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Submissive Men More Likely to Suffer Erectile Dysfunction

From the WebMD Archives

Nov. 2, 2000 -- Say "erectile dysfunction" these days, and the response is likely to be "Viagra." Such is the power of advertising. But there was a time, not that long ago, when psychotherapy was the mainstay of treatment for what was then known as "impotence." Has it become outdated or irrelevant?

It shouldn't be, say the New England Research Institutes. In a study published in the American Journal of Epidemiology, the Watertown, Mass.-based organization analyzed nearly 800 men of whom more than 160 had erectile dysfunction, and found that men who are submissive are much more likely to develop erectile dysfunction than those who are not -- and that problem can't be cured by the little blue pill.

Regardless, psychologists say they are feeling the pinch of the Viagra revolution. "There's a very significant drop in the number of men who come into a therapist now for ED [erectile dysfunction]," says Paul Tobias, PhD, a psychologist in private practice in Santa Monica, Calif. "Their primary response is to see an internist and get Viagra prescribed -- or not prescribed. As a psychologist, this [seems like] you deal with the symptom, not the cause. It's very easy to use a Band-Aid -- but quite often it doesn't take care of the root cause."

But even Tobias admits that Viagra can sometimes be the answer even when a psychological problem is the primary cause of a failed erection. Take the case of a man with performance anxiety -- perhaps the most common psychological cause of erectile dysfunction. If you increase performance by prescribing Viagra, then the anxiety part of the equation disappears.

But, Tobias says, Viagra is not a fix-all -- perhaps especially when the problems involve younger men. "Younger couples need to work with someone because the issues are quite often buried -- issues of power, dominance, virility. Often ED is just a symptom of a conflict that exists between a couple."

Psychologist Warren Edwards, PhD, remembers the days when erectile difficulties were thought to be connected to males' too-early viewing of a vagina. "In the early 1960s, we talked seriously about that stuff. Now we're more recognizing that things have changed -- and we're once again going back to the idea there's some organic component in most men's erectile dysfunction."

Edwards, a staff therapist with the Mercy Hospital in Des Moines, Iowa, points out that the reverse scenario also is true in many cases -- where otherwise psychologically healthy men develop erectile dysfunction for physical reasons, and then develop psychological problems. "I've worked a lot with men in their middle years, and typically they would have some organic contribution. Maybe they were overweight or had a pain in their back." Sex was uncomfortable for these men, he says, so they would resort to trying to get it over with quickly. That would lead to problems. "If you're 60 years old and trying to have sex in a hurry, you're probably going to fail."

Edwards says it's not new that men with erection problems consult their medical doctors first. "They always did go to the medical doctors. Psychotherapists weren't their first choice. It was in the hope there was something their doctors could give them. And now there is." But, he says, many older couples he's seen have found a simpler, less expensive (and safer) solution: a good lubricant.

Tobias suggests that while there may be value in Viagra, the ads for the drug encourage indiscriminate use: "The ads themselves lead to tremendous expectations, and Viagra may not even be the answer." He says: "No matter how many caveats you put in the ads, all the man hears is the opening statement: 'Here's the solution to your problem.'" Maybe that's true, Tobias says -- and maybe not.