Erectile Dysfunction

Erectile “Dysfunction” (ED) is defined as the inability to obtain and maintain an erection sufficient for satisfactory intercourse or other sexual expression. While the medical literature cites statistics showing high percentages of men suffering from ED, the numbers are based on certain criteria and do not necessarily reflect a true picture of men’s ability to get and stay erect. What ED simply means is that: 1) blood is not entering the penis adequately 2) blood is leaking out of the penis too fast and 3) the erectile tissue in the penis is unable to expand and fill with blood.

Many causes can underlie these conditions, i.e. vascular disease, heart disease, neurological dysfunction, diabetes, side effects of HIV medication and other medications or psychogenic factors. The latter is the most frequent cause of ED, with stress and anxiety being the most common contributors. They both activate the stress (fear) system in the brain, and this in turn interferes with the penile blood flow and erection. The recipe to counteract this stress response is to breathe deeply, relax the muscles throughout the body, be fully present to the moment, and focus the awareness on the erotic stimulation of skin and genitals.

If fantasies interfere with the ability to sustain an erection it is important to shift the focus from fantasy to sensation and breathing, and practice masturbation and erotic contact without fantasies. Relying on fantasies to get an erection (outside of masturbation) can easily result in premature ejaculation as well as interfere with the intimacy with one’s partner. Men who worry that their penis is too small, and use fantasies to get erect before they undress in front of their partner (to look bigger), can easily loose the erection during actual erotic contact. They can also come too fast as their fantasies push them way ahead of the real situation.

Many men loose their erection the moment they penetrate a bodily orifice, as they get too excited or too worried about not maintaining the erection. To change this, the key is to stay with what is, to breathe and concentrate on the feeling of the penis being inside, instead of the thoughts running through your head. In many cases this will bring back the erection. If this doesn’t work, he can pull out, relax for a moment and use manual stimulation to bring back the erection, and then slowly and patiently try penetrating again.

Men are not machines that can turn the erection on and off. The man and his partner need to be sensitive to and patient with his ED. Keep in mind that sex is more than intercourse, and that fingers, tongue, dildos and whatever you can find in the kitchen, can get you a long way. Sex is about pleasure, fun and creativity, so when one thing doesn’t work, use this obstacle as an opportunity to discover other roads to ecstasy.

Premature/Rapid Ejaculation

Premature ejaculation (PE) is one of the most common sexual problems for men in today’s society. The medical literature defines PE according to a set time before ejaculation following vaginal penetration, but the length of this time, in order to define it as PE, is still a topic of debate. I consider it PE it when a man has a subjective experience of ejaculating before he desires to do so. Most cases of PE are due to psychogenic factors, with anxiety the number one cause. This means (although some people would argue with this) that it is very rare to have any physiological factors contributing to PE.

The performance anxiety that many men are experiencing by thinking they have to last “forever,” and produce an orgasm both for themselves and their partner during intercourse is what often creates PE. The reality is that few women reach orgasm during intercourse, as the majority of women need clitoral stimulation to reach climax.

The brain interprets the man’s anxiety as a crisis, and the Sympathetic Nervous System (SNS), which is largely in charge of ejaculation, is activated. If a man starts to think and worry as he is about to penetrate, SNS will get activated, and this frequently causes ejaculation. The counterpart to the SNS is the Parasympathetic Nervous System (PNS), which is most active when a man is relaxed. PNS provides the penis with dilated arteries that fill with blood producing an erection. If a man, after having successfully penetrated, starts thinking about actually being inside the vagina or anal canal, he can get overexcited or fearful of not lasting “long enough” (a dangerous definition), causing the activation of the SNS and inducing PE.

To make the pre-orgasm pleasure last, the SNS and PNS need to be in optimal balance. The secret to this is to engage in sex in a total moment-to-moment frame of mind. In order to stay in the moment you need to use the breath and the sensory experience to bring yourself back every time you slip away from the momentary erotic event and into “thinking land.” The body will then have a chance to build up its natural arousal, which will eventually bring you to the point of orgasm and ejaculation. Depending on a person’s sexual history and his level and tolerance for stress, his susceptibility to PE will vary.

I have worked with a number of men with PE and for every one of them the “cure” was to learn to stop thinking about what they are doing, and instead be fully in what they are doing, dare to relax and breathe and trust the body. When PE is a problem it is important to practice masturbation without fantasies and again focus on the breath and the sensation in your penis. This will help re-configure the neurobiological sexual response pattern, and move you out of the traumatic cycle of PE. For anybody with PE who is in a relationship it is very helpful if the partner is included in the healing process, and for the partner it is essential to be supportive, patient, and not ridicule or put pressure on the suffering man.

Orgasmic/Intimacy Problems for Men

Delayed or inhibited orgasm in men is not uncommon. It is almost always due to a psychological barrier, which can be rooted in trauma early or later in life. It can also be due to certain sexual habits. The moment of orgasm is a moment of intense vulnerability, and for many men this can be very scary. Men, as much as women, need to feel safe with their partner, in order to let themselves go. Many, often single, men who get used to casual or anonymous sex, can sometimes experience orgasmic problems when entering into an intimate relationship. Men, who masturbate frequently to cybersex or other types of pornography, can develop non-intimate sexual habits that are based primarily on mental stimulation, and this again can create obstacles for intimate sexual/orgasmic experiences. The “cure” is to re-condition men to a less mental and more physical focus, help them feel safe, and support them in embodying the erotic and orgasmic experience. See also Intimacy for Women.

Men’s Lack of Desire

Lack of desire can be due to multiple factors including depression, side effects of medication, physical illness, changes in testosterone levels, or sexual neglect. In addition, stress, food, alcohol, cigarettes and recreational drugs, all have a numbing effect on the body, and thereby on sexual desire. Demanding careers can lead to physical and mental exhaustion and leave no energy for sexual pursuits. Similarly to attending to diet and exercise, we need to feed and polish the sexual drive. This requires rest, breath awareness, masturbation, and a conscious choice to explore one’s sexuality through the different stages of life. Many men expect the insatiable sex drive they had at age 17 to continue throughout their life. Wrong. As our bodies, our thinking and everything else change, so does our sex drive, and only through continuous exploration and maintenance of the ever-evolving sexual self, can the sexual desire be continually reinvigorated.


Sexual Compulsion

Sexual compulsion or addiction has become a frequently used term in the U.S. Sexual addiction is an umbrella term referring to people who feel they have lost control over their sexual behavior. The addiction can manifest as frequenting dungeons, prostitutes, massage parlors, bath houses, cruising strips, cybersex, and so on, to such a degree that it seriously interferes with the person’s functioning in the world. As with any addiction, the activity gives the “addict” an escape from his/her own reality, and can provide a temporary illusion of aliveness or justification for one’s existence. Trauma resulting in repression and/or alienation of all or parts of one’s sexuality can be a main factor underlying this behavioral pattern.

The therapeutic approach depends on the client’s intention and desire to change his or her behavior. The core concept is to support the client in grounding themselves in their body, increasing bodily and mental awareness, and in transforming dissociative behavioral patterns. Clients who are able and willing to commit to their healing process usually succeed in freeing themselves from their compulsion, achieve sexual integration and healthy erotic lives.

Orgasmic Problems for Women


For a woman who describes herself as an-orgasmic, the first step is to help her define her unique experience of an orgasm. Many women define orgasm according to the Hollywood version where a hard pumping man sends the moaning woman through the ceiling in about 2 minutes. Wrong. A majority of women do not reach orgasm during intercourse, but need direct stimulation of the clitoris by fingers, tongue or vibrator, either in combination with penetration or by itself.
There are as many orgasms as there are women, they come in all sizes, sounds and rhythms, and they are different from day to day and week to week. The key is that we don’t know what our orgasm is going to look or feel like when we start an erotic event, and the challenge is to engage fully in the erotic process while not worrying about the duration or the “result.”
Women often feel the buildup to an orgasm, but as they are getting close, tension interferes, and the energy implodes in their bodies. This can be rooted in emotional and/or physical trauma early or later in life. The fear conditioning system in the brain has established a muscular holding pattern that protects against the vulnerability that comes with letting go at the time of orgasm. The breath is the main tool to counteract this pattern. When reaching the point where fear of “losing control” threatens an orgasm, a woman can, with support, choose to breathe into that experience, focus on her bodily sensation, trust that she will not be hurt, and before she knows it she’s riding the waves of an orgasm. By repeating this over and over in similar and different versions, the fear conditioning will become extinct, and new orgasmic response patterns will develop in the brain.

Vaginismus/Dyspareunia

Many women experience pain (dyspareunia) during intercourse. This can be caused by anatomical or medical problems, but is frequently due to muscular tension and/or insufficient lubrication. One aspect of dyspareunia is referred to as vaginismus, which is an involuntary contraction of the outer third of the vagina in response to attempted penetration. This is a muscular fear response, controlled by the brain, established as a protective measure following one or many painful, perhaps non-lubricated, penetrations, early or later in life.

A non-medical healing process for this is to create a safe environment, free of performance pressure or other threats, and support the woman in staying aware and relaxed through touch and breath. With a partner or by herself a woman can explore a very slow, gentle and lubricated penetration and gradually increase the size of the penetrating object (fingers, dildo, penis). By honoring every step of the process she can create a deep felt sense of safety that can allow her to relax the pelvic floor, open up and be free of her vaginismus. Depending on each particular woman and her story, this process can take from a day to many months.

Lack of Desire/Arousal in Women

Lack of, or reduced, sexual desire and arousal can be due to numerous reasons including depression, anxiety, stress, side effects of medication, physical illness, lack of physical fitness, changes in hormone levels, sexual trauma and sexual neglect. Excessive use of alcohol, cigarettes, recreational drugs or food, has a numbing effect on the body and represses rather than stimulates sexual desire.

Of particular importance to women is self-acceptance; if we don’t desire ourselves, it is hard to desire anybody else. Many women struggle with self-consciousness about their bodies, as few women fit the twiggy version that’s promoted by the media and fashion industry. Women have a tendency--when they don’t accept their bodies--to hold their breath in order to look thinner. The effect of that can be an activation of the body’s stress response, leading to increased anxiety--sometimes panic attack, as well as numbness throughout the body. No desire is born out of this. The key is to accept and celebrate the body as is, and let the curves of the belly, breasts and hips be manifestations of eroticism and not of imperfection. As age, hormones, and bodily changes make their marks we need to continue to rediscover our desires and arousal, and make adjustments in our behavior that fit with our current needs.

Self-respect in the form of eating a healthy balanced diet, exercise in the way that works for each woman and attending to skin and hair grooming all feed a woman’s sexual desire. The clothes, from inner to outer, can also have impact on how the sexual desire is stimulated--sensible is not always erotic and vice versa, but it might be worth, at times, to let go of the practical in favor of the erotic.

For many women a daily routine includes attendance to career, children, chores and partner, and it is easy to “forget” about sex, as one is too busy and tired to feel any desire. In this case women might have to nudge themselves to devote time for self-exploration and self-stimulation (masturbation). It is essential to be familiar with your erotic body to discover how and where you like to be touched and what goes on in your erotic mind (fantasies). By getting to know the uniqueness of your sexual body, what feels pleasant and what brings you to orgasm, you can smoothly guide your partner to do the right things, and much hurt and frustration can be avoided while much desire and arousal can be awakened.

Women and Intimacy

The different aspects of female sexual problems are tightly interwoven. Intimacy is deeply rooted in trust--of oneself and others--and many women have never had anybody they could trust and have never been taught or supported to trust themselves.

Discomfort with and distrust of our own bodies and sexuality (see desire/arousal) is another obstacle to intimacy, and it is essential that we let go of the critical dialogue that continually runs through our heads. Sexual intimacy requires our full presence--with ourselves and with our partner--as it is something we experience, and not something we can obtain through thinking and analyzing. Our computerized hectic lifestyle has little room for intimacy. To transition into intimacy from a competitive stressful day takes time, and it might be necessary to schedule time for “intimacy dates.”

Intimacy is about seeing and being seen and it emerges from the moment-to-moment contact between two people willing to surrender fully to the present. A number of actions, for instance - playing, gazing, holding, touching, talking, laughing, crying, listening, smelling, massaging, dancing, eating, submitting, dominating, and many more can create a bond of intimacy. By allowing the truth to be present in the spontaneous interaction there is hardly any action that could not be the site of an intimate event.