Erectile Dysfunction: Michael Castleman Talks to Men


8/18/11 update: I’m bringing this older post to the top because it answers so many of the questions about erectile dysfunction that my readers are asking. Michael Castleman is also one of the experts in Naked at Our Age and I respect his knowledge and ability to convey important information simply and compassionately.

So many readers–both male and female–have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions. His interview starts here and continues here.

Q: Explain erectile dysfunction (ED) and why it happens.

MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.

Q: What about men who are capable of erections, but they’re less reliable than they used to be and require more stimulation?

MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call “erection dissatisfaction” (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don’t rise as quickly as they used to. They no longer rise from fantasy alone–seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man’s 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.

The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again–IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.

Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I’ve been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don’t have true ED. They have EDis.

Q: Many men fear that they can’t please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?

MC: Of course not. As you know, women’s pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON’T know this.

Q: How did men’s sexual education skip that important concept that women’s orgasms are based on clitoral stimulation, and that most women don’t need penis-in-vagina penetration for their pleasure?

Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they’re “too small.” Mainstream porn includes a bit of massage and cunnilingus, but it’s mostly about sucking and fucking, so that’s what men come to believe sex is all about.

I’ve spent my life as a sex educator and counselor trying to persuade men that they’ll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men’s #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.

Here’s where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You’ll enjoy sex more and have fewer sex problems–more cooperative erection and better ejaculatory control.

Great SexMichael Castleman, M.A., is the author of twelve books, including Great Sex: The Man’s Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com//.

Man, 82: “I don’t know how to approach a lady friend for sex”

I’m 82, I can get an orgasm but can’t get a firm erection. I don’t know how to approach a lady friend of 65 for sex. I’m afraid to reveal my problem. What can I do?

— Russ

Russ, by all means, talk to your lady friend about your situation. Frankly, I’m sure she’s assuming that you do have erectile difficulties at age 82, and she’s not bringing it up, leaving it up to you to decide when or how much to disclose.

Fortunately, you are capable or orgasms without erections. Many women don’t know this is possible, so you’ll be giving her good news. When you get to this point, please take matters into your own hands to show her exactly the kind of touch that you need. It may be difficult at first to do this, but understand that a woman can’t know how to please you unless you show her.

It used to be easy for us–as well as for you!–when an erection showed us that we were doing what you liked, and you pretty much liked anything we did! But now, both genders have changed in what works for us, and we all need to be more straightforward in communicating this with our partners.

As for her pleasure, are you aware that few women experience orgasms through intercourse alone? Our pleasure centers are our brains, our skin, and our clitoris — all of which are accessible without erections. I’ll be posting some techniques for giving women pleasure without an erection shortly, and I’ll have many more in my upcoming book, Naked at Our Age: Talking Out Loud about Senior Sex.

Since you’re not sexual yet with your lady friend, but you’d like to be, I hope you’re spending quality time with her, getting to know each other as friends, learning how to talk easily together. Let your inner “flirt” out at times, and see how she responds. Compliment her, take her hand, make eye contact, ask her questions about herself.

When you make casual, physical contact–taking her hand, touching her arm, leaning in closer to talk–be super sensitive to her reactions, especially her body language. When you lean in, does she match you, or pull away? When you touch her arm, does she slide it closer, or retract it? You can learn a lot about whether she feels sexual about you by how she reacts to these simple gestures.

I wish you well with your new relationship. I hope you’ll let us know how it develops!

– Joan

Viagra “not a sack of cement installer”

I’m writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob’s experience and his thoughts about it are important. – Joan

BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share — and he makes an important point:

I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.

Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.

I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.

Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.

And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.

So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.

All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.

BillyBob, thank you for sharing this experience. Viagra helps when there’s a physical cause for lack of erection, as you know, but it doesn’t increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave — touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other’s pleasure as well as our own.

It sounds like most of this experience was missing for you. What a bummer, I agree. I’m sorry you didn’t feel you could communicate your needs and desires to your partner — I don’t know, maybe she would have been happy to help you get aroused if she had understood. It’s hard to understand why she didn’t seem interested in stimulating you just as part of the sex play (with or without Viagra), since that’s a good part of the fun of sex.

I know you were too embarrassed to masturbate in front of her when she didn’t help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don’t know if your partner would have reacted this way, but I’ll bet she would have.

If you see a future or at least a repeat date with this woman, I hope you’ll communicate candidly with her before you get to “the act.” And please continue to write.

Thank you again, BillyBob.

— Joan

Erectile Dysfunction: Michael Castleman Talks to Women

Update note: I first posted this interview in June 2007. I have so many new readers now that I wanted to bring it to the forefront, because it’s such an important issue for both men and women. Often men feel they can’t talk about ED with their partners. Women tell me their men seem to emotionally disappear and avoid sexual activity and discussion. Michael Castleman helps all of us understand what’s going on. — Joan

In a previous post, I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:

Q: What don’t women understand about erectile dysfunction (ED)?

MC: Like men, few women understand the difference between true ED and erection dissatisfaction. [See Erectile Dysfunction: Michael Castleman Talks to Men for explanation of the difference.] Women also don’t really appreciate how men FEEL when EDis or ED develop. It’s sort of like how women feel when they lose a breast to cancer. You’re still alive, but you feel diminished. A part of your body you took for granted isn’t there anymore, or in the case of men, doesn’t work like it used to. And this isn’t just any part of the body. It’s a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.

Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden–and in many men this happens pretty suddenly–they’re in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then….nothing. Nothing happens.

Many don’t understand what’s happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.

Now women often (and rightly) believe that men are too focused on the penis. That’s often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it’s the end of sex, that they’re over the sexual hill, that it’s all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis… if they ever adjust.

Q: Why can’t men express these concerns?

MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the “strong silent type,” to keep a “stiff upper lip,” to “grin and bear it.” In other words, to deny what they’re feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they’re less skilled than women. Now some women believe that men don’t HAVE emotions because they don’t discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they’re less likely to be able to really articulate how they feel.

The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they’re young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex “too” much, not be “too” easy. But how easy is too easy? Young women also have issues with orgasm. Many don’t have them and have to learn how to release orgasms.

Meanwhile, few young men have sex problems–other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It’s almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don’t discuss their ED or EDis in part because it’s unimaginable–then it happens and they’re speechless.

To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he’s less of a man?

Q: When should a couple seek counseling?

There’s no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that’s when to consider counseling.

Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual–a desire difference, orgasm issues for the woman, erection issues for the man–then I’d start with a sex therapist.

Personally, I’m a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That’s pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.

To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.

Q: What if the man won’t go?

The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple’s issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.

Great Sex
Michael Castleman, M.A., is the author of twelve books, including Great Sex: The Man’s Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com/.