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A Treatment Model that Enhances Erectile Self-Efficacy

Giving the man what he needs, but not what he hoped for.

Key points

  • A return to totally predictable erections is an unrealistic and self-defeating approach.
  • Utilizing psychological, bio-medical, and relational resources can help build erectile self-efficacy.
  • When sex does not flow to intercourse, the couple can transition to a sensual or erotic scenario.

The great majority of men learn to be sexual with an autonomous, spontaneous, firm erection needing nothing from their partner except consent. A first experience of erectile problems can occur at age 25, 45, or 75. However, the man wants to return to a 100-percent predictable erection. He may consult a physician and receive a pro-erection medication or a penile injection, or he may consult a therapist to reduce performance anxiety and enjoy sensate focus. The clinician then promises a return to perfect erectile function. The truth: The clinician cannot deliver what he promises or what the man hopes for.

What the man needs to regain comfort and confidence with erections is to embrace the psychological, bio-medical, and relational factors that promote erectile self-efficacy. The majority, usually 85 percent or more, of sexual experiences flow from comfort to pleasure to arousal to erotic flow to intercourse and orgasm. He and his partner learn to accept that sex doesn't always flow to intercourse. They turn toward each other and share a sensual or erotic experience—manual, oral, or other. Sexuality is pleasure-oriented and satisfying, this is the good enough sex model.

A core psychological tenet is to drop the perfect individual performance model with intercourse as a pass-fail test. A couple can embrace a pleasure-oriented variable and flexible model that includes intercourse but does not demand intercourse. Sexuality is broadened to include sensual, playful, and erotic scenarios in addition to intercourse. He confronts and drops the traditional “sex=intercourse” and embraces broad-based, flexible sexual experiences that include intercourse, but is not limited to intercourse.

Positive sexual expectations replace anticipatory anxiety. A couple-pleasure orientation replaces an individual-performance orientation. Sexual acceptance is crucial. It's healthier to accept the penis whether erect or flaccid, rather than demand perfect erectile performance. Most important psychologically is the acceptance of oneself as a “wise man” who understands that variable, flexible sexuality—including responsive male sexual desire and erections that develop from stimulation—is more genuine and healthier than spontaneous erection. He and his partner accept that sex doesn't always flow to intercourse, and they can enjoy non-intercourse sexuality.

Bio-medically erectile self-efficacy includes awareness of medical and behavioral health factors that promote and support erectile function. Anything that is good for physical health is good for sexual health. This includes vascular, neurological, and hormonal factors as well as behavioral health, especially healthy sleep patterns. In addition, a man can stop smoking, reduce alcohol use (especially among the aging), exercise regularly, and practice mindfulness.

Relational factors are crucial to erectile function. The partner is his intimate and erotic friend-ally, not someone to perform for. Erectile self-efficacy is couple-oriented and focused on shared pleasure. Turn toward your partner even if a sexual experience was wonderful, good, or dysfunctional. This will help fight the traditional male trap of panicking or apologizing if an encounter does not result in intercourse. The couple accepts it is normal to not have an erection sufficient for intercourse, once a month or once a year. A measure of relational well-being is openness to engaging in sensual, playful, or erotic scenarios to reinforce sexual satisfaction.

To reinforce erectile self-efficacy, focus on three major themes. First, utilize all psychological, bio-medical, and relational resources. Second, be open to sensual and erotic scenarios when an encounter does not flow into intercourse. Third, embrace good enough sex as healthier than perfect individual intercourse performance.