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Even though men with erectile dysfunction due to psychological causes may find complete resolution with Viagra, the underlying emotional or interpersonal issues may not be ascertained, treated, and resolved. This situation parallels the diagnosis and treatment of clinical depression and other psychological disorders.

Optimum treatment results occur when there is full partnership between the diagnosing urologist or psychiatrist and the mental health professional trained to treat the emotional and interpersonal issues. Most urologists do not have the time, knowledge or expertise to adequately address psychological aspects of male erectile disorder. Sex therapists are not trained to identify and rule out physical causes of erectile failure. By working as a team, the urologist and certified sex therapist are able to optimize treatment for the benefit of each patient and his sexual partner.

Oftentimes, the man's sexual partner will be sexually comfortable and cooperative and there may be no real need for behavioral sex therapy. However, my clinical experience of over twenty years indicates sexual dysfunction is generally bilateral, meaning both partners will have one or more sexual issues requiring treatment and resolution. Gentle but firm encouragement from the urologist is often necessary for patients to agree to see a certified sex therapist.

Some patients are totally satisfied with medical treatment of their erectile disorder while others would prefer to resolve the issue without medication or mechanical measures. The same is true for some clinically depressed patients who prefer to make behavioral changes to end their depression rather than relying strictly and indefinitely upon anti-depression medication.

Unfortunately, active and mutually beneficial collaboration between urologists and sex therapists is relatively rare due to a variety of reasons. The patient may be unquestioningly compliant with the urologist's treatment options. The sex therapist may not take the time to make his or her availability and presence known to the urologist. The urologist may not be trained in holistic medicine or systems thinking, failing to take into account the whole person with emotional, relational, and spiritual needs as well as physical ones.

Patients need to be educated and encouraged to ask their urologist if they work collegially with certified sex therapists. Is referral for psychosexual treatment routinely done? Current professional trends support the wisdom of a team approach even when the sexual disorder is physical or organic. This ensures that sufficient sexual and relational comfort is present to allow full compliance with medical treatment.

Patients are people. People with any type of illness or injury suffer not just from the physical impairment, but from worry, intense feelings, impaired relationships with their partners and with themselves. Every health care professional should be required to periodically be an intensely sick patient so they are able to more emphatically heal and treat!

Someone once told me that we all need to make love with our sexual partners 24 hours a day, seven days a week! We then will be able to have meaningful, personal sexual intimacy for thirty or so minutes a day. Men and women both might benefit from internalizing the old cliche: women must have love (caring, tenderness or thoughtfulness) to experience sexual intimacy; men need sexual intimacy as a prerequisite for love (caring, tenderness, thoughtfulness) to occur. I suppose it is wise to not worry about what comes first, love or sex, but simply to strive to have both fully present.

Sex with Viagra can be very satisfying but the timeless requirement of having a loving, passionate partner for real fulfillment still exists. Sexual desire is so easily extinguished. Make love 24 hours a day - everyday! Sexual intimacy will follow.