Erectile Disorder: Totally Treatable

Many men find that they sometimes have difficulty with getting or maintaining a satisfying erection, especially as they get older. Some of this is related to normal changes associated with aging. Some of it is also due to the fact that older men tend to have more physical health problems that can negatively impact their erections—as can certain treatments.

Fortunately, despite all the angst that they can produce, erectile difficulties often respond quite well to medical and/or psychological treatment. The goal is not simply more reliable or firm erections, but also on helping the couple once again create a mutually enjoyable sex life. Some of this will involve working with both partners to help restore the man’s erectile ability, but treatment will probably also involve helping both partners to not tie all of their sexual satisfaction to the presence and firmness of the erection. This has the potential to create a sex life that is more enjoyable than it was before the erectile difficulties began.



Just as a good erection results from a combination of physical, psychological, and relationship factors, so too are erectile difficulties potentially influenced by all of these, so we need to look at all three in order to figure out what is getting in the way.

Physical Erectile capacity can be negatively impacted by any of the following: diabetes, hypertension, Peyronie’s disease (bent erections), endocrine problems, prostate surgery/radiotherapy, and neurological problems (Alzheimer’s, Parkinson’s). In addition, antihypertensives, antiandrogens, major tranquilizers, and SSRI antidepressants can all play a role.

Psychological Depression, anger, anxiety, low self-esteem, sexual self-doubt, and poor body image can all interfere with erectile ability, as well as general enjoyment of sex. Of course, erectile difficulties can also cause or worsen all of these. For some men (and their partners), one random bout of erectile difficulty can cause a downward spiral of performance anxiety where every time after they worry about their ability to get an erection which then undermines their ability to get one which reinforces the worry. . .

Relationship The presence of erectile difficulties in one partner obviously also impacts the other and can elicit many feelings, thoughts, and reactions. It is easy for both partners to get over-focused on the current state of the erection which makes sex much less enjoyable for both and thereby makes erections even more elusive.



Medical Treatment

If you suspect that other medical conditions or medications are impacting your erectile abilities, then speak with your treatment providers and, if necessary, explore your options. A urologist may test your body’s ability to create an erection to determine what is going on which then helps guide treatment.

Medications such as Viagra, Cialis, and Levitra can help to create more reliable erections for many men. There are also other medical treatments and devices such as tourniquets and vacuum pumps that can be useful, if necessary. If you find that a treatment is not working as expected, then talk with your treatment providers to see if refinements can be made.


Psychological Treatment

Once erectile difficulties begin, it can impact both members of the couple and how they relate to each other, both sexually and otherwise. When some couples do try to have sex, they wind up approaching it with such uncertainty that it is no longer enjoyable. If it becomes uncomfortable enough, some couples may avoid sex entirely. Therefore, a sex therapist can help you sort through this fall-out and rise above it to create a mutually satisfying sex life. This may begin by helping you and your partner to think through the various treatment options so you can make a well informed and well thought out decision, then make best use of the treatments that you do choose.

The goal of treatment may involve a return to your previous sex life or the creation of a new one. Therapy often begins by overcoming the erection killing trap where the more focused you get on the erection, the more it fades away. Ironically, focusing on each other and the pleasurable sensations and letting the erection do what it will do, makes for more reliable erections. A sex therapist can help you learn to create better erections, make better use of whatever erections you do get, and perhaps compensate for any limitations in your erectile capacity.

In addition to talking through your thoughts and feelings about your sex life and fostering communication with your partner, a sex therapist will probably also give you and your partner exercises to try at home. For example, sensate focus exercises can help you both learn to focus more on the enjoyable physical sensations and let distracting thoughts go. Stop-start techniques help the man to see that he has more control over his erections than he feared and helps both members of the couple to not fear its sudden disappearance.

Ironically, even though these techniques make erections more likely, perhaps the most important thing to keep in mind is to enjoy yourselves and be flexible about your expectations, so that you can still have fun even if the erection makes a temporary exit. If you can do this, you will have learned an important secret of a happy sex life.

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