Erection Difficulties/ ED
The terms 'erectile difficulties, 'erectile dysfunction, 'ED', 'erection problems' and 'impotence' are terms that are often used interchangeably; that a guy has difficulty either getting or maintaining an erection when he wants, which sometimes makes penetration difficult or impossible.
Some men lose their erection during sex, others at the point of penetration; still others are unable to get an erection at all. It might happen all the time, only with sex, only with a particular partner, only with a new partner or completely randomly. It can affect young and old men, although as men experience age related changes, ED becomes far more common. It can be very frustrating and upsetting for men and their partners.
Erection difficulties can have a multitude of causes. It is important to distinguish ED from Premature Ejaculation (See Premature Ejaculation PE), where the penis goes soft, as it should, after ejaculation has occurred, even if this is before the owner wishes it to happen.
You should also know that it is physically impossible to get an erection just after ejaculation, regardless of how keen the mind might be… The penis needs time to rest and recover. Just how much time varies widely between men, but generally it increases with age. For a young man, it might only be a minute or two, while someone in his sixties might need a couple of days. This is known as the Refractory Period.
It is important to tell your Doctor if you notice changes in erection ability, as research has shown a very strong association between ED and coronary artery disease, with the penile artery often one of the first blood vessels to be affected by narrowing. Paying attention to this signal might prevent a heart attack later. Unfortunately many men are uncomfortable or embarrassed to raise this issue with their GP, or do so and receive a dismissive or insufficient response. Don't give up!
We can talk confidentially to work out what factors might be at play in your case, lower your stress and anxiety through education and understanding, while exploring strategies that might be helpful. I offer practical suggestions to enhance arousal and improve erotic focus, and I encourage involving your partner in counselling. Sex is a dance where both participants need to complement each other.
Many studies have shown that the most successful treatment strategy for erectile difficulties is sex therapy in conjunction with appropriate medical treatment and positive lifestyle changes.
Premature Ejaculation PE
Also known as 'rapid ejaculation', there are a number of different definitions for PE. It is estimated that approximately 30% of men worry about how long they last during sex, making it the most common male sexual concern.
Often guys become so preoccupied with trying to control their ejaculation that they are unable to fully enjoy sex. It can affect sexual confidence, impact on libido and may even lead to, or happen because of erection problems.
There are a number of things men can do that can help them gain more control over ejaculation. We can discuss all the different treatment options and decide what appeals to you. With a focus on techniques that improve self-awareness and self-control, many men and their partners have benefited from my treatment program that emphasises pleasure and knowing each other's bodies, which improves confidence with intimacy.
Delayed Ejaculation DE
Delayed ejaculation may also be called 'retarded' or 'inhibited ejaculation.' Some men experience difficulty ejaculating with a partner but not when masturbating alone, others can't come at all, while some used to be able to but can't any more.
It could also mean that you cannot ejaculate through penetrative sex, or might take what you and/or your partner feel to be an excessively long time. Delayed ejaculation can respond well to sex therapy.
Sexuality after Prostate Cancer
Treatment for prostate cancer can affect your sex life. During and following treatment men may have less interest in, or desire for sex. A high percentage of men experience erection difficulties. Men may also experience a change in the way they look at their bodies and/or genitals, together with their sense of themselves as a man.
I can help you explore the range of options available to men after prostate treatment to get things going again. At times, I refer to other health practitioners, e.g. physiotherapists, and find a team approach can often be beneficial. We can look at mechanical modes of erection assistance, I can trouble-shoot if you are having difficulties getting a good effect from erection enhancing medications of all kinds and also offer lots of ideas on how to enhance pleasure and arousal for both you and your partner.
It upsets me that many men just give up on intimacy in any form because they can't find the right guidance in sexuality once their surgery and cancer treatments are over. Let's see if I can help.
Penis Size
It is not uncommon for men to have concerns about the size of their penis - we live in a society that gives many cultural messages that a bigger penis is better. Men often under-estimate their own size and over estimate the size of others, with comparisons frequently made of a flaccid penis that cannot indicate the amount it will grow when erect. In short, there are growers and there are "show-ers".
Concerns with penis size, can affect not only sexual desire, arousal and performance, but can also influence other aspects of life (e.g., not wanting to participate in team sports or use a public urinal). This can affect men of all ages. It is not just a young man's problem!
Therapy is part educational and we will also explore your thoughts, beliefs, perceptions and feelings about your genitals through a cognitive-behavioural approach to find a more positive space.
