Man & Sexual Performance Anxiety
It will happen to every man at some point. Men usually describe the first time they could not have full erection or they lost their erection during sexual intercourse as a particularly awkard moment that they could never have thought would ever happen to them. Then usually various thoughts cross their mind: "I have a serious health problem"; "Why happen to me?"; "I've made a fool of myself!"; "Already? From this age?" These thoughts induce embarassment, guilt, anger, annoyance, displeasure.
This unpleasant experience is usually recorded in the man's memory and the next time he attempts to have sexual contact, he has thoughts that take the form of threat and fear. These thoughts are usually the following: "Will I achieve erection?"; "Will I make a fool of myself again?"; "If I have no erection, then something bad is goint on with me!". There is no way for a man to arouse sexually when having such thoughts; on the contrary, these thoughts induce fear and anxiety as the time for sexual contact approaches or while the intercourse is taking place.
However, ALL men's body is made up in such a way that, when the brain sends a warning signal for a potential danger or threat, fear prevails and then the body gets prepared on a biological level to cope with the risk. This means that high amounts of adrenaline are produced, increasing heart rate and vascular contraction; as a result, blood cannot fully reach and perfuse the penis, something which is essentially required to achieve erection. In other words, when a man is anxious and feels fear during intercourse, it is almost impossible for him to reach erection, and even if he does it is still very hard to maintain it. And then, it is most likely that both he and his partner will go through moments of discomfort, uneasiness, dissappointment, even despair. In this way another negative experience is recorded in the brain.
And this is the onset of a domino process. When the next sexual contact comes, the same thoughts (mentioned above) will be repeated, but this time he will be even more obsessed with them; there will be more fear and anxiety and, therefore, the possibility for failure will be higher. As a consequence, a whole 'vicious circle' starts on, which very often results in avoiding sexual contact and any circumstances that could potentially lead to sexual intercourse. Some men realise that the problem is due to anxiety and they try to convince themselves that "they should not think about it". Others try to 'rationalize' the situation and convince themselves that "they are calm and have no stress". However, as long as they refuse to accept the problem and ask for help, they end up thinking about it even more and, thus, the vicious circle remains there and perpetuates.
From the above it becomes clear that not achieving or losing erection when there is fear or anxiety is an ABSOLUTELY NORMAL function of the male organism. A man's body is constructed in such a way that there is good sexual function only if he is calm and at ease. In many cases, the one and only cause of erectile dysfunction may be sexual performance anxiety (mentioned above), which maintains the problem for months or even years. Many men cannot easily accept that their problem is psychological. This reflects some common viewpoints according to which psychological problems are signs of weakness and every man should be able to overcome them on his own. It seems that even the most mature and consistent men have deeply rooted convictions supporting that a real man should always achieve erection on any circumstances and should always satisfy his female partner's sexual needs. Such convictions are the most fertile ground for creating and maintaining the so-called 'sexual performance anxiety'!
When there is organic etiology
In other cases, there may be organic etiology for erectile dysfunction and performance anxiety may aggravate the problem. Many diseases are related to erectile dysfunction, such as depression, hypertension, heart and circulatory problems, diabetes mellitus, multiple sclerosis, prostatic diseases.
Also related to erectile problems are various theraupeutic treatments, such as antidepressants and anxiolytics, antihypertensives, some surgical interventions of the prostate, bladder and intestines, hormonal therapy or radiotherapy for prostate cancer.
Whatever the case, it is particularly important that the man visits an expert, so as to identify and treat the cause of the problem. In many cases, the information the specialist physician collects is sufficient to differentiate whether the problem is due to psychological or organic causes. In some cases, however, there is need for specific examinations of the urinary, endocrine, vascular and nervous system, as well as laboratory testing.
The partner's role
Given that sexual intercourse involves the female partner as well, we should not forget that she herself also encounters her partner's erectile problem and probably she may also be experiencing her own 'vicious cirle'. Women usually start having thoughts such as: "I am not attractive for him anymore"; "Maybe there is another woman in his life"; "We will not be able to have children"; "My sexual life is over"' etc. Such thoughts are stressful and may lead to situations where the woman's sexual desire is reduced, she in in tension during intercourse and does not offer sufficient sexual stimuli to her partner. In the same way as it was described in men, women may also start experiencing unpleasant feelings and avoid sexual contact or there may be tension in the couple after every unsuccesful attempt, having negative impact on their everyday life and ultimately in their relationship.
When performance anxiety is the cause of erectile dysfunction, then it is essential to receive consultation and psychosexual therapy by experts. The specialist has to evaluate many factors that could possibly increase anxiety. For example, living conditions, general stress, relationship problems, other psychological problems (e.g. anxiety disorder), previous sexual experiences etc. After taking the man's history, the expert physician will suggest a theraupetic scheme, which in most cases lasts over 3 months. The psychological intervention gives significantly better results when the female partner also participates in the process and, thus, the intervention is implemented in the couple as a whole. In many cases, the psyco-sexual therapy can be combined with pharmacotherapy that facilitates erection, i.e. phosphodiesterase inhibitors (PDE inhibitors). During the first crucial period, these drugs help the man/the couple to reset and start again their sexual life, giving the necessary time for the therapy to work. Very often these drugs are administered on a daily basis, so that the couple is not burdened with the stress of scheduling sexual intercourses and spontaneity is enhanced.
Through the therapy, the couple has the potential to improve not only their sexual function, but also their sexual communication and the quality of their sexual relationship. And it happens very often that, once the therapy is completed, the couple starts enjoying their sexual life even more than they had used to before the problem occurred!