Causes and Treatment of Erectile Dysfunction by Nina Bingham

While the majority of couples will agree that a healthy sex life is important, "85-90% of adults in sexual relationships will have some sexual difficulties in their lives" (Sexual Dysfunction and the Response Cycle Video, 2012). "A review of the epidemiological data indicates that about 40-45% of adult women, and 20-30% of adult men have at least one sexual dysfunction" (Lewis, Fugl-Meyer, K., Bosch, Fugle-Meyer & A.R., Laumann, et al., 2004).

While a client may present with one complaint, problems in any one phase of the sexual response cycle may lead to problems in other phases (Leiblum & Rosen, 2000). Aside from medical problems which can cause sexual dysfunction, "Relationship factors were associated with sexual dysfunction for both men and women. Global deficits in the current relationship were more likely to occur among women with sexual dysfunction. Women who experienced the most relationship problems showed the highest level of breakdown in their sexual response by showing a lack of sexual desire. The major factor associated with sexual dysfunction for men was the level of conflict" (McCabe 2005). Besides the common problem of performance anxiety, other factors such as: stress, anxiety, fatigue and relationship conflict may impact the sexual response (McCabe, 2005). I would also like to add to this list depression, and other mental illness symptoms and medications (such as anti-depressants) which can inhibit sexual response.

According to the American Psychiatric Association (2000), "The human sexual response cycle is conceptualized in four stages: desire, arousal, orgasm and resolution." Of these stages, clients report problems in the arousal phase: erectile dysfunction (ED) for men, and vaginal dryness for women. I will address treatments for ED only in this brief article.

First, "In males under 40, chronic ED is commonly of psychological origin" (Sexual Dysfunction and the Response Cycle Video, 2012). This would indicate that in males over 40, a medical problem could exist, and a referral for a medical examination would be indicated.

Secondly, performance anxiety is key to the development of ED (Hawton, 1993, Louden, 1998). "The interesting finding is that for both men and women, performance anxiety has a negative impact on the three phases of the sexual response cycle (desire, arousal, orgasm)..."(McCarthy, Metz, 2008). Also contributing to ED were poor sexual sensitivity and communication problems (Lui, 2002), and Shives & Miller (1998) found ED in clients with general anxiety and depression.

In treating ED, "Most men follow the advice of marketing ads and feel all they need to do is ask their physician for Viagra..." (Rowland, 2007). However, "In assessing, treating and relapse prevention of ED, it is crucial to examine a range of causes to ensure that change is genuine and resilient...relapse prevention is usually ignored in the medication/perfect intercourse model" (McCarthy, Metz, 2008).

"In truth, it is not easy for the man to accept the concept of sex as a "team" sport; he learned sex as totally predictable and under his control" (McCarthy, Metz, 2008). Introducing an alternate approach to sex can be beneficial when performance anxiety is a hindrance. Termed the "Good Enough Sex" Model, "...the emphasis is placed on the man and woman as intimate, erotic friends. The key in relapse prevention (of ED) is to not regress to the cycle of anticipatory anxiety, failed intercourse and embarrassment and avoidance. This means dealing with a lapse, and not allowing it to become a relapse" (McCarthy, Metz, 2008). These researchers go on to say that treatment intervention strategies for ED should be concerned with: sexual performance anxiety, the dynamics of the relationship, developing positive attitudes towards sexual expression, and resolving conflict.

Certainly, sexual responsiveness and function is not only physiological, but emotional and psychological as well, and should be treated holistically. ED is a common enough problem among men that it ideally should be assessed both medically, and treated as a psychological and emotional issue through psychotherapy or couple's counseling.

References:

Sexual Dysfunction and the Response Cycle Video. (2012). Presented by: Capella University. Retrieved from: http://media.capella.edu/CourseMedia/COUN5226/sexualDysfunctions/sexualDysfunctions_wrapper.asp

Lewis, R.W., Fugl-Meyer, K.S., Bosch, R., Fugl-Meyer, A.R., Laumann E.O., Lizza, E., et al. (2004). Definitions, classification and epidemiology of sexual dysfunction.
In T.F. Lue, R. Basson, R. Rosen, F. Guiliano,
S. Khoury, & F Montorsi (Eds.), Sexual medicine: Se.Kual dysfunctions in men and woman: 2nd International consultation on sexual dysfunctions (Pads: International
Consultation on Urological Diseases (ICUD), International Society of Urology (SIU), International Society for Sexual and Impotence Research (ISSIR)).

Leiblum, S.R. & Rosen, R.C. (2000). Principles and practice of sex therapy. New York: Guilford Press.

McCabe, M.P. (2005). The role of performance anxiety in the development and maintenance of sexual dysfunction in men and women. International Journal of Stress Management, Vol. 12 (4), pp. 379-388. US: Educational Publishing Foundation.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, DSM-1V-TR. Arlington, VA.

Hawton, K. (1993). Sex therapy: A practical guide. Oxford, England. Oxford University Press.

Louden, J. (1998). Potential confusion between erectile dysfunction and premature ejaculation: An evaluation of men presenting with erectile dysfunction at a sex therapy clinic. Sexual and Marital Therapy, 13, 397-403.

McCarthy, B.W., Metz, M.E. (2008). The "good enough sex" model: a case illustration. Sexual & Relationship Therapy, Vol. 23, Issue 3, p. 227-234, 8p.

Lui, M. (2002). Influences of sexual performance anxiety on E.D. Chinese Journal of Clinical Psychology, 10, 47-49.

Shives, A. & Miller, D. (1998). A preliminary study comparing psychological factors associated with E.D. in heterosexual and homosexual men. Sexual and Marital Therapy, 13, 37-49.

Roland, D. (2007). Will medical solutions to sexual problems make sexologist care and science obsolete? Journal of Sex & Marital Therapy, 33, 385-397.