Does he need Viagra – or would something else help?
Before reaching for that little blue pill, there could be other reasons why his penis is less than perky. Here are some non-drug therapies that could make all the difference in the bedroom... By Karen Evennett
Viagra has revived the love lives of millions of couples and now cheaper generic versions are set to put smiles on even more faces. ‘But for some men non-drug therapies may be much more effective,’ says psychosexual therapist Jean Miller of www.muswellhilltherapy.co.uk
The first thing you need to know…
Viagra, or the generic Sildenafil, works by increasing blood flow to the penis – but it will only produce an erection in a man who is already sexually aroused.
The lowdown…
Sexual stimulation causes nerves in the erectile tissue of the penis to release nitric oxide (NO). This stimulates the production of a chemical called cyclic guanosine monophosphate (cGMP) which relaxes the smooth muscle cells. One result of this is that the arteries in the penis dilate so that blood can flow into it more easily.
A man who is not aroused may need extra help…
Sildenafil works by maintaining the level of cGMP in the smooth muscle cells – but if a man is not aroused his brain will not stimulate the release of any nitric oxide and there will be no cGMP for the drug to maintain. And no erection as a result.
Professional help…
'If the problem happens when he’s with you, but not when he’s on his own (if he’s masturbating) the main treatment for erectile dysfunction (ED) is usually a combination of masturbatory exercises, psychotherapy and Sensate Focus (see below). A psychosexual therapist can help with all these therapies,’ says Jean.
Try the magic touch…
Sensate Focus is a technique where both partners take it in turns to massage each other, with all sexual body parts out of bounds (including buttocks and breasts), and a complete ban on sexual activity during the session – and it can help. ‘It’s a structured way of touching which can help to bring back the simple pleasure of being tactile together without any performance pressure. It can also be helpful in highlighting what triggers someone’s difficulties in physical intimacy,’ says Jean.
Do try this at home…
‘The idea is to let erections come and go within an agreed period during which sex is off limits. A psychosexual therapist can guide you and set sensate focus homework until you are ready to attempt intercourse without fear of it turning into a flop.’
Stress can also be a factor…
While an estimated eight out of 10 cases of erectile dysfunction have a physical cause such as diabetes which can lessen natural blood flow to the penis, cases where there’s a psychological trigger – such as stress – will not always respond to the little blue pills. ‘Even when a man is aroused, if he is stressed he may not get an erection in spite of taking a pill, and that can be very distressing,’ says Jean.
It’s all about fight or flight
Stress is a primitive response which diverts blood to the limbs and heart as part of the fight or flight response. Getting blood flow to the penis was not a priority for the caveman trying to escape a predator – and the brain and body respond in exactly the same way, even when the stress in question has nothing to do with danger and everything to do with performance anxiety. ‘The fear of not being able to get an erection is the death knell for many a romantic night in,’ says Jean.
All in the mind?
Cognitive Behavioural Therapy (CBT) and hypnotherapy can help to tackle deeply ingrained problems with stress, with studies in the British Journal of Urology showing that Clinical Hypnosis can work for 80% of patients with psychological impotence.
Dr Kate Barnes, a practising GP with a special interest in hypnotherapy, says: ‘Once I’ve ruled out a physical cause and taken note of any medication that could be aggravating the problem I find that stress factors commonly predominate. These stressors can range from performance anxiety, relationship difficulties, worries and stress about a job to alcohol and drugs - all of which can be addressed by using relaxation techniques and positive suggestion in a hypnotherapeutic setting.'
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