PART 2: -
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A SIX-STEP SURVIVAL GUIDE FOR WOMEN
WHAT MEN THINK ABOUT IMPOTENCE
"If I can't have normal sex with my wife, I'm a failure as a man and lover. I feel like a real loser and I can't stop thinking about the problem."
Men who equate sexual satisfaction solely with performance may think of themselves as failures. This problem causes a lapse of confidence and a crisis in self-esteem. Men commonly report that the problem occupies a lot of their mental energy and that they can't seem to stop thinking about their problem.
"If I show her affection, she'll want to have intercourse and then what?"
Men with erectile difficulties tend to emotionally and physically withdraw from their partners. They fear that any physical affection will precipitate a request or desire for intercourse from their mates and remind them of their inability to achieve an erection. Compounding the problem, women may also cease being affectionate.
"Something must be wrong with me. I feel that I have no control over my own body and now that sex is out, I'm lonely. She won't touch me anymore."
Many men, especially older ones, think that it is inappropriate to need nurture and affection. So, they frequently do without the warmth, comfort and emotional support often more available to women. It is frequently considered inappropriate for a man to admit that he needs a hug and someone to hold him. When a man cannot perform intercourse and satisfy his own(and his partner's)sexual needs, he feels emasculated, devastated and very much alone.
"If I can't meet her sexual needs, she will leave me."
Men, too, share fears of abandonment. Younger men, particularly, feel vulnerable and concerned that their partner will seek a new, more fulfilling, less problematic relationship. To some extent their fears are realistic. A younger woman may want to have an active sexual life and over a long period of time be less patient and supportive.
"Before I developed my erectile problem, I found my partner sexually stimulating. Not any more. The thrill is gone. I wonder if I've fallen out of love? She just doesn't appeal to me anymore."
When a man or woman loses a loving sexual relationship due to impotence, either or both individuals may choose to "desexualize" their mate. Paul describes his feelings about Ellen. "I used to be very frustrated about being impotent. I'd feel excited, but my body wouldn't respond. I'd think about how wonderful our relationship was for so many years and get so damned depressed. Now I try to block everything out and think of Ellen as my sister."
Feeling enormously guilty, Paul could not confide in anyone about his lack of sexual desire and his fear that he had "fallen out of love."
Intellectually, he just turned himself off. Sometimes women do the same thing. After experiencing the pain associated with rejection and partner apathy, women divert their attention to other matters in order to compensate for the loss of their sexual partner.
It may take counseling intervention before couples can rekindle romance and "reprogram" themselves and once again think of each other as desirable, stimulating sexual companions.
EXAMINE YOUR BEHAVIOR
Men and women are socially conditioned to behave in different ways. The process of gender role socialization prescribes appropriate male and female behavior regarding sexuality. Individuals absorb these values and appropriately comply with acceptable standards of behavior. Most people naturally go along with their assigned roles. Sometimes, these roles are contrary and detrimental to getting interpersonal needs met. What you really feel and need sexually is frequently in conflict with how you are supposed to think and behave. Consequently, impotence tends to divide and distance couples, creating conflict and pain.
Men and women also share similar behaviors when dealing with impotence. These behaviors, although sometimes dysfunctional, enable couples to cope with the stresses they experience. These behaviors include :
IGNORING, DENYING OR MAKING EXCUSES FOR THE PROBLEM
Impotence generally does not respond well to neglect. Some erectile disorders do improve with the passage of time, but chronic impotence usually has an organic basis and requires medical attention. Couples sometimes intentionally, or unintentionally, choose to ignore or deny the problem, prolonging recovery and decreasing chances for a positive treatment experience.
WITHHOLDING AFFECTION AND AVOIDING SEXUAL SITUATIONS
Erectile dysfunction can cause a warm and loving partner to withdraw affection and avoid any situation that might stimulate romance or a sexual encounter. The man doesn't want to start something he can't finish. The woman doesn't want to remind her mate of past failures or create additional tension.
GIVING AND RECEIVING "DOUBLE MESSAGES"
Women sometimes pressure reluctant partners to seek treatment. When an ambivalent woman feels she cannot be honest about her feelings and misgivings, double messages are sometimes communicated to the partner. Situations are occasionally created where a seemingly cooperative female partner will inadvertently speak or behave in a way that sabotages the success of treatment or a sexual encounter. Timing and clear communication are one critical variable in the successful treatment of impotence.
Individuals who are unable to authentically communicate negative feelings to their partner frequently turn frustration inward and neglect their own appearance, physical or mental health. This suppression of feelings can create somatic problems including : headaches, backaches, anxiety, insomnia, panic attacks and a range of other health problems. Some people become physically unattractive in an effort to alienate their partner and discourage sexual advances.
Alcohol, drug abuse and other addictive/compulsive behaviors have negative sexual side-effects. Some individuals deal with sexual anxiety by becoming workaholics or exercising excessively.
STEP 2. CONSIDER YOUR PHYSICAL AND PSYCHOLOGICAL HEALTH
Women who contemplate resumption of intercourse after a long period of abstinence have physical, psychological and health needs to consider.
PHYSICAL HEALTH ISSUES
When a monogamous couple considers resumption of sexual activity after a long period of abstinence, both partners are faced with a physiological and psychological adjustment. Women contemplating the resumption of intercourse after a significant period of time should have a comprehensive gynecological examination. With appropriate medical consultation and treatment, most women, regardless of age, can resume normal sexual activity with no difficulty. Since the average age of an impotent man is 55-65 years and his partner is usually of similar age, medical issues due to aging are important.
AGE-RELATED PHYSICAL HEALTH ISSUES
Women from different generations have contrasting attitudes and values regarding sexuality. These attitudes and values have health care implications. In general terms, younger women may view the sudden loss of a sexual partner due to illness or traumatic injury as catastrophic. For an older woman, the gradual decline in sexual interest and activity may be considered a normal part of the aging process.
The medical considerations regarding resumption of intercourse vary depending on age. Particularly for the older woman, prolonged sexual abstinence can contribute to several physical problems, including vaginal dryness, loss of vaginal muscle tone, hormonal imbalances, cystitis, non-specific vaginitis, and painful intercourse. Regardless of age, most problems can be resolved in consultation with the physician.
It is important to be aware of the many sexual changes associated with aging for both men and women.
PRESCRIPTION AND RECREATIONAL DRUGS
Prescription drugs and alcohol often have side effects that impair sexual functioning. It is important to evaluate the effect of these drugs on each person's capacity and desire for sex.
Physiological Changes Associated with Aging
Size of Cervix, Uterus, and Ovaries
Production of Sperm
Thickness and Elasticity of Vagina
Size of Testes
Viscosity and Volume of Ejaculate
The Effects of Aging on Sexual Responsiveness
More Stimulation Required
More Stimulation Required
Clitoral Response Intact
Erection Less Firm
Orgasms of Shorter Duration
Orgasms of Shorter Duration
Multi-Orgasmic Capacity Retained
Multi-Orgasmic Capacity Impaired
PSYCHOLOGICAL HEALTH ISSUES
FLUCTUATIONS IN SEXUAL DESIRE
Sex therapists document that low sexual desire is the number one complaint that brings couples into treatment. Many professionals believe that is you do not have sexual thoughts, fantasies or urges more than two times a month, there may be a problem. This yardstick is certainly arbitrary, but when either or both partners avoid sexual activity on a regular basis, something is amiss.
Women reach their orgasmic prime in their forties and fifties. It is not unusual for a mid-to-post menopausal woman to experience an increase in sexual interest as she ages. Simultaneously, men begin to experience cardiac and prostate disease, which can cause impotence. At a life period when many women are most interested in making love, their partners begin to lose their ability to perform.
When a woman experiences a lack of interest in sexual activity, there is usually a good medical or psychological reason. If you are not orgasmic, find out why. Discuss this problem with your physician and consider your treatment options.
Depression frequently accompanies sexual dysfunction in both women and men. In the general population, depression appears to more commonly affect females and older adults. It is important to have this problem evaluated if it is severe. If any individual experiences more than two of the following symptoms, he/she should consult a physician: suicidal feelings, impaired concentration, low energy, lack of interest in usual pleasurable activities(that includes sex), sleep disturbance, and significant weight loss or gain.
STEP 3. EXPLORE THE RELATIONSHIP FACTORS THAT PREDICT SUCCESSFUL TREATMENT
Successful treatment of any sexual dysfunction is directly related to the quality of your relationship. You can determine whether you and your partner can benefit from medical treatment and opportunities for renewed intimacy by answering the following question:
* Are you committed to working with your partner on solving this problem? Is your partner motivated to work with you?
Research indicates that couples who are in love and share a strong commitment to their relationship benefit most from medical treatment and/or psychological counseling.
* Do you both share a successful history of problem-solving?
Good communication skills are essential in identifying and solving most problems.
* Are you and your partner interested in learning about impotence?
There is no substitute for accurate, up-to-date information upon which to base informed decisions. You and your partner will need to educate yourselves about sexual functioning, impotence and treatments available.
* Are you and your partner willing to jointly participate in the evaluation process?
Impotence is not just a "man's problem." Successful treatment depends on joint cooperation and involvement in the problem-solving process.
* Do you have a sense of humor?
While impotence is no laughing matter, couples who are able to share a smile in times of stress seem better able to survive life's trials. Some levity can make formidable tasks less arduous.
* Are you willing to have a frank discussion with your partner about his impotence and its effect on you?
Communication and motivation are the key to effective sex therapy. It takes a delicate balance of courage, tact and skill to discuss this sensitive subject honestly and openly.
* Did you and your partner have a good sexual relationship prior to the onset of impotence?
A normally active, fully functioning sex life is a good indication that you can, once again, recapture the sensuality you once enjoyed.
* In spite of impotence, are you and your mate sexually attracted to one another?
Sexual desire for your mate is a predictor of favorable outcome for sex therapy.
* How long has the erectile dysfunction existed?
Prompt treatment of an erectile problem ensures the most positive results. As with any problem, the longer it lasts, the more difficult it is to resolve. But, even long-standing impotence can be resolved when there is proper motivation and appropriate treatment methods are explored.
* Can you be realistic about the benefits of restored potency?
The ability to obtain an erection is not a quick-fix for on-going conflicts and disagreements between partners. However, medical intervention and counseling can be effective in ensuring long-term benefits.
Although there is no way to accurately predict your chances for successful treatment of impotence, the more positive your responses, the greater likelihood that treatment will be effective.
STEP 4. LEARN ABOUT THE CAUSES AND TREATMENTS FOR IMPOTENCE
Studies affirm the positive results women experience when their partners find a successful means to manage their impotence. This section of the guide will focus on the causes and diagnosis of impotence, present a brief description of all treatment options, and explain the many benefits associated with each option. Special concerns for women will be explored and important questions answered.
DIAGNOSIS OF IMPOTENCE
Impotence may be diagnosed by a comprehensive physical examination, blood work, laboratory analysis, and a variety of simple tests. These tests are conducted on an out-patient basis under the supervision of a physician who specializes in the diagnosis and treatment of sexual dysfunction.
Origins of Impotence
Erectile disorders of any kind demand medical consultation, diagnosis and treatment. More than four out of five cases of impotence are the result of a medical problem. Physical impotence can be caused by many conditions, including diabetes, diseases of the blood vessels (arteriosclerosis, coronary artery disease, hypertension), prostate, bladder, colon, endocrine and hormonal disorders, as well as nerve damage, radiation therapy, prescription drugs, and substance abuse. There is often some psychological involvement, even when the cause is physical.
PSYCHOLOGICAL (NON-ORGANIC) IMPOTENCE
Emotional or psychological causes of impotence can include stress-related disorders secondary to depression, addiction, or problems caused by work or family.
CURRENT TREATMENTS FOR IMPOTENCE
There are several routes possible for the treatment of male impotence. A brief discussion is available in the article "What every Adult needs to know about Impotence".
Premature ejaculation is a common male sexual disorder. Men who experience premature ejaculation cannot exert voluntary control over ejaculation, and once sexually aroused, ejaculate quickly and cannot resume intercourse for an undetermined period. Many times men ejaculate with very little direct penile stimulation and cannot accomplish intercourse.
The best news for the partners of premature ejaculators is that penile injections or a variation of an external vacuum device enables men to maintain an erection even after ejaculation. This improved performance may enable you to have intercourse and experience a higher level of vaginal stimulation and satisfaction. With practice, men may learn to gain better ejaculatory control by anticipating the body cues that trigger ejaculation.
STEP 5. DISCUSS THE PROBLEM WITH YOUR MATE AND SEEK MEDICAL CONSULTATION.
COMMUNICATION WITH YOUR PARTNER
Through the eyes of women, communication between the sexes is complex. Many excellent books detail strategies to improve the quality of sexual communication between partners. One reference that may be of interest is a book by Bernie Zilbergeld, The New Male Sexuality (1992). Under the best circumstances, sexuality and impotence are sensitive subjects. Your attitude and approach will make a critical difference in encouraging a reluctant partner to seek treatment or discuss feelings and options. As you take this final step, your relationship is on the way to becoming more gratifying than ever before.
The suggestions presented here are relatively simple. They involve diplomacy, honesty, and common sense. You know your partner better than anyone else. After carefully examining communication options, you will know which approach will be most effective in your individual situation. If the process suggested here proves ineffective or results in any escalated conflict, a profession counselor should be consulted.
CONSIDER HIS POINT OF VIEW
Although a woman can empathize with the feelings of an impotent partner, she can never really comprehend the problem from a man's unique perspective. A woman can fake an orgasm, but a man cannot fake an erection. The secret is out and cannot be hidden. So men use all sorts of stratagems to deal with the problem - making excuses, pretending it does not bother them, avoiding intimacy. Blaming himself, ashamed of himself, and fearful of the future, all his thoughts are focused on his inability to perform. He may sometimes forget the parts he can still do - kissing, fondling, caressing, speaking of his love. His mind focuses not on giving pleasure to his partner, but on trying to meet his own performance standards. For a man not to be able to participate in intercourse is a devastating loss. He feels he has failed not only himself but his lover.
Some men prefer to solve erectile problems with no help or assistance from their mate. Some even choose to seek medical advice and treatment without their partner's knowledge. They may have a strong sense of pride and resent any intrusion on their privacy. Communicating with your partner and seeking a solution together is vital to the success of any treatment. Lack of partner involvement in seeking treatment is the number one reason for non-use of an external vacuum device and also accounts for why more than 10% of the men treated with a penile implant never use the prosthesis for intercourse. Your support is essential. You can certainly offer gentleness, kindness and understanding. Ask him directly, "What can I do to be supportive of you?" He will probably give you a straight answer. Respect his position, but try to take good care of yourself, too.
CONSIDER YOUR POINT OF VIEW
Women are confronted with a dilemma. How do you tactfully broach the subject of impotence without inflicting more pain or embarrassment? What do you say to prevent an escalation of existing conflict? How can you recover a conversation that is deteriorating and re-focus it in a more positive direction? These are complex questions with few simple answers. However, the process we describe is a basic format for initiating effective communication about impotence.
The place to begin is with yourself. You now have an understanding of what your partner is thinking and feeling. Now you need to consider how this problem is affecting you and determine your personal and sexual needs. Once this information is available, you are ready to develop goals and formulate an effective plan.
There are two important variables affecting successful communication with your partner. One variable is a positive attitude that demonstrates caring and compassion. The other is your willingness to tackle the problem. Although everyone theoretically recognizes that impotence is a shared problem, for the purposes of an introductory conversation with your partner, you must be willing to take responsibility for your needs, desires and feelings. Whatever the nature of your feelings, they belong to you alone. In a spirit of friendly cooperation, you must solicit your partner's support in solving the problem. A simple statement, "I have a problem and I need your help in resolving it," obviously takes him off the defensive and promotes attentive listening.
DEFINE WHAT IT IS YOU WANT
Think about your personal feelings and sexual needs. Translate your feelings and needs into short sentences. Example: "I feel lonely and I want more affection." Statements that begin with "I feel..." encourage open sharing of feelings, are non-demanding and should be well accepted by your partner.
TRANSLATE YOUR FEELINGS AND WANTS INTO A SPECIFIC BEHAVIORAL REQUEST
"I want you to hug and kiss me when you leave the house in the morning and when you come home in the evening." Sometimes, the message you intend to convey is not the one your partner receives-so make an effort to develop clear requests. Hinting or suggesting may not be sufficient. Some women expect their mates to magically understand what they want and need. This doesn't work well. Try to be sensitive, yet assertive, and avoid manipulation, subtleties, or double messages.
DECIDE HOW, WHEN AND WHERE TO COMMUNICATE WHAT YOU WANT TO YOUR PARTNER
Choose a place and time that are stress-free, perhaps out of the house in a neutral setting, when you are both well rested an in a fairly good mood. [Helpful hint: Never discuss sexual problems in the bedroom.] Be aware that your tone of voice as well as the words you speak will contribute to the spirit of cooperation you are trying to foster. Be positive. Talk about what you want, rather than what is wrong. Verbally acknowledge your share of responsibility for the problem.
PLAN AND REHEARSE WHAT YOU ARE GOING TO SAY, ANTICIPATE QUESTIONS AND HAVE WRITTEN MATERIALS AVAILABLE IF HE SEEMS RECEPTIVE
Focus on "the" problem and on "your" feelings about it. Keep your one goal clearly in mind...that you both seek a solution to impotence together. You care too much about him, and miss your previous intimacy too much to think about sacrificing it permanently. Plan what you are going to say, write it down in the form of a "script," and try to anticipate his responses.
PREVENT ESCALATION OF CONFLICT AND RE-FOCUS NEGATIVE DIALOGUE
Conversations about potentially volatile subjects tend to sour or escalate when the topic or question is changed, expanded, contradicted or diverted. Try to agree ahead of time to limit and contain discussion to one specific issue at a time. Example: "How can we get medical advice concerning impotence?" Stick with your planned agenda and redirect conversation back to the original subject as necessary.
ASK FOR FEEDBACK, PREPARE TO LISTEN TO HIS THOUGHTS AND FEELINGS
An accepting, non-critical attitude and reflective listening can encourage him to discuss painful feelings. You may not agree with what he thinks, but you can support his feelings, positive as well as negative.
VERBALLY AND PHYSICALLY REINFORCE POSITIVE BEHAVIOR
Always recognize and appreciate the energy he invests in trying to resolve this sensitive problem. Attempt to rekindle your relationship with touching and expressing words of love.
STEP 6. SEEK MEDICAL CONSULTATION
If you are experiencing erectile dysfunction, medical care is essential. Many primary care physicians are assuming a more active role in the diagnosis and treatment of impotence. This involvement by the non-surgeon is increasing because of the development, in recent years, of non-surgical treatment alternatives, and because most impotence is experienced by patients who are already under the care of a family physician for other disorders.
When the resolution of erectile dysfunction demands medical consultation, evaluation, diagnosis and treatment from a specialist, your physician may refer you to a urologist. Urologists are physicians who specialize in the treatment of the genito-urinary system, which includes the kidneys, ureters, bladder, prostate and the genitals. Urologists may prescribe any of the treatments discussed in this article.
Your physician should inspire trust and encourage you, as well as your partner, to be an important part of the treatment process. When your partner(and hopefully you) has made a decision to seek medical consultation, these suggestions may make your visit to the physician more informative and productive.
For the first medical consultation, the ideal situation is for the couple to see the physician together. However, as discussed, some men simply prefer to go alone and wish to have their preference respected. You are in the best position to determine whether or not to accompany your partner.
Prepare in advance for your first visit with the physician. Write down your questions and concerns ahead of time. Some of the information conveyed by the doctor may be technical and difficult to remember. This is no time to be shy. You need to fully understand all of your options. In order to make a sound, mutual decision about the appropriate medical approach to this problem, you need to have all of your question answered. Bring a notebook along if you would like to take notes as you are talking. A tape recorder can also be helpful if all participants in the discussion agree. You can also bring this article along and share it with your doctor.
A NEW BEGINNING FOR ELLEN AND PAUL
Ellen became increasingly concerned about Paul's withdrawn and uncharacteristic behavior. She strongly suspected that their sexual problems accounted for his depression and her own unhappiness. Ellen decided to confide in her personal physician. She received reassuring advice and accurate information about impotence. As her knowledge increased, so did her confidence and determination to solve their shared problem. She then thoughtfully planned a positive, tactful intervention with Paul, using simple, effective communication techniques such as those outlined in this guide.
Ellen and Paul were fortunate. They had a solid relationship based on trust, caring and friendship. As a couple, their communication and problem-solving skills were good. They sought medical consultation together, recognizing the importance of mutual decision-making. Their choice of treatment was a well-informed and successful one.
After six months, Ellen and Paul were engaging in intercourse 4-6 times per month. Each reported improvements in mood, self-esteem and marital satisfaction. Anxious and futile attempts at love-making were replaced by renewed confidence and pleasure. This couple considered the treatment they had chosen an investment in their future relationship. A new beginning for the years ahead.
A NOTE TO MEN
On a personal level, men and women both wish the problems associated with impotence would just go away. A man does not want to live with feelings of inadequacy and failure. A woman does not want her partner to need an implant, injection or external vacuum device to achieve an erection. Everyone would like the resolution to be a pill or some simple treatment not visible in the bedroom. Unfortunately, this is not always possible. Yet couples want the difficulty to be resolved. This article describes the realities of impotence for both sexes and the current treatment options available
Your partner is greatly affected by your erectile difficulty. This problem is not your fault. You are not to blame. The fact that you are reading this article is evidence of your positive motivation to understand how your partner feels. She may feel that you are no longer attracted to her and worry that she has lost her power to "turn you on." You can do a great deal to offer her reassurance. Tell her that she is loved and desired, that you want to have sexual intercourse and are even willing to use one of the medical treatments available just to be close and prove your love for her. Ask for her cooperation in renewing your bond of intimacy.
(Adapted from a booklet published by the Geddings Osbon Foundation, formerly in Augusta, Georgia>