Prime Time - Jane Fonda [96]
Creating a combination treatment by adding counseling and education to the mix, along with the pharmaceuticals, may be what is needed to create a positive sexual tipping point for the couple. Right now, however, too few doctors may take psychosocial, behavioral, or cultural factors into account when treating sexual dysfunction. In a 26,000-person study done in 2005, “only 14% of adults in the United States reported that a physician asked about their sexual concerns within the past three years.”2 Dr. Perelman feels that ignoring the nonphysiologic factors of sexual dysfunction—such as anxiety, anger, depression, early trauma, fear of failure, loss of confidence, and relationship issues—is what lies behind the 20 to 50 percent discontinuation rates reported for current erectile dysfunction treatments. A pill is not a magic bullet.
Erectile Function After a Prostate Operation
I asked Dr. Perelman what the current practice is to restore erectile function in men who have had various kinds of prostate operations or radiation. “What the medical profession is doing now to help restore erectile capacity is what we call penile rehabilitation right after surgery,” he said. “The trick is to get these men getting erections as quickly as possible based on numerous theories, including one that brings blood flow and oxygen to the penis. The hope is that this will help the recovery process. So now urologists will give Viagra, Levitra, or Cialis to most men on a daily basis, or every other day, and begin to restore erections in that manner. But does restoring erections make for a good sex life? I think of it as something very helpful but not sufficient in and of itself. It depends on what else happens.”
Male Orgasmic Capacity
Dr. Perelman told me that for some men, sexual-enhancement drugs and implants actually create a new problem. “In general, as men age, it becomes a little more difficult to reach orgasms for the same reasons that we don’t hear as well, we don’t see as well, our touch isn’t as sensitive. The drugs are restoring their erectile capacity, but they are not helping them with their orgasmic capacity. Some guys can be kind of naive, and go, ‘I must be turned on, I have an erection,’ but they have an erection because they took a pill, or injected themselves, or they have a prosthesis”—a pump—“that is providing them with an erection. So they are presuming they are excited, and their partner might presume they are excited because, after all, he has got an erection, and maybe he hasn’t even told her he has done this. So she is thinking everything is fine, and they make love, and he is unable to reach orgasm because he may not really be excited.”
The problem is, Dr. Perelman explained, that “he is artificially induced into an erection, which would be much the same thing as a woman who is using too much lubricant and isn’t really turned on, but she is able to have intercourse because she is so wet, the penis slides in. So men are starting to have this problem that we used to only hear about from women, about not being able to reach orgasms. Initially, the woman will feel, ‘Oh, there must be something about me, it’s my fault.’ But then she will start getting angry and we begin to see the same sort of compulsive ‘How come he’s not coming?’ that you see in some men who are dragging their wives and girlfriends in here saying, ‘I want to see her have an orgasm, a real orgasm, none of this vibrator or clitoral stuff. I want to give her one!’ The men, of course, are very distressed because it is a loss of something that was vital to both their sense of themselves as a man and their capacity. Right now I am describing probably 3 to 5 percent of men benefitting from medical assistance.