When many men and women think of treatment for erectile dysfunction, they think about medication such as Viagra or Cialis. You may be wondering why bother with sex therapy if Viagra or Cialis is so effective? There are two reasons: Medication does not address any underlying issues that are contributing to the erection problem and sometimes the underlying issues are so big that the medication does not work. Also, there are side effects with medication, such as headache, stomach upset, and dizziness, medication can be expensive, and you can become dependent on using it. If you do not have any medical issues that are causing the erection problem, sex therapy can be an effective treatment. It can help put you back in control of your penis. You can gain control of having sex when and how you want it. Treatment of Erectile Dysfunctions typically ranges from 8-12 sessions.

What to expect in the initial session with a sex therapist

     The first session of sex therapy is a time when your therapist will do a thorough evaluation of your erectile problem. You will be asked many questions such as:

• Do you have problems getting an erection, maintaining an erection, or both?
• Does it happen all the time, most of the time, sometimes, or rarely?
• Does the problem occur during masturbation, partner sex, or both?
• Does the problem occur during all types of sexual stimulation (e.g. oral sex, vaginal sex, anal sex)?
• Has it occurred with different partners? Has there been a period in your life when it hasn’t occurred?
• Do you feel desire to have sex?
• Do you feel sexually attracted to your current partner?
• Do you feel anxious when you are going to be sexual with a partner because of the erection problem?
• How long have you been dealing with the problem?
• What kinds of things have you tried to solve the problem?

     In addition, the therapist will assess any aspects of your life that may be contributing to the problem. Some examples are your confidence with your sexuality, certain medications or medical problems, and/or relationship problems. At the end of the first session, the therapist will talk with you about the different factors that may be contributing to the erectile dysfunction and a plan for treating them.

Treatment

     Treatments for erectile dysfunction can vary due to the contributing factors; however, most sex therapy treatments for erectile dysfunction have one major component in common: awareness of your body and sensations during the sexual experience. A sex therapist will always rule out and address any medical problems that may be contributing to the condition, often with a referral to the urologist. Once medical conditions are ruled out or treated, the therapist will work with you on learning how to attend to and fully experience bodily sensations. There are two primary ways of addressing this issue.

Use of Masturbation

Masturbation is typically the first step in learning how to be aware of your body and attend to bodily sensations. You are instructed to masturbate without the use of fantasy, pornography, etc. The goal of the masturbation is to be 100% focused on the sensations that are happening in your body. How does is feel when you touch yourself? What kinds of touch do you like? What sensations feel good? What pacing feels good for masturbation? You may not be used to masturbating this way and you may find it challenging to get an erection initially, even if you historically do not have problems getting erections through masturbation. Remember, you are learning a new skill. If any anxiety or other thoughts come up that are distracting you from focusing on your sensations, you are instructed to acknowledge the thoughts but not react to them, and bring your focus back to your sensations. Once you feel comfortable getting and maintaining erections during masturbation, the skill is then transferred to sex with a partner.

With a Partner

     As you can imagine, transferring this skill to sex with a partner presents a new set of challenges. First, if performance anxiety is a problem, you are now in the situation that triggers it. The skill is the same, but you will have a lot more anxiety to acknowledge and focus away from. Another factor is wanting to please your partner. You are no longer the only person in the room and will likely be concerned about your partner having a good experience. Feeling pressure and anxiety about what is going to happen is normal. You need to practice the skill of managing it and attending to your bodily sensations to master your erection problem. Practice attending to bodily sensations with your partner by trying the following two exercises:

• Undress and have one person lay on the bed. For 10 minutes, the other partner is to practice different types of touch such as soft, hard, or very light all over the upper part of the body above the waist. The person receiving the touch is to focus on the bodily sensations that are happening. What does it feel like? How would you describe it? Do not focus on getting an erection or getting aroused. The purpose is to relax and focus on the sensations. After 10 minutes, switch roles.
• The next exercise is very similar but instead of touching the upper part of the body the focus is on the genitals. Again, have one partner lay on the bed while the other partner tries different types of touch on the genitals. As with the first exercise, focus on the sensations. Don’t try to get an erection or worry about getting an erection. If you find that those thoughts enter your head, shift your focus back to the sensations that you are feeling. After 10 minutes, switch roles. You may need to practice these exercises several times. The more you practice attending to the sensations, the easier it will be to focus away from anxious thoughts and to relax and be in the moment. The more you can attend to your sensations and be in the moment, the easier it becomes to get and maintain erections.

     The therapist will also address any other contributing factors like communications problems about sex, lack of sexual desire or stimulation, other relationship problems, unrealistic expectations about sex, etc. You can begin to address an erection problem without being in a relationship by practicing masturbation that focuses on your bodily sensations and coping with any fears about being in new sexual relationships. With the help of a sex therapist, erectile dysfunction can be treated.

written by Jennifer Foust, Ph.D., M.S., LPC

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