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Question:
I'm a sexually active 25 year old male from Canada. About a year and a half ago i picked up a girl at a bar in Los Angeles and brought her back to my hotel room. I was pretty drunk and had trouble obtaining and/or sustaining an erection. After about 30 minutes to an hour we did manage to have intercourse, however the even was particularly puzzling and disturbing for me since that had never happened to me before.
Over the next year, I successfully had intercourse with two partners with no problems. The next girl however, had a problem getting comfortable as i penetrated and asked me to hold still for a moment. For a split second I felt my erection begin to subside and that was it (this occurred about 5 months ago). I could not get it back (i think the evening in los angeles was lingering in the back of my mind) and was terribly disturbed by the entire situation. The same thing happened the next time we were together. Eventually, I got over it and maintained my erection but sex was not nearly as exciting as it had been in the past because of my lingering fears. We broke up a couple months later.
Recently, the event has reoccurred with a new girl who i have strong feelings for and is incredibly attractive. I explained to her my take on the predicament (she was pretty understanding) but fear that if this keeps happening she may lose interest. I do not want this situation to get worse and hope that this self-perpetuating cycle will cease immediately before it gets out of hand. How do i stop it?
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Answer:
by Hussein Ghanem: (06/04/2004)
You have described your condition accurately as a self-perpetuating cycle. Erectile dysfunction could be either physical or psychogenic (mainly performance-anxiety or fear of failure. It is safe to assume that your condition is psychological since it occurred suddenly, it is intermittent with periods where you function normally, your young age, and the absence of significant medical illnesses.
The performance-anxiety cycle can be broken by either the sensate focus exercises prescribed by a sex therapist or occasionally by medication. The goal of sex therapy is to retrain both sexual partners to relax and enjoy the pleasure of the sexual contact without focusing on the outcome.
The following are some strategies that the sex therapists commonly prescribe.
Strategies for sex therapy
1- Sensate focus (relaxed sensual massage, Developed by Masters & Johnson)): Taking turns at giving & receiving stimulation while forbidding genital touching, vaginal penetration & orgasm. The period prescribed for sensual massage could be days or weeks depending on the severity of the performance related anxiety.
2- Non-demand genital touching: The next step is to allow mutual genital & breast touching but still intercourse & orgasm are not allowed.
3- Vaginal containment (quite vagina): Vaginal penetration is allowed but both partners remain still (no pelvic thrusting).
4- Fantasy: Imagining sexually stimulating situations.
5- Squeeze technique & start stop technique (Semans maneuver) to treat premature ejaculation: In the squeeze technique, the female partner stimulates the penis then squeezes the glans firmly when the male patner signals he is about to ejaculate. In the start stop technique, stimulation is stopped before ejaculation is inevitable & then resumed once more. The cycle is repeated over & over again.
Since your problem appears to be psychogenic and your partner is supportive, I expect the problem would resolve with sex therapy.
For general information purposes, I am enclosing this general classification of therapy for erectile dysfunction. Therapy is generally classified into first line, second line, and third line treatments options. Naturally, second line and third surgical options are mainly prescribed for patients with significant physical factors.
Treatment decision-making
. 1st line therapy (Oral erectogenic agents): e.g. Viagra and new medications in clinical trials Vardenafil & Cialis; Vacuum devices; Couples/sexual therapy
. 2nd line therapy (Local treatments): Intraurethral alprostadil; Intracavernosal self injections
. 3rd line therapy (Surgery):
Please check my recent article on this subject - Modern Trends In The Management of Erectile Dysfunction - on sexualhealth.com (recent articles)
Best wishes, Hussein Ghanem, MD
Reviewed by Sexual Health Editorial Team
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