Thank you for your very compelling and sensitive question.
Actually you are not alone in this regard.
Much of our desire is ruled by hormone levels. At age 46, on average, males have less than half of the testosterone levels they had at age 24. testosterone is, as you know is the hormone most responsible for male sexual drive (libido).
But there is more to this than just hormones. that is only part of the story. Testosterone levels are influenced by level of exercise and diet in addition to the decline associated by aging. Desire is also influences by the character of your relationship. For example:
You are on the right tract to suggest counseling, but you also pulled that option out of the mix by stating that your spouse will not attend. BUT do not discount the value of you attending on your own, without the partner. If for no other reason, than to try to learn new ways of communicating and influencing your partner in positive ways.
Your wife is also part of the mix, as she is in fact going through changes. She is loosing lubrication, but her desire may also be affected by loss of interest in you because of drinking and overweight, and general appearance. Her hormones are also beginning to be out of balance, though her testosterone ratio may actually increase.
Since she will not go to counseling, then you need to do the following as a couple (you can go without her as I already mentioned). Though it would be better to go with her; sometimes when she sees changes in you, she will then consider going.
1. You are already working on weight and drinking. let me suggest a program for you that will not only reduce weight but also encourage your body to build testosterone.
Go to the following website and enroll in their program of virtual men's personal trainer. (incidentally,they also have a program for women). This men's health program has a diet and exercise program that helps to increase testosterone levels and lose weight. I am currently enrolled in the Testosterone diet and the belly off exercise program. Once I achieve my belly off program, I will switch to the testosterone exercise program for a few months. I am 58 and I can happily report positive effects in my libido.
with the men's health you can be looking more appealing and attractive to your wife in 8 to 12 weeks....looking like a god as they say.
2. This will hurt: but you need to get rid of the porno for now. It may help with your wife at some point in the future to help you get ready for sex with her, but for now, to recover libido and attraction to your spouse, you need to get rid of it. The issue is based on the psychology of attraction in these kind of situations. Right now it is easier for you to get aroused with the porno, and to masturbate, getting quick and easy satisfaction. You need to give you body and mind a chance to get, well...horny, as they say, and then direct that energy toward your wife.
3. I do not know the level of your drinking, nor the level of interaction between you and your wife. BUT it is important to not drink instead of expressing your feelings; and when expressing your feelings, even angry ones, in your situation, you need to express them in a non-negative way. In psychology, some disciplines suggest if we are angry to express it, and to also show it; yet in other disciplines it is sufficient to simply express: I am angry, without acting out. In your circumstances, I am suggesting that you need to increase the number of positive interactions with your spouse every day. These include things such as self esteem building phrases. Maybe your are already doing this, but remember, the more positive interactions you have, the better it will be:
NOTE: during this time of building positive interactions, avoid direct arguments. Respond to anger with things, like: I understand how that makes you feel; Can I help in some way? I apologize, what do you want me to do different and so forth.
ALSO: Take away the pressure to perform; do not focus on having sex or lets do it. Just allow that moment to arrive on its own, however many days it takes. Just spend time having positive interactions.
4. Buy some lubricant such as KY jelly to have available by the bed side, so that when the moment comes, you will be able to help her with her problem of loosing lubrication. Then, because your erections do not last a long time, have longer foreplay...much longer.
5. See your physician to get some Viagra or cialus, which ever he feels will be best for your. I recommend Cialus, because it is longer lasting. BUT, you and your physician should decide.
6. Encourage your wife to join you in the exercise and diet program by men's health. Remember, they have a women's program as well.
7. Finally, you can not remove any guilt she may feel about herself; but you can for yourself. AND you can give her support in a way to allow her to diffuse the guilt. Guilt interferes with libido, as well as does stress. The exercise and positive interactiosn will do a lot to reduce stress. Not focussing on performance will do the same. For any feelings of guilt she may have; simply be a broken record over time...each time she might mention this, simply say words to the effect that you understand, and not to worry about it; ask her if you can help in some way? be supportive, and do not use words that blame or focus on her.
What surgery are you talking about?
I understand, I think. The doctors work from a large surgical clinic, and would be expensive, right?
The think is, that you can get viagra and cialus from sources on line or by traveling to foreing countries.
But in this venue I can not recommend that, because it may be illegal.
I have clients who get thier viagra by prescription on line, where the on line doctor, takes a medical history and then based on that stated history, creates a prescription that is submitted and filled by mail. The legality of such operation is questionable. The potential for malpractice based on mis-prescription is high.
While technically meeting legal parameters, for example in the U.S., these operatiosn are still illegal in 12 of the U.S. states.
I could not in all good conscious and responsibility refer you to a source of medication that does not include an inperson interview and or examination by a licensed physician.
Forgive me for saying, but even though the physicians know you, I do not understand that you can not share that information; after all they are physicians,and this is a medical matter.
There is no safer way to get the medication than from a licensed physician face to face.
The medication can help. Considere this:
Theat you would be able to maintain an erection long enough to complete the sex act. This will translate, hopefully to your wife feeling more adequate, and you feeling more satisfied, and this means...that you may start to find each other attractive again.
Sometimes the lack of peformance contributes to stress and feelings of guilt in the relationship. Remove that, and miracles happen.
I have given you a very comprehensive program for improving you relationship, sexual perfomrance and attraction, and the only thing requiring a physician is the prescription of the viagra.
Tantric massage may help to relieve stress,and there for provide a better experience with the sexual act.
however, there is no guarantee. It works to the extent that your body is capable of sustaining the sex act. Tantric massage will not help you last longer. It may help you and her get in the mood. Couples Tantric massage has been effective as an ongoing therapy to help couple desire each other again.
Viagra's effectiveness depends on the level of any vascular disease you have. In otherwise healthy males, it is effective 97.5% of the time.
however there is less effective ness depending on underlying medical conditions involved.
Thank you for the very insightful additional information. I applaud you for being sensitive to your own libido and condition. It would be nice to bring your wife along with you. However, you know your own situation best, XXXXX XXXXX she sees the changes in you, first, then it would be a big step in the right direction. I agree with you on that issue. It is a healthy position. I like your attitude.
Diabetes, as you know, is a leading cause of circulatory problems. A man's ability to get an erection, is a direct indicator of the condition of the health of his circulatory system.
Often, in men, the first sign of cardiac, and pulmonary disease, is the extent to which we are not able to get an erection. This is because the arteries and vasculature of the penis are the same kind of vasculature that involves our cardio pulmonary system.
a Quote from Doctor Oz, the funny sounding named physician who appear on the Oprah show from time to time, here in the U.S. "...Erections of the penis reflect the vascular health of a man's heart..." Doctor Oz is head of the cardo surgical department of Columbia University. he says that one of the first things he asks male patients is: "how hard do you get"...Because it is an indicator of the health of the circulatory system. Often, it is an early indicator that will help lead to treatment to ward off any more serious conditions of the heart itself.
So the diabetes is a significant factor. Previously Because of the association of diabetes and circulation problems, it was not considered safe for diabetics to take Viagra, cialus, etc.
However, over the past two years, researchers have found it is safe to take for diabetics. AND with regard to the studies, using as controlled medication level of 10mg tabs, 30 percent of the persons who had erectile dysfunction, were able to maintain erections long enough to complete the sexual act, while taking Viagra. So we can say, at the 10mg dose, that Viagra is expected to be effective in 30% of patients with erectile dysfunction having diabetes as complicating or underlying factor.
Of course dosage levels affect the effectiveness of the drugs. So you and a physician would have to start out at low doses, and gradually increase them, until you and the physician arrived at a level that would help you. BUT, remember, it is not as effective with circulation problems caused by diabetes.
If I were to predict, that it would work for you, I would say it would. The reason? Because you can still get erections as you stated, when looking at pornography, and you can get it up for sex with your wife, but just not long enough (if I understood you correctly). So all you need is a boost, or jump start as they say. Further, if you still get the occasional erection in your sleep or in the morning, it is an additional factor that would indicate you do not yet have a non-reversable circulatory condition.
Chances are, if you are on the cusp, as you said, the diet, exercise, and tantric massage, without Viagra, you may be able to reverse some of this; but Viagra would be an added benefit, if you and your physician thought it was right for you. The fact that you are able to control diabetes with diet is a big plus on your side.
I believe it would be effective in your case, but again, I do not have the benefit being able to examine you. You need to really see your physician to discuss the Viagra issue specific to your self.
I did notice the other question.
Well you are in luck. By my credentials you will see that I am a former Special Forces Medic. I am no longer practicing, but while in the Special Forces we did all sorts of meditation, and massage. AND, I am a Jungian in terms of my psychology and philosophy. Which means also, that I get into the various new age, and exotic practices of the other world, such as Tantric Sex, Tantric Massage, etc as curative methods. We also used these methods at the "School of Exceptional Living" in Chicago, Illinois here in the U.S.
The tantric massage will help if the sole reason for the sexual performance issue is psychological or stress related. Studies have shown that only 20% of the cases of erectile dysfunction are related to psychological conditions.
So to the extent of your confidence,and the extent that stress, and to the extent that you may have gotten out of touch or out of tune with your body, and feelings of sexuality, tantric massage may in fact help. I have experienced the tantric massage, and I even have a tantric chair (see link below), that I use. AND it does help...but it does not completely cure the situation.
Not all the pages are viewable at this link. You will have to click on some of the links to get to view the chair. The tantra chair is used for yoga, meditation, and yes, tantric sex.
But remember, such therapy is only effective to the extent that your issue is related to psychological factors, inhibition, stress and self image. But if your problem includes physical circulatory issues, then you will still need to use medication as part of your overall plan.
It is like any other kind of massage, where if you have an underlying physical issue, you have to also take care of that, also. For example, you may start to have more desire or libido, and start to once again lust after your spouse; but if you can not hold the erection because of circulatory issues, you will still have to have the medications. I recommend doing both.
Remember, in this venue, I am not trying to sell you something, or get your business. I have spent more than two hours on your problem for what, 9 bucks. So you can see my interest is in helping you, more than it is for the money.
Under the heading of "healer heal they self", I use a tantric chair, and have used tantric massage, but I also use medication.
So yes, I would use tantric massage, because it will help, but alone, it may not.
BUT, do not look at the tantric massage as the cure all and end all. It is the same as any other massage, except that it focuses instead on the sexual organs, including the tactile effect of skin as a sexual organ, and helps you to get back in touch with how your body feels, and helps you to build a better self image of you as a person, sexually. It does not cure circulatory problems such as ED.
Remember, when you masturbate, it lasts only a few seconds to a few minutes; but when you have sex, you need more time than that. ANd this is the issue. Using pornography to get sexually aroused, and masturbating you have a short span of time. YOu need to be able to hold the erection long enough for regular sex to be effective.
I do not believe the tantric massage will get you there by itself. It is of course worth the try.
I can not direct you to a tantric masseuses in your area. BUT I can suggest that you contact a school of yoga, and they will be able to direct you or even provide the service.