Dr. Robert Roop
Professional Counseling
1013 Magnolia Drive
Clearwater, Florida 33756
Common
Male Sexual Dysfunction
In an article in the St. Petersberg
Times dated Feb. 10, 1999 the author, Raymond Rosen, stated
that the Journal
of the American Medical Association had presented
a sexual report said to be the most comprehensive U.S.
sex survey since the 1948 Kinsey report. (1) More
than 40% of women and 31% of men shared they had one
or more persistent problems with sex. It appears that
men are less likely to admit sexual problems than women
are, and in fact, exaggerate the quantity and quality
of their performance. This would suggest that the
above figure for 31% for men is probably low. The
difficulty in admitting to the reality of their performance
also extends to the time they wait until they are willing
to admit to any dysfunction. When the problem is finally
addressed in counseling it is a good guess the problem
has existed for one to five years. The causes
of this may include embarrassment, or lack of motivation
from an unhappy marriage, no partner, or deeply buried
sexual inhibitions. It is important to understand that
procrastination will only make the problem worse, and
in most cases, the problem will not go away by itself. In
fact, ignoring a sexual problem can lead to other relationship
problems in a ripple effect. In my experience of counseling
couples with sexual problems a great majority shared
that unresolved sexual issues had, in part, led to
extramarital affairs and marital break-up. Many statistics
concerning sexual issues remain consistent even in
Christian populations. There are many gimmicks, groups,
and unhealthy methods available. However, experts suggest
that a motivated couple with a good sex therapist should
see real change in at least six months. Dr. Douglas
Rosenau states in A Celebration of Sex, “An
intimate marriage + mature lovers = a fulfilling sex
life.“
With
any disorder that involves both physiological and psychological
causes, it is prudent to begin by ruling out the physiological
causes first. Serious underlying diseases may cause
some of the symptoms of sexual dysfunction. These diseases
may include, but are not limited to, sexually transmitted
diseases, alcohol and drug addiction, thyroid problems,
multiple sclerosis, infections, vascular problems,
cancer, diabetes, hormonal abnormalities, and low testosterone.
The side effects from many types of medications can
cause sexual problems. Classifications of drugs that
may be suspected in sexual dysfunction include antidepressants,
antiepileptics, antipsychotics, analgesics, tranquilizers,
and high blood pressure medication.
If
one recalls Maslow’s hierarchy of needs it is noted
that sex is not one of the immediate survival needs. This
would suggest that our Creator put together a system
that interrupts non-essential functions when more severe
organic problems exist. Ruling out the possibility
of a medical cause becomes the first step in diagnosing
the client’s condition. Proverbs 16:22 states that “Understanding
is a well-spring of life unto him that hath it, but
the instruction of fools is folly.” Help will be needed
to diagnose the physical problems and this can be accomplished
in a working relationship with a good urologist. This
individual should have a proven history of caution,
foresight, and deliberateness, rather than acting hastily
and expeditiously. The urologist should enjoy working
with sexual dysfunction and be willing to consider
a therapist’s input in treatment. Some of the causes
of sexual dysfunction will be found in the examination
and test results done by the urologist. The client
who experiences relatively quick diagnosis and recovery
usually returns to a normal satisfactory sex life. Those
that need more intense medical intervention such as
surgery, radiation treatments, chemotherapy, or strong
medications usually need a therapist’s help in adjusting
to the effects of their debilitating condition. Whether
long or short term, they will need support, education,
and a trusted individual to help develop reachable
sexual goals. There will be a need to improve communication
between the client and his spouse to create a united
front against the medical problem. The separateness
of male and female can meld into oneness and each can
learn to touch, please, and experience the patience
of true Christian love as one flesh. (Gen. 2:24). Those
with organic complications will require specific therapeutic
interventions developed by the sex therapist involving
the client and his spouse.
Psychological
factors are often difficult to isolate because depression
and anxiety can both cause and result from sexual difficulties.
The most common psychological problems are in one of
four areas. These can be seen in the four stages of
the male sexual response cycle; desire, excitement,
orgasm and resolution. A comprehensive sexual history
is extremely helpful in establishing whether the problem
is chronic or acute, situational, age-related, experiential
(such as abuse), or a factor of individual life style.
The
following problems are commonly found in each stage
of the male sexual response cycle. The first one is
impaired desire. Desire is the spark that lights the
fire. According to Dr. Howard Gazer, Ph.D., a professor
at Cornell University Medical College, “Lack of interest
in love-making, is now the number one reason couples
consult a sex therapist.” One major
problem for males, is a lack of desire or interest
due to fatigue,
and/or unresolved conflicts and anger. For men already
overwhelmed with the stress of this world sex becomes
just another chore. It assumes the position of an
obligation rather than a joy. Males tend to squeeze
in lovemaking when they find the time. This is usually
late at night where they use sex as a stress reducer
or sleep aid. When sex is sandwiched in it is not
very fulfilling for the wife and can result in resentment
on her part. Lovemaking gets pushed lower and lower
on the priority list. Work, finances, household responsibilities,
church, and kids leave little time for resolving conflicts,
sharing hurts and unmet needs, and building intimacy. Sex
is more and more in the movies and less and less at
home. The urgent takes precedence over the important
and couples tend to neglect the emotional connection
of a loving sexual encounter blaming time pressure
and poor planning. Psychoeducation at our counseling
center includes what we call the “Romance Plan”. It
includes date night at least once a week, a night away
at a hotel every three months and one weeks vacation
without the kids. Sex must be a priority and not left
until the last minute. Encouragement is made to couples
to take turns planning date night to keep it varied
and make sure the date includes a passionate fulfilling
sexual experience. Spontaneity is great in theory
but in most couples busy life if date night isn’t planned,
it won’t happen.
Unmet
personal needs are a major cause of anger and a huge
block to intimacy. Identifying needs and speaking
those truths in love goes a long way to preventing
resentment and frustration that can evidence itself
in the bedroom. Teaching confrontation, good conflict
resolution, and communication helps couples get honest
with themselves and each other and moves them toward
forgiveness and renewed connection. This enhances
sexual and non-sexual communication. Reevaluating
how each is doing toward meeting the others needs periodically
helps them to make needed changes and stay on course.
The
next stage of the sexual response cycle where males
display sexual dysfunction is the arousal stage. At
this point investigation into early life traumas needs
to be addressed and processed as this may be the cause
for arousal difficulties. The male either experiences
desire but is unable to achieve an erection sufficient
for intercourse (erectile dysfunction) or he is unable
to exercise any control over his ejaculation process
(premature ejaculation). After organic causes have
been ruled out, performance anxiety and depression
may accompany E.D or P.E. In achieving erection, the
male’s self-esteem hangs in the balance. Men tie their
self-respect to their erection. Almost all men have
had at least a few encounters with a reluctant erection
or losing an erection at a bad time. Erection problems
that are not organic tend to be due to unrealistic
expectations, aging, absence of a sensual environment,
or spectatoring, which is self consciously watching
your performance with anxiety. Men who report sudden
onset of sexual problems often suffer from performance
anxiety, since organic causes of sexual dysfunction
develop gradually. One therapeutic intervention for
erectile dysfunction is to teach the couple sensate
focus exercises as developed by Master’s and Johnson. However,
helping the client normalize his problem can be a very
positive aspect of the therapy. Psychoeducation regarding
the effects of aging, and interventions to reduce anxiety
will also be helpful here. Premature ejaculation can
be defined as a man having minimal or no control over
his ejaculation. Estimates state 40% of men have suffered
from premature ejaculation at one time or another. The
actual cause is not known for sure but the problem
may lie in one of two broad areas. The first is early
life masturbation or sexual experiences that carried
the risk of discovery. Speed to orgasm was a benefit
at the time but may have become a liability later. The
second is lack of education about ways to gain control
of the time of ejaculation. This can be done by teaching
a client to pay attention to his level of arousal and
recognize his point of ejaculatory inevitability. Once
the client knows this point he can more easily control
and delay his premature ejaculation
The
third stage of the sexual response cycle is orgasm. One common
problem in orgasm is the male’s inability to reach
ejaculation and is called retarded ejaculation. This,
with few exceptions, has its cause in the mis-use of
alcohol and/or drugs. Alcohol depresses the nervous
system and can decrease the sensation needed to produce
orgasm. The cure for this problem requires life style
changes and a good dose of common sense.
The
last stage of the male sexual response cycle is resolution. Orgasm
is the release of pent up sexual tension that is typically
followed by relaxation, peace, and rest. This is a
wonderful time for a husband and wife to talk about
their sexual experience and what they enjoyed the most. The
biggest problem can be an uncomfortable feeling of
guilt or shame about having had sex or enjoying it. This
anxiety can stem from a concern about having lost control,
source family teachings, rigid family values, or misunderstanding
God’s word that says the marriage bed is undefiled.
A
man’s strength will never be tested more than in the
area of his self esteem and sexuality. Since God has
promised that all things will work together for our
good, even sexual dysfunction can help us to grow and
mature. E.L. Coe in Strong Men in Tough Times, states
that “Life is lived on levels and arrived at in stages. That’s
why the steps of a righteous man are ordered by the
Lord. (Psalm 37:23) Each step advances to a new level
of responsibility, knowledge or authority and calls
for further deepening of character”. Even in this
most difficult area we as Christians can believe that
God is faithful and guides all of our steps.
Bio
on Dr. Robert Roop
Dr.
Robert Roop is a Florida Licensed Mental Health Counselor
and is board certified in Human Sexuality by the American
Board of Sexology. He completed his undergraduate
work in Psychology at the University of South Florida
and received his Masters degree in Counseling Psychology
from Nova University in Ft. Lauderdale, Florida. He
received his doctoral degree from the Institute for
Advanced Study of Human Sexuality located in California. He
has twenty years experience in all aspects of mental
health. He and his wife, Dr. Shay Roop, presently practice
together in their clinic in Clearwater, Fla.
