Show Transcript for Episode 278: Erectile Dysfunction—Overcoming Anxiety with Vulnerability

Listen to the episode here!

Laurie Watson 00:02
George, you have emphasized to me the difficulty that men feel about having EDI or erectile dysfunction. More than anything I’ve learned in the podcast from you is just how sensitive they feel, how much humiliation there is for them. And it has changed my work. I mean, I asked more I understand more. So let’s talk about Ed.

George Faller 00:25
Alright.

Laurie Watson 00:29
Welcome to foreplay radio, couples in sex therapy. I’m Laurie Watson, your sex therapist.

George Faller 00:34
And I’m George Faller, couples therapist,

Laurie Watson 00:37
and we are passionate about talking about sex and helping you develop a way to talk to each other.

George Faller 00:42
Our mission is to help our audience develop a healthier relationship to sex that integrates the mind, the heart and the body.

Laurie Watson 00:53
So what’s up in your world man?

George Faller 00:55
Just did a little hiking this weekend, which reminded me I’m getting older. Never had to take a couple of breaks climbing a mountain, but I guess that’s the sort of things to come. Yeah, yeah.

Laurie Watson 01:06
Yeah, we had houseguests. Everybody was vaccinated. And it was really fun. One of my best friends and a friend of Derek’s game, and we hike in a state park here Umstead, which is just acres and acres of natural North Carolina property. And it’s just beautiful. And so we hiked Yeah, we we got lost, we took a wrong turn. And my girlfriend had to get to the airport. So it was this stressful thing. Like Where are we in? One of the guys starts jogging ahead. I’m like, Oh, my gosh, she doesn’t know where we’re going. And he doesn’t know the park. And so he got lost. It was crazy. I couldn’t find the car. But it was a good hike. And it was lovely out there. Awesome.

George Faller 01:49
There was nothing like this. I was with one of my sons and my wife. And you know, we he was complaining the whole time over there. Yeah, sure we turn around is pretty funny. But you know, we get to the top and it’s just all these fires. And all of a sudden, you get to stop at a mountain or holding clears and it opens up in the views are just like breathtaking. And it’s like, this is why we kept going. Yeah, it just to kind of sit up there just be part of that is really magical.

Laurie Watson 02:15
Ah, that’s great. I know. We had friends who hiked the Appalachian Trail every summer and they said their kids would like, throw their backpacks down and pound the ground. I’m not going forward. I’m not going forward. And they would just keep going. I don’t know how they did it every summer. But they said all year long. All their kids talked about was being on the trail. You know, sometimes.

George Faller 02:37
Sometimes it was a great parenting moment when my son as I, because I knew he was in a rush to get back as like, let’s go. He’s like, No, Dad, let’s stay up here a couple more minutes. Right. So there was something about that, that moment that for him to was I think pretty special.

Laurie Watson 02:52
Big win. That’s great. That’s great.

George Faller 02:55
We need to take whatever wins we got right, Laurie Absolutely. wins the losses here. Now let’s get to erectile dysfunction. Okay, so, you know, let’s start off what is it?

Laurie Watson 03:08
So erectile dysfunction, or ED is basically when a man’s erection fails, or he can’t hold on to it when he wants it. Sometimes men have ED before they even can penetrate, you know, before they just can’t get aroused, they have ED that they can’t get an erection period. Or maybe just at the point of penetration, they lose their erection or maybe while they’re inside their partner, they got in fine their heart, but something happens and then they lose their erection. Alright, so at any point, we consider it, ed. And there’s a lot of different causes for it. I mean, it could just be anxiety. And obviously, that’s the one that sex therapy really focuses on and can do the most good and helping fix and I would say even if there’s another medical cause, or physiological cause, like, there’s valve problems with when men age, their valves don’t shut quite as tightly sometimes. And so there’s a little leakage and so they don’t have as hard of an erection, medications blood pressure medicine, hmm. You know, that’s a killer. For erections. an erection is a hydraulic event, right? It’s blood flow into the penis. And so if you’re trying to lower the blood pressure, I mean, you’re just almost absolutely going to impact directions.

George Faller 04:38
And then is surgery like prostate surgeries that can impact your erection.

Laurie Watson 04:44
Yeah, and so this is a really big problem. Prostate Cancer is pretty common. And almost all the techniques that attack the cancer surgery, radiation therapy, almost all of them have an impact. On the nerves that impact erection, and doctors don’t talk about that as much. So, you know, obviously men know that this is a problem. And it’s part of the fear of prostate cancer, even though that’s usually very curable, the cure, often men lose their erections. And so, you know, a lot of fear in that, I will say there’s a new treatment that I have a lot of hope for, they’ve learned to use ultrasound on just the cancer and it spares the nerves in a new way, there’s showing great results with nerve sparing treatment that allows a man to become cancer free and keep his erections and so, so important, man, you have to have a digital exam. Every year, I know it’s uncomfortable. I know, men hate to have that exam, but you absolutely have to have it every year, and your PSA blood checked every single year. So make sure you get that because it’s important to get this early. So you know, potentially that earlier treatments are less problematic for erections. Right? So that I mean, those are the causes. I would kind of like us to talk about the anxiety piece, and what men can do about it. But I would say truly, you’ve really changed the way I think about it. I think as a woman, I’m just not as aware of the humiliation that men feel about this. I think there’s so many workarounds, it’s like, you know, no big deal, you just go a little longer, or you use more stimulation or, or it’s not his night, and you know, no big deal, right? Maybe they focus on her. I mean, I think, you know, I have, in my scope, a lot of flexibility of, you know, what constitutes a good sexual event, but for men, you know, if they lose their erection, kind of game over, or if they can’t get an erection, you even in roleplays, you’ve talked about how that means. If he doesn’t feel arousal, he doesn’t feel desire.

George Faller 07:06
Well, I would love for the pornography industry, to show a film of a man losing his erection. how healthy would that be? Right? That’s what do you do? Right? Again, we don’t see anything like it. So every man that experiences it is dealing with it in total isolation by himself with his own brain to make sense of it. And it’s usually doesn’t go to a good place. And it’s got to go to a place of feeling like a failure, feeling inadequate, not feeling manly. I mean, and if that was the end of it, just to trauma that that would be bad enough, but it’s a gift that keeps on giving. It’s like in the next sexual episode. It’s the shadow that’s lingering now now you got to worry about that happening again. Right? So it isn’t takes that nasty tall on men. And we wonder why they become so penis focused, when everything’s focused on their erection? Are they going to lose it or not lose it. And again, we know pressure is only going to make this problem worse. And yet so many men are totally set up for a pressure intense pressure filled episode.

Laurie Watson 08:12
You are so right. And I of course the porn industry is not going to show that

George Faller 08:17
why not do that?

Laurie Watson 08:19
Yeah, but the porn industry makes it worse, right? Because it’s all about men having bigger reactions, long lasting erections, which, you know, you got to think about those are clips too. I mean, men don’t last that long woman can take it admin lasted that long. Listen, I think

George Faller 08:35
this could be a best seller out there. Somebody Listen, have you made a real film around somebody losing erection and what they could do about it? I think everybody would like to see something like that.

Laurie Watson 08:48
Maybe,

George Faller 08:49
maybe not everybody, but enough to make it a best seller, right?

Laurie Watson 08:54
But you said the shadow of having lost your erection creates more anxiety. Right? And if anxiety is one of the things that causes erectile dysfunction, then a first time event, you know, men start to feel anxious. Can I just say that? It is normal to lose your erection every once in a while that is totally normal. And I think men are unprepared for that. So of course it creates a lot of anxiety. And as men age, it’s normal to need more stimulation to get an erection. You know, I think men are so used to their body working without any stimulation. And to be honest, right women are used to that too. They think it’s unfortunately about their attractiveness. You know, if he doesn’t have an instant erection, he’s not finding me attractive and it’s like he may just need more stimulation. So it is a big setup between couples for misunderstanding and problems. Think the humiliation about when it happens and him turning away in bed. You know, getting out of the bed, okay? Not my night, forget about it. And she’s like, Well, What about me? Or just the loss of their connection? You know, he’s feeling he’s in shame and feeling the desire to just kind of go away and hole up. And she’s like, what’s happening? Why are you leaving me? Can’t we still be together? There’s just a big problem of disconnection that we want to help couples with.

George Faller 10:35
Exactly. So let’s talk more about this disconnection. When we come back.

Laurie Watson 10:39
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George Faller 11:24
I mean, it’s a better touch. And you know, when 1000s of doctors, sex therapists and clients are all agreeing and recommending the same thing, you’re onto something.

Laurie Watson 11:33
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George Faller 11:43
So we’re talking about this disconnection. And if we lean into the males experience for a second here, the worst part is not it not working. It’s the how they make sense of it not working, that really creates the problem. So you’re describing a really healthy perspective that says this happens, we note 10% of sexual acts are somewhat disappointing. Like this is par for the course for every couple out there. But if you see that it’s just normal and not a big deal, then it’s fine. But that’s not where most bang go. Most men go, how they make sense of it is, there’s something wrong with me, I’ve failed, I am less of a man, I am not performing, I am not producing their fi I am less than, right. And when these tapes start to play, what also is so bad is they they have no experience being able to talk about these places in themselves. So not only did they have these bad feelings, but now the avoidance kicks in to really weather those storms on their own. So you know, their partner is like no big deal. But meanwhile, that man’s going off into really, hell, right? They go into a place of feeling bad about themselves feeling like a failure inadequate, and they’re hiding it all. And now they’re so step two is the hiding it and then step three is the fear that it’s going to come back and get you again. So you can see how much pressure This is going to create inside that man’s in a world.

Laurie Watson 13:13
Yeah, absolutely. erections are so tied into the way a man perceives himself as masculine. You know, it’s just part and parcel of the same thing. And so if he’s losing his erection, is he a man? I, you know, he’s he must be asking himself that stuff. Do you think? I don’t know if you’ve heard men talk about this? But do you think it’s worse? When it happens? Is it like, worse if it have a can’t get an erection? Or is it worse? That, you know, right, as he’s penetrating it, he loses it or if he’s inside, and then he maybe has a different thought and he loses it? I mean, it’s,

George Faller 13:51
it’s all bad. It’s all bad. Just to just measuring different degrees of bed. You know, yeah, you can’t get it started out feels really bad. You know, it’s, it’s, you know, when you’re then trying to penetrate it the act of penetration, it don’t work. That’s, that’s, that’s really bad, too. You know, and then when you know you’re having intercourse and it just kind of conked out on your that’s, you know, that’s, that’s, I mean, they’re all bad.

Laurie Watson 14:19
Bad, bad and more bad, bad

George Faller 14:22
worse, and I’m getting depressed here. You know, what also makes it complicated is that when the a lot of these men masturbate they don’t have any of these problems because they don’t have the pressure right? So they got a short thing they’re watching some pornography, everything’s working they you know, have control they relax, they kind of orgasm and it’s like it works fine. Yeah, which that means more pressure once they go back to the actually act with their partner, then with their with their partner, think about that penis the whole time. So all those things we’ve been preaching, right about being in your body being emotionally attached spiritually. All that stuff gets thrown out the window. And we wonder why it doesn’t work. I mean, it’s like a math equation, these numbers can’t work. Right? When you got all this pressure, all this fear, you’re not relaxed. You know, it’s just not, you know, it’s why

Laurie Watson 15:15
George just demoed with his finger what it looks like, Got it. Got it. So this is not best sex right there. They’re in their body, not in a, they’re in their head with anxiety and fear. They’re not in their body and joint sensation. They’re not emotionally connected, they go through disconnect their spirit, you know, they are not feeling some sort of euphoric, transcendent experience. And their thoughts are telling them, they’re not a good lover. They’re not a man. It’s killing them.

George Faller 15:48
They’re not in the present moment, right? A lot of them are thinking about some pornography clip, that just thinking about the ejaculation.

Laurie Watson 15:57
They’re using those thoughts to, to hopefully stay hard to stay out so they can have an

George Faller 16:03
orgasm. And then it’s like, literally, they’re looking at a target that’s in front of them. They’re not with themselves or with their partner when this is happening.

Laurie Watson 16:11
Right. I think what you said, you know, if they’re masturbating, and they are hard, and they do keep their erection, and they do get to ejaculation fairly easily. The problem is that that does, by definition mean that they’re ED is caused by anxiety. So I mean, that’s kind of the good news, bad news. Because anxiety, we can fix valve problems, blood pressure issues, not as easily fixed. So we have to have more compensation in order to get there. But anxiety is something pretty manageable.

George Faller 16:44
Yes. And so much of what we’re trying to do is to get to reduce the pressure, the head towards relaxation. That’s the antidote to a lot of these Edy problems. rattle viagara

Laurie Watson 16:57
Yeah, and I think viagara actually, so this is one thing I do suggest to men, you know, how do they deal with it? Are they going to actively seek a solution? You know, are they going to tell their doctor, first of all, getting a man to a doctor sometimes is a problem. Men, in my experience, have some resistance going to the doctor, you know, let alone calling a sex therapist. That could seem really weird. But I think telling your doctor look, and I’m having occasional ad, when it starts or the first time you feel it that that is a smart solution. And I think viagara if your ad is caused by anxiety, using Viagra is kind of like insurance. And it takes down that anxious piece like, Okay, I know, if I use viagara By and large, I’m gonna get there. I mean, to me, there’s, you know, low side effects. Why not just do that? I don’t know, man. Well,

George Faller 17:54
is it here? Well, I think the fear is that once you go on Viagra, you won’t ever be able to go off it. That’s the fear that a lot of men have, that they become dependent on the Viagra and they lose their own kind of natural ability to do that. I know you’re saying you’re the opposite. But I think that’s a lot of the fears that men have.

Laurie Watson 18:14
Well, that’s good feedback for me, I guess, you know, it isn’t something that’s addictive, first of all, and some of what I see is, you know, men start to feel more confident again, and then they don’t necessarily need it. And to me, if a guy needs it, let’s say he’s struggling, you know, why would he just not get up and go take a pill and then work on her for 15 minutes. I mean, vinaigrette takes about 15 minutes to work. It isn’t usually a half an hour. I mean, it starts working fairly quickly. So I mean, I don’t know, I had one patient who goes and gets it and feels a lot of shame and transmits that shame to his partner, you know, I have to go get it, I have to go. I have to go take a pill. And I’m like, What if he just said, Hey, baby, you know, I gotta go take a pill. I’ll be right back, you know, and just had some energy about it. And, you know, he’s conveying right that he’s excited about being with her. And he’s gonna do the thing that he knows works for himself. And that kind of confidence and playfulness. I mean, then both of them are more relaxed. She’s not like, Did he take his pal? Did he not take this pill? What’s going to happen? Are we going into this encounter, and he’s going to be upset? I mean, I think that freaks out the woman.

George Faller 19:35
I agree. It’s such a great experiment, to see if we take the pressure off. You don’t have to worry about the mechanics. Yeah, you know, can you be more confident and relaxed and and if that works, then that should translate into the next encounter the next encounter, like what is it like to be present, to not have to be kind of focusing on some fantasy in your brain to be more in your body to be more emotionally connected. Like I think these are, it’s a beautiful opportunity to learn new moves.

Laurie Watson 20:07
So talking to a doctor or going to a sex therapist, I mean, it’s, you know, this is something that we deal with all the time in my practice, and there are good sex therapy practices throughout the state. Certainly, I mean, I’m sure throughout the world, but it’s, it is something that in terms of anxiety, we can talk the couple through it most of the time, I suggest that the couple come together, I mean, it’s fine. If he comes first explains the problem, you know, maybe some of his fear is worked through. Again, sex therapy is all talk therapy. And so there’s, this is not any funny business, it’s just talk therapy. But it’s, it’s great because we have so much experience talking men through their anxiety and their fears about it, and how to communicate those things to their partner. So that the two of them getting get on the same page. I mean, it’s definitely something to seek and to figure out as a solution.

George Faller 21:04
Good stuff.

Laurie Watson 21:05
Okay, let’s come back and talk about the vulnerability, what to do about it, how to share it with your partner, what the partner needs to give in terms of reassurance in this next section.

George Faller 21:20
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George Faller 23:38
So the vulnerability Laurie, here’s the opportunity in erectile dysfunction. This is what I think most men and their partners often don’t say. And I always want to start off with what is the goal? What is the goal of the sex of the intimacy? Is it the orgasm, and then it could be part of it? Or is the goal connection to feel closer to be part of something bigger than yourself? If the goal is connection, then as a beautiful opportunity in the end to kind of come alongside parts of each other that almost never get the light of connection brought into it. Right? So when we think about these men, this is their moment of greatest need. They’re feeling like a failure. They’re feeling inadequate, feeling less than they’re feeling pressure. And yet, they want to hide this because they don’t want it to be used against them. They don’t want people to see them as less than the way they’re seeing themselves. So their only move is to hide and wait for the storm to pass. Think about how different life could be if these moments where they feel less than they could learn to let their partner in and actually face those fears with someone else instead of alone and this research is crystal clear on this. The way I buy response to fear is qualitatively different if we’re alone or were with somebody else

Laurie Watson 25:06
that is so true talk about that some more George, how the research shows that,

George Faller 25:11
yeah, be co regulation, which is two nervous systems joining together to face anxiety is 20 times more effective than self regulation when you’re facing it on your own. Yeah, and that’s what these men are doing all the time. They’re facing it on their own. And it’s just each time gets more and more and more and more. So yes, we’re trying to help men see the value, and you can’t talk people into it, their nervous system has to actually experience somebody else with them in that place.

Laurie Watson 25:40
And I would say you just set it but I want to emphasize that if this has happened, in a pattern, she’s anxious, too, we want them to share this together so that they co regulate instead of both being alone in their fear about it, maybe his fear of it’s going to happen, she’s gonna be angry, she’s gonna be upset, or her fear of, you know, he’s gonna stop, I’m not going to be fulfilled, he’s gonna feel bad, I feel bad when he feels bad. Is it going to happen again,

George Faller 26:11
you know, all of that anxiety building up? So how different Could it be if the guy would say something like, you know what, I’m, I’m a little nervous right now that I’m not, you know, I’m gonna lose my erection. But he could name that fear and actually say it out loud. And his partner could be like, it’s alright. Right? Let me help you relax. If you lose it, it’s totally okay. We’ll find another way to kind of get that going. But I want you to focus on my boobs right now. Whatever it is to just kind of like get them that relaxation is the goal. How did they get that partner the focus back in on the connection back into the kissing back into their body back into thinking about how important their love is to each other. The goal is to connect skin to skin can speak beautifully to each other in these places, they just need to remind them that the anxiety is not telling the whole story, the anxiety has just given us a little tunnel vision of what’s going on. Right? That relaxation is trying to expand that frame, they can start taking in so much more that’s actually happening in that room, they just need help to see that

Laurie Watson 27:18
is that is so great, I had a man tell me that his partner told him, You know, I just want you to now you know, if you have an erection, or if you lose your erection, it’s not that big a deal to me, it’s not a showstopper, you know, we will work it out, we will work out a sex life that is enjoyable and pleasurable for both of us. I just, I don’t want you to even think about that. And as we’ve talked about so many times, most women don’t climax through sexual intercourse. So for them, I think if men could take the pressure off themselves thinking, this is the way I perform, it may not be it probably is not the way he performs and gives her the most pleasure and gives her an orgasm. I mean, I know he wants to have an erection and he wants to have an orgasm that way. But also, it turns out that erections and orgasms for men are separate functions, so he can still have an orgasm without an erection with enough touch and stimulation. So he can still have pleasure. I mean, I really think they could work it out if he will begin like you said, saying, Hey, I’m a little fearful here and her responding with you know, baby, let’s let’s do this for a while, you know, a redirect or it’s okay. Even if you don’t, even if whatever happens, even if your erection fails. I’m glad we’re naked together. I’m glad we’re doing this. I’m glad we’re trying this. I’m glad to be with you. That’s what’s most important.

George Faller 28:48
Good stuff, Laurie. That’s That’s why we want to listen to emotions. They’re so wise. They tell us what we need. A lot of times with these men I will lean into their worst fears, like catastrophic fears we call it so what happens if you can’t maintain your erection? What does that mean lean into those places. And at its core, it’s I am a failure therefore I’m unlovable you know a lot of shame not that’s gonna be rejected. I deserve the rejection because who I am is on lovable lots it out.

Laurie Watson 29:19
It’s more painful.

George Faller 29:20
Yeah. And if we listen to that, it tells us the antidote to failure is even in a worst case scenario, your worst fear. You’re still got to be loved. You still got to be wanted. Like that’s that’s amazing reassurance to be had. I love that example that you gave where the wife’s able to say it’s okay. You lose your erection. It’s still okay, we still get to have a good time with each other. We’re still gonna connect with each other. I still would choose you. I still think you’re pretty wonderful. Right? And once that pressure starts to be taken off, really good things happen. Yeah. Goal just for one second because again, if the goal is just a erection of the orgasm. Hmm. To me, the goal is so much bigger The goal is to connect. And you can do that regardless of what happens. And if you focus on connection, everything else kind of falls into place. But if you focus just on that erection, it actually becomes harder to kind of maintain that erection. so to speak. Yeah, so to speak. Yeah, so

Laurie Watson 30:23
men have to think rethink lovemaking, right? This is about us being together. It’s not about my penis, and it’s not about my penis performance. Do you think that it helps men to realize that most women don’t climax that way, like, in partnership? I mean, I’ve said that to men who have ED. And for me saying it, I don’t really see it resonate, like, okay, so it’s not all dependent on my erection. You know, yeah, that’s supposed to be good news. But they don’t seem to take it in as good news.

George Faller 30:58
It’s like a roaring house fire. And your words are like a little water gun squirting into it. I mean, they’ve had so many 1000s of voices saying it’s all about the performance, it’s all of this is the masculinity. And here comes somebody being nice, and it’s not a big deal. It’s okay, that’s like, it’s hard to trust that it’s not a one time voice, they need to hear that if the story has to change in our own head, to recognize, you know that. And a lot of this is their own self compassion, they got to learn instead of being so harsh to themselves, and saying they’re a failure, and then hiding themselves, so they never get any empathy, to recognize they have to stand up for themselves in a different way. If they want to work towards relaxation, it makes sense to talk about their fear, there’s not strength and hide in the fears that strength and courage and sharing their fears. And to me, that’s the pivotal shifting point for a man to see that they want to engage and to share their vulnerability not for their partner’s sake, but for their own sake, because their life will be more enriched and doing it

Laurie Watson 31:59
right. And this, the secret’s out, the fear is out. We know that when we reveal things, there’s an opportunity for light. And when you’re hiding in shame in the darkness, you’re all alone, and bringing it to your partner, I think, a good opportunity for the two people to comfort each other. So but wow, what a tough conversation, especially if there’s been anger over it. I have a couple that I work with regularly. And you know, he thinks it’s all about his erection. And I’m like, you know, what, if you would use your words, to tell her how beautiful she is, how sexy she is, all the anger would disappear, because she’s misinterpreting your ad as about her, and about your attraction to her. So I mean, just make it up with your words like Hey, baby, it’s, it’s, I’m struggling here, but you’re hot. You look great. You know, I want to do you, you know, what else can we do? How can I make bring you pleasure? And let’s just do that for a while. I mean, then focus off his pain is no big deal. But it’s that retreating part of him that just kills it for them.

George Faller 33:13
You’re trying to pump the gas pedal there. Laurie I love it at all ed is for a lot of men. It’s just the break. That’s all anxiety, is it just something stopping a natural process, the more they can name that put it out there, they can free that break up to kind of have the love life that both of them really crave and deserve? Absolutely.

Laurie Watson 33:34
So trust me when I say it’s usually not that big a deal to her. Especially if you can keep the connection and keep going sex isn’t over just because your erection may not work that time. You know, you can still have pleasure, she can still have pleasure, you can still be a great lover, a great lover without an erection. So thanks. Keep it hot.

Announcer 33:59
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