Mental Exercises for Psychological Erectile Dysfunction
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It may be going too far to say that the mind is everything when it comes to sex. But if it’s not everything, it’s certainly far ahead of whatever is in second place.
Let’s look at two men who both had a problem the last time they had sex (say, they didn’t get erections). The first one, Bud, was disappointed but not greatly upset. He had a good time anyway. He’s eagerly looking forward to making love with his partner again today. He tells himself it’s going to be another great experience and imagines kissing and fondling her breasts, which gives him great pleasure.
Because he’s feeling so good about the prospects, his mind conjures up a picture of her taking his penis in her mouth, which gives him even greater pleasure. When he and his partner get together in bed, his mind will focus on the pleasurable sensations he’s feeling, thus maximizing the chances that he will get aroused and that the arousal is translated into an erection.
Art, on the other hand, keeps thinking about what he calls his “failure.” He tells himself he may be impotent, that he may not get it up the next time. He, too, has mental images, but they’re different from Bud’s. He imagines his wife indicating she’s ready for intercourse but himself being totally soft, which makes him feel terrible and hopeless.
He’s working up a nice stew of defeat and failure. As he gets caught in this muck and mire, he has more depressing thoughts and pictures. Finally, he imagines his wife getting furious and telling him he’s not a real man. He gets into such a state of anxiety and despair that he almost jumps out of his skin when she tries to hug him. If he does try to make love, his mind will be busy focusing on the possibility of failure and its consequences rather than on what’s going on at the moment, thus helping to ensure that failure is what he gets.
- 1 How to Fix Psychological Erectile Dysfunction
- 2 How your Mind Operates
- 3 Mind Power For Better Erections
- 4 Reducing Anxiety About Performance
- 5 Just Play
- 6 Introduction to Mental Exercises for ED
- 7 What if You Don’t Have a Regular Partner?
How to Fix Psychological Erectile Dysfunction
Two men, two minds. One is headed for pleasure and a good time, the other for anxiety and a miserable time. The difference is not in their penises but in their heads.
This fact deserves your attention.
The reality is the same for both men: no erection the last time they had sex. But they deal differently with that reality. As psychologist Albert Ellis, the father of what is now called cognitive therapy has been demonstrating for over four decades, it’s not reality itself but rather how you construe or interpret it that makes all the difference.
Your mind can make for beautiful, functional, and satisfying sex, but it can also make sex an agony. Perhaps most important for our purposes, it can create and maintain sex problems and make resolving the problems difficult or even impossible. With your mind on your side, however, it’s much easier to solve any problems.
To get the most from your self-help program, it’s essential to make sure your mind is working with you rather than against you. In a number of places, I have given examples of using your mind to your advantage, such as mentally rehearsing things you want to say and do and using fantasies to increase arousal. But now we need to get into more detail.
How your Mind Operates
The mind operates in basically two ways: through thoughts (ideas) and through pictures (images). It’s constantly talking to itself with words and images about you. Because these messages are to and about yourself, they are called self-statements.
You may or may not be aware of these internal communications, but take it as an article of faith that you spend a good part of every day talking to yourself about you. If you’re not aware of what you’re saying, you soon will be.
Thoughts and images can be mainly positive or mainly negative. The mind is quite judgmental, much like a child. It knows good and bad, success and failure, and not much in between.
In what may be a sad commentary about the state of humanity, a very large proportion of the population goes around making negative statements and showing itself negative pictures. The result is what is called low self-esteem.
People who tell and show themselves negative things feel bad much of the time. The bad feelings affect their relationships, behavior, sex life, and everything else.
Men who have had ED or who for some other reason don’t feel good about themselves sexually do a lot of what Albert Ellis calls “catastrophizing” and “awfulizing.” Any disappointment or frustration, any less-than-perfect event — such as a sexual activity that doesn’t live up to every single standard in the man’s mind is made into a catastrophe. Lack of erection becomes “impotence” or “I’m over the hill” or “my wife will leave me.”
Self-statements have a kind of magnetic quality. They attract other statements of the same kind and build on one another.
If you regard your latest sexual activity as positive, your mind will tend to call up supporting positive ideas and images. It may recall another very satisfying sexual event from the past, or some sexual compliments you’ve received. This will reinforce and heighten your good feelings.
Unfortunately, it works the other way as well. Negative thoughts and feelings tend to conjure up other bad experiences, thoughts, and feelings. One bad experience recalls another and another until you’re feeling totally discouraged.
Before going further, it’s necessary to say more about images, because there’s so much confusion about them. One source of the confusion is the varied terms used to refer to them, including “pictures” and “fantasies.”
When I use the term “image,” I mean any nonverbal representation in your mind. It could be sounds (some people can hear things in their head but they don’t have pictures), or sensations or senses (for example, you sense in your mind that your partner pulls away from you).
But most people have some kind of visual representation (pictures). These can be still, like photographs, or they can be like movies. They can be clear or somewhat fuzzy. Images can also be fragmentary and fleeting (like a quick view of a breast or a fleeting and unclear view of somebody doing something to somebody else).
If you’re having a sex problem of any kind, it’s probable that you are helping to maintain that problem by the activity of your mind. Such negative thinking makes it difficult for the problem to fix itself and for therapy or self-help materials to work.
Make Your Mind Work for You Not Against You
You need to get your mind out of your way and on your side. Put differently, you need to think more positively. A negative thought (or image) is anything that leads to negative or bad results for you. A positive thought (or image) is anything that leads to better feelings and helps you do what you want.
More positive and helpful thoughts and fewer negative thoughts are what you need.
It’s crucial to understand that what’s important are the effects of telling yourself certain things or having certain images. Whether or not these ideas and images are true is entirely beside the point.
People tend to say, “That’s not negative thinking, that’s reality!” My response is that it doesn’t make any difference if it’s true or not; what counts is the effect it has on you.
In 1989, as he approached the last day of the Tour de France, the world’s most prestigious bicycle race, American cyclist Greg LeMond knew he had to accomplish something that most experts considered impossible. He was fifty seconds behind and would have to make up more than that on a very short ride.
Even his former coach said it was impossible. LeMond didn’t deny the difficulty of the task; he simply didn’t bother with it. Focusing on how difficult the task was would only make him feel bad. Instead, he focused on riding the race of his life.
So intent was he on concentrating on his racing that he told his support crew not to inform him of his times as he went by, a highly unusual request. He would focus only on his position on the bike and his pedaling technique, and what would be would be. Greg LeMond won the race by eight seconds, the closest Tour ever run.
If there’s no physical reason for your ED, the main difficulty may well be in how you think your penis should function. A great many men uncritically accept the superhuman standards and myths about penises, then get upset when they discover they are merely human.
A married man of thirty-nine called early one morning and virtually demanded an immediate appointment.
When he arrived, it was obvious he was in a panic. While still standing at the door to the building, he started talking with great emotion about his “impotence” and his need to know whether he needed a penile implant.
I finally got him into my office, but couldn’t get a word in for fifteen minutes. After he calmed down a bit and I was able to ask some questions, it turned out that the impotence consisted solely of a failure to have an erection with his wife the night before.
Then, in response to my question of how last night had differed from other times he had sex with her, he began to sob. Yesterday, with no warning at all, he had lost the job he had held for fourteen years and that meant the world to him.
After wiping his eyes and making an obvious attempt to pull himself together, he smiled weakly and said without a trace of humor, “Other than that, everything was as usual. I just don’t understand it.” It hadn’t occurred to him that his feelings about being fired might have affected his sexual functioning.
Nonmedical erection problems are almost always due to one or more of the following: unrealistic expectations, lack of arousal, the absence of the proper conditions, and the anxiety generated by the need for an erection.
- A sixty-year-old man getting upset because his penis doesn’t jump to attention when he kisses his partner. He’s not taking into account that a sixty-year-old penis differs from a twenty-year-old one and that he’s not getting the direct penile stimulation he now requires.
- A man who expects an erection even though he isn’t feeling aroused. He just expects his penis to function regardless of how he feels as if his penis had nothing to do with the rest of him.
- A man who is very tense during sex. He’s been criticized by his partner for his “failure to perform” in the past, and he’s anticipating more criticism. Because of the way men have been trained, it doesn’t occur to him to ask how anyone could get an erection in that situation.
If you are tense or anxious, if you are angry at your partner, if you aren’t getting the physical and emotional stimulation you like, if you aren’t turned on, if you are preoccupied with other matters — if any of these things are true, what makes you think you should have an erection? The answer, of course, is our sexual conditioning.
If you’re having erection difficulties and there’s nothing physically wrong, chances are good you’re worried about sex even before it begins, you’re focusing on how your penis is doing rather than on what you feel.
In order to resolve an erection problem, you need to look forward to sex with positive anticipation, focus on the pleasurable sensations, accurately judge the signs of increasing arousal and allow them to increase arousal and erection.
Another way of saying this is that you need to stop being distracted by negative images and thoughts and to get more focused on the joys, pleasures, and positive cues.
To increase your sexual pleasure and improve your erections, stop stacking the deck against yourself and start stacking it on your side. This means getting your mind on your side; meeting your conditions for good sex; having sex only when you are aroused, and decreasing your anxiety.
Mind Power For Better Erections
To derive maximum benefit from sexual activity, you need to get your mind working with you. Men who have had erection difficulties tend to say negative things to themselves and to think of themselves as sexual flops. They run movies in their heads of losing their erections and tend to ruminate over past failures.
This is, for sure, a reflection of reality, but it also becomes a generator of anxiety, a predictor of future behavior, and a reinforcer of a self-image you want to change. It will be easier to change your behavior if you also change your view of yourself.
Starting as soon as possible, you need to imagine yourself as you’d like to be as much as possible and spend as little time as possible imagining how you’ve been.
The following exercises are similar to the ones for rapid ejaculators given in the article “Developing Ejaculatory Control.”
Whenever you’re aware of telling yourself that you’re impotent or inadequate, or having an image that embodies that idea, argue with it and change it.
For example: “It’s true, I’ve had troubles getting it up for the last few months. But I’m going to do this program and change that. I’m going to have good erections again.”
When you picture yourself not getting or losing an erection, tell yourself “that was then” and follow this with an image of having a good, long-lasting erection accompanied by words like “that’s the way it’s going to be.”
This is an image, really more like a movie, that you should spend thirty to ninety seconds on every day; doing it several times a day is even better.
Imagine yourself having good erections with a partner, which includes several components. Imagine having a good erection, entering your partner, feeling relaxed and comfortable, and just being still inside her for a moment or two. No movement, just enjoying being in her.
Then imagine slow movements, just taking it easy, still enjoying the feeling of being in her. Then gradually increase the pace of your thrusts. Now slow down again.
Now again increase the pace gradually, until you’re moving almost as much as you want, still feeling calm and easy. Now imagine slowing down and stopping all movement.
Stop thrusting and just experience the pleasure. Then gradually increase the movements, slowly building up until you’re moving with abandon, letting your body do what it wants.
When you want, and only when you want, imagine a wonderful ejaculation. When you’re done with the movie, be sure to end with a statement to yourself of this kind: “As it is in my mind, so it shall be in reality” or “This is how it’s going to be.”
Before you do a physical exercise, spend a few seconds imagining yourself doing it perfectly, exactly as it is supposed to be done.
Be sure to imagine all the parts: For example, asking your partner to participate, attending to your arousal and physical sensations, asking her to stop if you get anxious, asking her to resume stimulation, and so on.
This mental rehearsal takes only a few seconds and can he very helpful. It’s exactly what many great athletes, entertainers, and business people do to improve their performances.
You can do it anyplace. For example, if you and your partner are getting ready to do an exercise, you can close your eyes and do your mental rehearsal right there or you can go into another room and take a few seconds to do it there.
Every day, preferably just after awakening or just before retiring for the night, take a few seconds to imagine how good you’re going to feel once your erections are back on track.
Whenever the problem recurs, make every effort not to let it get you down. Instead of telling yourself that this is further proof you’ll never get it together, ask yourself what you can learn from this experience.
Maybe you were too anxious, too tired, too much in a hurry, too little aroused. Then tell yourself something like this: “No reason to get upset. I learned that it doesn’t work to have sex when I’m this anxious and tired. Next time I’m this nervous, I’ll stop and just talk to Jeannie about what’s going on.”
Meeting Your Conditions
You now need to determine the conditions you need to have met for having more or better erections. Consider your desire, arousal, anxiety, mental and physical stimulation, time of day, the state of your relationship, your partner’s attitude, and behavior, and anything else that seems relevant.
Some men need for their partners to be more enthusiastic or aroused. Others need to be less preoccupied and more focused on matters at hand when they have sex.
There are only two important considerations about your conditions: finding out what they are and fulfilling them.
You are who you are and you need what you need. Make sure you get it.
Arousal is basically what powers erections. If there’s nothing seriously wrong with you physically, if you are relatively relaxed, if your conditions are met, and if you are aroused, you will get good erections.
One of the major ways of increasing arousal is to focus on physical sensation, to attend to and fully experience your partner touching, kissing, caressing, and stroking You. Another way of increasing arousal is to ensure that you get the kinds of stimulation that are most arousing to you.
Reducing Anxiety About Performance
Since worrying about how your penis will perform is perhaps the major obstacle to good functioning, anything that reduces this worry is helpful.
All the methods discussed above play a role in this endeavor, but there are several other things that can help as well.
Since intercourse is the act that causes the greatest anxiety for men with erection problems, it’s best to agree not to have intercourse until you are confident of your erections.
Talk to your partner about this ban on intercourse and see if she can accept it. But this by no means implies no sex. You’ll be engaging in lots of enjoyable sexual activity until then.
If you have experience with any relaxation method — meditation, biofeedback, self-hypnosis, yoga, relaxation tapes — I suggest you resume that activity as soon as possible. If you’ve never done any of these things, you might want to invest in a good relaxation audiotape, many of which are available in bookstores, and listen for ten to fifteen minutes twice each day.
Whatever method you use, your goal should be to be able to get relaxed quickly in almost any situation, without special equipment or postures.
One effective approach to resolving erection problems involves no exercises beyond those already given. To follow this approach, you do steps I through IV above, and get together with your partner sexually as often as both of you desire. You can do whatever you want except have intercourse. When she’s stimulating you, you should focus on sensation and try to build excitement as high as possible. Arousal and pleasure, not erection, are the only goals. And that’s all there is to it.
This approach is so simple that some men have trouble with it. It seems too easy to them. It is simple and easy, but it’s also effective.
It will help to keep a few things in mind. One is that the goal really is pleasure and arousal. You will of course note how your penis is doing, but try not to get concerned if it’s not acting as you would like. It will in time. Be sure that all your conditions are met, that you have the best stimulation, and that you focus on the pleasurable physical stimulation.
Introduction to Mental Exercises for ED
Which Exercises You Should Do
Everyone should do the mind-power exercises and the two masturbation exercises that follow. If you think you don’t need to do the masturbation, it’s a good idea to do each of them once just to make sure you can easily and comfortably handle them.
If you don’t want to masturbate, you can skip those exercises and start with the first partner exercise.
How Often to do the Exercises
Good results can be achieved by doing the exercises anywhere from every other day to once or twice a week. Masters and Johnson noticed two things about penises that work against doing the exercises as often as you want.
The first is what they called a refractory period, a time after ejaculation when your penis will not respond to stimulation no matter how skillfully done and no matter how long it lasts.
For many teenagers, the refractory period lasts only a few minutes. But it definitely increases with age. Some men in their fifties and sixties can’t get another erection until days after their last ejaculation. Masters and Johnson also noticed that many older men can’t regain an erection for a day or more after sex even if they don’t ejaculate. Take account of these facts in deciding how often to do the exercises.
It is essential that you do the exercises only when you are relaxed and feeling sexy, or believe you can get into a sexy mood with a little time and stimulation. Doing the exercises when feeling under pressure or with gritted teeth will not help at all.
What About Ejaculating While Doing the Exercises
In general, the less you ejaculate the more easily you will become aroused and perhaps erect the next time you do an exercise. This does not mean you should never ejaculate, only that it is in your interest not to ejaculate unless you really want to.
What About Having Intercourse While Doing the Exercises?
Many men with erection problems develop an understandable but destructive habit. As soon as they notice they have an erection — whether they are engaged in loveplay or not, whether they are doing an exercise or not — they automatically try to stick it in their partner before it goes away.
Although this sometimes results in a few thrusts or minutes of intercourse, it usually doesn’t because the mind/body tends to interpret the frantic effort to stick it in as anxiety, which it is. This stick-it-in-before-you-lose-it practice causes all sorts of problems. It usually results in lost erections, which makes the man feel more hopeless, and it reinforces the idea that he has a serious problem.
It does nothing to alleviate the anxiety that is a large part of the problem to begin with. And it often makes the man’s partner upset or angry, because in entering her so frantically he may not notice that she’s not ready or interested at the moment.
One woman’s account of what happened one morning when she was still asleep is telling:
I was in a rage, but now it seems incredibly funny. I awoke with this horrible pushing feeling inside of my vagina. It took me a few seconds to comprehend what was happening. Frank was behind me trying to shove his cock in me. He didn’t even notice that I had a tampon in and his penis was pushing it further into me. I shrieked and fought him off. After an hour or so of yelling and arguing, we finally were able to talk. Turned out that he’s been feeling so frustrated because of his lack of erections that when he woke up with one all he could think of was to get it in me. Incredible that he wasn’t even aware of the tampon as he pushed against it.
Whether you’re with a new partner or an old one, whether you’re doing exercises or not, please do not try to put your penis anyplace. Frantic movements will do nothing to help. Anything based on anxiety will only cause more trouble.
What if You Don’t Have a Regular Partner?
If you don’t have a partner with whom to do the couples exercises, you should attend to steps I through IV given above and do the two masturbation exercises below. When you do get into a relationship, get into sex very slowly.
Also, consider telling your partner about your problem. Then, as you desire it, just play. If it seems necessary, you can also do the partner exercises in this chapter with your new friend. An alternative is to go through the surrogate therapy discussed later in this chapter before you enter a new relationship.
For men who don’t have a sex partner but do have a sex problem, perhaps the most effective and certainly the most controversial treatment is what’s called surrogate therapy. The word surrogate, which means substitute, was chosen by Masters and Johnson to refer to a woman employee who did the sexual exercises that ordinarily a man would do with his partner.
Despite widespread media publicity about surrogate therapy, there is still much confusion about what it is. Some people think that a surrogate is nothing more than a prostitute, because she has sex for money. It’s true that surrogates — just like therapists, lawyers, and physicians — like to get paid for their work. But the similarity ends there. A prostitute’s goal is to give her customers a good time and get them off, usually as quickly as possible.
A surrogate’s role is different. Her job is to teach clients skills they need to be more effective socially and sexually. Reputable surrogates work with therapists — that is, the client has a session with the surrogate and then goes to see the therapist, with or without the surrogate — and function more like the therapist’s associate or assistant rather than as a wife substitute. The surrogate’s goal is not getting the man off or giving him a good time. Rather, it is therapeutic, helping to diagnose and treat his problem.
A lot of the time the man spends with the surrogate is devoted to talking, which in itself is different than what happens with a prostitute. Talking usually takes up most of the first session, followed by a relaxation exercise or two and perhaps some light touching with both surrogate and client fully dressed. In subsequent sessions, there is a progression to nudity, communication exercises, sensual touching, and finally more direct sexual activity. The physical/sextial activities they engage in, often called body-work, are similar to the partner exercises given in this book. Depending on the surrogate, the therapist, and the nature of the problem, there may or may not be much intercourse. In almost all cases, the surrogate spends a great deal of time helping the client learn ways to reduce the anxiety he feels in sex and increase his confidence.
Surrogate therapy at its best involves the therapist and surrogate working together toward a common goal, with each contributing his or her own strengths. For example, the surrogate may tell me that our client is fine with sexplay as long as there’s no thought of intercourse. When intercourse is a possibility, he immediately tenses up and loses his erection. To help prepare him for intercourse, I may do some relaxation work with him, pairing relaxation with scenes of moving toward intercourse. What I do with him in his imagination, she does in reality.
The main advantage of surrogate therapy is that it is highly effective. Although little research has been done on this treatment, the therapists I know who do it agree with me that it is the most effective therapy for men without regular sex partners. It has been almost 100 percent effective with male virgins of all ages. Usually these men have already failed with several women and have felt so humiliated that they refuse to try again until they feel their problem is resolved.
Some people assume that even if surrogate work helps a client function with the surrogate, it won’t carry over to other partners. Fortunately, this assumption doesn’t seem to be true. The surrogates I’ve worked with and I are very much aware of the issue and direct our efforts to resolving it. We would view it as an unmitigated failure if a man could function with the surrogate but not with real-life partners. So we always focus on the partner(s) he doesn’t yet have.
Say a client is able to do something today with the surrogate that he’s never been able to do before. When we ask him why, he usually gives credit to the surrogate: “She made me feel so relaxed (or confident) by saying X or doing Y.” Then we ask the crucial question: Suppose you’re with a woman doesn’t say X or do Y? What could you do to feel as relaxed (or confident)? And then we work on what he needs to be able to do, often involving role-playing with the surrogate and the therapist. In the many cases I’ve worked with, the ability to function as well with a real-life partner as with a surrogate is over 90 percent.
Surrogate treatment also has some disadvantages. First, it is applicable only for a small segment of the population: Those men with sex problems who don’t have a regular sex partner and who probably won’t find one until their problem is resolved. Second, it is expensive, because two people are being paid. Surrogates generally charge less per hour than therapists, but their sessions are longer, usually two hours. Third, this kind of therapy is not widely available. As far as I know, the main — perhaps the only — places to find it are the major metropolitan centers, especially New York, Los Angeles, and San Francisco. My surrogate and I have had clients from all over the country and from abroad come to us for treatment because it wasn’t available closer to home. Men living elsewhere may have to consider coming to one of these cities for two weeks or so of intensive surrogate therapy, which of course involves the additional expenses of travel and lodging.
An important question has to do with sexually transmitted diseases. After all, surrogates have sex with many partners and they seem like prime candidates for contracting one or more of the many common diseases. The fear of spreading or getting AIDS, or of being sued for transmitting it, has caused some therapists who work with surrogates to stop doing surrogate therapy.
I cannot speak for all surrogates, but the ones I have worked with are extremely careful about disease and were this way before the advent of AIDS. As far as I know, not one has ever had any sexually transmitted disease. The surrogate I now work with gets an HIV antibody test every six months and demands two negative test results from every new client. Safe sex is the name of the game, and it is played compulsively. Clients learn just about everything there is to learn about condoms and spermicides.
If you’re interested in this kind of therapy, I have a few suggestions:
- Work only with a surrogate-therapist team, not a surrogate alone. You see both of them and they keep in touch about you. The therapist is crucial: Surrogates are trained in sexuality and surrogate work, but they are not trained psychotherapists. Besides, as many surrogates will be the first to admit, it’s often hard to be objective when you’re doing bodywork with someone. Some therapists refer clients to surrogates and then have nothing further to do with the case. I do not recommend this practice. Both client and surrogate need support and assistance from an experienced therapist.
- Before making any appointments, ask about safe sex practices and proof that the surrogate has had a recent negative HIV antibody test. If the surrogate and therapist don’t seem concerned about safe sex, if she won’t provide the proof, or if she doesn’t require similar proof from you stay away.
- Work only with a surrogate who respects who you are. Good surrogate work, like any good therapy, requires an understanding of and respect for you and your problem. It should begin where you are and gradually take you to where you want to go. It should not ask you to do what you can’t do and it should not humiliate or terrify you. I have heard a number of horror stories over the years about surrogates who work alone. One of them asked a very anxious man with erection problems to undress and masturbate in front of her — after he had known her only half an hour! If he could do that, he wouldn’t have needed her help. The only effects were to further embarrass and humiliate him and to convince him that he would never get better.
- Feel free to bring up any complaints or problems with the surrogate and the therapist. Years ago, a man told me about a difficult session he had just had with the surrogate. In trying to determine what went wrong, we finally hit upon the temperature at her place. He said it was as hot as a sauna and he had felt totally depleted. When I asked why he didn’t ask her to turn down the heat or open a window, he answered, “I thought the heat was part of the program.” Don’t make the same mistake. Anything that bothers you or that makes you uncomfortable should be expressed as soon as possible. This is also good training for what you need to be able to do with your own partners: express what’s on your mind.
Since surrogate therapy is expensive ($1,000 is probably the minimum, and it can go as high as $10,000 for a full course of therapy), I recommend trying other treatment options first — for example, the exercises in this book relevant to your problem. If you make some progress but not as much as you want, you can see a surrogate later; the work you’ve done on your own will probably decrease the number of sessions you’ll need with her.
Masturbation Exercises For Better Erections
If you’re willing to masturbate, I recommend doing these masturbation exercises before you begin working with your partner. If you’re not willing to masturbate and have a partner, you can begin with the first partner exercise.