Male Sexual Functioning Problems
Sexual functioning is so strongly linked with our societal, and often our personal, beliefs of what it means to be a “man”. Regardless of how you identify or what type of relationship you are in, likely your sexual functioning is tied into your self-esteem and your relationship functioning. So, when things go wrong, that can wreak havoc on a variety of areas of your life. Sexual functioning problems can be biologically/medically driven, they can be age-related, or they can be psychologically driven by anxiety or depression or relationship issues. More often than not, it is a combination of factors, and I am here to work with you to sort out the cause, and provide solutions! Whether there is an underlying medical cause or not, working in conjunction with a medical provider to determine if there is a medical factor is always best practice and can provide you with the best results. Sometimes we can resolve the problem relatively easily, sometimes the problem is not resolvable, but instead, we work on how to shift your mindset and deal with what is happening in more constructive ways. Therapy for male sexual functioning can be done individually or with a partner, the benefits of including a partner are to address any concerns you might have about your partner’s perceptions of your sexual functioning as well as to include them in the treatment exercises. Whatever the problem is, you are not alone and I am here to help!
Erectile Dysfunction
Erectile dysfunction, sometimes referred to as “impotence” is not an uncommon problem for men in general with 6.5% of men of all ages reporting “frequent” problems with erectile functioning.1It is certainly one of the primary concerns that bring men of all ages and sexual identities into my office. When there is consistent difficulty in getting or keeping an erection, it can impact various areas of your life. Many men notice decreased self-confidence and struggles with relationships that extend beyond just the bedroom. They may avoid dating or avoid any form of intimacy with a current partner. While pills such as Viagra (sildenafil) or Cialis (tadalafil) can assist with erections in the moment, sex therapy helps resolve the underlying anxiety pattern that continues to exacerbate problems with erectile functioning, as well as addressing the relational and self-esteem effects. For men who are partnered, including a partner can be a helpful part of treatment, but is not necessary.
Laumann, E. O., Glasser, D. B., Neves, R. C. S., & Moreira, E. D. (2009). A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. International Journal of Impotence Research, 21(3), 171-178.
Premature Ejaculation
All men have had the experience of ejaculating before they would like, and most have felt embarrassment at this having happened. Premature ejaculation disorder is when ejaculation occurs sooner than a man, or his partner, would like, on a consistent basis, not just once in a while. While this happens more often to younger men, it can happen at any age, and it is commonly seen in men who also have erectile functioning problems. The first line of treatment is often a combination of education around sexual functioning and ejaculation control exercises, both of which can be accomplished through the guidance of a sex therapist. For men who are partnered, including a partner can be a helpful part of treatment, but is not necessary.
Delayed Ejaculation/Orgasm Difficulties
While many men worry about “cumming too soon”, for some men, the problem is that they worry about ejaculating at all. For some delayed ejaculation or the inability to orgasm only happens during partnered sex, while for others, there is also difficulty ejaculating and reaching orgasm during masturbation. In sex therapy, you will explore potential underlying causes as well as associated solutions. Understanding underlying medical or lifestyle factors is important. Certain medications or health conditions can cause delayed ejaculation and a full medical history needs to be considered when formulating a treatment plan. For men who are partnered, including a partner can be a helpful part of treatment, but is not necessary.
Pain
While pain during intercourse is fairly infrequent in men, it does exist, and it’s an area in which I specialize. Many of the causes are medical, and I often work in conjunction with a pelvic floor physiotherapist and urologist in helping men cope with their pain.
Low Desire/Arousal
The stereotypical person with low desire is the heterosexual housewife. When we talk about sexual desire as a culture, we make broad gender-based assumptions that men always want sex. As such, it can be difficult for men to admit, and then to seek help for this problem. In addition to the shame or confusion that may come with low desire in men, there is also commonly hurt and anger on the part of their partner, who may be taking it personally given the deeply ingrained belief that men always want sex, so “what is wrong with me?” Causes can range from physical and health issues to relationship and mental health problems. While low desire is more common in women, it is not atypical in men. Research suggests that 14 t o19% of men regularly experience low sexual desire.2You are not alone! Just as when I work with women with low desire, I use a combination of cognitive-behavioral therapy (CBT), mindfulness, and relationship therapy to address this complex issue. I look at desire and arousal from an approach that explores biology/medical, psychology, and your relationships. This means that you get an integrated and multifaceted approach, which I am able to provide as a result of my background in basic science as well as psychology.
2. Brotto, L.A. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in men. Journal of Sexual Medicine, 7, 2015-2030.