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Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr. Margarita Holmes.
Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in three continents, he has been training with Dr. Holmes for the last 10 years as co-lecturer and, occasionally, as co-therapist, especially with clients whose financial concerns intrude into their daily lives.
Together, they have written two books: Love Triangles: Understanding the Macho-Mistress Mentality and Imported Love: Filipino-Foreign Liaisons.
Dear Dr. Holmes and Mr. Baer,
Thank you for your time reading my letter. I am 56 years old. I notice that my sexual performance has diminished and I can’t even perform, not even 30 minutes.
My partner keeps on arguing with me because I am not able to satisfy her in bed. I am not an alcoholic, not even a smoker, so why am I suffering from this?
Thank you for helping me.
– Rob
Dear Rob,
Thank you for your message.
What you’re describing — difficulty maintaining sexual activity for extended periods and changes in your performance since 2017 — is quite common. The fact that you don’t smoke or drink heavily actually eliminates two common causes, which will be helpful information.
Erectile dysfunction can stem from various factors: stress, relationship dynamics, hormonal changes, underlying health conditions, medication side effects, or simply the natural aging process. Even seemingly unrelated issues like sleep quality, exercise habits, or dietary changes can impact sexual function. Long COVID is also a recent addition to this list.
Rather than focusing solely on “lasting longer,” perhaps you should consult a healthcare provider for a proper evaluation. They can check for underlying medical causes and if appropriate discuss treatment options tailored to your specific situation.
If there is no medical issue, the problem may well be psychological. You could then consult a therapist or counselor who specializes in intimate relationships, as factors such as performance anxiety, depression and past trauma often play a significant role, either alone or in conjunction with physical issues.
Finally, you should have an open, compassionate conversation with your partner about exploring different approaches to mutual satisfaction that don’t simply emphasize duration. Remember that intimacy involves far more than just one aspect of performance and couples can find great satisfaction through broadening their definition of intimacy beyond the traditional. Sex is after all multifaceted and penile penetration is absolutely not the only route to orgasm, as even a cursory search of the internet will illustrate.
Best wishes,
JAF Baer
Dear Rob,
Thank you very much for your letter. I am sorry that you are undergoing your current difficulties. I am also sorry that there isn’t much more I can tell you in addition to what Mr Baer already has.
The best thing I thought I could offer is expound on Mr. Baer’s suggestion that you see a health care provider, ideally a urologist.
This is usually the first thing sexologists tell someone suffering from erection difficulties. The reasoning is simple: A urologist can determine whether your erection difficulties/dysfunction (ED) has a physical/physiological basis or not.
If he rules this out, then at last you know for sure that your problem is psychological and seeing a non medical professional will be the only help you need.
However, if your urologist discovers a physical reason for your ED, whether it be the only reason or a combination of both physical and psychological problems, they will at least be able to deal with the physical issues. Sometimes, a man might be treated by both a urologist and a psychologist for the same period of time, and that might be the most promising solution yet.
In addition to an in-depth lifestyle evaluation and sexual history, the following are medical tests a doctor might ask you to take. Two of the more interesting ones are the Ultrasound Examination and the Artificial Erection Test (AET).
Both tests require injecting the penis with medication, but I have been reassured (both by the doctor and the client) that this sounds far more painful than it actually is.
A duplex ultrasound is a test to examine the blood flow through the arteries and veins in the penis. It combines traditional ultrasound with doppler ultrasound. Traditional ultrasound uses sound waves that bounce off blood vessels to create images. Doppler ultrasound records sound waves reflecting off moving objects (example: blood cells), to measure their speed and other aspects of how they flow.
This procedure involves the injection of erection inducing medication into the penis. The drugs cause a dilation of the blood vessels supplying the penis, thus causing an erection. Men with diseased blood vessels which may be caused by high blood pressure, arteriosclerosis, diabetes, etc., will not develop a full erection. Therefore, the test will tell us whether the erectile dysfunction is due to arterial vascular disease.
In addition, the ultrasound allows the doctors to visualize the cavernosal arteries and muscle tissue, allowing for the detection of abnormalities such as fibrosis and calcifications of the erectile muscle.
Lastly, the ultrasound examination can detect the presence of what is called a “veno-occlusive dysfunction,” which is what prevents the trapping and storing of blood in the penis, which is necessary to maintain an erection.
Another test is the Artificial Erection Test (AET), which involves injecting a powerful erection inducing medication (most common compound is Alprostadil) in one of the corpora cavernosa of your penis. After the injection, the doctor will evaluate your erection hardness score using the following scale:
0 – Penis does not enlarge.
1 – Penis is larger, but not hard.
2 – Penis is hard, but not hard enough for penetration.
3 – Penis is hard enough for penetration, but not completely hard.
4 – Penis is completely hard and fully rigid.
If you have a low score then the doctor might gradually increase the dose of the medication until you get a 3 or 4 score. Based on your response and the maximum dose administer, the doctor will be able to assess the severity of your ED.
The AET is a very useful tool to identify patients whose erections are very severely damaged and who do not get any response from the injection. In such rare cases (less than 10% of men suffering from ED) the only viable treatment option is usually a penile implant surgery. In addition, the doctor is able to examine the penis in the erect state and note any abnormalities such as plaques or curvature seen in Peyronie’s disease.
Dearest Rob, all this information sounds so antiseptic and impersonal but in reality, the doctors, nurses, lab technicians, are warm and helpful, especially since they know how nervous you must be. Knowing this is your first step on your road to recovery will inspire you to carry on.
All the best,
MG Holmes
– Rappler.com
Please send any comments, questions, or requests for advice to twopronged@rappler.com.
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