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Erectile Dysfunction - Treatment | August 27, 2021, 11:11 CDT

Sex Therapists Offer Unique, Essential Knowledge to ED Sufferers

Therapy designed specifically for sexual function bridges patients' mental and physical issues.
Aleck Woogmaster

A healthy and otherwise successful man in his mid-40s has struggled with intimacy and sexual performance his entire adult life. Physicians and therapists have seen him, sized him up and determined he just needs to relax and his sexual problems will go away. He's also been diagnosed with anxiety disorder, though no medication or additional therapy has been offered to treat the condition.

Erectile dysfunction (ED) is at the top of his worry list, and the more he focuses on the problem, the more he worries. Eventually, the man finds himself involved in a relationship with a supportive partner who encourages him to see a therapist with a sexual medicine background. In no time, the man is treating his anxiety, checking in with his therapist about lingering sexual performance issues, and mostly enjoying sex and healthy erectile function with his partner.

This idealized scenario might sound familiar to men who have dealt with ED or other sexual disorders. Sex therapists see this sequence frequently. And after failed attempts and mixed results for treating a sex-related issue with one or multiple medical professionals, patients either seek or are referred to a sex therapist, who is able to bridge the gaps in varying medical disciplines, tying them all together.

The importance of sexual study

A number of physiological conditions and factors can contribute to or be the root cause of ED. Physical conditions capable of impacting erectile performance include chronic pain, heart problems, obesity and diabetes. Medications, either individually or in combination, can also negatively impact erectile function.

"Over everything, these guys need to have a medical evaluation by a sexual medicine physician, and those are hard to come by," said Deborah Fox, M.S.W., LICSW, a certified sex therapist in Washington, D.C., with 30 years in practice.

Fox indicated physical conditions or experiences with a sexual component often get treated, or at least addressed, by healthcare practitioners who do not possess a base knowledge of comprehensive sexual medicine.

"It's not your average urologist," she said.

A sex therapist can work collaboratively with the patient and their partner(s) to break down barriers to a satisfying sexual experience.

Sex therapy with either a mental or sensual emphasis can be misguided or undermined by an errant or absent physical health diagnosis, which may or may not be connected to sexuality in some way. For example, ED related to diabetes is not likely to be resolved through sex therapy unless the patient and therapist are made aware of the chronic condition and collaborate with specialists in other areas as needed. According to Fox, the difficult task of interconnecting mental, physical and sexual health comprehensively requires all parties involved to be aware of where one aspect of a health issue ends and another begins.

"It should never be assumed that it's not physical until they've seen a really competent sexual medicine urologist," Fox said.

Once sexual health and dysfunction have been addressed by a physician, a sex therapist can work collaboratively with the patient and their partner(s) to break down barriers to a satisfying sexual experience.

Mental health is key

Fox identified anxiety as a key factor related to treating ED in a sex therapy context. Anxiety can impact people in a number of ways, from generalized anxiety disorder to what Fox referred to as "spectatoring," which she compared to the watched pot never boiling. In this case, the watched penis never gets erect. Anxiety can be incidental or habitual, but it can also be linked to chronic or repeating conditions that may require broader treatment than sex therapy.

Anxiety or other feelings that interrupt erectile performance may not always manifest until attachment becomes a factor, Fox said. Some men may feel anxiety most prevalently affects their sexual performance while in the "dating pool," so to speak. Others may develop erectile performance problems once they have become invested in a relationship and have to accept the realities of attachment or sincere involvement with another human being.

Understanding the patient's sexual history is important for a sex therapist, and this process can take time, depending on the patient's comfort and communication levels. To that end, working with men as well as their partners often yields the best results. Men from all walks of life come in for sex therapy, Fox said, but she's always happy to work with a supportive and involved partner as well as the patient.

"They may not be part of the problem but they are part of the solution," she said.

Working with couples vs. singles

A man's relationship status can be an important factor in sex therapy.

"There really would be somewhat of a difference in the approach if you're talking about a guy who is in a relationship, who has a partner or who does not have a partner," said Lawrence A. Siegel, M.A., CSE, CSES, a clinical sexologist in Boynton Beach, Florida.

Siegel echoed some of Fox's statements about anxiety in all forms affecting erections, and he pointed out that working with couples can be essential to identifying internal processes and external reference points that exist within the man and the partnership, respectively.

Talk therapy is often an instrumental element of sex therapy. Having a partner or multiple partners who are willing to contribute to the process results in more input. Therapists may often assign "homework" or make recommendations to their patients for life at home, obviously with the big picture of the therapeutic process in mind.

Even though couples or partnerships can stimulate more divergent options in therapy, single men dealing with ED should feel encouraged to work with a sex therapist, as well. As Siegel indicated, the approach might be somewhat different, but the techniques and tones of therapy for partnered or single individuals are relatively the same.

One point Siegel emphasized was the process of pushing back against societal expectations of male sexual performance.

"Nobody's body is going to do what they want it to do, whenever they want it to do it, all of the time," he said.

This fact is an often understated aspect of the human condition in any context—think of an Olympic favorite who fades down the stretch of a race they're supposed to win—but is certainly an important consideration for sexual function and satisfaction, Siegel added.

All that glitters is not sex therapy

Each therapy experience between patient and therapist is unique, so it is difficult to predict the therapeutic path for any individual. It's important to point out, however, that not all counselors and/or therapists are trained specifically to work with you on matters of sexual function and in the context of improving your enjoyment of sexual health and experience.

There are plenty of good, qualified and well-intentioned therapists and couples counselors whose patients would likely benefit from working with a sex therapist in addition to their domestic counseling sessions. Sex therapists such as Siegel and Fox frequently see single men who have previously struggled to approach sexual health issues with physicians and counselors who have not studied human sexuality beyond basic biology.

Not all counselors and/or therapists are trained specifically to work with you on matters of sexual function.

Dealing with ED can involve a lot of different methods of intervention and activity. Many of these techniques involve an emphasis on mindfulness, relaxation, sensation focus and other disciplines best pursued with increased tranquility rather than anxiety.

"Unfortunately, a lot of couples therapists really don't have any training in sex therapy," Siegel said. "Many American family therapists have absolutely no training in sex therapy whatsoever."

Fortunately, many well-trained, highly educated sex therapists are available if you're experiencing erectile dysfunction and want to seek treatment. Always talk to your primary care doctor about what's going on in your sex life and ask for a referral to a therapist if needed.

Aleck Woogmaster