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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4731
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have an interesting - and troubling - form of ED. When arroused,

Resolved Question:

I have an interesting - and troubling - form of ED. When arroused, I can get an erection fairly easily. However every time I approach actual intercourse, I lose my erection. This occurs even with the aid of Viagra (the only suggestion from an MD whom I saw for this problem).
I am 66 years old and divorced. I think this problem was a major contributing factor in the failure to (re-) establish a relationship with an old college girlfriend. I dated another woman for over two years and had this problem for the entire time we were together.
Any ideas? Thanks.
Submitted: 9 months ago.
Category: Mental Health
Expert:  Dr. Z replied 9 months ago.

Dr. Z :

Hello

Dr. Z :

I believe I can help you with your concern

Customer:

That would be good...

Dr. Z :

I am so sorry that you are having this type of erectile dysfunction while have sexual intercourse, I can imagine how distressing this can be

Dr. Z :

Since you went to a medical doctor I am assuming that your medical doctor stated that there is physically nothing wrong, but that this was a psychological issue?

Customer:

He didn't give me anything like a diagnosis or explanation; I think it's psychological though.

Dr. Z :

Okay, well there are possible physical causes for this that are usually ruled out before a psychological treatment is discussed, your urologist should have done that, so I would recommend seeing a different urologists for a full physical check-up, but I agree that this is most likely a psychological issue in the form of "performance anxiety." For this you can two things, you can see a certified sex therapist (I can recommend a few in your area) and/or you can take an antidepressant called Wellbutrin that can actually reverse this issue and it has been very successful in studies. Here is an article explaining a little more about this medication

Dr. Z :

A sex therapist is also a wise thing as they are specifically trained in this area, and this is common as it effects 1/3 of men.

Customer:

Is 'Wellbutrin' something that must be taken regularly and/or over a long period? (Not wild about that!)

Customer:

Plus I've tried to find a sex therapist anywhere near me with little success...that's why/how I found your page.

Dr. Z :

Yes it is something you would want to take regularly. My advice is to take it to immediately fix this issue as it can start being effective in 2-3 weeks for you, and at the same time see a sex therapist to help lessen psychological issues surrounding this problem you are having.

Dr. Z :

And then after awhile in therapy, you will no longer need the medication and you can taper off of it because therapy takes months to be effective (6-12 months on average)

Dr. Z :

What is your zipcode and maybe I can find somebody using my database

Customer:

95383

Customer:

(I live in the boonies!)

Dr. Z :

You do, but you are actually close to me, I work in Santa Clara and live in Livermore

Dr. Z :

How far would you be willing to travel to see a sex therapist?

Customer:

I'm in the Sierra, above Sonora... To Modesto or Stockton I guess.

Customer:

Perhaps farther...depends.

Dr. Z :

Okay give me a couple minutes to look for you real quicj

Customer:

You say this problem

Dr. Z :

*quick

Customer:

oops...affects 1/3 of men. This precise problem (i.e., "ED only upon proximity of insertion" - my term for it)?

Dr. Z :

Well erectile dysfunction effects 1/3 of men overall, most studies do not gauge of the specificity of what type of ED and at what degree. But because you can achieve an erection during sexual arousal but not during intercourse, most likely this is a psychological cause. As to the percentage of how often this occurs, I cannot be certain as most studies on ED are very generalized.

Customer:

That's what I've found online. I've never heard of this specific problem. I have a theory as to its cause, which should, in my mind, allow me to overcome the problem. Haven't been able to do that however.

Dr. Z :

Would you like to share your theory?

Customer:

It'll take a little while to type it out. You got the time?

Dr. Z :

Sure I have the time, it will allow me some time to find more therapists for you, so far I have only found two

Customer:

My marriage began disintegrating in late 2008 or early 2009. My (then-) wife began to sporadically demean me..."You''re fat/lazy/ unattractive," etc. Most of these episodes would be followed by an apology, usually claiming too much alcohol as the cause. In the summer of '09 we started to have sex. In the middle of that, however, she turned away, closed her legs and...that was that. several days later she explained that she found me so unattractive that she could no longer have sex with me. At the time I was waiting to see if I would be accepted into the Peace Corps (one of the reasons for that application was that we had, for much of the preceding year, seemed to have been "happier" if separated ("absence makes the heart grow fonder," etc.). I thought - mistakenly as it turned out - that an absence of 2 years just might put our marriage back together. Within a month of my arrival in Ethiopia, however, she was dating, and the marriage was effectively over. Whew!

Customer:

PS She is 10 years younger than I am and is now remarried

Dr. Z :

Wow, I am so sorry to hear that. It definitely sounds like your past marriage effected your psychologically with your self-confidence and caused anxiety in you, which can cause this issue.

Customer:

PPS: I'm no "hunk," but I'm not THAT bad for my age (he said modestly).

Customer:

THat's my theory. So how do I get out of this?

Dr. Z :

Well the predominant treatment for this by therapists that practice sex therapy and those that do not is that Cognitive Behavioral Therapy (CBT) is the most effective to treat this. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Customer:

During the (attempted) sex act, I am most definitely NOT thinking about this crap; if this is the cause, it must be, I presume, un/subconscious.

Customer:

It's not something I dwell on; it is the only thing that, so far anyway, makes sense to me.

Dr. Z :

Yes most likely it is in the subconscious

Dr. Z :

So there is one therapist in your area that has experience providing sex therapy, although is not a certified sex therapist, but may help you still

Dr. Z :

Also these therapists are really good providing CBT therapy and specialize in anxiety and self-esteem issues too

Customer:

Systems question: If I click on these links will I come back here?

Dr. Z :

I think so, but to be honest I do not know. You can right click the link though and select "Open Link in New Window"

Customer:

Ah...clever. So THAT's what that means...

Dr. Z :

No problem, you learn something new everyday :)

Customer:

Okay. I'll see if I can connect with one of these folks. Do you have any experience with any of them (i.e. a recommendation)?

Dr. Z :

I do not have experience working with them, I usually do more of my work in the bay area and in other major cities. But I looked closely at their specialties when I picked them out, so most likely one of them will work well with you concerning this issue.

Dr. Z :

Is there anything else I can assist you with today?

Customer:

If you had a magic wand perhaps... Otherwise I guess not. Thanks.

Dr. Z :

Well for some people the Wellbutrin is like a magic wand and that is why I made that suggestion as well

Customer:

I'll discuss that with whomever I contact.

Dr. Z :

That sounds good. Well I wish you the best of luck with your treatment and I truly hope that this issue resolves soon for you. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

Thanks again. Bye.

Dr. Z :

You are most welcome :)

Dr. Z :

Goodbye

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4731
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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