Coping As A Couple

Dr John Dean MB BS, MRCGP, a Medical Sexologist in Plymouth offers helpful advice to couples being treated for impotence. 

Losing the ability to achieve and maintain an erection (impotence) can be a devastating experience for a man. Aside from the obvious feelings of embarrassment that may result, he may be concerned that this is the first sign of a serious illness or he is getting old and beginning to physically decay. Certainly, there are a number of conditions that are associated with impotence, such as depression, high blood pressure, heart and circulation problems, diabetes and multiple sclerosis. Some medical and surgical treatments can also cause impotence, including blood pressure medications, antidepressants, tranquillisers, prostate gland and some types of bowel and bladder surgery. For this reason, it is vital that men with impotence seek professional advice and have an appropriate medical assessment. There are now a number of simple, safe and effective treatments available and most men can expect to be able to regain their erections. However, just restoring a man's erections isn't the whole story. Impotence usually affects two people and it is very important to remember the needs and concerns of partners, too.

Men & Sex
Men and women often feel differently about sex and although we do not like to generalise, the following descriptions might help us to understand each other a little better. For many men, sex means penetration, intercourse and orgasm, hopefully for both partners. Sex is "doing" something either with or to their partner, so that they can both get relief from a build up of sexual tension. Feeling turned on, through kissing, cuddling and stroking each other, is generally not adequate on its own and should normally lead to intercourse. If this doesn't happen, either because they can't get an adequate erection or because their partner doesn't want to, then they may feel inadequate, frustrated and angry. Even if they can have intercourse, and have an orgasm with ejaculation themselves, they may feel bad if their partner doesn't have an orgasm, too. This feeling may be of guilt about their "performance" or disappointment with their partner, because the partner couldn't respond.

Women & Sex
For many women, sex means sharing love, being as close to one another as you can possibly be, getting wrapped up inside each other. This isn't just romantic love, but sharing the ultimate physical and emotional intimacy that a couple can enjoy together. Kissing, cuddling, holding and stroking each other, things that might be otherwise described as foreplay can be great sex too, and may be all that is desired. Penetration can be nice, but isn't always essential. The unspoken pressure to allow a man to penetrate her whenever any form of physical intimacy occurs can be very unpleasant and lead to avoidance of physical contact altogether. Orgasm, too, can feel great, but it isn't essential every time for her to enjoy great sex. Once again, the unspoken pressure to be seen to have an orgasm, for her partner rather than for herself, can be unpleasant and distracting.

Communication
These two different viewpoints can often be accommodated within a relationship, but misunderstanding a partner's needs may lead to ill feeling or even conflict. Talking about sex with a partner can help, although many couples find it difficult and embarrassing to discuss. This taboo is often learned in childhood, or may be the result of strong cultural or religious beliefs. Women, in particular, can feel that for them to enjoy sex is somehow "not nice". Society in general now has a more open and positive attitude towards enjoying sex, but this can still be a difficult area for many older men and women.

Past experience can be either a help or be a hindrance. If there are traumatic memories of some earlier sexual experiences, or of sexual abuse, this can affect attitudes towards sex in the present day. Some men and women find it very difficult to begin a sexual relationship with a new partner after bereavement or divorce, because of guilt or unresolved grief. Professional help is often necessary to learn to cope with these feelings.

Men and women who have been sexually abstinent for some years often adapt to life without sex. If a previously impotent man is suddenly able to get erections again, the pressure upon his partner to resume intercourse can be difficult to cope with. For this reason, it is very important that both partners are involved in any treatment decisions. It is important that both give proper attention to the emotional and relationship aspects of sex rather than just focusing upon treatments that can only restore penile rigidity.

Some Problems Experienced By Men

Anxiety
A man will often describe the first time that he couldn't get, or lost his erection whilst lovemaking, as one of the most embarrassing things that has ever happened to him. This may be accompanied by guilt and anger both with himself and his partner. Sometimes these feelings are well concealed and sometimes not. The next time that he approaches lovemaking, he will be understandably anxious that he should not "fail" again. However, the body responds to anxiety with changes in heart rate, blood pressure, blood vessels and the nervous system, which are likely to make it difficult, if not impossible, to get an erection. A vicious circle of erectile failure, guilt or anger, anxiety about sex and then more failure is quite easily established. Sometimes this "performance pressure anxiety" can be the sole cause of impotence. For other men, it can be a contributory factor, along with the physical conditions mentioned above. The effects of anxiety can be so important and profound that they can even prevent usually effective drug treatments from working properly.

Many men find it difficult or even impossible to accept that their erection problem may have a psychological cause. This reflects the quite widely held view that psychological problems are signs of weakness and that a man should be able to just "pull himself together". Even in the most well adjusted and self-aware man, there seems to be something deep and primitive in their subconscious telling them that they always ought to be able to get an erection and satisfy their partner's sexual needs. Challenging this sexual myth, and others, is a part of psychosexual therapy.

Loss Of Sexual Desire (Libido):
Another widely accepted myth is that men should always be ready for sex and that loss of libido is almost exclusively a woman's disorder. This is quite untrue and now more and more men feel able to

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