Case Example: Getting Hard

Alex, a big strapping guy with a well-trimmed beard was almost 40 when he walked into my office with a complaint of difficulty getting, and keeping, erections. He was an intelligent proud fellow who had been married, without children, and for a number of years had been divorced. On getting back to dating, he initially experienced a variety of awkward moments when he noticed that his erections were not what he was used to; that his penis was not “performing” as it should.

As soon as he used the word “perform,” I kind of jumped on him and told him in clear terms that that word was not allowed to be used in my office. I said “sex is not a performance.” “Sex is a form of adult play and a potentially profound form of communication.” As he continued to tell me his story, it became clear that Alex’s whole social life became significantly constricted as a result of his fear of failure in bed.

Like many men I see with such problems, Alex was handsome, well-toned, intelligent, and had a good steady job and source of income. Also, he felt really keen to have a relationship and relieve some of what he felt were the burdens of single life, like loneliness, at times. Similar to many people who experienced a good marriage, even in part, or a good relationship, they crave and want to recreate that aspect of the previous experience.

Also, as with many patients, Alex’s main problem was not that he could not attract women who might be interested in going out with him. He was quite acceptably handsome and clearly would appeal to some members of the opposite sex. Unfortunately, the fear of having to go to the bedroom at some point in the relationship, and potentially suffering a “failure experience,” so inhibited Alex from even attempting to meet women that his whole social life became very severely restricted.

Eventually, Alex attempted to get help by going to a highly advertised clinic where his penis was injected and a firm erection thereby produced. However, he was reluctant to follow their advice and precede every act of potential intercourse with putting a needle into his penis. In exploring alternatives, he also tried Viagra and this too worked with some effect in him but not consistently, and he reported that he had some headaches as well, and he found timing a problem, having to take the pill about an hour before intended sexual contact.

Alex was very relieved when we discussed our approach to treating his sexual problem without any medications whatsoever. Rather, relying on a cognitive/behavioural treatment, which entailed reprogramming the autonomic part of his central nervous system, would then enable his blood vessels to be relaxed and open wide, thus allowing blood to flow to the penis freely and produce an erection whenever he would want.

Indeed, following this 8 to 10 session program, supplemented with readings and homeplay assignments, and looking at carefully selected sex education films and videos, Alex made marvelous progress, like most of my patients.

In one of our last sessions, he related how recently he met on a street near his home a lovely tall blond “with legs up to here,” whom he asked for a coffee after a brief chat. That led to dinner in a nice restaurant and some very exploratory discussion about what each of them had in mind for the future. It turned out that she had also been married once before, and was ready and keen on a serious long-term relationship with children, as was Alex. They both agreed to go slow and to explore each other’s values, goals, and ability to communicate in a meaningful soul-to-soul level. There is every indication now that this relationship will meet Alex’s expectations and even exceed them, and that his long period of solitary life and fear of sexual failure will come to a happy end.

It is stories like Alex’s, repeated many times, in my practice that makes my work so meaningful and rewarding. It is most important that men in a similar position as Alex recognize that these days there are a variety of approaches to help with all kinds of sexual problems, dealing with erections as well as with ejaculation control problems and desire issues as well. It’s most important that people take responsibility when they do have a problem, and seek out appropriate help with a well-qualified doctor or therapist with whom they feel comfortable. If something seems not be working out, do not hesitate to explore alternatives. Do it sooner rather than later, as this makes the treatment program easier. Among resources available to you besides, of course, the Yellow Pages would be preferably referrals from your family doctor and/or a phone call to your local hospital and/or medical society.

– Dr. Frank Sommers