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

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.

New clients always welcome.
Please email Mary or
phone 408.371.4847.

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

Problems with Sexual Desire and Frequency 

Problems with sexual 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 fantasies and desire for sexual activity.  The clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life, makes the judgment of deficiency or absence.

Prevalence

Studies report Hypoactive Sexual Desire diagnosis ranges from 14-63%.

Causes and Barriers
  • Biological
    • Hormonal factors, Health/major illnesses, street drugs, medications, and 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, and 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.

    Back to Top of Page

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

    Back to Top of Page

Erection Difficulty

Definition

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.  The disturbance causes marked distress or interpersonal difficulty.  The erectile dysfunction is not better accounted for by another Axis I disorder, a\nod is not due to the direct physiological\l effects of a substance (drugs, alcohol, medications) or a general medical condition.

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 use, street drugs, medications, high fat diet, and lack of exercise. It is helpful to get an exam by a urologist 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 and depression. 

Treatment

Medical options

  • Vasodilators like Viagra, Vasomax, or apomorphine
  • Vacuum pump like ErecAid
  • Injectible like Caverjet
  • Suppository like Muse
  • 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 ma\n 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.

    Back to Top of Page

Inhibited or Delayed Ejaculation

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person’s age, judges to be adequate in focus, intensity and duration.  The disturbance causes marked distress or interpersonal difficulty.  The orgasmic dysfunction is not better accounted for by another Axis I disorder and is not due exclusively to the direct physiological effects of a substance (drug abuse, alcohol, medication or a general medical condition).

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 Ejaculation

Definition

Persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before a person wishes it.  The clinician must take into account factors that affect duration of the excitement phase such as age, novelty of sexual partner or situation, and frequency of sexual activity.

The disturbance ca\uses marked distress or interpersonal difficulty.  The premature ejaculation is not due exclusively to the direct effects of a substance.

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 and depression. 

    Back to Top of Page

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.
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.
  • Diagnostic Criteria from DSM-IV,American Psychiatric Association, 1994.
  • Great Sex for Moms, Valerie Raskin, M.D., Simon & Schuster, 2002.
  • The Mother’s Guide to Sex: Enjoying Your Sexuality Through All Stages of Motherhood, Anne Semans & Cathy Winks, Three Rivers Press, 2001.
  • Hot Monogamy:  Essential Steps to More Passionate, Intimate Lovemaking, Love, et al, Plume, 1999.
  • Therapist Manual for the film Treating Vaginismus, by Joseph LoPiccolo, PH.D.

    Back to Top of Page

7/25/11

[Home] [Male Sex Problems] [How I Can Help] [Help with Painful Sex] [My Experience] [Sexuality Articles-Videos]
[Other Resources] [Meet Mary on Video] [FAQ] [Contact Mary/Location]

Mary M Buxton LCSW, Inc. - Sex & Couple Therapy - Licensed Clinical Social Worker  #LCS 7780
3425 S. Bascom Ave., Suite F, Campbell, CA 95008 -  Phone: 408.371.4847 -  Email Mary

 Important Legal Information.  Copyright 2016, Mary M Buxton LCSW, Inc. - Web site by CommCraft