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Question:
My boyfriend is 40 years old, I'm 33. He has been divorced for 6 years (no relationships during that time); I have been divorced for 3 years (he is my first loving and sexual relationship in that time) we have been sexually active with each other for four weeks now. We are very loving, a lot of foreplay, a lot of kissing, and a lot of touching. In the last week, he is losing his erection, regaining it, losing it. We will stop and he’ll pleasure me or give me back rubs, which in turn, turns him on, gets him hard and seven out of ten times can perform intercourse and climax in the end. He is starting to feel bad when he loses his erection, questioning what is wrong with him. I am the second women in 20 years he as been intimate with, we both have daughter, mine 9, his 11, and we are all very loving together. He also spent 12 years in federal prison for several drug charges when he was in his early 20's. Karry tells me that for many years, he fantasized and masturbated, when he got out of prison, the relationship with his daughter’s mother was cold and unloving, and though they had a sexual relationship, it was not a continuos thing. I am very sexual, I like to touch and kiss and rub, glide my fingers on his body...I am all his fantasy's he says, which I think could be part of the problem, I think I may intimidate him a bit, he says no and he loves the way I touch and treat him, which from the reaction of his body I know it's true. He is a wonderful man and a wonderful father. He has asked me to help him with this, and of course I said yes. He has told me it is not me, that it's something in him, he doesn't know what though. How do I help him, do I continue to be very sexual with him, or should I scale back a bit. He is a very hard worker, takes care of his mother, and has a very loving relationship with myself and my daughter...I think it could be stress to. I need to know how to unleash his anxiety. Karry wants to get a physical, thinking because of his age, something there could be part of the problem. He is a very fit, athletic beautiful person. How do I help him? Thank you, Tina
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Answer:
by Hussein Ghanem: (06/13/2004)
Recent statistics suggest that some degree of erectile dysfunction may affect up to 30-40% of men around the age of forty. The good news is that most problems can currently be resolved. The history you give –intermittent problem- is suggestive of psychogenic erectile dysfunction that is most commonly related to performance anxiety or fear of failure. You both need to visit an Andrologist / sex therapist for evaluation to exclude physical risk factors for the dysfunction.
I am quite optimistic about the outcome of therapy in your particular case since your letter clearly demonstrates that you have a strong supportive relationship.
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
2- 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.
Generally the most important causes of erectile dysfunction include:
PSYCHOGENIC FACTORS:
Most important factors are performance anxiety (fear of failure during intercourse) & depression.
ORGANIC FACTORS:
- Vascular: Example athersclerosis & related risk factors (Diabetes, Hypertension, high cholesterol and smoking.
- Neurogenic: Example multiple sclerosis, spinal cord injury, neuropathies, and radical pelvic surgery.
- - Endocrine: Mainly Diabetes, decreased male hormone levels or elevated Prolactin, or disturbed thyroid hormone levels.
- - Drugs: Medications: e.g. some antihypertensives,
antidepressants, antiandrogens & major tranquilizers
Cigarette smoking
Alcoholism
Recreational drugs: e.g. Marijuana & Heroin
- - Other diseases: Erectile dysfunction might be associated with liver, renal & heart disease..
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. In persistent cases, It may be helpful to get the man to obtain erections through medication in order to overcome the psychogenic factors. Please check my recent article on this subject http://www.sexualhealth.com/fullstory.cfm?id=33
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): Mainly for persistent physical problems.
Best wishes, Hussein Ghanem, MD
Reviewed by Sexual Health Editorial Team
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