Erectile Dysfunction Treatment

Ninety per cent of sexual inadequacies in the male are due to inadequate knowledge and needless anxieties about sexual functioning. The family physician is ideally suited to sort out such simple sexual problems and earn his eternal gratitude. The problems of the remaining ten per cent are too deep rooted and need to be treated by a qualified sex therapist or a psychologist.

Modern sex therapists concentrate on the immediate causes of sexual dysfunction while psychoanalysts dwell on anxiety resolution of the remote causes, ignoring the immediate causes. Kaplan advocates a happy marriage of both groups of causes, immediate and remote, for a wider therapeutic spectrum instead of exclusively concentrating on one or the other.

PSYCHOTHERAPY: The main aim is to resolve the childhood sexual conflicts responsible for erectile dysfunction.

BEHAVIOR THERAPY: Dr. Masters and Mrs. Johnson (now Mrs. Masters) formulated the unique concept that the marital unit must be treated as one, with both partners being treated simultaneously and not just the partner with a sexual problem. They along with the marital partners, form what is called the 'therapeutic foursome'. The Masters Johnson treatment is expensive and even in the USA a large number of solo therapists treat the marital unit.

SINGLE THERAPIST AND SINGLE PARTNER: This is used where the female partner is not available for treatment.

THERAPY WITH SURROGATE PARTNERS: In the early stages, Dr. Masters used surrogate partners. The word 'surrogate' means substitute. The sex foundation supplies a properly trained partner for the sexually inadequate male. Dr. Masters has given up this practice and so have many other American clinics.

NEW SEX THERAPY: Dr. Helen Singer Kaplan of Cornell University Medical College in New York has wedded the insight and techniques of psychotherapy to behavior methods. Her method combines the best of behavior therapy and psychotherapy at the surface, going deeper only if necessary. According to her, lack of knowledge of sex is the commonest cause which can be easily reversed by learning. If the sexual inadequacy stems from recent anxiety, Kaplan recommends a series of guided sexual exercises.

RATIONAL EMOTIVE THERAPY: This is an outpatient procedure for only one person. According to Dr. Ellis, the therapist instructs and educates an impotent male that it is not what happens that upsets him but his belief that he must have an erection when he is with a woman.

GROUP THERAPY: A sexually inadequate male feels that he is 'alone and palely loitering' in a world of sexual Casanovas. Besides, the cost of sex therapy in the West is prohibitive and many cannot afford it. To make the inadequate male feel one among many others in his neighborhood who are sexually inadequate and also to reduce the financial burden, group sex therapy has been evolved in the West. Charles Lobitz and Joseph LoPiccollo were the first to demonstrate that women who have never reached an orgasm could be treated in groups where they were taught masturbation. However, group therapy is more popular among anorgasmic females learning to be orgasmic. Bernard Zilbergeld, Co director of Clinical Training of the Human Sexuality Programme in the University of California, has developed a successful group therapy programme for males.

The sexual history is taken in great detail to study the sexual makeup of the individual and find out the exact cause of his erectile dysfunction. Psychological erectile dysfunction occurs only under a certain set of conditions. The highly selective nature of psychological erectile dysfunction distinguishes it from organic erectile dysfunction and erectile dysfunction due to drugs, where the erectile dysfunction is present at all times and is not selective. For example, in psychogenic erectile dysfunction an individual may be potent with his mistress but not his wife or vice versa, or may have erection and ejaculation during masturbation but not during attempted intercourse with a female.

He may have morning erections but not at any other time. Morning erections occur three or four times at night during a sexual or an asexual dream. Their exact cause is not known but according to Bernard Zilbergild in Men and Sex, 'Morning erections are erections which accompany the last dream of the night.' It was formerly believed that morning erections were due to the reflex action of a full bladder. If this was true the problem of psychological erectile dysfunction would be immediately solved. All the impotent male would have to do was to attempt intercourse with a full bladder. Morning erections in a man who cannot achieve erection during intercourse are, according to Stekel, the most reliable symptom of psychic erectile dysfunction. To prove that the erectile dysfunction is psychic the following questions are asked:

(1) Do you have an erection in the early morning?

(2) Do you have erections during masturbation?

(3) Do you have erections during dreams?

(4) Do you have erections during sexual fantasy or daydreams?

(5) Is intercourse possible with a female partner other than your wife?

(6) Do you have erections under other conditions like riding or in a train?

In psychic erectile dysfunction the answer to any of these questions is 'Yes'. If the answer is 'No' to all the questions, the individual is asked to observe for a week or two whether he has any erections in the morning. Many males have morning erections about which they are not conscious unless they are told to observe them. He is also asked to masturbate by recalling the same fantasy and see if he gets an erection. If the patient still reports no erection, the erectile dysfunction is psychological, if other causes (organic or drugs) are excluded.

DURATION OF SEXUAL DIFFICULTY: When did he first notice it? Is there a complete loss of erection? General questions like 'How is your sex life?' should not be asked. Instead specific questions framed in a particular way should be asked. For example, 'Is there a desire for sex?' Detailed questions about the nature of erection, penetration, maintenance of erection, orgasm and ejaculation, and, similarly in women, about desire, lubrication, accommodation and orgasm, should be framed on the following lines.

SEXUAL EXPERIENCE IN BOYHOOD AND PUBERTY

(1) When did you first have an erection?

(2) What was the frequency of night discharge?

(3) Have you had intercourse?

(4) What was the result?

MASTURBATION

(1) What is your attitude towards masturbation?

(2) What is the frequency?

(3) Do you have remorse or guilt after masturbation?

(4) What were the nature of fantasies before or during masturbation?

INTERCOURSE

(1) Do you know the mechanics of intercourse? (Many men have difficulties because they are unaware of the anatomy and physiology of the male and female reproductive organs.)

FEAR

(1) Does any type of fear dominate your attitude towards sex? (The commonest fear is that of erectile dysfunction. There may also be a fear about an unwanted pregnancy or venereal disease.)

PREREQUISITES

(1) Are there any prerequisites for your potency?

(2) Are you potent with a certain type of woman, like call girls or prostitutes?

(3) Do you need to take alcohol before you can have sex?

(4) Are there any other prerequisites, such as the female fondling your penis or wearing a particular sari or blouse or pantie?