Twenty or thirty years ago, it was assumed that 90 percent of erectile problems were caused by psychological or relational factors. But our culture tends to veer wildly from one extreme to another, and the current majority view is firmly in the opposite camp: Faulty physiology is to blame. Luckily, there’s been a neat little remedy on the market since 1998: Viagra. The entire North American population seems to devoutly believe in its powers to restore the sexual vigor, and rigor, of youth.
For the majority of middle-aged and older men experiencing problems getting and maintaining erections, however, the drugs promoted in the media are hardly a panacea.
Consider Bill. Bill is 51 years old and has been married for seven years to his partner Cynthia, who is 48. Like half of men by age 50, Bill has begun experiencing occasional difficulties getting an erection.
Believing that a little blue pill would do the trick, Bill went alone to get some Viagra. His doctor made sure he had no systemic medical problems and then prescribed the medication. The doctor assumed that the pill, all by itself, would bring back the frisky, confident potency Bill had enjoyed earlier in life.
In fact, Viagra did improve matters, but the results were oddly disappointing. Because he wasn’t entirely sure of the longevity of his new chemically induced erection, Bill was often in an anxious “use it or lose it” mode. Cynthia didn’t want to add to his anxiety, so she didn’t object to the speediness of the proceedings, but she (understandably) found sex uncomfortable when her body hadn’t had time to “get into it.”
Disconcerted, Bill stopped taking the pill within a few months and began avoiding sex completely. He didn’t think there was a solution: He’d seen the doctor and taken his Viagra. What else could he do?
This didn’t seem like much of a plan to Cynthia, who felt emotionally rejected, sexually abandoned, and completely blindsided by the deterioration of their relationship.
At heart, the problem was the disabling, but very common, belief held by both Bill and Cynthia that sex is a zero-sum game, a win-lose athletic performance, measured entirely by the “success” or “failure” of the arousal-intercourse-orgasm sequence. So the first step was to educate the couple to the amazing possibility that they could develop a new sexual style, replete with desire, pleasure, and mutual satisfaction.
What’s known as “good enough sex” therapy doesn’t attempt to have a couple talk through their sexual impasses. Instead, it uses psychosexual skill exercises designed in session to eliminate performance demands on each partner.
Cynthia and Bill learned how to build comfort with touch, both inside and outside the bedroom, how to take turns being stimulated, how to make verbal requests, and how to “let their fingers do the talking.” They explored Cynthia’s patterns of receptivity and response. They created opportunities for Bill to “piggyback” his arousal on Cynthia’s, a totally new experience for him. Bill also had to learn that life wasn’t over when sex didn’t end with intercourse—that they could both be happy and comfortable with an erotic, nonintercourse scenario, sensual cuddling that ended in sleep, or a request for a rain check.
At first Bill disliked the idea of doing exercises that not only permitted but required him to lose his erection—to let it wax and wane—while he and Cynthia focused on pleasuring. But once the performance anxiety was removed, he grew to enjoy the playfulness of sex and learned not to panic if his erection “took a break.” Both Cynthia and Bill found the emphasis on giving each other pleasure a positive experience, which helped them feel like an intimate team again.
To achieve satisfying, mature sex, it’s vital that both partners understand that the quality of sex in a committed relationship is inherently variable. Sex is an interpersonal process, not an autonomous one, and is dependent upon all the emotional complexity and flux of any connection between two distinct personalities. Sex exhibits as many moods as the relationship itself.
Among healthy sexual couples, fewer than 50 percent of encounters are considered satisfying in the sense that both partners experience high levels of desire, arousal, orgasm, and satisfaction. Even in satisfied couples, the quality of sex varies from experience to experience—from exceptional to downright lousy. The resilient couple can revel in the great times, take some pleasure from the mediocre times, and accept with equanimity the distinctly bad sex.
The challenge is to stop clinging to the “perfect intercourse” model and replace it with positive, realistic expectations of oneself, one’s partner, and one’s relationship.
Michael Metz and Barry McCarthy are clinical psychologists and coauthors of Men’s Sexual Health, among other books. Excerpted from Psychotherapy Networker(July-Aug. 2008); www.psychotherapynetworker.com.