Men with sexual dysfunction disorders generally have one of three problems: impotence, inability to become sexually aroused, or inability to reach orgasm. This handout explores each of these disorders, their causes, and their treatment.

What Is Erectile Dysfunction? It is estimated that more than 50 percent of men over age 40 in the United States have erectile dysfunction (ED), also known as impotence. A man with ED is unable to achieve or maintain an erection sufficient for sexual intercourse.

What Causes ED? Healthy men achieve an erection because they have a normal penis, with intact nerves and proper blood flow, and properly circulating hormones. When they experience an arousing stimulus, the brain sends a signal, carried by neurotransmitters (chemical stimuli), that causes the tissue in the penis (corpora cavernosa) to fill with blood and become erect. In men with ED, one of these elements fails and the erectile reflex is impaired.

Almost all men experience ED at some point during their lives. It may be a lifelong condition (in which a man has never had an erection) or acquired (in which a man has had erections in the past but is no longer able to have them). Acquired ED may be situational (occurring only in certain situations) or generalized (occurring in all situations). It may happen during foreplay, during intercourse, or only with certain partners.

Physical causes. In some men, ED is caused by decreased blood flow to the penis during normal aging. Smooth muscle is replaced by tissue that can’t expand enough to achieve or maintain an erection.

Psychological causes. Some experts say that over 80 percent of ED is caused by psychological factors. In fact, the most common cause of ED is performance anxiety. This can happen when a man has failed to achieve or maintain an erection in the past and becomes anxious when he feels pressured to achieve an erection at a later time. Being anxious prevents him from achieving an erection; a cycle of anxiety and failure results.

ED can be caused by any of the following:

Medications. Viagra, Vasomax, and other medications are very effective for about half of all men with ED. However, as men age, the loss of muscle in the penis means that oral medications lose their effectiveness. For these men, penile injections are needed; for others, penile implants solve the problem.

Sex therapy. This therapy is needed for many men whose ED is caused by psychological problems such as anxiety or stress. It is important to locate a clinician with special training and experience in sex therapy.

What is Premature Ejaculation? PE is the inability to delay ejaculation to a moment that pleases both partners. The actual timing is up to the preference of the two partners. The factor that determines a diagnosis of premature ejaculation (PE) is whether a man is satisfied with the length of lovemaking before ejaculation occurs.

What Causes PE? PE is a very common problem, especially among young men with little sexual experience or men who have not had sex for a long time. Its cause is uncertain, but it is thought to be a psychological problem. As a young man gains more sexual experience, he usually develops greater control over orgasm and no longer experiences PE. However, some men remain anxious about sex and are troubled by PE for a longer time.

What Is the Treatment for PE? Sex therapists advise men with PE to try the following treatments:

• Masters and Johnson method. In this method, a man identifies and learns to control the feelings that precede orgasm. With or without a sexual partner, the man gradually brings himself to orgasm, paying close attention to where the point of orgasm is and stopping before he loses control. He repeats this process several times until he better understands the feelings that precede orgasm and how he can control them.

• Squeeze technique. In this method, a variation of the Masters and Johnson method, the man’s sexual partner squeezes the tip or the base of his penis just before the point of orgasm. This squeeze stops orgasm because it forces blood out of the penis and lessens the erection.

• Other methods. Using special creams that minimize the sensations that a man feels during intercourse; using condoms, which also lessen the level of stimulation and arousal; and trying different sexual positions.

Male orgasmic disorder occurs when a man is unable to ejaculate into his partner’s vagina. Like the other sexual dysfunctions, it can be either lifelong or acquired and is either generalized or situational. The lifelong form of this disorder is very rare; the acquired form is more common and is usually the result of psychological factors—for example, a very strict, religious background, a lack of trust, or a high need to be in control. The treatment is to gradually desensitize the man to the factors that keep him from experiencing ejaculation.

Inhibited sexual desire (ISD) is the complete lack of interest in sexual activity. A man with ISD engages in little or no sexual activity, including having sexual dreams and fantasies and being attracted to sexual partners. He has no interest in sex and is not at all frustrated if sex is not available. He is said to have ISD when this lack of interest causes harm to his relationship with his partner. The causes, which can be both physical and psychological, include depression, alcoholism, chronic illness, relationship problems, and a history of sexual trauma. People who experience major life changes sometimes have a period of a lack of sexual desire. Counseling sessions are the most effective treatment, enabling the patient to explore the factors that contribute to his lack of desire. Sensate-focus exercises (see box) may also be effective.

Most sex therapists assign sensate-focus exercises in their treatment of patients with sexual dysfunction. During these exercises, the patient couple is instructed to refrain from intercourse and orgasm. There are four levels of exercises, described as follows:

Level I. Each partner touches his or her partner’s body but avoids the genitals and breasts. The purpose of this exercise is for each partner to learn about the other person’s body. The person being touched is silent except when feeling uncomfortable.

Level II. The purpose of the touching is to bring pleasure to one’s partner but still avoids the genitals and breasts. The one being touched tells the partner what feels good and at what pressure.

Level III. This exercise is similar to Level II but includes the genitals and breasts, along with the rest of the body. The couple still must avoid intercourse and orgasm.

Level IV. This exercise involves mutual touching but avoids intercourse and orgasm.

Delayed ejaculation is the opposite of premature ejaculation and can be just as upsetting. The inability to ejaculate in a reasonable amount of time can make sex less pleasurable and even cause a man to avoid sex altogether. This disorder may have a physical cause, so it is important to seek treatment by a physician. If a physical cause is ruled out, a sex therapist may be able to help.

For some men, sexual intercourse is painful. The pain may be caused by tight skin or a lesion on the penis or by a disorder such as herpes simplex or Peyronie’s disease (mentioned elsewhere in this handout). A physical exam should be scheduled to determine the proper treatment.

Barbach, Lonnie. For Each Other: Sharing Sexual Intimacy. New York: Signet, 2001.

Comfort, Alex. The New Joy of Sex. New York: Pocket Books, 1992.

Kaplan, Helen Singer. Illustrated Manual of Sex Therapy. New York: Brunner/Mazel, 1988.

Lue, Tom. A Patient’s Guide to Male Sexual Dysfunction. Newtown, PA: Handbooks in Health Care, 2000.

Newman, Alfred. Beyond Viagra: Plain Talk about Treating Male and Female Sexual Dysfunction.Washington, DC: Starrhill Press, 1999.

Building Your Self-Esteem

Depression

Managing Anxiety

Relaxation Techniques

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