Erectile dysfunction: What women need to understand

I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:

Q: What don’t women understand about erectile dysfunction (ED)?

MC: Like men, few women understand the difference between true ED and erection dissatisfaction (EDis). Women also don’t really appreciate how men FEEL when EDis or ED develop. It’s sort of like how women feel when they lose a breast to cancer. You’re still alive, but you feel diminished. A part of your body you took for granted isn’t there anymore, or in the case of men, doesn’t work like it used to. And this isn’t just any part of the body. It’s a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.

Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden–and in many men this happens pretty suddenly–they’re in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then….nothing. Nothing happens.

Many don’t understand what’s happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.

Now women often (and rightly) believe that men are too focused on the penis. That’s often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it’s the end of sex, that they’re over the sexual hill, that it’s all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis… if they ever adjust.

Q: Why can’t men express these concerns?

MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the “strong silent type,” to keep a “stiff upper lip,” to “grin and bear it.” In other words, to deny what they’re feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they’re less skilled than women. Now some women believe that men don’t HAVE emotions because they don’t discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they’re less likely to be able to really articulate how they feel.

The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they’re young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex “too” much, not be “too” easy. But how easy is too easy? Young women also have issues with orgasm. Many don’t have them and have to learn how to release orgasms.

Meanwhile, few young men have sex problems–other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It’s almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don’t discuss their ED or EDis in part because it’s unimaginable–then it happens and they’re speechless.

To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he’s less of a man?

Q: When should a couple seek counseling?

There’s no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that’s when to consider counseling.

Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual–a desire difference, orgasm issues for the woman, erection issues for the man–then I’d start with a sex therapist.

Personally, I’m a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That’s pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.

To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.

Q: What if the man won’t go?

The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple’s issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.

Michael Castleman, M.A., is the author of twelve books, including <a href="http://www.amazon.com/gp/product/159486991X?ie=UTF8&tag=wwwvibrantnat-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=159486991X”>Great Sex: The Man’s Guide to the Secrets of Whole-Body Sensuality<img src="http://www.assoc-amazon.com/e/ir?t=wwwvibrantnat-20&l=as2&o=1&a=159486991X” width=”1″ height=”1″ border=”0″ alt=”" style=”border:none !important; margin:0px !important;” /> and <a href="http://www.amazon.com/gp/product/067167577X?ie=UTF8&tag=wwwvibrantnat-20&linkCode=as2&camp=1789&creative=390957&creativeASIN=067167577X”>Sexual solutions: For men and the women who love them<img src="http://www.assoc-amazon.com/e/ir?t=wwwvibrantnat-20&l=as2&o=1&a=067167577X” width=”1″ height=”1″ border=”0″ alt=”" style=”border:none !important; margin:0px !important;” />. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife.

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Posted in Better Than I Ever Expected: Sex and Aging, love & sex.

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6 Responses

  1. Sunblossom Sunblossom says

    Well, I can’t see any therapy working when it is BP/Diabetic drug induced ED…..really I don’t think there is a lot of resolution to that other than trying to get off the meds…..I would think Viagra etc. would be dangerous for someone also on BP meds…I mention this because this is becoming a new problem for us as some med dosages have been upped recently for him….there was never a problem before that…

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    • JoanPrice JoanPrice says

      Therapy still helps you relate to each other in a loving AND sensual way, and explore alteratives to intercourse. I still recommend it.

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  2. Matriarch Matriarch says

    I think I will get your book and leave it about, perhaps he will read it.  He seems to be in the avoidance mode.  Will kiss and hug me, but as for sex well forget about it.  I’m afraid to initiate sex at all because of his ED problems.  Perhaps the practice thing will work.  But he and I cuddled when we were younger, not so much anymore.  Seems his overheated body sparks hot flashes in me.  We have a great marriage outside of sex, and we really had a great sex life till just the past few years.  This year especially, his mom died, so I have been giving him his space to grieve, since of course he rarely even mentions it.  I guess I don’t understand men, they bottle everything up, close themselves off, and we are supposed to look up to them as manly men?  I often feel like live a sexstarved life, but since I’m married the only thing I can do is satisfy myself.  Anyways, a few comments helped here, and I hope to try them out.  Thanks


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    • JoanPrice JoanPrice says

      There are so many ways to make love without an erection, and avoiding sex will just make it harder to reclaim your intimacy later. Your husband had a great loss with the death of his mother, and his ED problems feel like a death of sorts to him. Would he accept a loving, whole body massage from you? If you make it clear that you want to give, you’re not asking anything, he might realize again how wonderful it feels to be touched. At another time, you could ask if he would do that for you. That’s just one of many ways to become intimate again without him feeling he has to perform.

      But — avoiding talking about it doesn’t do your relationship any good. Can you ask him, “I love you very much and I miss our intimacy. I would love it if you would caress me to orgasm. Would you be willing to do that?” When he sees he can give you sexual pleasure, he’ll remember how important sex is in your lives as a couple. 

      Counseling would be very helpful. He’s probably depressed and he’s not talking. That doesn’t make the depression or the grief go away — in fact, it makes it worse. This isn’t a “man” thing — it’s your husband, the individual, who is pulling away and doesn’t know any other way of dealing with his grief. I enourage you to suggest counseling for the two of you, since he doesn’t sound like he’d go on his own.

      If he won’t go, it would be useful for you to go to learn ways to talk about these things.

      I wish I had my new book, Naked at Our Age, ready for you — there are several chapters that apply exactly to what you and your husband are going through. I’m stiill writing it, and it won’t be out until Spring 2011.

      - Joan

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  3. Cathryn Wellner Cathryn Wellner says

    Wonderful posting. I’m in a later-in-life relationship with a man who understands whole-body sensuality. He misses the days of instant erections and hard partners, but he makes up for it with a slow sensuality my young partners never had.

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