Wednesday, September 15, 2010

Treating Erectile Dysfunction

I often get interesting psychological books from publishers. One that I received recently caught my eye and I picked it up. The title? Erectile Dysfunction: Integrating Couple Therapy, Sex Therapy, and Medical Treatment. The book is written for sex and couple therapists and physicians, as well as for the person seeking treatment and for his spouse.

The books starts with the staggering facts about erectile dysfunction. The prevalence rate for men who are 40 is 39% and increases to 67% for men who are 70. The authors point out that as baby boomers age, many more men will be affected by this problem. They do discuss medical interventions for erectile dysfunction but I thought they did a good job of focusing on the psychological factors in a chapter entitled, "Assessment of Psychological Risk Factors."

The major risk factors include: vulnerabilities within the individual, factors arising from the family of origin, and relationship issues. The book uses a systemic approach to treating the problem and does not automatically assume it lies only with the man. At one point, the authors suggest to therapists "not to assume that her [my emphasis] inhibitions, if present, were precipitated by him."

In another chapter on couples' relationship problems, the authors address anger and conflict issues and they make a good point: "The question is not whether anger and conflict occur between partners, but how they manage it when it does occur."

Overall, the book seems to have good information on treating erectile dysfunction and looks from my perspective to be a good resource for therapists, physicians or those who want to understand more about the problem.

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42 Comments:

Blogger Cham said...

I have never seen a subject weighed in by so many counselors, sex therapists, urologists, experts and professionals with one opinion and the cold reality of the subject be something so different. I'm going to get a good laugh over this discussion about erectile dysfunction, go ahead experts and dazzle us all.

8:40 AM, September 15, 2010  
Blogger DADvocate said...

Erectile dysfunction?! I thought it was reptile dysfunction. But, then, it is referred to as a snake sometimes.

BTW- in my experience this is never talked about between men (and maybe women). I've never heard it brought up in any conversation, anywhere, in which someone was referring to their or their spouses problem. Or, maybe I just happen to always be with a particular virile group of men, which I doubt.

9:17 AM, September 15, 2010  
Blogger Professor Hale said...

This comment has been removed by the author.

10:24 AM, September 15, 2010  
Blogger Professor Hale said...

I am just guessing because I do not have this problem and don't expect to. I suspect it is related more to the wife than the husband. As a man gets older, so does his wife. She becomes flabby, fat and unattractive and his ability to be aroused by her falls off as a result. Ethical boundaries constrain the man within his marriage and he learns to get by with less. It is also not very likely that a man will admit in a couples therapy session that his wife no longer arouses him. Most men are smarter than that. A lifetime of marriage teaches men to lie well.

It would be interesting to see if there is any study among men with younger wives for differences in the rates.

10:28 AM, September 15, 2010  
Blogger Kevin M said...

Eliminate from the population of men with ED those whose affliction is the result of:

Lack of regular exercise,
Weight gain,
Smoking,
Alcohol & drug abuse, or
Regular watching of The View, Oprah or Martha Stewart...

and you'll end up with a population of afflicted men whose numbers would never warrant books, TV spots, endless TV commercials and that glassy-eyed moron, Smilin' Bob.

This is nothing but the American pharmaceuticals industry going off on a money-grubbing tear.

I used to live next door to a 67-year old man whose wife loudly and regularly remarked of his voracious sexual appetite. He never smoked, drank only wine at dinner and jogged 5 miles a day until his knees made him walk ten miles instead.

No Ph.D. or M.D. needed here.

10:50 AM, September 15, 2010  
Blogger TMink said...

Cham the thought of men suffering sexually is amusing to you? Wow.

Trey

11:04 AM, September 15, 2010  
Blogger Dr.D said...

I think all of you are missing the point. What man in his right mind is going to brag about his ED?

The American pharmaceutical industry is making a bundle selling Viagra, Cialis, etc., and this simply would not be happening if there were no market. The fact that men do not talk about it does not mean that the problem does not exist. The MDs hear about it, not the guy in the next cube.

11:08 AM, September 15, 2010  
Blogger TMink said...

Well, also Dr. D, I understand that the ED drugs are used recreationally. So that inflates (sorry) the numbers a bit.

Trey

12:59 PM, September 15, 2010  
Blogger dr.alistair said...

cham, what do you think the problem is?

it happens occasionally between my wife and i.

i`m usually too tired, or something is on my mind....and my wife understands and waits a couple of hours, or until morning, which is generally better for me anyhow.


some of the artifacts of a 15 year controlling relationship still weigh in occasionally i might add...and as i explore some of those issues (from a safe distance) i discover just how much they still influence my life now.

the two products that work for me are horny goat weed (no joke!) and a product called forta, which i save for special occasions...because my wife deserves the best.

1:05 PM, September 15, 2010  
Blogger Video said...

The medical community widely considers erectile dysfunction a bellwether of cardiovascular disease. It is, after all, a matter of getting a requisite quantity of blood to travel somewhere.

The fact that a significant portion of the population is on some manner of antidepressant medication may have something to do with it as well.

Men may also grow more particular as they get older. Personally, I can't wait until the libido disappears. Although by all indicators, it's not going to. That's a shame.

1:19 PM, September 15, 2010  
Blogger Der Hahn said...

The fact that most of the commercials include the phrase 'Ask your doctor if your healthy enough for sexual activity' is a pretty good indicator that these drugs are mostly making up for a lifetime of unhealthy habits. I've had some experience with ED caused by a combination of being out of shape and overconsuming OTC pain killers following an accident where I busted up my shoulder. That was hard.. uh, more difficult than just poppping a pill. Once I fixed those issues I improved quite a bit though I have learned to scale my expectations to the fact I'm 48, not 28.

Prof Hale's post was a bit crude but there is a grain of truth to the joke about the man who needs Viagra with his wife, but not with the housekeeper.

1:35 PM, September 15, 2010  
Blogger dr.alistair said...

i suffer from niether cardiovascular disease or am i on anti-depressants, though these are evidently factors of ED.

my drive allows my wife and i sometimes twice or three times in a day.

we laugh and call ourselves a rare anglo-saxon mating pair (ornitological reference), but occasionally we are presented with a non-starter, generally in the late evening, and we love eachother anyway and do something else together.

i think in many mature relationships the simple fact that a spouse is unattractive to the other is a common issue and not one that needs to be medically treated, but the fact remains that many overweight emotionally unavailable women are getting some now is attributable to a little blue pill.

my ex asked me to ask the doctor for some viagra, and he said that i didn`t love her any more.

i could have kissed him.

at that moment i finally felt the courage to begin to leave her.

1:43 PM, September 15, 2010  
Blogger dr.alistair said...

video said;

The medical community widely considers erectile dysfunction a bellwether of cardiovascular disease. It is, after all, a matter of getting a requisite quantity of blood to travel somewhere.


if you are losing morning wood as well....

1:58 PM, September 15, 2010  
Blogger Topher said...

I don't think Cham was misandrist or out of line at all. She's simply saying that this topic will bring out all sorts of self-appointed experts to share their anecdotes and prescribe solutions.

As it has. Much like last week's thread about the habits of the wealthy.

2:15 PM, September 15, 2010  
Blogger Topher said...

dr alistair,

"but the fact remains that many overweight emotionally unavailable "

I read this sentence too fast, and thus coined a new word for my vocabularly: "emotionally overweight." Aka drama kings and queens. Thanks for the inspiration!

2:20 PM, September 15, 2010  
Blogger Topher said...

"i suffer from niether cardiovascular disease or am i on anti-depressants, though these are evidently factors of ED."

Chicken and egg...is it the antidepressant drugs or the fact one is depressed to begin with?
(The same could be asked of the acne drug accutane.) I have known some people with mental issues who get those "side effects" when they go on the drugs so I'm sure it's not just one or the other.

2:22 PM, September 15, 2010  
Blogger DADvocate said...

my drive allows my wife and i sometimes twice or three times in a day.

Reminds me of the old fella who went to the doctor complaining of having difficulty performing sexually. The doctor asked when he first noticed his problem. The old fella says, "Twice last night and once this morning."

2:45 PM, September 15, 2010  
Blogger dr.alistair said...

topher, i think there is some redundancy in the term emotionally overweight in and of it`s self.

and dad, i could be considered old in some circles....50 next month.

3:31 PM, September 15, 2010  
Blogger DADvocate said...

You're almost 10 years younger than I. Oh, to be 50 again.

4:04 PM, September 15, 2010  
Blogger Cham said...

Sorry, I've had a really busy day. I'll have to break this up in 2 posts. I'm laughing at all the experts and their comments, not the affliction.

Okay, let me weigh in with my opinion. There are 2 competing challenges with erectile dysfunction. The first challenge is that men often may define themselves through sex. Men find it very important to become aroused, to perform sexually and have an orgasm. Some think this is biological, I think it is more cultural. Men's importance within the household has been slowly diminished. They aren't needed much for heavy lifting because there is less heavy lifting to be done. Financially women can earn money and pay the bills. We have all sorts of media and peer pressure for men to be sexual beings, get laid, laid often and sometimes to get laid by many women. Sex has become increasingly more important to men in the last few years.

Then there is the other problem. The increase in weight and decrease in exercise. The girth of all waist lines is expanding at a record rate. Depression rates are probably staying steady though lifespan is increasing. Men's food choices often lead to unhealthy fatty foods that wreak havoc on the heart and veins. As another poster pointed out, all of this decreases blood flow to various organs including the penis.

So what we end up with is men are desperate to have sex and have an orgasm, but an ever increasing group of men is having trouble doing the deed. I don't think I have told anyone here anything new so let me move on with the reality part.

8:37 PM, September 15, 2010  
Blogger Cham said...

Continued.

I'll be hypothetical here, but maybe there isn't much hypothetical about what I have to write. I'm going to get graphic here so if you don't like it quit reading.

A man and woman decides to have sex. He's excited, she's excited. They take their clothes off. His penis doesn't work. He suggests a blowjob, she gives him a blowjob. He gets an erection. He refuses to perform foreplay on her because he feels the erection might be short-lived. They have sex. He loses the erection. He wants a handjob, a blowjob, anything. She's getting irritated. He prods her into getting his erection back. They continue to have sex. She stays perfectly still lest any movement upset the erection situation. He concentrates on his pleasure and his orgasm. After 20 minutes of pumping he finally comes. He rolls over and falls asleep satisfied that he has performed successfully. She knows only one thing, the relationship has to end and the sooner the better.

Viagra is another side of the same coin. With all the psychological experts, medical experts and men talking about their deep personal issues and how they must have sex, perform sexually and be the man in the bedroom I don't see anyone talking about how their partner feels about the erectile dysfunction acrobatics they are forced to perform to keep the illusion that all is fine and dandy with the poor performing penis. Ask any woman over the age of 40 and they all have their own horror stories about this.

8:38 PM, September 15, 2010  
Blogger br549 said...

Say what you want. I smoked most of my life, and yes, it causes vascular problems. I had a prostate the size of a tennis ball. Yes, it caused problems. Flomax caused even more problems. There are a couple other things, all have been dealt with.

Long and short, beta sitosterol removed the prostate problem. Viagra works like a champ. Some testosterone replacement (had a tumor on my pituitary gland) and I am literally 25again.

Like I said, say what you want. There are physical as well as phycological reasons. Mine were physical, and my problems are gone.

So Cham what about you, me, and the moonlight?

9:09 PM, September 15, 2010  
Blogger TMink said...

Topher, you made a good point, I believed you. Oh well, better luck next time. You are still right 98.3% of the time. 8)

Cham, you did not dissapoint with your masculine stereotypes.

Trey

8:04 AM, September 16, 2010  
Blogger Xiaoding said...

People do not go on so about broken legs.

I take pill, I do it long time! Feel better.

10:13 PM, September 16, 2010  
Blogger Professor Hale said...

I don't see anyone talking about how their partner feels about the erectile dysfunction acrobatics they are forced to perform to keep the illusion that all is fine and dandy with the poor performing penis.

The women in the Cialis commercials look really happy. That's good enough for me.

10:36 AM, September 17, 2010  
Blogger Tether said...

"She knows only one thing, the relationship has to end and the sooner the better."

-----

Well, she's got to wait until some money drifts her way first. No sense rushing.

2:43 PM, September 17, 2010  
Blogger dr.alistair said...

i believe cham is reporting what she knows of her own experiences, and maybe a few other not-in-love types.

my wifes orgasms come (no pun) before mine in my mind, if not in physical reality occasionally.

sometimes she says she will wait for me, which is so damned sweet, and other times she indulges in my attentions...

...we don`t have rules.

and my wife takes from me. i catch her occasionally. she takes dollar coins from my side of the dresser and giggles like a little kid.

but i guess i have a distorted view of reality...blinded by love i suppose.

3:34 PM, September 17, 2010  
Blogger God Of Bacon said...

Aren't you supposed to get less horny as you age? I always thought it was normal...like getting older.

4:19 PM, September 17, 2010  
Blogger BarryD said...

This comment has been removed by the author.

5:26 PM, September 17, 2010  
Blogger Tether said...

BarryD:

That's on-the-money advice. Resentment does build up between spouses over time, over decades.

dr.alistair:

Do you realize how much you are into yourself? Right down to the "Dr." handle when you say on your own Web site that you are "working on" some Ph.D. in some dorky theological subject?

Bragging about yourself on the Internet is not gaining you karma points in life.

5:35 PM, September 17, 2010  
Blogger BarryD said...

There are two entirely different factors that increase with time:

1. Physical age and problems with the blood vessels and nervous system (exacerbated by obesity, smoking, etc.), or prostate problems.

2. Unaddressed resentments between spouses.

I suspect that the #1 situations are relatively easy to identify in the majority of cases. #2 could well be more common... The fact is that a lot of buried emotional crap can reduce the effective libido. Even a man finds it difficult to be turned on by someone he quietly loathes.

To put it bluntly, if someone finds women attractive, and pornography to be a turn-on, but somehow suffers "erectile dysfunction" with his wife, it's not a physical problem we're dealing with, here...

5:35 PM, September 17, 2010  
Blogger Tether said...

This comment has been removed by the author.

5:36 PM, September 17, 2010  
Blogger BarryD said...


my ex asked me to ask the doctor for some viagra, and he said that i didn`t love her any more.


That sums it up...

5:36 PM, September 17, 2010  
Blogger Tether said...

Just a side note, but why do we have a system in which a man has to go to a doctor to beg for viagra; the doctor will at most measure his blood pressure and ask if he uses some nitro compounds ... and then prescribe it. Just prescribe it the same as if you answered the same questions on the Internet. After the doctor gives a stern look with a raised eyebrow like Spock on Star Trek, of course. Depending on the doctor, you may also have to pay homage to his greatness.

Just get it on the Internet (at a trusted site).

The best health care reform: That Americans see through the myth that physicians are Gods.

5:41 PM, September 17, 2010  
Blogger Xiaoding said...

"To put it bluntly, if someone finds women attractive, and pornography to be a turn-on, but somehow suffers "erectile dysfunction" with his wife, it's not a physical problem we're dealing with, here...
"

Well. perhaps.

You keep hearing that, but I wonder. Pornagraphy, the stimulation is visual and mental, all in your mind. So that's one way.

But in bed, with another person, more sensation, no fantasy, hardly any visual. and you might not really want the visual. All kinds of emotional crap, too.

It's a different route, so does the brain treat it the same? Could still be a physical problem, I theorize. The systems involved are very complicated.

6:35 PM, September 17, 2010  
Blogger Xiaoding said...

+1 to Tether! check out "Fred on Everything", and his comparisons of our medical tyrany, compared to Mexico's freedoms. You want an anti-biotic? You go to the drugstore, and YOU BUY IT. Five bucks, you out of there. now ThATS a free country!

6:37 PM, September 17, 2010  
Blogger Tether said...

I saw that there was physician opposition to making Zantac prescription-free, for God's sake.

They really want to protect their turf.

7:08 PM, September 17, 2010  
Blogger br549 said...

Further to my earlier post, if you smoke, quit.

It does a heck of a lot more to you than just throat and lung damage. The vascular damage can be halted, but not reverted. And living with only one lung puts a serious damper on your capabilities, perovided you survive in the first place. And it will offset the cost of Viagra.

12:05 AM, September 18, 2010  
Blogger Cham said...

Br549, erectile dysfunction is like a lot of other afflictions. Smoking, drinking, lack of exercise and a bad diet are going to contribute. Do you really think people want to seriously consider a lifestyle change when a blue pill will solve the problem? The pharmaceutical companies are fat and happy churning out Lipitor, Viagara, and thousands of other concoctions that wouldn't be necessary if people changed what they did. Doctors get speaking fees and steak dinners from pharmaceutical companies for not suggesting a lifestyle change and writing those prescriptions. One can write scrip in less than a minute, thereby the doctor get to see and bill more patients. Talking about weightloss, smoking cessation, stopping that lifelong drinking habit is too much effort, makes your customers unhappy and most likely will fall on deaf ears.

8:15 AM, September 18, 2010  
Blogger dr.alistair said...

tether, you are boring.

toe to toe your tone would be substantially different.

my statements make you scoff, but the proof would make you cry.

remember, when you stare into the abyss...it stares back.

2:25 PM, September 18, 2010  
Blogger BarryD said...

Could still be a physical problem, I theorize.

Well, sure. The problem that one's spouse is genuinely physically repulsive.

However, genuine repulsion is almost invariably more than skin deep.

11:10 AM, September 19, 2010  
Blogger dr.alistair said...

well said barry.

12:53 PM, September 20, 2010  

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