Erection Problems, Premature Ejaculation and Delayed Ejaculation

The most prevalent sexual problems for men are erection and ejaculation difficulties. Viagra, Levitra, Cialis and Staxyn are not complete answers to these problems. Erection problems may mask a cardiovascular malfunction, and they may also express mental health problems such as severe anxiety and performance anxiety.

In the Western world there is a tendency to believe there is a magic pill for every problem. This tendency can be dangerous because serious issues can be overlooked with this simplistic approach. The most effective treatment plan must simultaneously address mental, physical and medical and relationship causes for E.D., P.E. and D.E. Physicians need to work with sex therapists, which is how I approach many sexual problems.

When a man comes to me with E.D., P.E. or D.E., I always see his female or male partner too. I initially see both lovers apart, and then together. I often find that the partner has a sexual problem too. I deal with all of the problems to improve the sexual relationship. When there is no partner, I see the man alone.

E.D. affects millions of men, from young to old. P.E. is more common with younger men, but it also can affect older men. D.E. affects older men the most, but is also prevalent with some younger and middle-aged men. After prostate surgery for prostate cancer or an enlarged prostate, some men experience a lack of ejaculation, or a retrograde ejaculation into their bladder.

Similarly, couples in medical treatment for infertility experience stress about conceiving during a small window of opportunity. I help these couples relax and enjoy sex, rather than relegating lovemaking to a chore to conceive. A sense of humor and playfulness helps!

Since orgasm and ejaculation are different events, these men can often still experience orgasm. In some cases, penile injections or a medication (MUSE) inserted in the urethra can improve erections. If these additional steps are not satisfactory, some men elect the final solution of prosthesis surgery, where two tubes are implanted in the penis with a reservoir in the scrotum. The reservoir holds saline solution, and by pressing the reservoir, an erection occurs. A second pressing of the reservoir brings the erection back down.

Most of these men and their partners can benefit from couples sex therapy to fully utilize the new device for sound lovemaking. I work with these couples. Lovemaking may require some adjustments after prostate and/or prosthesis surgery. Such adjustments are facilitated by me working with a couple and with the man’s urologist.

I use basic cognitive-behavior therapy (CBT) to help men get rid of distorted thoughts so they can function without predicting continual problems (fortune-telling), and without blaming themselves or their partner. I work on the communication between the man and his lover so everything is out in the open. Opening up is a critical step toward solving any sexual issue.

Sometimes medicines such as some antidepressants and blood pressure medications hinder desire and arousal in men and in women. I address all of these issues and I map out a concrete treatment plan from Day One.

Once the man is functioning with good erections and ejaculations, I help the couple improve their sexual expression. What is a man to do with a raging erection if he has no clue how to use it to the benefit of himself and his partner? One of the keys is for a man to get into his own pleasure, rather than obsessing about satisfying his partner. This helps with erections and ejaculations.

When men learn to have languishing and erotic foreplay, it is easier to solve these and related sexual problems. I make specific suggestions about foreplay and actual lovemaking. Sometimes I have couples view The Better Sex adult education series, for which I was one of two original co-hosts (with Dr. Judith Seifer).

P.E. and D.E. are solved with a combination of mental, physical/medical and relationship exercises. I use my imagination and over thirty-five years of experience to craft a treatment plan that works. Each plan is tailored to the specific sexual issues I help solve. I assemble pieces of the puzzle with physicians and other professionals when this is called for.

Each of these male problems is actually a couple’s problem. It is not accurate or helpful for one partner to claim that a given problem is not their problem at all. Blaming and attempting to withdraw from the treatment plan assures that the problem will not be fully dealt with.

My use of CBT, medical consultations, suggestions for basic health issues such as diet, exercise and sleep, along with my humor, constitutes a treatment plan that works as fast as the couple acts on my very direct suggestions. The homework and home-play I assign combine to facilitate quick progress. My job is to work myself out of a job as quickly as I can.