Male Sex Problems

It is estimated that at least 40 - 60% of couples struggle with a sexual problem at some time in the course of their relationship

 

by
Mary M Buxton LCSW, Inc. AASECT Certified Sex Therapist

(Note: Links are to headings on this page which can also be reached by scrolling.)

Introduction

The information below may help you define and better understand your sexual problem as well as demystify the process of sex therapy. Below you will find separate sections defining the common sexual problems, along with their causes and treatments. Knowledge is a good antidote to the shame and discomfort that many people feel about having a sexual concern. Hopefully, the information below will decrease the barriers you have to understanding and working on the problem and increase your comfort as you do so.

Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below. Others won't. There is usually a hidden part of sexual problems, the emotional part that is unique to each individual and / or the couple. Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.

General Factors that Contribute to Male Sexual Disorders

  • Cultural messages from specific cultural backgrounds:
    • Nice girls don’t,
    • Women should be passive
    • Sex is a woman’s duty
    • and on and on.
  • Personal history can contribute to male sexual difficulties.
    • Lack of information about sex
    • Generalized anxiety disorder and depression
    • Poor communication regarding sexual needs
    • Fears of being intimate with a partner
    • Relationship issues of power, control and conflict (especially hostility and resentment)
    • Severe cultural, religious and family restrictions on masturbation and premarital sexuality or other negative messages about sex
    • Aversion to sex
    • Past sexual trauma - rape or sexual abuse
    • Painful first attempts at intercourse or history of chronic painful intercourse
    • Expectation that sex hurts
    • Fear and distrust of men or partner
    • Fear of pregnancy
    • Sexual \ orientation conflict
    • Relationship conflict (especially hostility)
    • Unconscious fears and ambivalence

General Approaches to Treating Male Sexual Disorders

Psychological treatment will always start with taking a comprehensive sex history and exploring causes

  • Psycho-education
  • Role modeling
  • Relaxation techniques
  • Humor
  • Touching exercises for self and for partner
  • Body image exercises
  • Reading and specific sex education videos
  • Journaling
  • Assertion training

Medical Treatment

  • Medications
  • Surgical interventions

Male Hypoactive Sexual Desire Disorder (302.71)

Problems with sexual arousal, desire and sexual frequency are some of the most common and complicated concerns that cause individuals and couples to seek sex therapy.

Definition

Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and socio- cultural contexts of the individual’s life.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of Male Hypoactive Sexual Desire Disorder ranges from 14-63%.

Causes and Barriers

  • Biological
    • Hormonal factors
    • Health/major illnesses
    • Street drugs
    • Medications
    • Age and aging.
  • Emotional
    • Religious, cultural, and family messages about sex.
    • Self and body image concerns
    • Inhibitions regarding sexual fantasies
    • Sexual trauma history
    • Masked sexual orientation issues
    • Lack of information
    • Unrealistic expectations and fears of intimacy and closeness
    • Lack of differentiation from family of origin or from partner.
  • Relationship
    • Stored anger
    • Resentment and chronic conflict
    • Need for power and control
    • Not attracted to partner
    • Disagreements about conditions and reasons for sex
    • Inability to negotiate differences as a fundamental relationship problem.
  • Lifestyle / Culture
    • Life in the fast lane
    • Role overload
    • Fatigue
    • Unrealistic expectations for sex, body image and relationships from media influence.
  • Unrealistic Expectations
    • Initial infatuation stage vs. deeper, more calm stage of attachment (not all-consumed with sex). Real love is built on communication and intimacy. Sex becomes a part of the whole relationship, not the center of it.

Treatment

Some people will possibly be able to resolve what is bothering them by just reading and applying some of the ideas below. Others won’t. There is usually a hidden part of sexual problems, the emotional part that is unique to each individual and /or the couple. Many people often need the boost of professional help to get the many aspects of their concern sorted through and resolved.

Improving Communication About Sex

  • Do sex checks.
  • State what I want in positive respectful terms.
  • Talk about sex more often.
  • Listen carefully and non-defensively to what my partner has to say.
  • Be willing to try what my partner suggests while respecting my own sexual limits.
  • Refrain from blame and criticism.
  • Praise my partner daily.
  • Talk about my resistance and hesitancy to communicate about sex.

Good Sex Takes Effort Once You’re Past The Infatuation Stage of Relationship

  • Sexual excitement is made not born
  • Cultivate sexual mindfulness

Finding Time in Your Busy Life

  • If you don’t make an effort, forgetting to have sex can become a habit
  • The key to a good sex life within a busy life is planning

Finding Couple Time and Making Sex a Priority

  • Ask for help and say no.
  • Divide the labor.
  • Find couple time:
    • Overlap shifts
    • Extend day care
    • Meet for lunch
    • Cancel appointments
    • Enforce bedtime
    • Use the media
    • Use baby sitters, relatives and friends or trade with other parents.
    • Regular date nights
    • 15 minute face to face talks
    • Daily and romantic weekends away.

Conditions for Good Sex

  • Turn off the TV, computer
  • Go to bed at the same time, and earlier in the evening
  • Light meals and little or no alcohol
  • Feeling rested and connected
  • Candlelight and flowers?

Restore Touch & Affection So That Touch Does Not Equal Sex

  • Eye contact
  • Touch gently during conversation
  • Sit close on couch
  • Spoon
  • Hold hands

Romantic Love Starter Kit - Cultivate Good Feelings

  • Say, “I love you”
  • Send me a card in the mail
  • Bring me a flower
  • Do a chore without being asked
  • Go for a walk and talk with me

My Sex Tackle Box - Be Prepared!

  • Lock on the door
  • White noise or radio near the door
  • Phone off in bedroom
  • Special underwear & sleepwear
  • Massage oil
  • Videos, erotic books & magazines
  • Birth control & lubes

Better Sex Through Chemistry?

  • Sex is more than just chemistry
  • Drugs may reduce or enhance libido
  • Consult with your physician

Erectile Disorder (302.72)

Definition

At least one of the three following symptoms must be experienced on almost all or all (75-100%) occasions of sexual activity

  • Marked difficulty in obtaining an erection during sexual activity.
  • Marked difficulty in maintaining an erection during sexual activity.
  • Marked decrease in erectile rigidity.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of inability to maintain an erection is 10.4% (Laumann et al, 1994)

Causes

  • Physiological causes of erection difficulty are:
    • Hormonal, vascular, or neurological disorders
    • Smoking, alcohol & drug use
    • Medications
    • High fat diet, and lack of exercise.

It is helpful to get an exam by an MD to rule out these physical causes early in the sex therapy. It is now thought that erection difficulty might have a physiological basis in as high as 50% of the cases.

  • Psychological causes of erection difficulty:
  • Life stress
  • Relationship difficulty
  • Stored anger
  • Performance anxiety
  • Depression.

Treatment

Medical options

  • Vasodilators - Viagra - like pills
  • Vacuum pump
  • Injectible
  • Penile suppository
  • Penile implants
  • Altering your medications to reduce the negative effect on your sexual functioning

Psychological treatment

  • Sex history taking to develop a sense of the individual’s unique strengths and difficulties. Areas to be covered:
    • Sex education from family, church and peers.
    • A history of sexual experiences and relationships and the impact of them.
    • Exploring how assertive the person is in asking for what he wants and saying no.
  • Learning about the cultural myths that affect male sexuality and developing conditions for good sex.
  • Graduated steps of touching and couple exercises that can help the man overcome erectile dysfunction.
  • Ban on intercourse to take the performance pressure away.
  • Graduated massage sessions can help in addition with other relaxation training. The touching exercises start with the man learning to focus on his soft penis and notice sensations. Then he practices masturbation to gain and lose erections. Once he is confident that he can gain and lose erections alone, he can include his partner to do the same thing, manually and orally.
  • Penetration - graduated steps to achieving penetration and thrusting.
  • Using mental imagery and self-talk to enhance performance is another technique that can assist the man in developing the confidence in his erections again.
  • Sex education videos, books, massage therapy, are all adjunctive strategies that will probably b included in the course of treatment.

Delayed Ejaculation (302.74)

Definition

Either of the following symptoms must be experienced on almost all or all occasions (75-100%) of partnered sexual activity and without the individual desiring the delay:

  • Marked delay in ejaculation.
  • Marked infrequency or absence of ejaculation.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence - No orgasm, 8.3% (Laumann et al, 1994)

Causes

  • Unrealistic beliefs and expectations
  • Automatic thoughts and distortions
  • Negative and restrictive sexual scripts

Treatment

See general treatment approaches above.

Premature (early) Ejaculation (302.75)

Definition

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity with in approximately 1 minute following vaginal penetration and before the individual wishes it.

Note: Although the diagnosis of premature ( early) ejaculation may be applied to individuals engaged in non vaginal sexual activities, specific duration criteria have not been established for these activities.

These symptoms have persisted for a minimum duration of 6 months, cause significant distress. The symptoms can be lifelong or acquired, generalized or situational, and mild, moderate or severe in severity.

Prevalence of orgasm to early is 28.5% (Laumann et al, 1994) 75% success rate in treatment.

Causes

  • Unrealistic expectations - It is important to define what the man is describing as premature ejaculation…before, during or after penetration, how many thrusts and so on.
  • Genetics - some men find that they have a family history of premature ejaculation, if they are comfortable enough to ask the other men in their family.
  • Psychological causes of premature ejaculation. They are:
    • Life stress
    • Relationship difficulty
    • Stored anger
    • Performance anxiety
    • Depression.

Treatment

Medical options:

  • SSRI drugs that are normally used for depression. These drugs have a side effect of delaying ejaculation and orgasm that can be helpful for someone who is struggling with coming too soon. You would need a prescription from your doctor. You may not want to rush to these drugs, or do them without the benefit of sex therapy. It is always better to coordinate any medical intervention with psychological interventions.

Psychological treatment

  • Sex history to develop a sense of the individual’s unique strengths and difficulties. Areas to be covered are:
  • Sex education from family, church and peers
  • Sexual experiences and relationships and the impact of them.
  • Exploring how assertive the person is in asking for what he wants and saying no.
  • Learning about the cultural myths that affect male sexuality and developing conditions for good sex.
  • Challenging unrealistic beliefs and expectations, automatic thoughts and distortions, self-fulfilling prophecy, restrictive sexual script.
  • Temporary ban on intercourse to take the performance pressure away.
  • Graduated massage sessions with a partner can help in addition with other relaxation training.
  • Graduated steps of touching and couple exercises that can help the man overcome premature ejaculation and achieve penetration and thrusting.
  • Using mental imagery and self-talk to enhance performance is another technique that can assist the man in developing the confidence in his ability to last for more pleasure in partner sex.
  • Sex education videos, books, massage therapy, are all adjunctive strategies that will probably be included in the course of treatment.

Post Traumatic Stress Disorder (309-81)

Childhood sexual abuse, rape and other sexual trauma may be a factor in painful sex.

Where to Get Professional Help

  • Many people often need the boost of professional help to get the many aspects of their sexual concern sorted through and resolved.
  • I offer individual and couple counseling services with a specialization in sex and couple therapy.
  • For referrals to a sex therapist in your area, contact www.aasect.org

___________________________________________

Adapted from:

  • Clinical Update on Sex Therapy, course notes, Linda De Villers, Ph.D.
  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, 2013.
  • Coping With Premature Ejaculation: How to Overcome PE, Please Your Partner & Have Great Sex - Michael E. Metz and Barry W. McCarthy, 2004
  • The New Male Sexuality, Revised Edition, Bernie Zilbergeld, Random House, 1999
  • Coping With Erectile Dysfunction: How to Regain Confidence and Enjoy Great Sex - Michael E., Ph.D. Metz and Barry W., Ph.D. McCarthy, 2004
  • Hot Monogamy: Essential Steps to More Passionate, Intimate Lovemaking, Love, et al, Plume, 1999.

Updated Dec. 11, 2015

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