in impotence, as can surgery carried out on the bowel or the prostate. However, the fact that any of these conditions is present in an impotent man does not necessarily mean that his impotence is solely, or even mainly, attributable to that cause. Psychosexual or sexual therapy can improve the performance of at least some of the men with this problem.

Erection problems which are present only intermittently, or in which a full, hard erection occurs at some stage in the proceedings, can be, but rarely are, of physical origin (unless they are attributable to intermittent medication with an offending drug). Men who can masturbate satisfactorily and who wake with a hard erection or have one during the night are also unlikely to be impotent as a result of a physical cause. However, the fact that a man has erection problems in both masturbation and intercourse does not prove that the cause is physical; in fact it is commonly a result of depression, sexual despair or high levels of anxiety from previous failures in intercourse which have spilled over into masturbation as well.

In couples in whom the problem has persisted or for whom it suddenly starts after a period of adequate functioning, the psychosexual and emotional state of both partners needs to be assessed, as do their personalities and the relationship. In some cases the briefest assessment reveals the nature of the problem, which is usually something along the lines given earlier, and leads to a prompt cure. In others it can be much more difficult.

In general, the couple are best advised to avoid intercourse and return to courtship. Where the basic relationship is sound, most couples take to this happily and usually with much more enthusiasm than in their original courtship. A holiday often helps. Encouraging total communication and then giving each other physical pleasure, perhaps using sensual massage, all helps. The man learns, often for the first time, of his partner’s real eroticism. Learning how to read her signs of sexual arousal comes as a revelation to many such men. It is also a good idea to introduce more eroticism into your life generally, perhaps including books and films. If a woman is under-confident or prudish about her body, as some are, her partner will have to persuade her to see it from his point of view. In this way he can make her more confident. Most men are aroused by watching their partner masturbate and this can be incorporated into foreplay. Very often a couple need to be persuaded to set aside time to tease, undress, explore and investigate each other.

Many men with erection problems based on an unconscious desire to avoid intercourse (or their partner) fear having an erection because they think that this will lead to their partner expecting, attempting or even demanding intercourse. Once intercourse has been ‘prohibited’ by a therapist he is free to erect and does so readily. Confidence in his ability to erect can be increased by the woman repeatedly rubbing his penis, stopping, letting the erection subside and then restoring it. The man’s attention can be increasingly distracted from the performance of his penis by encouraging him simultaneously to concentrate on giving pleasure to his wife. A penis which is fearfully watched by its owner never erects, just as a watched pot never boils!

When his secondary anxiety and fears have gone and he is more confident about his penis, the man usually (provided any underlying problem has been treated) begins to suggest intercourse or has a try at it. In collusion with the therapist the partner may have been instructed to avoid it. Eventually the man reaches a point where his desires so exceed his fears that he can tolerate his frustration no longer and he ‘forces’ the woman to have intercourse. At this point the confidence of both partners greatly increases, the man’s for obvious reasons and the woman’s because she sees herself as desirable and desired. Most partners of men with erection problems consider, at some point, either that their loss of attractiveness is to blame or that the man has another woman. Usually neither is the case.

In some cases a variety of pills and potions will help if the man thinks they can but none can ‘make’ him have intercourse. Using Anglo-Saxon words for the couple’s sex organs and sexual functioning has an aphrodisiac effect on some men (and women). Sex aids can help as can the woman playing with the scrotum and compressing the base of the penis during intercourse.

Although aphrodisiacs have a bad reputation, in a recent trial in 48 men thought to have psychological impotence, 6 mg of yohimbine were given three times a day for 10 weeks. Nearly half showed at least some improvement after two or three weeks. Men with physical reasons for impotence also improved.

Surgery, or other medical treatment, may relieve impotence from physical causes. A new treatment which is carried out on the penis itself, and can help both physical and psychological impotence, is to inject a substance called papaverine into one of the corpora cavernosa. Men can be taught to do it themselves in hospital and then carry it out at home and have intercourse. This restores confidence and in many cases only a few injections are required. One danger is

prolonged erection, ‘priapism’, and the other warning sign is that the manufacturers of papaverine in the US take no responsibility if it is used for this purpose.

Rigid or inflatable tubes are also now available and can be implanted inside the penis at an operation. They make intercourse possible. They are useful in impotence from physical causes that can not be relieved in any other way. Before going this far a man should consult a sex or psychosexual therapist to see what can be achieved by other means. It is a treatment of last resort.

Although expensive, a device called ErecAid avoids injections and implants and has been shown to help impotent diabetics. Others may benefit too. It works best if the partner is interested and helpful in the treatment. The lubricated penis is placed in a tube, suction is applied to the tube to induce an erection and a constricting band is applied at the base of the penis to retain the erection and permit intercourse. Used in conjunction with psychosexual counselling it can be highly satisfactory but not everyone, perhaps due to underlying marital reasons, benefits.

After a few uses spontaneous erections may return, relegating the device to become a reassuring back-up to be used if necessary.

Another, similar, device is called Correct Aid. It is rather like ErecAid but is actually worn during intercourse.

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