While an erection isn’t necessary for sexual satisfaction, most men and their partners do like having one around during sex. Not surprisingly, then, erection problems and rapid ejaculation are two of the most common problems in my practice.

One or more of the following common dynamics usually causes such problems:

Conditions: Do you have the conditions you need to get or keep erections? For various men, these include a sense of safety, trust, privacy, affection, relaxation and a partner’s enthusiasm.

Performance anxiety: Do you feel pressured to get erect quickly, or to maintain an erection until your partner climaxes? Do you (or your partner) feel that the dependability of your erection reflects your level of masculinity, or of how much you desire your partner?

The relationship: Does your relationship offer peace of mind, emotional satisfaction, a sense of belonging? Or is it a place of periodic turmoil, in which you feel misunderstood, powerless, resentful?

Internal psychology: How do you feel about yourself, women (men if you’re gay), sex? Do you have unfinished business from a previous relationship, from childhood or adolescence?

When men want my help in getting or keeping erections, I start at the top of this list and work downward until the problem is resolved. And it usually is — erection difficulties and rapid ejaculation are among the most easily resolved sexual complaints.

I accomplish this by de-emphasizing intercourse and other sources of performance anxiety; encouraging communication before, during and after sex to demystify the erotic relationship; supporting self-knowledge and the entitlement to ask for what one wants; and helping clients develop insight into their psychological processes and character dynamics.

If you or a loved one is struggling with getting or keeping it up, see a professional before the month’s out. No man (or couple) should suffer unnecessarily.

Sex therapists, psychologists and physicians are the professionals best trained to diagnose and treat erection and rapid ejaculation problems. Herbs, creams, “aphrodisiacs” and gadgets are worthless for getting it up or lasting longer. Viagra doesn’t work for everyone, and it doesn’t solve psychological or relationship problems for anyone.

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Foreplay begins not when you start caressing each other, but earlier — as soon as you begin thinking about each other. The brain is the body’s biggest sexual organ. Use it to arouse your whole day.

Call your partner during the day of your “date” and tell her how much you like her body. Talk dirty a little.

For women, self-esteem is crucial, Blank says. If you’re confident enough to not have any negative feelings about your body, you’re one of a tiny minority. Women need to know that they’re sexy.

Some men like to know that their mate is wearing sexy underwear all day; it heightens their anticipation.

Ask her one day over dinner what turns her on. It could be as simple as candlelight, or as involved as her pretending to be the sea captain and you her galley slave. Whatever. Then, another day, make her fantasy come true. Women enjoy sex much more when you properly set the mood.

Personally, I feel more comfortable making love if I’ve had a shower. I feel better about my body if I know it doesn’t smell of sweat, and I prefer my partner to be clean too. Any time we travel, we look for a place with a hot tub.

But this is (ba-da-dum) personal taste. The French believe that body odor is crucial to sex, as evidenced by the famous telegraph from Napoleon to Josephine: “I will be arriving in Paris tomorrow evening. Don’t wash.”

Ah, those French, they’ll eat anything. One last point about scheduling: don’t limit yourself to the evening. Men are more easily aroused, and have more energy, in the morning. Consider breakfast in bed next weekend; food is optional.


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It seems you can’t pick up a newspaper or magazine these days without reading about “sexual dysfunction.” While it’s great that sexual issues are being discussed publicly, some of the talk is misleading.

Some physicians, drug companies and the self-help industry seem to believe that everyone should be able to function sexually under all circumstances — and that if we can’t, we have a sexual dysfunction. That’s how they arrive at their recent inflated numbers: that 20 million men are “impotent,” and 40 million women have “female sexual dysfunction.”

These numbers are a product of extremely broad categories. In reality, no body works perfectly all the time. Someone should only be diagnosed sexually dysfunctional if his or her difficulty is chronic, occurring repetitively over a period of time.

All limp penises are not alike. The guy who can’t get it up while feeling the pressure of trying to conceive, the guy who loses his erection when he has sex while angry and the guy who has never had reliable erections as an adult are three entirely different cases. The first two men are certainly not impotent, and the third’s problem may be emotional, physical or some of each.

Similarly, a woman who can’t climax with a husband who criticizes her all week long, a woman who can’t orgasm because she’s too inhibited to ask for her favorite touching and a woman who can’t enjoy sex at all because she was traumatized as a girl are three entirely different situations. We’d have to know more about each of them to know exactly what’s wrong, and what would help them most.

Sexual desire and response involve a complicated mix of biology, psychology, culture and situation. Our bodies require the right blend of all of these to function the way we’d like. Labeling someone or yourself as “dysfunctional” without taking this into account is a mistake. Don’t let a narrow-minded pharmaceutical/medical industry or the simplistic popular press persuade you that you have a problem when you’re merely human.

Our emotions and genitals are connected, and so our feelings affect our sexual functioning. An occasional disappointment does not make you dysfunctional. For an accurate diagnosis of any sexual difficulty, see a sex therapist or specially trained physician; magazines or self-help books are insufficient.

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