Erectile dysfunction in men 45 and older in a partnered relationship is a problem with solutions. Listen to Laurie and Tony distinguish physiological ED and partnered ED and offer approaches to solve this problem in this podcast spurred by a question from a listener. If you want Laurie and Tony to address a question you are concerned about, email [email protected].

TRANSCRIPT:

Laurie Watson: Hi, it’s time for Foreplay Radio, Sex Therapy. I’m certified sex therapist, Laurie Watson. And I’m here with my cohost Tony Delmedico, who’s a marriage family therapist.

Tony Delmedico: You can check us out on the web at ForeplayRST.com. Find us on Twitter, YouTube, and Facebook. We’d love to hear from you. Laurie, where will Foreplay lead us today?

Laurie Watson: Ooh, Tony. Today we’re going to talk about 52 and Needing Blue.

Tony Delmedico: So, we’ve got another listener that’s written in.

Laurie Watson: Yes, we do.

Tony Delmedico: Would you like me to read what he’s written?

Laurie Watson: Please do, I think you should read this one.

Tony Delmedico: All right. So, dear Laurie and Tony, I am 52 and starting to struggle with my erections. They’re fine with porn. And the one time I recently had an affair with a younger woman. I love my wife who’s 45. And don’t particularly want to leave the marriage. But I’m way too young to give up on sex. So, Laurie, does stuff like this come into your office on a regular basis? Is this a rare case?

Laurie Watson: Yeah, I mean all the time. I think men struggling with erections. Having ED. And this is a big problem. And people come in all the time. There was a time maybe before the advent of Viagra, that this was a serious problem. This meant the end of his sex life.

Tony Delmedico: So, do men come in on their own to see you? And this is a typical presentation and say, “Ah, I’m not sure things are working the way they used to.”

Laurie Watson: Well, and I think that this guy is saying, “I’m not sure that it’s not my wife.” I mean really, he’s not. He’s wondering is it me a little bit. But he’s wondering is it that I’m just not attracted to her because you know, I can do it fine by myself. And this other younger woman turned me on. And so, I had a fine erection at that point.

Tony Delmedico: So, one of the things that you typically do is do a wonderful job with triage. So, your first step would be trying to figure out is this an erectile dysfunction issue or is this something else? And right away you’re saying, “Wait, he’s getting erections in other places and he doesn’t seem to be having problems maintaining them to orgasms.”

Laurie Watson: So, I still think this guy has ED.

Tony Delmedico: No kidding? So, for me, I would say, wait a minute. This is not a physical problem. This is a psychological problem.

Laurie Watson: Yes, there is something psychogenic in it. You’re right. There’s a component of that. But I think he is also struggling with erections just in general. And I mean —

Tony Delmedico: Wait a minute, wait a minute now. So, I can watch porn and masturbate all day long and I can have an affair with a younger woman. I’ve got ED problems if I can’t maintain my erection with my wife?

Laurie Watson: Or get an erection?

Tony Delmedico: To whom I’m no longer attracted to.

Laurie Watson: Yes.

Tony Delmedico: And that’s called erectile dysfunction.

Laurie Watson: It is erectile dysfunction. Yes. Because what happens when he’s been having sex with the younger woman for a year? Some of the pop — Okay. So, some of the pop of the eroticism, you know, boosts him, makes him feel good inside. So, horny that then it kind of overrides this function. And he goes ahead. And he has a great erection. But I’m telling you, if he was with her for a year, he would still go back to having ED.

Tony Delmedico: So, he’s going to wind up in the same boat with this person?

Laurie Watson: He is. He is.

Tony Delmedico: So, how do you explain the porn then?

Laurie Watson: You know, when we’re by ourselves, it’s kind of this perfect feedback mechanism. And men often use porn to provide the same sort of input. I mean, they’re not necessarily having partnered sex, right? It’s not one person that they’re looking at. They’re looking at person after person, after person on pornography, and that provides enough dopamine that it’s like the eventual blast creates a better erection.

Tony Delmedico: So, are you saying that over time he’s going to have erectile dysfunction while watching porn as well, or will that always sort of be there for him?

Laurie Watson: I mean, I hate to say it, but porn can give young men ED. And in fact, I see that all the time. Because it’s about the dopamine in their brain. They’re having erections, not because they’re looking at porn. They’re having erections. Oh, okay, wait, start over. They’re having problems because they look at porn so much that they build up all this dopamine. And then they need that, because a single partner by themselves is not exciting enough for them to have a good erection. And so, they’re having partner sex ED.

Tony Delmedico: Got you. So, maybe the newness of this younger woman was giving him enough of a hit to sustain the erection.

Laurie Watson: Right.

Tony Delmedico: And the excitement of porn was stimulating that all the way around.

Laurie Watson: Exactly.

Tony Delmedico: Got you.

Laurie Watson: You can see how confusing this is to him. How troubling it is. It’s like, okay, do I need to get out and do I need variety? Is that what’s going to give this to me? And you know, but he says, I don’t want to leave my relationship.

Tony Delmedico: Right. So, when he comes in, I’m hearing you say you’re really going to go towards the, how much porn are you actually using day in and day out? And is that going to be a root cause for the ED?

Laurie Watson: Sure. And I also want to know, I mean more than the porn with this guy. What I want to know is what is the quality of their erotic life? You know, does he talk about his sexual fantasies with her? A lot of times, I’ll have a man who says, you know, I’m just not attracted to her anymore. I just don’t feel it as much. And it’s boring. And I challenge him. Okay, do you bring to the party your own thoughts and fantasies that make it exciting? You know, because oftentimes he shut down. He’s not really being vulnerable and courageous about what he likes. And he’s not asking her and so it’s not inventive anymore. And yeah, I mean now he’s starting to struggle.

Tony Delmedico: And those guys I think are bringing their creativity and their inventiveness to the affair.

Laurie Watson: Right. Or to their work. You know, at 52 maybe they’re putting it all there. And they just think somehow, or another sex should take care of itself. And they don’t realize how much work there is in sex.

Tony Delmedico: And he was at least putting some of it to a younger woman.

Laurie Watson: Yeah, he did. But it sounds like that wasn’t necessarily the direction he wants to go. And affairs are another topic. But I mean I think this guy, you know, there needs to be a lot of discussion in the coupleship. He needs to come back to it and he should use Viagra, or you know, I’m sorry I’m plugging Viagra. You know, he should use one of the meds that gives them erections and a lot of them are different, right? So, Viagra and Levitra.

Tony Delmedico: Cialis.

Laurie Watson: They all have different effects per the individual male. So, he should try them. He can go to his urologists, get a bunch of samples. Try them and see if that doesn’t bring back the erections. I mean the good news is actually these drugs just help. I mean they help if you have dysfunction. If you’re fully functional, they don’t help further. They don’t age you and give you a better, bigger erection or something like that.

Tony Delmedico: And as a marriage and family therapist, I’m going towards, so you can bring back the erection. That doesn’t necessarily bring back the desire.

Laurie Watson: Yeah. And it doesn’t necessarily make sex exciting again. Just if you have good erections.

Tony Delmedico: Right.

Laurie Watson: Yeah. So, I mean certainly there is something here problematic about desire that actually impacts functioning. Which are two kind of separate issues. Desire and arousal are different.

Tony Delmedico: With this guy would you be telling him to curtail some of his porn use? Would you ask him to stop the affair in an effort to get back in? Or how do you approach that with people that have an outside?

Laurie Watson: I mean, certainly an affair is a division of, I mean, it’s so problematic for so many reasons. Yes, of course. I’m going to say, if you’re going to work on your marriage, you have to give up the affair. And that’s grief and sadness to think that we can’t have our cake and eat it too and be monogamous. And there are losses when with a decision to be monogamous, right. We forfeit sometimes some of the high highs in life because we’re going towards something else, which is more stable. I mean, I think people toggle between their needs for excitement and stability.

Tony Delmedico: So, you’re going to be asking this guy to give up his new red convertible Corvette and go back to his Buick.

Laurie Watson: No, no. Keep the Corvette, that’s fine. Give up the other woman. Absolutely.

Tony Delmedico: Okay. Got you. You’re assuming that the wife is the Corvette. And I’m assuming the hot new flashy thing in the middle of life may be the shiny sparkly thing.

Laurie Watson: No, I’m saying keep the real Corvette and give up the younger woman. I mean, I’m being literal.

Tony Delmedico: You’re not going to let me reduce it to stereotypes. Darn it.

Laurie Watson: No, no. I’m sorry. I’m sorry.

Tony Delmedico: I mean, to get the easy way out on this.

Laurie Watson: I mean, this is a strategy, right? For him to say, okay, can I have sexual excitement, and can I have the stability of my marriage? And a lot of times people try this strategy, they divide and conquer so that they don’t have to change anything. They don’t to leave the marriage and go off and forge a new relationship or they think they will be able to have sexual excitement and just keep things at the same, the marriage. But ultimately that messes things up. I mean, very seldom can we have both.

Tony Delmedico: I hate to say it. I’m such a guy here. So, what’s going through my mind now is the El Camino. So, you’re asking him, really what you’re asking them to do is merge passion with someone that he’s been with. You’re asking him to do both.

Laurie Watson: Do you drive an El Camino, Tony?

Tony Delmedico: I don’t. Is it a car, is it a truck? But I think you’re touching on something that’s really, really important here. Which is can you have passion with a person that you’ve been a longtime partner with who’s just become run of the mill and maybe he’s become run of the mill for her as well.

Laurie Watson: Right. Can passion last? Can it be hot in a long term relationship? Which I think is what Foreplay Radio, Sex Therapy is all about. Let’s come back to this, Tony, and talk about the problems of midlife. And talk about this dilemma that I think is all about being vulnerable and staying vulnerable in a relationship so that we continue to have to desire.

Tony Delmedico: That sounds great, Laurie.

Laurie Watson: We’ll be right back with more Foreplay.

Commercial: Wanting Sex Again, how to rediscover desire and heal a sexless marriage by certified sex therapist, Laurie Watson. Each chapter is designed to fix one of the problems that caused low libido from early marriage through the childbearing years, even all the way through menopause. I’ve also had men read it and tell me that for them it was the most helpful thing they read about resolving sexual problems. Look for Wanting Sex Again on Amazon.com. You can also talk to Laurie Watson for therapy in person or via Skype. I offer couples counseling and sex therapy and I think about both aspects of the relationship, emotional intimacy, and sexual technique. And that combination together helps marriages be happy. Improve your sex. And improve your relationship with awakening center for couples and intimacy. Find out more at AwakenLoveandSex.com and sign up for their next couples retreat weekend hosted by Laurie Watson. AwakenLoveandSex.com, awaken what’s possible.

Tony Delmedico: Hey, welcome back to Foreplay Radio, Sex Therapy. I’m Tony Delmedico, marriage and family therapist. And I’m here with Laurie Watson author and certified sex therapists. Laurie, we’ve been going hard at it in the first part of this session with 52 and Needing Blue. And we’ve talked about erections and El Camino’s and erectile dysfunction and we’re all over the map here. So, I think it’s bringing up a lot here. So, it’s a really interesting write in. And trying to figure out, because I was a bit taken aback when you said this guy has erectile dysfunction. And I’m thinking he’s just attracted to somebody else. So, can we talk about that a little bit more for a few minutes?

Laurie Watson: Certainly, he has partnered ED.

Tony Delmedico: Partnered erectile dysfunction.

Laurie Watson: Right. He is having trouble with his stable partner.

Tony Delmedico: So, you’re saying there all types of erectile dysfunction? It’s not just, I can’t get it up.

Laurie Watson: Okay. There are real physiological problems and oftentimes, just for the record guys, there is erection problems often signify heart disease. It’s one of the first issues that come up in heart disease. So, if you are having ED, definitely go see your urologist. Go see your main doctor and tell them this. Because you might need to address your cholesterol, your weight, especially just a tiny little bit of belly weight can cause ED. And it’s just so little, it’s surprising. And men thing, you’re kidding, now I have heart disease as well.

Tony Delmedico: Smoking as well?

Laurie Watson: Smoking definitely a big problem. Because what happens is the capillaries and the penis, that is the first thing that goes, that fills with cholesterol, and also that smoking would begin to constrict.

Tony Delmedico: That’s funny. They don’t put that on the packs of Marlboros as a warning label.

Laurie Watson: Be careful of your erections. Take care. You’re going to have ED. They should. And doctors will be screaming about this.

Tony Delmedico: And it might curb smoking.

Laurie Watson: Also, there are valve problems that happen that are outside of a man’s control that have nothing to do with diet. And that can cause ED to at about this age as well. Really 45 and up. That can be a problem with ED. But this man, I think the point, the reason he’s writing is he’s saying, “Okay, I had erectile problems. Now, I’m having them with my wife. I’m not having them outside this. But I want to stay with my wife. So, what do I do about it?”

Tony Delmedico: Does he want to say with his wife? If he’s saying he doesn’t want to give up on sex.

Laurie Watson: Okay. I guess what he’s saying is, “I love my wife.”

Tony Delmedico: I love my wife. I don’t want to particularly leave the marriage. You’re right. Yeah.

Laurie Watson: So, I’m believing he’s looking to us for a solution of how do I keep sex? You know, hot again. And I think you’re right. As I’ve been thinking about it over the break, that there is obviously an issue of desire and attraction. And so, how does he find that again? You know, I think that even for men, while it’s probably more in his head in terms of, you know, does he find her attractive or not? I think there are components about vulnerability that are really important. I mean, at 52 suddenly we’re faced with our mortality and can I keep on, am I going to die?

You know, is my partner going to die? Is this stable? And that fear I think can impact the way we relate to each other. And sometimes people withdraw from each other.

Tony Delmedico: During this time?

Laurie Watson: You could die, you could die on me. I don’t want to be as vulnerable. You know, you could stop loving me, right? These are the reasons that we stop having desires sometimes because our desire is so exquisitely vulnerable to give somebody that, to stay in that with somebody, when faced with the fact that they could leave us? Or they could literally leave us. I mean, every love story ends badly. No matter what. It all ends badly. You know, the best love story, somebody dies. And so, it’s even more tragic. So, for whatever reason, maybe he’s facing mortality. And he’s stopped being vulnerable. And he needs to kind of work that through with his wife.

Tony Delmedico: Does that explain the younger woman versus having an affair with an older woman?

Laurie Watson: Well, yes. You know, of course. I think that he needs to question, “Okay, why did I do that?? Is it just a test, you know, a sexual test? I just wanted to see if it still worked. You know, we want to know, did he fall in love with this woman?

Tony Delmedico: Well, that’s the question, he’s saying, he’s had a onetime affair and oftentimes when you talk to men, they may have been cultivating an emotional relationship with that person for months, sometimes years.

Laurie Watson: Sure.

Tony Delmedico: So just one time doesn’t necessarily reveal a whole lot. It might’ve been one physical. And there may be a huge emotional bond there. And asking a man to let go of that, some men that I see really struggle with it because you’re asking them to let go of something that was really special. Even if it was cultivated on the side. And they’ve gotten a taste of that, again. And they’re not getting that in their marriage. So, there is a loss that goes on. And of course, the woman that has been cheated on, doesn’t want to hear that.

Laurie Watson: Right.

Tony Delmedico: But he’s having to hold a lot there trying to shut down potentially an amazing new relationship.

Laurie Watson: And we don’t know if he means just a one night stand with this young woman or a one. I’ve only had one affair. I think what this indicates is the affair was a test. A test of sexual potency. And you know, I think there’s a lot of anxiety at this age in midlife that says, am I going to be still attractive? I mean, I think for men and for women, the ability to walk into the room, turn heads or have people feel that kind of charisma goes missing as we age. And suddenly he wants to know, am I still attractive to others? He tests this out. And he’s wondering how this all connects with his erections. Can he have good erections again in the marriage? And I think the question for me to help him in terms of staying in the marriage, how can he do that?

Tony Delmedico: Got you. So, you’re trying to draw the connection between ego strokes and his erections and sexual prowess and this being a very normal time to question all of that or feel insecure about it as your body changes.

Laurie Watson: Yeah, and let’s just think about this. I mean, maybe he’s pulled away, had this affair. And she’s not getting the attention, the connection that she needs. So, she’s not giving him those kinds of verbal strokes about how attractive he is. And maybe at this age, they haven’t been courageous in bed. They haven’t told each other their fantasies, they’ve just kind of boiled it down to something that works, a routine that works, and it’s not very erotic anymore. And so, he doesn’t get what he needs.

Tony Delmedico: You know, chances are she hasn’t been getting what she needs either.

Laurie Watson: Of course.

Tony Delmedico: And we don’t know if she’s had an affair along the way or not.

Laurie Watson: Sure. And I don’t think necessarily women have affairs because they don’t get what they need in bed. I think sometimes that’s true. And that’s another topic. But I want to come back to him at 52. I think the other thing that changes for me and they are unaware of, is oftentimes men do not get spontaneous, easy erections at that age. You know, a woman walking out of the shower and their penis would levitate, you know, instant erection.

Tony Delmedico: Maybe just the winds blowing doesn’t even have to be a woman out of the shower.

Laurie Watson: Yeah, sure. But I mean, oftentimes at this age, men need a lot more stimulation. They need, you know, some work and they don’t like that. You know, they want it to be the old way. They want it to be just instantaneous and they feel less than that. And so, the fact of asking their partner, “Hey, could you touch me in this way? Could you give me more attention? Could you do this or that?” They feel less manly about that.

Tony Delmedico: So that, that, I’m thinking about an earlier podcast that we did about how to have ongoing sexual conversations and over the decades our bodies are going to shift and change. Our libidos are going to wax and wane. Our erections are not going to come as quickly or as firmly initially. And how does a couple have that conversation on an ongoing way?

Laurie Watson: And I talk with these couples a lot, these kind of winter spring marriages that have come out of this. And I just know that —

Tony Delmedico: Wait a minute, what’s a winter spring marriage?

Laurie Watson: Okay. And older man, a younger woman. So, you know, a lot of times initially the affair is so hot that that burst of eroticism gives some better functioning. A lot of the times though he’s popping a pill on the side. But that’s another story. But then when they are married to each other, all the difficulties of marriage, you know, come into play, interrupt their sex life, and they too have to work it out. So, I think, you know, why not work it out if you really love your wife? Why not try to work it out here and talk about it? I mean, I think men are loath to say to their partner, I’m having problems with erections. You know, and maybe she knows. And he does blame her. He says, you know, “You’re just not attractive enough for me.” You know, talk about a shove away and not maybe inviting your partner into the problem and solving the problem. You know, he’s blaming her. I had this one guy who came in to see me and he blamed her basically for his erectile dysfunction. Actually, he said, you know, she doesn’t have any libido. And part of it was, he was so critical of her. And she was beautiful. I mean, she was a little bit younger than he was. Size six, you know, breast implants. I mean, this woman was a knockout. And he kept criticizing her. You know, her thighs aren’t so good. You know this, she’s exercising though, boy, she’s getting on top of it. But there was always this subtle criticism and he was pushing her away saying she didn’t have enough libido for him. But eventually she agreed, you know what, I will have sex with you three times a week, you know, two quickies, one longie. And she really got on board and she started approaching him. And he said, “Laurie you created this monster. Now she’s always after me.” And one of the things he was hiding was he was having ED. And so, the strategy was he pushed her away, made her feel crummy about herself, and then she didn’t want to have sex. And then wouldn’t discover that he was struggling and feeling really anxious about this ED problem.

Tony Delmedico: Wow.

Laurie Watson: So, it, you know, it doesn’t have to be just about attraction. It can be his own humiliation about changing. And some of these changes are normal and there’s so many good work arounds. And I got to say, the pills really work easily for men, resolving most of them.

Tony Delmedico: And then becoming vulnerable again in relationship. I do have this, how are we going to work through it? I’ve been hiding. I’ve caused you some damage by the way. I’ve treated you over time.

Laurie Watson: Right.

Tony Delmedico: How does the couple repair those wounds?

Laurie Watson: Right. And that’s when the couple comes to see you, Tony. You know, so they can work on the marriage and figure out what do they do now that they’ve thrown these stones, thrown this mud.

Tony Delmedico: That’s not easy to do. I don’t think. It takes time.

Laurie Watson: It takes some time to repair this. And I think it takes some sexual energy and some creativity and thinking about it again, you know, daring to be different. Daring to bring into the relationship, the ideas of their fantasies.

Tony Delmedico: Yeah. Well Laurie, we’ve spent a good 25 minutes on this. Do you have a tip for this guy who wrote in?

Laurie Watson:  I think first stop at your urologist. And second talk with your wife about what’s inside your head sexually.

Tony Delmedico: And I think my tip would be to try to ease up on the porn and shut down that outside relationship. Take all the energy, divert it back into the relationship and see what happens. Thank you for joining us today on Foreplay Radio, Sex Therapy. I’m psychotherapist, Tony Delmedico, marriage and family therapist with Laurie Watson, sex therapist and author. Thank you so much for joining us.

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