He's Just Not Up for It Anymore (16 page)

What If the Pills Don’t Work?

For men with psychological impotence and without additional physiological factors, the efficacy rate is 80 percent; as previously stated, this decreases to about 65 percent for men with physical causatives and 50 percent for men with severe medical conditions such as a combination of diabetes and hypertension. The drugs most commonly fail in men over 60 with severe insulin-dependent diabetes or impaired arterial blood flow. There are other reasons why these drugs don’t have an even higher success rate. Some men simply use them incorrectly, for example, by taking Viagra on a full stomach.

He is only 40 and the fact that neither Viagra nor Cialis worked suggests to me that something else is going on and he’s not telling me. This is just my guess. I have snooped all over the house and have found nothing illicit, but I just can’t believe the ED drugs didn’t work for any reason. The lack of intimacy is killing my spirit. I don’t even feel like a woman anymore. (Female, 30s)

It concerns us that a woman might think she is the reason the pills aren’t working. After all, he can’t get an erection—that’s ego deflating enough. Then, he takes a pill that’s supposed to give him one, and
that
doesn’t work. It can seem like the end of the road, incontrovert-ible proof that her husband no longer finds her attractive, when the truth is that the medicine is unfortunately ineffective in his case. We mentioned earlier that it is extremely difficult for a woman to realize the devastation a man likely feels if he experiences erectile dysfunction, especially on a regular basis. It may be equally impossible for a 134

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man to understand how insecure his partner feels if he doesn’t get an erection even after taking a pill.

It is extremely important to remember the statistics here. These drugs are not infallible, and the reason they don’t work is probably because they are the wrong medication for the situation; they simply aren’t improving blood flow to the penis. While it is true that a man may no longer find his partner attractive, and a man may fall out of love, that probably isn’t a man who will take a pill in an attempt to re-activate his sex life. Conversely, a man may adore his wife and find her irresistible, but not be able to achieve an erection, even with that pill.

If the drugs prove ineffective, there are other paths to explore, including implant surgery, penile suppositories, revascularization (rees-tablishment of blood supply) and injection therapy. And although the ED drugs are most often prescribed by a family physician, if they fail and incorrect usage is not the reason, the urologist should most certainly be consulted.

We strongly suggest a couple visit doctors together to learn about the PDE5s’ correct usage and efficacy rate, and to explore alternative options if they don’t work. We don’t suggest this is easy, but, realistically, it’s not that difficult, either. Men just have to get over their fear of impotency making them less of a man—if that were true, there wouldn’t be that many “real men” around over the age of 40—and women have to get past thinking that the pills are getting him aroused and she’s not.

If there is ever a time in a marriage to each put the other’s feelings first, and to try and imagine what your partner is going through, this is it.

SEXUAL INTIMACY

Many of the metaphors for penis (rod, battering ram, and wand, for example) reinforce the fantasy that a penis is always hard, stiff, and ready. Sociologist Susan Bordo recommends that we “rethink that term ‘hard’ as it relates to the penis. When we imagine the erect pe-erectile dysfunction: the silent passion killer 135

nis as ‘hard’ we endow it with armor. . . . The penis, far from being an impenetrable knight in armor, in fact wears its heart on its sleeve.

That’s what’s so magical about it.”

Wouldn’t it be fantastic to do this, to rethink “rock hard” as being mandatory for pleasurable sex? A less than firm erection might even be a positive thing, as Abraham Morgentaler elegantly suggests: “Curiously, some women have found that the man’s inability to achieve a firm erection provides an opportunity for a different type of connecting: one in which the man is more vulnerable and in some ways more accessible to them emotionally. Being accepting of the man, whether or not he is ‘performing well,’ can unleash in him a flood of warm, positive feelings, which is likely to cause warmth and firmness in the penis as well.” These words can be applied to all aspects of a truly intimate relationship; simple “acceptance” of a less than perfect situation can sometimes create something wonderful.

A man’s lack of an erection may feed

his partner’s insecurities.

The penis is a delicate, vulnerable, and, yes, magical organ. Its very lack of predictability is what makes it so exciting; it is attached to a living being with emotions, fears, self-doubts, and the ability to love and be loved. And although it may perform on command when a guy is 18, it isn’t necessarily as reliable in later years. This often happens to a man just as his wife is going through menopause with all of the emotional and physiological baggage that accompanies the euphemistically labeled

“change of life.” She may not be feeling too sexy in our youth-oriented culture. (For example, when Larry King interviewed a widowed Candice Bergen about dating, she said that her age made her “invisible”—

this from a tall, blond, beautiful, and, at the time, fiftysomething star.) A man’s lack of an erection may feed his partner’s insecurities.

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especially in midlife when ED is most likely causing cracks in otherwise solid marriages, and the problems of impotence may compound exponentially.

And so, acceptance can be the most intimate and rewarding gift a couple can give each other at this time. Then, they can work together toward a solution.

ED IS RARELY ONE-DIMENSIONAL

Sometimes a couple starts out trying to solve the problem with intelligence and tact, but then ego and foolish choices undermine success.

A woman whose husband stopped being sexual with her when they were in their 30s (they have been together since college and married for ten years) states:

Before things went sour we openly communicated about not wanting our relationship to become stagnant like other couples we knew.
[Up to that point, sex was]
pretty good. He was overly sexual until the decline and he is attractive, in shape, and very powerful in the workplace. Of course, in the early years everything is better and more frequent.

When sex became a rarity and infidelity was suspected, she went through his briefcase and discovered evidence that he had been using an escort service when out of town on business. She also found pornographic material and condoms. Angry and hurt by the betrayal but still in love with her husband, they entered therapy, and then saw a physician. (Many men are reluctant to see a therapist, especially for impotence; this man seemed eager, at first, to improve the situation.) I still had extreme feelings and couldn’t leave the marriage.

Communication got better, but sex hasn’t in the short or long erectile dysfunction: the silent passion killer 137

term. My husband can’t get it up, for me, anyway. We went to a doctor and he got all the pills—Viagra, Cialis, and Levitra. I cannot tell you the feeling I have when my husband has to take a pill so he can touch me. It hurts to the core. I’ve built a wall now and have become quite numb to the whole thing.

This woman is understandably upset. She has been let down twice, first by her husband, and then by a pill. She won’t allow herself to understand what seems obvious: her husband doesn’t need a pill to touch her; he needs a pill to prevent embarrassment. He would not be aroused unless he was stimulated, and it is extremely possible that her “numbness” stops him from being fully aroused even then. Indeed, she goes on to say that the pills: “only work once in a while.”

She also mentions that even if he gets an erection strong enough for penetration, he will lose the erection but continue the intercourse.

“That does zero for me,” she says.

When asked if her husband is ever interested in being sexual in ways that didn’t require an erection, she answered: “Nope. He has kissed me probably a handful of times in the past year, but always a substance evoking it, not while sober, ever.” And when questioned as to why her husband is no longer sexual with her, she is mystified.

“Boredom, career moves, stress. Honestly, I’m just making things up.

I really don’t know.”

Here is a successful man terrified of failure in this part of his life.

Clearly, he still has desire when performance anxiety is omitted, thus his choice of escort service and masturbation. It is possible that a physical condition caused his ED, embarrassing him so much he shut down with his partner, and it compounded when he was given pills that only occasionally work. His wife, who takes tremendous pride in her appearance (“I’m attractive, 5'8", 130–135 lbs., with six-pack abs, 36C

breasts, and long hair”), is devastated, believing she is no longer desired by her husband, not even with the aid of medication. So a man who thrives on success is giving up sex with his attractive partner to eliminate 138

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the possibility of failure, and a woman who needs reassurance about her looks is unwilling to accept a penis that is anything less than a battering ram as proof that she is still sexy and loved.

Anger, tension, job insecurity, financial or family problems—any of these can prevent a man

from functioning in an optimal way.

There is no mention of the couple ever seeing a urologist to determine why a 36-year-old once “overly sexual” man in “good shape” would suddenly stop making love to his attractive wife. They were willing to see a therapist and a physician, and yet do not seem to be going any further to solve the problem, possibly because they are each too caught up in their personal angers, resentments, self-doubts, and fears. They are choosing resignation rather than acceptance. When asked about the future, the woman states: “I think about divorce a lot; however, we get along great, have great friends, and a great life. Is sex worth throw-ing it all away for? The time vested and deep care I have for him remains. I know he would do anything for me . . . well, almost, right?”

Anger, tension, job insecurity, financial or family problems—any of these can prevent a man from functioning in an optimal way.

These problems can combine with medical conditions, prescription drugs, and lifestyle issues. ED is often a multidimensional problem. A 34-year-old woman told us:

He is a proud man, and the fact that he could not always function, or that I didn’t have many orgasms with him, probably played into his decision [to stop having sex] quite a lot. But there were other problems, too. I think between my dissatisfaction with him working thirteen or more hours a day, six days a week, and my dissatisfaction with our neighborhood, and his impotence—he just quit.

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She poignantly adds:

A man seems to need to protect his ego in this area, but in doing so he risks making his wife feel angry and unloved. It is such a shame a man will let his marriage fall into ruin just to protect his own feelings.

MEN SPEAK UP ABOUT ED

With all the negativity, fear, and embarrassment that surround impotence, 30 percent of our male respondents still checked this box as a reason why they no longer have sex with their wives. Although we still think the figure may be even higher, we believe that it’s positive almost one-third of the men would admit to ED, even anonymously. Perhaps there is a shift toward acceptance, as boomers turn 60. (Thirty-nine percent of the women said that their husbands suffered from erectile dysfunction.) Not surprisingly, very few of the men who reported having ED wanted to talk about it. Here are some who did.

As I got older, my own body did not respond as quickly as it had when I was in my 20s and 30s (I am now 61). She would pull me on top of her and say something like, “You can do this,”

but, discovering that I had little or no erection, she would say

“See? You really don’t want to!” and roll over. This sort of cas-trating behavior actually started around twenty years ago; I was still approaching her regularly, and she would sometimes say “You’re getting too old for this.” I have always been vigor-ous and in good health. (Male, 61)

It is possible that this man’s impotence was initially the result of anger toward his wife, whom he appears to consider critical and dis-140

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engaged. He also wrote that although she would occasionally “allow”

him to perform oral sex, she refused to reciprocate.

ED has a profound effect on a man’s confidence
and can undermine a marriage that is otherwise
functioning well.

And this 55-year-old divorced man says that both erectile dysfunction and premature ejaculation were major problems in his marriage, and they continue to be so now that he is alone: I am still having these problems and I am very hesitant to get into a relationship with ANY woman.

ED has a profound effect on a man’s confidence and can undermine a marriage that is otherwise functioning well. If you are a man suffering from this issue, we can’t urge you strongly enough to see your physician. And remember that impotence can be devastating to your partner, too. If you are a woman whose partner has the problem, encourage him to get help, and remind yourself that it is extremely unlikely that you are the cause.

RAPID EJACULATION

The Kinsey report on male sexuality, published in 1948, stated that 75 percent of men ejaculated within two minutes. However, some therapists suggest that PE (premature, or “rapid,” ejaculation) only became a “problem” that needed treatment a few decades ago, when sexual pleasure for the other half of the team became truly worthy of consideration, and female enjoyment was tied into length of in-erectile dysfunction: the silent passion killer 141