Sidney McGill - HEALTHY SEX 101

EZEKIEL, A married man of 45 years and his wife, visited my office because of an erectile problem. They were married for less than a week and the marriage could not be consummated because of the sudden onset of his erectile disorder.

Ezekiel was in a state of panic because this was the first occurrence, and he felt less of a man at this crucial point in his life. He was a farmer who was used to hard life and had many children with several women. The marriage was his ticket to live with his newly wed abroad but her aggressive and anxious nature clearly helped to psychologically emasculate him. Furthermore, he really did not love her. On their honeymoon his penis refused to budge though he cajoled and forced it to function.

Erectile disorder (ED) formerly known as impotence is no longer the hidden secret it once was, perhaps due to Viagra, the first oral drug for this condition. Viagra represents sexual emancipation, especially for men over age 65.

Whilst new drugs like Viagra have raised awareness of ED, it is important for men to understand that ED may be a symptom of other illnesses. The disorder in some young men may be an early warning sign of heart disease and stroke. Complete diagnostic evaluation of ED should include screening for cardiovascular risk factors such as diabetes and hypertension.

Atherosclerosis, the build-up of a wax-like plaque obstructs blood flow through vessels, including blood vessels in the penis. The condition is responsible for many cardiovascular problems in Jamaica. Smoking also greatly increases the risk factor for cardiovascular disease and studies have shown there are strong relationships between smoking, coronary artery disease, atherosclerosis, and ED.

Men with concerns about erectile problems should ask their doctor about treatment options which include:

Oral medications: Viagra is still the treatment of choice though a second medication was approved by the FDA in 2003.

Injected drugs: men can inject drugs into the penis to enhance blood flow.

Self-administered intra-urethral therapy: this involves using a small applicator to insert a tiny pellet of medicine into the urethra.

Vacuum devices: these devices are a hollow plastic tube which is placed over the penis and pumped to create a vacuum that pulls blood into the penis.

Surgical options: these are usually considered if other treatments aren't working.

Semi-rigid rods or inflatable devices may be surgically implanted.

If there is no physical reason for the erection problem, the main difficulty may be unrealistic expectations, lack of arousal, relational and emotional problems (such as depression and anxiety), and the fear of subsequent erection failure.

A limp penis may be the only sign of the contention between a man's cultural and moral beliefs and his sexual intentions. The conflict produces anxiety. The sex therapist's role is to reduce this anxiety and restore the client's confidence in having sex without the fear of losing his erection.

Ezekiel's wife was the main cause of the anxiety. She was afraid of having sexual intercourse with her husband because of the relatively large size of his penis. She was assured that mutual masturbation was an option as they got to intimately know each other. Both of them had to learn ways of distracting obsessive fearful thoughts and that there was really no urgent demand to have sexual intercourse with penetration until they regained confidence in their sexual abilities. Ezekiel was unavoidably vulnerable and his wife had to take the lead in helping him restore his sense of manhood. Viagra was also used to enhance the process.

Name and details were modified to protect the confidentiality of the above mentioned persons.

Dr. Sidney McGill is a Marriage and Family Therapist.