Erectile dysfunction, also known as ED or impotence, is the inability to attain or maintain an erection of the penis adequate for the sexual satisfaction of both partners. It can be devastating to the self-esteem of a man and of his partner. As many as 30 million American men are afflicted on a continuing basis, and transient episodes affect nearly all adult males. But nearly all men who seek treatment find some measure of relief.
"What I see as a problem is the public has been educated to believe that good sex requires an erect penis that stays hard through the entire sexual encounter," Shaw tells WebMD. "This definition of good sex changes the basic nature of an encounter from intimacy and pleasure to achievement and performance."
This focus on performance, Shaw says, robs men and their partners of the opportunity to deepen their relationships -- and their sexuality. The sexual needs of adolescents, she says, are different that those of adults. Yet by making erections the be-all and end-all of sex, grown men are retreating to adolescent sexual values.
"Having an erection does not mean you are being sexual. Being sexual comes from inside your sense of yourself," Shaw says. "You can be sexual, you can feel sexual, you can behave sexually without an erection. A penis is not the only part of a man's body that can be used sexually."
Shaw makes a distinction between genital behavior and sexual behavior. Mistaking one for the other, she says, leads to dishonesty and dissatisfaction.
"You can behave genitally whether you feel sexual or not," Shaw notes. "Women and men can fake it. Lots of men get an erection, penetrate, and lose the erection and pretend they have had an orgasm because they want to be perfect. They don't say, 'Hey, I didn't have an orgasm but maybe next time. Being near you is enough.'"
In her practice, Shaw finds that physical problems don't lie at the heart of most men's sexual problems.
"Actually, it is psychological distress associated with not measuring up rather than physiological problems that causes most sexual dissatisfaction," Shaw says. "For many, many men -- maybe most -- problems with sex are due to ignorance, anxiety, and inability to communicate with their partners. I think sexual dysfunction is the inevitable result of the effort to attain perfection."
SOURCES: Gerald Brock, MD, associate professor, St. Joseph's
Health Center, London, Ontario, Canada. Chad Ritenour, MD, professor of
urology, Emory University, Atlanta. Jeanne Shaw, PhD, clinical psychologist;
certified sex therapist, private practice, Atlanta.