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New York City Sex Therapy Diary: The Other Side of Saturday Night

Want to Test Your Knowledge of Male Sexual Psychology?  

Take this quiz:

QUIZ:  It’s Saturday night.  Paul, 25 years old, is on a date with a new woman whom he likes very much and finds very sexy.  Unfortunately, later that night when they undress together, he suddenly has no erection.  She is very understanding and kind, and tells him it’s OK.

QUESTION:  What will Paul most likely do in this situation?

A.  He’ll feel reassured, and they’ll go on to have a wonderful evening together.

B.  He’ll go home very depressed and spend the rest of the night feverishly masturbating to prove to himself that he can still get hard.

You all know the answer — it’s B, right?  Loss of an erection — what we call Erectile Dysfunction, or ED — in the presence of a new partner.  It’s one of the biggest psychological catastrophes that can happen to a young man.

Despite over 20 years in the sexuality field, I’m not sure if I understand exactly why ED is so dramatic for men.  But it is.  Men’s partners often tell me that the worst part of living with a man with ED is dealing with his moods after an episode of erectile failure.

When ED is due to psychological factors, it often occurs right before intercourse.  Which is another mystery.  The fact that a man’s erection should suddenly lose power in anticipation of intercourse is a source of confusion for women.  They worry that they’ve somehow turned the man off.

Why would a man, or his penis, slam on the brakes in anticipation of intercourse?  That’s a deep question.  We’ll discuss it in future articles.

But for now let’s get back to Paul, and to our quiz.  These days, in New York City where I work, someone like Paul has a relatively new option available-

C.  He’ll go online.  He’ll google “Manhattan sex therapist,” or something like that.  He’ll scroll down the list of names, looking for a sex therapist.

Since the scenario in question often happens on a Saturday night, many times C happens on a Sunday morning — which is when Paul is mostly likely to call.


Meanwhile, Somewhere Across Town . . .

Sunday morning I sometimes go to the office for a few hours —  to escape the noise of my kids watching TV at home, to catch up on some paperwork, and to enjoy the peace and quiet.

When I get to the office Sunday morning, I sometimes find a message from someone like Paul.  He’ll usually be surprised that I called him back so soon.

We’ll have a brief conversation about the problem.  A thought will occur to him, and he’ll ask, “Is there any chance I could see you today?”

If I’m just doing paperwork, I’ll tell him to come right over.

It takes courage to go see a therapist on a Sunday morning about a sex problem — since it involves trusting a complete stranger with very private information.  At a time of profound discouragement, when one can’t really risk feeling much worse.

When he arrives, I’ll have an hour or so to figure out what’s going on. Most often, ED due to psychological factors is not a “dysfunction” at all. It’s just the sexual system doing its job, which is to evaluate the situation and decide whether it feels comfortable or not.

The sexual system is very honest, but its vocabulary is limited.  All it can do is say yes or no.  We all do things at times to try to convince our sexual systems to say yes when the sexual system knows better.   And the result is usually frustration.


Getting Back on Track

Before Paul leaves my office, I’ll present him with a plan of action. This usually includes practical suggestions (stay tuned for discussion of the more common issues in future articles) — together with some form of psychotherapy.  And sometimes medication too, such as Viagra or Cialis.  My goal is for him to leave the office feeling relieved and hopeful.

I’ll consider it a morning well spent.  There’s a saying In the Jewish tradition — “He who saves a life, it is considered as if he saved the whole world.”

It would be an exaggeration to say I helped saved Paul’s life.  But it wouldn’t be a crazy thing to say, either.  Helping someone get back on track with sex, and with all that goes with it such as finding a life partner, sometimes feels almost like saving a life.

Next Sunday, we’ll see who calls.  Whoever it is, he’s probably just now making plans for Saturday night.

stephen snyder md author photo Stephen Snyder, MD

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