Sex therapy can be complicated. Fortunately, sometimes it isn’t.
About three months ago my patient Sam finally started dating again after his wife left him last summer. After a few nondescript experiences, he met Yolanda, they hit it off, and a few weeks later he found himself in bed with her. Two days later he came in for his weekly session. Five minutes before it ended, he mentioned how he couldn’t “y’know” when he wanted to “y’know.”
“Oh,” I said. “You didn’t get an erection when you wanted one?” Yes, that was it, poor guy. I knew he wasn’t taking any prescription medication, so I checked that he hadn’t been drinking before the sex. Our time was then up, and I suggested we discuss it the following week.
We did, especially since he had had another “y’know” situation. Sam assumed we’d need to discuss his grief over his wife leaving him, or “maybe my relationship with my mother.”
Instead, I asked him a simple question: “Sam, from what activities were you supposed to get an erection?” He didn’t quite understand the question. “Um,” he said, “we were kissing, and it looked like we might have sex, and I was excited about that. And we were rubbing against each other while making out.”
I told Sam that he needed to have direct stimulation on his penis in order to get an erection. He disagreed; shouldn’t it be enough that he was “excited”? “It’s important that you’re emotionally aroused,” I partially agreed. “But you need to be physically aroused as well.”
He didn’t quite believe me. He didn’t WANT to believe me. Because that would involve communicating with Yolanda: His desire to be touched or licked. How he wanted to be touched or licked. And, of course, the ways he didn’t want to be touched or licked.
Sam was shy about that. “Having sex is one thing,” he said. “Talking about it is much more difficult.” I agreed: “Yes, talking about sex is much more intimate than doing it.”
“You know,” I continued, “Sex would be a lot easier on the nerves if you didn’t feel pressured to get erect for it. If you just counted everything as sex, and you two decided to enjoy each others’ bodies in whatever ways were available, getting an erection wouldn’t matter.”
Sam didn’t especially like that. “She won’t like that,” was the way he put it. “How do you know?” I asked. He didn’t, of course. “Women want an erection” was the best he could do. Well, some women do, of course, but not all. “And without asking,” I gently smiled, “you can’t know how Yolanda feels about it.”
Sam really wanted an erection, but he wasn’t willing to arrange for the physical stimulation he apparently needed for it (and forget, by the way, him touching his penis in front of her. “No way,” he said firmly).
This conveniently illustrates the three rules for not getting an erection when you want one:
* Don’t get the physical stimulation you need
* Envision “sex” as something that requires an erection
* Don’t discuss this dilemma with your partner
For most men, there’s actually a fourth rule:
* Have sex with someone you don’t like, you’re not attracted to, or you’re angry with
Sam wondered if he had “erectile dysfunction,” and if a drug would help. “Getting a stomach ache from eating at McDonald’s three times a day for a month isn’t a stomach dysfunction, it’s the way your system is built,” I replied. “Not getting an erection when your penis doesn’t get sufficient stimulation isn’t erectile dysfunction—it’s the way your system is built.”
Sam sighed. “I guess you’re right,” he said. “But I wish this whole sex thing were easier.” I sympathized with Sam, as I do with all people who say this. And I replied as I often do: “Sam, sex would be easier if you didn’t make it so complicated.”