Psychological Self-Help

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effective for only 5 or 6 hours; actually, nothing happens penis-wise if
the man doesn’t experience some sexually arousing situation or
fantasy. That is, you don’t get an erection just by taking the pill. The
little relaxing muscle doesn’t make you more horny or more potent, so
don’t think of Viagra as an aphrodisiac. There are some reported side
effects: headaches, painful erections, upset stomach, and vision
problems (difficulty distinguishing certain colors or just poor vision for
several hours). And, of course, the long-term effects of frequent use, if
any, are totally unknown. Caution: Reports in February, 1999,
indicate that a few healthy men, who have misguidedly taken Viagra
as an aphrodisiac, have permanently damaged their penis so that
getting an erection becomes difficult or impossible permanently. Also,
it could be dangerous to take Viagra with heart medicine or with
certain recreational drugs, such as nitrates ("poppers"). Be careful. 
Perhaps the most important thing to realize is that the Alternative
Medicine snake oil salesmen are out in full force attempting to make
big bucks selling their potions to uninformed people who have heard
about the real scientific breakthrough (Viagra). The cons waste no
time... during the first month after the FDA announcement I received
five or six medical-sounding ads for some miracle herbal cure for
impotence. The best advice, at this time, is to get a prescription for
Viagra from your doctor. Don’t order something through the mail. 
Health insurance will, in some cases, pay for Viagra or, at least, for
5 or 6 per month. Other companies said they would pay for
physiologically caused impotence but not psychologically caused
problems, but this seems discriminatory and besides it is likely to be
hard to tell the difference. 
An average, normal male has several erections every night; even
at age 65 the penis is erect an hour and a half every night! If erections
do not occur after being checked and treated for physical problems
and taking Viagra, then psychological treatment is needed. Most
therapists treat an erection problem by (1) teaching the male to
satisfy his partner without using his penis and (2) having the partner
stimulate the penis repeatedly (without intercourse or ejaculation)
until the male gains confidence it will work. Most importantly the
relationship often needs to be worked on, especially resentment and
feeling insecure. There is a self-help book for this problem (Williams,
1986). A variety of psychotherapies have been effective about 2/3rds
of the time, reflecting the role of psychological and interpersonal
factors. But don't overlook the physical causes and the new drug,
Viagra; they are important first steps. 
Anxiety is when for the first time you can't do it a second time; panic is when for the
second time you can't do it once.
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