Now let's talk about some of the most common treatments for Erectile Difficulties.

Because causes vary, treatments will depend on the underlying issue. Often a combination of treatments is needed with the most common prescribed being:

Medications, therapy, and manual bodywork.

Medications

Although I don’t advocate medications as the first course of action in treating ED, I want you to have a basic understanding of how they work so you can make the best decision for yourself. 

The most well-known ED medications include: Cialis, Viagra, Levitra, and Stendra. These prescription drugs work by increasing the levels of nitric oxide in your blood. Nitric oxide is a vasodilator, meaning it makes your blood vessels widen to help increase the blood flow. These drugs are especially effective at widening the blood vessels in the penis. More blood in your penis makes it much easier for you to get an erection when you are sexually aroused.

One of the issues I have seen with men taking ED meds is that they haven’t gotten to the root of what the real problem is. I have worked with men who had been in long term relationships with no erection problems. But after separating from their partner, and meeting someone new, they found they were having difficulty getting and staying hard. They immediately assumed something must be broken with their body and sought out one of these medications from their doctor, who is often all too happy to prescribe it without investigating the psychological factors that may be contributing to this “new” problem. 

It’s also important to note that ED meds do not work if you are not turned on.  If you do not become aroused, no medication will stimulate an erection. Drugs like viagra makes an erection possible, but your mind and body do the real work.

That's why it's important to rule out psychological or emotional factors before assuming you have a physical problem when you really don’t. If it truly is a blood flow issue, then let’s get to the root of that, and find ways to up your nitric oxide levels naturally and optimize blood flow through your body and to your penis.

So one thing that is helpful in determining if your erectile issues are truly physical in nature is if you are having nighttime erections or not. A healthy man can expect to get hard three to five times per night. Nocturnal erections keep your penile tissue soft and stretchy. They also prompt the smooth muscles in your penis to relax, allowing the blood to rush in and get you hard. That keeps your penis in top shape for when you’re awake and need it.

Morning Wood is a good indicator of erectile health. If you usually wake up with an erection it's a good sign that your body is physiologically capable of achieving an erection. It's also perfectly normal to occasionally not wake up with a hard on. However, if you rarely wake up with an erection, it could be a sign that your issue has a physical component, although not necessarily. 

If you are concerned you are not getting nighttime erections you can try the simple postage stamp test. It’s done by taking a length of connected postage stamps  and securing them around your flaccid penis prior to going to sleep. It’s important not to stick them to the penis. Just overlap the strip and stick the last stamp to the first, and don’t make it too tight. If the perforated connections are torn when you wake up it's evidence that you're experiencing nocturnal erections. It is suggested that you do this test 3 nights in a row. It's certainly not a perfect test but it's simple and you can do it by yourself. And you can use the stamps for sending me fan mail later! 

If you are still uncertain if you are getting nighttime erection, you can work with your urologist who can administer a more scientific  version of this test, although it may include an overnight stay in a sleep lab. 

PsychoTherapy

Now, if you have erections during sleep or upon waking, the results of your physical health exams and blood tests are normal, and you are generally in good health, then Psychotherapy can be useful for treating erectile difficulties. There are a few different approaches to this type of therapy.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is a common type of psychotherapy that's used to treat all sorts of health conditions, including sexual issues. It's what most of us think of when we think of talk therapy. Cognitive Behavioral Therapy can help you reframe negative thinking thinking and teach you relaxation exercises to help ease anxiety related to sex and performance. Lucky for you, you are learning many of these techniques in this course. So stick with me.

Psychosexual Counseling

Psychosexual counseling is a type of sex therapy that also involves talk therapy. Often your partner is an important part of this therapeutic model. Together, with a counselor, you discuss the expectations and emotions involved in your sex life. You learn how to express what you want or don't want during sex and reduce nervous thoughts that might lead to erectile difficulties when "in the moment." 

Studies show that doing this type of counseling with your partner significantly improves persistent erectile dysfunction, when compared to medications. So please don’t underestimate its effectiveness.

Here is a little Psychosexual Exercise that you can do with your partner or by yourself if you don’t currently have an intimate partner. It’s best to set aside a special time for this exercise when you won’t be interrupted and you both have the energy to be fully present. Take turns discussing these statements and to what extent you agree or don’t agree with them. And if you’re doing this exercise alone, you can spend a little time contemplating these statements and even doing a little writing about your thoughts and feelings. 

As you go through this list, I want you to reflect on your answers in a thoughtful way and see what reactions are evoked.

So here we go!!

I believe sex is for fun.

I have sexual fantasies at times.

Masturbation is an acceptable way of relieving sexual tensions, even if I am  in a committed relationship.

I’m okay with my partner self-pleasuring.

I believe oral-genital sex is an acceptable alternative to intercourse.

I believe mutual stimulation to orgasm is an acceptable alternative to intercourse.

I believe that a good sexual relationship is the most important factor in a marriage or intimate relationship.

For me, love is necessary in order to have good sex.

For me, casual sex, such as a one-night stand, can be exciting, fulfilling, and practiced with little guilt.

When it comes to sex, there is a great difference between what I do and what I would like to do.

I feel comfortable discussing sexual issues with my partner.

I have had difficulty reconciling my religious beliefs with my sexual behaviors.

How was that for you? Are there some that are easy to answer? Others that are more difficult?

There are no right or wrong answers here. Just an insight into your own psychology around sex. You can find this exercise in a PDF in your Resource Page that you can download and print

The goal of this type of sex therapy is to help empower you to understand the nature and sources your sexual problems, better express your sexual wants and needs, and broaden your menu of sensual and sexual expression.

Sensate-Focus Therapy

Another type of sex therapy is Sensate-Focus Therapy. This may seem counter-intuitive, but sex is completely restricted during this type of therapy, at least in the beginning. You and your partner will agree to be completely sex-free for a certain number of weeks, maybe even months. You can kiss and even touch each other, but erogenous zones are off-limits. One of the goals is to explore each other's bodies in a nonsexual way and to make the anticipation build. If you do not have a partner, you will be asked to refrain from masturbating for a period of time. 

During each session, you are given a set of sensual touching exercises. For example, your homework may be to give each other a 15-minute massage while partially clothed, and only later completely naked. Or if you are single, you’ll be guided in ways to sensually touch yourself. After the sex-free period is over, you'll slowly begin touching and kissing each other more intimately. This type of increased sexual stimulation can help you get and keep an erection. 

Body Work

Almost all cultures have developed systems of therapeutic massage and manual bodywork. Hands-on healing techniques are an important part of many traditional medical systems such as those found in Chinese, Thai, Indian, Hawaiian, and the Mayan cultures. In these traditional systems, massage is considered to be preventative medicine.

The type of bodywork most of us are familiar with in the west is some version of the Swedish massage, which emphasizes relaxation. It is beneficial for sexual dysfunction in that it helps lower stress hormone levels which can interfere with your ability to get an erection. Western styles of massage are often touted as a “full body massage”, but they’re not really full body.  They generally avoid touching the front of your torso, including the chest and abdomen as well as the buttocks, inner thighs, and groin area. Often this is because of legal restrictions put into place out of the fear of sexual misconduct. But in general western cultures just have more taboos around certain body parts.

Many traditional cultures outside of the Western world that use massage as a preventative and healing modality almost always include abdominal and organ massage. And several include external massage techniques on the groin and genital area as well as internal techniques on the muscles within the pelvic bowl itself. These systems understand the great value of bringing fresh blood flow to this region and helping move out stagnation and toxins. 

Karsai Nei Tsang is a traditional healing treatment that combines Chinese and Thai Massage techniques that focus predominantly on the diaphragm, abdomen, and the sex organs. Don’t have access to a Karsai Nei Tsang practitioner?  Don’t worry, You have one right here and I am teaching you some of these techniques that you can do yourself in the privacy of your own home.

In the Western World there is a growing field within physio therapy that focuses on the pelvic floor which includes internal bodywork. You may be wondering, how do they access the pelvic floor internally?  

Well Fellas, there’s only one way in for you guys.  

During internal massage therapy, a lubricated finger or a specialized tool is used to carefully stimulate the prostate or massage pelvic floor muscles via the anus for medical or therapeutic reasons including for the treatment of erectile dysfunction, prostatitis or chronic pelvic pain syndrome and it is often used in combination with other treatments.

Tissues in and around the prostate are massaged with gentle pressure while pelvic floor muscles can receive more direct pressure.   This can enhance blood flow to the region, improve urinary flow, eliminate blocked fluids and release tension, tightness and trigger points found in these muscles. This massage can be performed by a professional such as a pelvic floor therapist, or by a trusted partner, or even on yourself with a little bit of training and a slight bit of awkwardness.

So in this video we covered some of the most commonly known treatments for sexual and erectile issues. Throughout the course I will be introducing you to many more techniques as well as cutting edge technology that you can use for optimizing your ability to enjoy hard and long lasting erections.