Some 20 or 30 years ago, it was assumed that 90 percent of erectile problems were caused by psychological or relational factors. But since our culture tends to veer wildly from one extreme to another, the majority view today is firmly in the opposite camp: faulty physiology is widely assumed to be the culprit. Luckily, there's been a neat, little remedy on the market since 1998: Viagra. Today it seems that the entire North American population not only knows about Viagra, but devoutly believes in its miraculous powers to restore the lost sexual vigor, and rigor, of youth.
Unfortunately, for the majority of middle-aged and older men experiencing problems getting and/or maintaining their erections, the drugs being promoted in the media are hardly a panacea. We've found that helping couples deal with erectile problems and other sexual realities brought on by the aging process has as much or more to do with their psychological and relational lives as it does with their physiological capacities.
Like the great majority of males, Bill learned from his first experience of sexual intercourse in his late teens that sex was powerful, self-validating, and completely predictable—desire, erection, intercourse, and orgasm followed each other as regularly, quickly, and easily as clockwork. Even more important for his masculine pride, his sexual response seemed entirely autonomous: his entire physical mechanism worked perfectly, almost regardless of the help or enthusiasm of his sexual partner.
Fast forward 33 years. Bill is 51 years old and has been married for seven years to 48-year-old, perimenopausal Cynthia (a second marriage for both). He's finding that his equipment is definitely performing below par. Like half of men by age 50, Bill has begun experiencing occasional difficulties getting an erection.