What is Erectile Dysfunction?

Erectile Dysfunction (ED) is when a man is unable to get an erection and keep it firm enough for sexual intercourse. Despite the increase in awareness, many men are still not clear about ED. ED being a common and widely spread problem, it constitutes for about 50% of OPD complaints in men seeking treatment for sexual disorders.

What is premature ejaculation?

Premature Ejaculation (PME) is when a man experiences an orgasm and when semen emits just before the start of sexual intercourse. PME, again being a common problem, constitutes for about 35 to 40 % of OPD complaints in men seeking treatment for sexual disorders.

Even though there are various physiological causes of ED and PME, the psychological causes are as significant, but given the least amount of importance leading to poor resolution.

Psychological causes of ED and PE:

In today’s day, life can be quite stressful. When a man is busy finding a balance between his work life, family life and managing finances, his sexual life seems to be affected considerably. It can take a toll on his mental health leading to excessive worry and related anxiety.There comes a time when a man may have constant feelings of sadness of mood, loss of interest in previously pleasurable activity, generalized weakness, anxiety about one’s performance in bed, loss of interest in sex or even loss of sexual arousal leading to sexual inadequacy. Certain men may have low self-esteem either due to previous years of conditioning or due to poor body image which in turn causes anxiety and can impact one’s sexual life significantly.

Even though India has progressed in many fields, sex education is still considered to be a taboo. Whatever information is obtained is through friends, magazines or the internet, there being immense amount of information available out there, it does not guarantee it to be correct. This leads to a lot of misconception about the human body, sexual organs, mind to body connection and sexual act. If anyone has gone through a past traumatic sexual experience, this could cause emotional scarring and the patient may develop a negative attitude about sex.

As times have changed, both the partners are striving equally to take on the household responsibility. The age old saying of ‘a man is the head of the family’ does not hold true today, as women are taking higher positions in their work fields, this could lead to power struggle in bed leading to dissatisfying sex life. A couple could be facing relationship issues either due to decreased trust for each other, poor communication causing lesser physical and emotional affinity towards each other.

Psychological help to treat sexual dysfunction

1. Psychoeducation

• Patient is taught and explained in detail about the human body, functioning of the sexual organs, sexual act and mind-body connection pertaining to sexual disorder.
• This can help the patient in relieving anxiety and stress related to sex as opposed to their prefixed maladaptive beliefs and techniques

2. Relaxation techniques

• There are two techniques that can be helpful namely Jacobson Progressive Muscular Relaxation technique and Benson Henry Relaxation technique.
• It focuses on tightening and then relaxing specific muscle groups in a sequence.
• This helps one become more aware of one’s body and physical sensation and also helps in reducing anxiety.

3. Non-genital sensate focus: 

• During this technique both the partners are engaged in foreplay without actual intercourse.
• This allows to gain physical intimacy leading to open communication about one’s feelings and desires.
• This also helps the couple to gain trust with each other.

4. Behavioural techniques to deal with PE

Start–stop technique: 

• This was developed by Masters & Johnson.
• It aims at increasing the frequency of sensory threshold of the penis through sexual contact.
• This technique involves a man lying down on his back and focusing his attention completely to the sensation either provided by his partner or self (in absentia of partner) by stimulating his penis.
• As soon as he feels highly aroused to ejaculate, the stimulation of his penis is stopped abruptly. 
• This process is repeated two times or more until the man develops a control over his ejaculation.

Squeeze technique: 

• In this technique, the same steps are involved as in the stop-start technique until when the man has an urgent need to ejaculate.
• Here either the partner or self (in absentia of partner) are asked to squeeze the tip of the penis firmly for about 15 to 20 seconds.
• This will inhibit the ejaculatory reflex.
• These steps are repeated for about three times in a given session and on the fourth time, the patient is encouraged to ejaculate.

These techniques have shown to have a success rate of 60 to 95%. These behavioural   techniques help the man to develop more control over his ejaculations and eventually decrease the related anxiety.

5. Mindfulness: 

The man is encouraged to be mindful which means he is asked to be fully present during the sexual act rather than being mind-full ( being preoccupied with his life worries such as work pressure, family pressure, financial targets,  previously cultivated beliefs, etc.)

6.Busting preconceived notions about sex:

MYTH: Man should be the sexual leader.

FACT: Anyone can take the lead as long as the sexual act is enjoyed by both partners.

MYTH: Masturbation is wrong.

FACT: Masturbation can ease a lot of sex related anxiety and tension.

MYTH: Men who express their emotions are not ‘MAN ENOUGH’.

FACT: expressing your emotions can soothe your relationship with your partner, increasing the level of  intimacy.

MYTH: Sex happens automatically.

FACT: although sex is a primate instinct, it needs to be enjoyed by both partners. Setting the mood and environment for physical intimacy such as use of candles, aroma, etc. can ease one’s anxiety and give one a good sexual experience.

MYTH: There is an issue in the relationship, if the sex is not good.

FACT: many people value emotional intimacy over physical intimacy. Open communication with one’s partner can help them know your deeper desires.

MYTH: Size of the penis must be of a particular length.

FACT: the average size of a flaccid penis is 3.61 inches and an erect one is of 5.16 inches. However the size may vary from an individual to another

MYTH: watching porn will increase the sex drive.

FACT: watching porn is only going to increase unrealistic expectations of sex. Hence follow each other’s desires rather than being present with a prefixed mind.

MYTH: Consuming alcohol will enhance the sexual experience.

FACT: Alcohol is a depressant and it can heavily lower one’s mood, decrease sexual desire and make it difficult for a man to achieve an erection or orgasm under the influence.

7. Treatment of psychological issues:

PME and ED can be secondary to mental illness such as depression and or generalized anxiety. In such a case, that should be addressed first and treated before treating PME and ED.

8. Lifestyle modification:

• Regular exercise.
• Obesity management.
• Diabetes should be in check.
• High blood pressure must be in control.
• Smoking cessation.
• Avoid alcohol