TV's 'Sex and the City' Tackles Real-Life Problem: Impotence

From the WebMD Archives

Sept. 29, 2000 -- Millions are tuning in to the HBO hit Sex and the City as two distressed newlyweds cope with erectile dysfunction (ED), but is the TV story line an accurate portrayal of this common problem? Experts say Charlotte and Trey are on the right track, but there's a bit more to know about ED if you live in the real world.

When Trey was unable to consummate the relationship the night before their wedding, Charlotte probably didn't realize that erectile dysfunction affects up to 20 million men in the U.S. and is mostly caused by psychological factors such as guilt, fear, depression, and anxiety. Even though ED often occurs only occasionally or in certain situations, an important first step is to determine whether the cause is physical or psychological.

In a hilarious attempt to make this call, Charlotte fitted her husband with a penile ring made of postage stamps. "It sounds crazy, but sex therapists recommend it all the time," says William Grazig, PhD, president of the American Board of Sexology and director of the sex therapy training program at Maimonides University in North Miami Beach. "Because the ring was broken the next morning, it was clear that Trey had an erection during the night," ruling out a physical cause for his ED, he explains in an interview with WebMD.

Relieved to learn that there was nothing physically wrong with her husband, Charlotte then surfed the Internet in search of a cure. She had great hope for a rigid or inflatable penile implant, but the mere mention sent her husband-the-surgeon running -- actually, leaving their uptown digs to go for a jog. His response may have been appropriate, given that these surgical implants are a last resort, usually reserved for men who have failed or rejected other treatments.

In search of a less invasive option, Charlotte then suggested medication, but Trey pooh-poohed the popular drug Viagra, agreeing instead to see a sex therapist. Unfortunately, the therapist's "homework" assignment caused our young bride to learn that her groom was self-pleasuring with the help of a magazine. Ever-resourceful and desperate to remain a part of her husband's fantasy life, she simply pasted a photo of her patrician face on top of the buxom beauties' bodies.

So what's likely to happen next for the unhappy couple? "Their therapist will try to integrate Trey's masturbatory fantasies into sexual intercourse," Grazig tells WebMD. "But with so much riding on his success, performance anxiety may get in the way."

Doctors say sex therapy can be effective, but it's often used in combination with Viagra. That's why Trey's concern about the drug's side effects may be misguided.

"About 15% of men report mild side effects like headache, facial flushing, and nasal congestion, but few discontinue the drug because of it," says Drogo Montague, MD, director of the Center for Sexual Function at Ohio's Cleveland Clinic. "Of course, people with heart disease that are on nitroglycerine or long-acting nitrates, such as Isordil or Imdur, shouldn't take Viagra," he cautions.

Trey might also want to cut back on the wine with dinner, says Montague, who is also chairman of the American Urological Association's ED Guidelines Panel. "As they age, men become more vulnerable to the effects of fatigue, stress, and alcohol. So it's very important to get enough sleep, exercise regularly, and limit alcohol intake," he says.

When in doubt about the cause of erectile dysfunction, Montague says, urologists run a souped-up version of the stamp test. But if you'd like to give Charlotte's method a try, here are a few tips from Grazig:

  • Use a roll of stamps with unbroken perforations
  • Moisten just enough stamps to fit around the penis
  • Attach them to the middle of the shaft while flaccid

Then, see what happens. If the stamp ring is broken in the morning, that means there's a good chance the ED has a psychological, rather than physical, cause. Either way, doctors say, real-life couples should follow the example of Trey and the tireless Charlotte, and work together to try to figure out a solution.