SEXUAL PROBLEMS: SEX THERAPY

Unfortunately, many men share similar attitude: They take advice to see a sex therapist as an indication that someone thinks they are crazy. In fact, nothing could be further from the truth. Sex therapy is for people who want to overcome habits and attitudes which sabotage their sex lives—if s usually not for people with serious emotional or mental problems, because often they can’t benefit from it. Generally, a sex therapist will not focus on your unconscious, or attempt to analyze you. A sex therapist will help you define your goals and possibly revise them so they are more attainable; identify problem areas and suggest solutions; and provide suggestions and exercises for making positive changes.

The fact is, sexual problems affect most people at some point in their lives. Think about it: Why would this emotionally packed area of human behavior be any more immune from disturbance than other parts of life? And sex therapy doesn’t take a lifetime. Sometimes, just a brief period of help can make a very positive and rewarding difference.

Although there are lots of variations of sex therapy, modern-day sex therapy began with the work of Masters and Johnson. As the term is usually used, sex therapy is designed to focus on the needs, concerns and expectations of the client. It can be a highly structured, short-term program lasting a few weeks or months, or it may be more flexible in design.

Different forms of sex therapy can benefit men and women with a wide variety of sexual difficulties, but we’re going to concentrate on how sex therapy can help men who experience erection problems.

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IMPOTENCY: BLOOD FLOW

The arteries in the penis are quite tiny, and zeroing in on them to take the pressure can be difficult. If the wrong arteries get measured, the results will be inaccurate. Generally speaking, if you get a low reading, you can probably figure the test was done correctly, Sometimes, though, you may get a false normal reading, If blood-flow problems are suspected, you then may need a more sophisticated measurement, called the duplex Doppler test.

Using the radar-like duplex Doppler, doctors can actually measure the increase in blood flow that a man is able to generate to get an erection. This sophisticated and nearly painless test can let the doctor actually see the arteries in the penis, and figure out how well they’re doing their job.

For years, doctors have used the duplex Doppler to look at other parts of the body. Tom F. Lue, M.D., and colleagues at the University of California Medical School in San Francisco, developed a new way to use it. We can now measure the increase in blood flow to the penis and the change in diameter of the blood vessels during an erection. This crucial information shows if the arteries are sufficiently healthy to deliver enough blood to the penis to sustain an erection.

Usually, these measurements are taken before and after a penile shot of papaverine which will, of course, usually produce an erection. By checking the change in blood flow between a man’s erect and nonerect state, the doctor knows if the arterial expressways are doing their job.

Sometimes a man with blocked arteries may be advised to have surgery to reroute blood around the defective arteries. If you’re considering this, you’ll need to have an arteriogram which can actually pinpoint the arteries at fault. First, dye is injected into the arteries which supply the penis, and then an X-ray is taken. f

Another artery test, thermography, measures the heat in the penis. The temperature is an indication of the amount of bloopl flow. But thermography has recently fallen out of favor with many urologists, since more accurate measurements of blood flow are now available.

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CONTROL TOUR EJACULATION: THE STOP-START METHOD

The stop-start method aims at giving the man a sense of control over his ejaculations. It starts with masturbation. In a quiet, private, secure place where he can relax, the man stimulates himself up and down the length of his penis, so that what he feels is similar to what he would enjoy during intercourse. While doing this, he needs to concentrate on how he feels, especially in his penis. When he senses he is going to ejaculate, he stops and waits until this feeling completely passes. Then, he begins self-pleasuring all over again. He may continue in this manner until the fourth time of wanting to ejaculate, when he allows himself to do so. He continues these exercises over a period of time, until he can control his ejaculation to his satisfaction.

Now, if there’s a partner, she can become involved by caressing her lover in the way described above. He can control her hands and stop her when necessary. Sexual fantasies can be an important part of this process.

Once a man can delay his ejaculation with masturbation and with his lover’s manual stimulation, he’s ready to try intercourse. If s best to start with the woman on top, because in this position the man has less general body tension and his partner is free to stop moving when he signals her to do so. When the couple first begins intercourse, the man and woman may lie still for a while or may enjoy caressing each other in nongenital areas. Once thrusting begins, he can use the stop-start technique to avoid early ejaculation. He may want to hold on to her hips to control the movement and the stimulation he feels.

The next-to-the-last step in the process is for the woman to be able to thrust herself while on top, without the man being in control. However, he may stop her if he feels he will ejaculate too soon.

Reaping the benefits of this technique takes time. You should expect premature ejaculation to continue for a while as you’re becoming familiar with the method. Once you have mastered each phase (a week for each period would be expected), you can try other positions during intercourse.

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PEYRONIE’S DISEASE CAN CAUSE ERECTION PROBLEMS

Peyronie’s disease, named for the doctor who discovered it, can also cause erection problems. Most often, this condition occurs in middle-aged men, who usually show up in the doctor’s office complaining of a penis that curves to one side when erect. Sometimes this curvature makes intercourse difficult. Sometimes there is also pain that disappears when the erection does. And some patients can actually feel a lump in their penis. (They usually think they have cancer, but growths caused by Peyronie’s disease are not cancerous.)

Not all men with Peyronie’s disease become impotent, but some do. Sometimes the disease appears to be caused by injury to the penis, and even, according to some experts, by medications. And there appears to be a genetic component, since it sometimes runs in families.

For reasons doctors don’t fully understand, the disease causes scarring in the corpora cavernosa, those all-important cylinders in the penis which must fill up with blood for erections to occur. This scarring can create the lumps, bending and pain which are the hallmarks of the illness.

A whole variety of treatments have been tried to stop the progress of the disease, including medication, radiation, injection of steroids into the penis and surgical removal of the lumps, but none have been proven particularly effective. About half of all patients get better over time (usually after about a year), so it’s important to take the most conservative approach you can live with. If you do decide to try any type of treatment, be sure you’re well informed about all the possible consequences. You may want to get a second (or third) opinion before proceeding. If severe bending with erection persists, an operation to straighten the penis may offer a permanent solution. In some cases, a penile implant may be necessary.

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ERECTION PROBLEMS: TROUBLE AT HOME

An unhappy relationship coupled with a demanding partner is another possible source of erection problems. In this case, as in others, separating the erection problem from the relationship is often counterproductive. Marion and Walter, for example, had been married for more than 20 years. It was not a happy relationship. Walter did not turn out to be the ambitious, energetic man Marion had wanted. Faced with conflict, he withdrew. Over the years, Marion had built up a lot of anger over her husband’s “failure,” his lack of responsibility, his unwillingness to participate in family events. But she did not deal with the issues openly. Instead, she took the battles into the bedroom. She compared her husband’s sexual skills with those of her best friend’s spouse, with the expected disastrous results. “Mary’s husband doesn’t have erection problems. But you do!”

The predictable result was that Walter’s erection problems increased, and Marion had something else to be angry about.

This was a no-win situation for both partners, but the erection problem was only a part of a very troubled and unfulfilling marriage. Some people might see Walter’s lack of erection as a way of punishing his wife, or as a logical response to a hostile situation. Feeling under attack, he and his penis withdrew.

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