Sex is a critical component for men as it is meaningful to their connection. While men are typically reluctant to share their thoughts regarding their sexual concerns, there is a prevalence of sexual problems that generate frustration for men. These obstacles stand in the way of them becoming engaged, satisfying and confident partners, both in and out of the bedroom. Sex therapy can assist in enhancing self-esteem, alleviating anxiety and depression along with helping them to build the intimacy and connection they desire.

Sex therapy for men typically focuses on desire, arousal and orgasmic disorders. These typically include:

• Sexual Desire Disorders
• Erectile Dysfunction
• Premature or Delayed Ejaculation
• Sexual Identity, Orientation and Fetishes
• Sexual Abuse or Trauma

Men routinely ask for help with sexual functioning although there are times where either a paucity or an abundance of desire is a concern as well. In many cases the etiology of sexual dysfunction is psychological. However other common causes of inadequate sexual functioning might include endocrine, neurological and cardiac issues, medication side effects and overall lifestyle concerns. In many cases it is multi-determined.

As a sexologist, Dr. Winter brings together both traditional methods of sex and psychotherapy as well as state-of- the-art evidenced based therapies and techniques to help you restore your sexual functioning. With access to extensive and a unique blending of knowledge and experience, she will assess each and every factor to design and implement a treatment plan to help revive your sexual functioning and help you regain a satisfying sexual relationship.

In order to meet the criteria for hypoactive sexual desire disorder a man must have low desire and activity for sex and for sexual fantasy. The context of the relationship and stage of life needs to be considered when assessing whether or not a man has an issue. Like other sexual issues, emotional, physiological and physical as well as relational concerns all need to be considered. This particular problem is more prevalent in men aged 66-74 (41%) while men 16-44 only report this in 1.8% of the population.

The inability to attain or maintain an erection sufficient to achieve and maintain penetration, erectile dysfunction is present in almost 50% of men over 40. 26% of men under 40 seeking help.

Five to twenty percent of men in the general population have moderate to severe erectile dysfunction. Like most psychosexual disturbances, erectile dysfunction has at its roots in a multiplicity of causes. With repeated episodes, one develops performance anxiety, which only enhances the problem. Diagnosed via a thorough history taking and the exclusion of physiological or organic etiology and risk factors, erectile dysfunction is treatable via psychotherapy. Treatment focuses more on the root cause and assists the man in being more present in the sexual experience.

Erectile dysfunction can be primary (never having achieved an erection sufficient to complete the sexual act) or secondary (having had a prior completed sexual act). Both can have physiological and/or emotional etiologies.

Porn Induced Erectile Dysfunction (PIED) is rapidly becoming a prevalent problem today. An addiction, PIED is precipitated by the repetitive masturbation to images that are accessible, anonymous and, most of all, able to be manipulated. Before boys will experience a real physical relationship, many of them are becoming hardwired to function inadequately; it happens with older men as well however given that they have typically had successful sex prior to the onset of PIED, their prognosis may be better and their recovery quicker.

Sex therapy can help; often there is assistance from a medical doctor, typically a urologist, who can provide short and long term options as well.

Premature ejaculation is estimated to occur in approximately 24% of men. It is defined diagnostically as an orgasmic disorder in which the sexual act is completed within two minutes from penetration to orgasm.

Premature ejaculation can be primary (never having achieved completed sex since the outset of sexual involvement) or secondary (intermittent after a period of normal sexual functioning). The cause can be rooted in the mind and/or body- psychogenic or biogenic. Healthy functioning can be compromised at the emotional, spiritual, physiological, physical and relational level-that is, within the self and/or in the relationship. As with erectile dysfunction, there can be multiple root causes, more of which are becoming evident in today’s world.

One of the known etiologies is the learning of the behavior. That is, having had sex and/or masturbation interrupted whereby orgasm was achieved quickly can set the stage for challenges with orgasmic control. With the accessibility of pornography and the increase in multitasking and distractions in today’s world, this has become an increasingly common complaint.

The inability or difficulty achieving orgasm with penetration and with sexual desire is known to occur in approximately 8% of men. Defined as ejaculation that occurs after 30 to 45 minutes of intercourse, delayed ejaculation is least common of the sexual dysfunctions amongst men. Despite the difficulty these men are typically able to orgasm with masturbation.

Both physical and physiological etiology may exist to explain the difficulty, which for most starts after a period of normal functioning. Psychological reasons might include lifestyle factors, masturbation habits and emotional withholding.

Treatment carries with it a 70-80% success rate; without it there can be avoidance of sexual contact, a lowering of libido and marital and sexual distress.

Sexologist Dr. Winter has experience helping with with ejaculation disorders—both premature and delayed.