One of the most common questions I hear, even by mental health professionals, is that if sexual function issues are anxiety based, why do we recommend using medical intervention? Their assumption is that if it is not a physiological problem, why treat it medically? I could write a whole book on the interconnectedness of the mind and body when it comes to sexuality, but the sort answer is: It works!
A common scenario might be that a man comes to us complaining of Erectile Dysfunction and, after a full medical workup, we conclude that his problems are caused by an underlying anxiety disorder. One example of this is evidenced by his having great erections for masturbation, but losing the erection when feeling anxious when he is about to penetrate his partner, or with different specific partners. But, even with this situation, we must still rule out underlying physical causes.
This patient might have symptoms of anxiety in other parts of his life, even if he never recognized them as such. He might not notice that he has intrusive thoughts, or he perseverates on various issues, or he has a hard time unwinding at night. Anxiety can appear in many ways in different people. This is why it’s important to consult a mental health professional to discover what else might be going on.
If anxiety is an underlying problem, we treat the anxiety. This is often a combination of talk therapy as well as medication to help control the levels of anxiety. We are careful to prescribe antidepressants which will have minimal sexual side effects. We also encourage patients to learn stress management by recognizing what is causing stress and ways to respond to stress.
When it comes to sexual function, we have a two-pronged approach: 1) We treat the acute condition and stabilize the patient medically. 2) We simultaneously teach behavior modification and education to shift sexual expression away from performing.
This is similar to many medical treatments. Second sentence should read: For example, if someone sprains an ankle and we stabilize the injury by using a cast/splint, they will not re-injure themselves. Physical therapy then follows with exercises as well as education about body mechanics and learning how to prevent more injuries (i.e.: better shoes, better choices).
When it comes to sexual function, we need to prevent re-traumatizing situations such as losing an erection. By using medical intervention, we can help the patient escape the death-spiral of repeated failures; If he is able to get an erection, panic about erections will subside.
At the same time, we engage in therapy to talk about choices he is making (often unwittingly) about sexual activity where he may be judging himself or is in a pass/fail sexual performance. Many men feel they must ‘do sex right’ and put enormous, unrealistic pressure on themselves to perform. We explore new ways to approach sex that allow it to be fun, playful, connecting, and fulfilling.
Eventually, when anxiety about sex has dissipated, we are able to wean the patient off the medication and sexual function is no longer an issue. The fact is: every man is going to lose an erection at some point. The challenge is to not let that moment define who you are sexually but recognize it for being a normal occurrence and shift sexual activity from penetrative activity to playful activity.
Treating the whole person – medically and therapeutically – can result in resuming a satisfying sex life while continuing treatment.
If you are suffering from sexual dysfunction and feel that you would benefit from this integrated approach to treatment, contact us for more information.