ERECTILE DYSFUNCTION:

ERECTILE DYSFUNCTION:

Dear Sumner:

I have asked George, a 62 year old man, to call you for an appointment, since, unfortunately, I have been unable to provide him with satisfactory solutions for his problem with maintaining erections. He states he is able to gain a fairly firm erection, but as soon as he attempts insertion, the penis becomes flaccid. He has tried oral and intraurethral medications, penile injections as well as a vacuum pump, all with variable degrees of success. I found no obvious causes for his difficulties. It’s your turn now! Thanks in advance for your help.

Dear Craig:

Most of my time with George involved listening: having him tell me when and under what conditions he had difficulties (or no difficulties) achieving and/or maintaining erections. I questioned him about his occupation, interpersonal relationships, the time and situation of onset of his erectile dysfunction and how he performs sexually under varying circumstances, including self stimulation or with a partner-- or partners. (I had a patient consult me because he was having problems maintaining an erection when with his wife. He had no such problems when with his mistress.) When I learned that George was able to have firm erections during vacation without the use of medications or devices I felt confident that he had no physiological disturbance of his erectile “mechanism.”

My main approach was one of counseling--and reassurance. I pointed out to him that while a teenager may be able to attain an erection “at will”, this ability lessens with age (and George realizes that he is no longer a teenager). Our discussion included the fact that most men over the age of 50, and often younger men as well, experience intermittent difficulty with erectile function.

But perhaps the most meaningful point of discussion for George was his realization that he often tried to gain an erection even when there was no sexual stimulation. Almost every time he was unsuccessful. This series of failures eventually turned into a self-fulfilling prophecy of erectile dysfunction—at least when he was not on vacation.

If his problem continues, I suggested he utilize variations of the techniques of Masters and Johnson, sometimes referred to as “sensate exercises”. This involves stimulating and subsequently bringing his partner to orgasm without his inserting, the purpose being to avoid any pressure on him to “perform. “ (Usually, during the time of his partner’s being stimulated, he himself becomes aroused--and erect). Hopefully, after awhile, George will be more relaxed when with his partner and the “problem” will straighten itself out spontaneously. I am optimistic that the self realization that his reactions are not abnormal will itself be therapeutic. He was somewhat concerned about his wife’s reaction to his perceived failure of performance. If his problem does not resolve, he agreed to make another appointment for both him and his wife . Craig, I’d like to share a story with you how one’s attitude can influence his reaction to his erectile function. One of my patients told me that on his 85^th birthday he wrote in his diary: “Last night I had an erection. I was unable to bend it with both hands.” On his 86^th birthday he entered in his diary: “Last night I had an erection. I was able to bend it with both hands. I must be getting stronger.”