Sexual dysfunction depression
I saw man today who reported that he has intermittent erectile problems. He he has been experiencing the problem frequently quite recently, although he has had it occasionally all his adult life. He is very worried that this is going to ruin his relationship with the woman he has only been seeing for a few months.When the relationship started, in order to avoid any problems, he would take Cialis and that ensured that everything worked okay. Previously she lived in a fairly distant town and he visited her mostly on weekends. The woman is now living with him and so the opportunity for sex is more frequent also.
As well as that worry, he revealed a deeper issue. Some weeks ago, they went out drinking, and he got very drunk. According to his partner, at some point he said "I would rather f*** a rat than some fat bitch like you." He has no memory of this incident at all, and has never done anything like it before. So he is deeply concerned about this. And of course it put him off side with his partner big time. So this has made him even more concerned that if he is unable to perform sexually, then she is going to take this is as confirmation of what he really thinks about her, and she will leave him.
He has been to the doctor and had all the tests and everything seems to be okay physically. So the problem must be something psychological. I asked him what was going through his mind when he wanted sex, but couldn't perform. He said "it's like I always have something running through my head at the time like a song you can't get rid of. I can't focus on the thing because of this distraction."
Finding the psychological reason
I asked him "would you say that your mind is always busy?" He agreed. I asked him "do you find yourself dwelling on things that happened in the past?" He agreed with that too. I asked him "do you get irritated when people don't do things they should do? Like bad driving behaviour?" "Yes", he said. "I get really annoyed at other drivers' bad behaviour. It happens every day."
It was fairly obvious from this that he actually has depression. I asked some more probing questions and it became quite clear that he has dysthymia. Like most people with dysthymia, he had no idea that he had it. And no idea that it was affecting his behaviour in many ways.
I explored with him aspects of his behaviour since he was a teenager. And as we looked into it more and more, it became more and more obvious to him that much of what he was doing was in fact a reflection of his dysthymia. He then revealed that his brother has depression. And that uncle. Thinking about it, many members of his family showed quite clearly behaviour consistent with low-grade depression.
H0w Dysthymia affects behavior
I then addressed one of the common issues with depression, which is perfectionism. Most people with dysthymia have high expectations of themselves, and of other people, and get irritated when these expectations are not met. It is quite likely that is sexual dysfunction is related to this. One possible mechanism is that he thinks about the fact that it might go wrong, and that would lead him to deep embarrassment. The more he thinks about the possibility, the more anxious he gets, which leads to exactly the thing he doesn't want. He is actually worrying himself into erectile failure.
The same mechanism would explain his outburst when he was drunk. Alcohol removes inhibitions. I would speculate that some point during his drinking binge, he began to dwell on his sexual problems and how he felt about that. In his drunken state that would have accelerated into an overwhelming feeling of frustration, and he just lashed out.
So the next stage is to help him deal with the way he thinks. Normally three or four sessions are enough to get rid of most of it. I am quite positive about the outcome.