SOS: Save Our Sexlife (Or, Do-It-Yourself sex therapy when your man has erectile disorder he won't treat)
Dear Duana,
This New Year’s, I’m resolved to get my husband’s and my sexlife back. We’re best friends with a great sexual history—but for two years, he’s had erectile dysfunction he won’t discuss or treat. Eric says is he’s “fine” with how things are. I think it’s closer to truth to say he’s anxious and would rather shut down sexually than be crushed by trying something that doesn’t work. Is there a way to resume sex of *some* sort with the man I love and married?!
Cassandra
Dear Cassandra,
I hear your frustration, but I’m not a sex therapist. I could claim to be—in most of the USA, *anyone* can
So you might have to treat Erik’s ED* under-the-radar, and here’s how:
1. Rule out physical causes.
Ever met a guy with a penectomy**? I have. And I think if more men understood what that implied, they’d visit the doc at the first sign of ED.
ED is a frequent early sign of diabetes and other conditions that need immediate treatment to preserve life and, um, limb. Left untreated, diabetes doesn’t just create dead wood in 28% of men—it can, albeit rarely, result in guys who are literally dickless. And I’ve never met the man who was “fine” with that.
Which is why I didn’t suggest slipping Cialis™ into Erik’s morning brew; you don’t want to treat only the ED if it’s firing red flares about your man’s health.
Instead, reflect on this core finding of marriage research: Nagging Saves Lives
2. Figure out Erik’s head.
Given your prior active sexlife and emotional closeness to Erik, you’re probably spot-on that he’s not really “fine”, but has instead reached such a point of such fear that attempting any treatment feels threatening.
A partial list of the Bone-A-Fide Psychological Causes Of ED includes three that seem especially pertinent:
—Wrong Beliefs, such as, “My penis should always get hard when I want and stay that way the whole time, or sex is worthless,” “Aging should not affect my erection,” and/or “I’ll never get an erection, so why bother?”
—Performance Anxiety, aka worry about what Mr. Weenie will/won’t do; and
—Spectatoring, a term Masters & Johnson coined for when folks spend their sexual time as if they were outside their bodies and keeping score of their performance.
3. Get your sexlife back.
At this point you haven’t much access to helping Erik correct Wrong Beliefs, because he won’t discuss what isn’t up.
But you have a formidable ally for eradicating Spectatoring and Performance Anxiety—and it lets your hands do the talking.
The technique, called sensate focus, was invented pre-1970 by Masters & Johnson, and its success is based on eliminating a goal orientation in sex. Best part? You recover some level of sensuality immediately, and you get back some of your sexlife (usually All Of It) within a few weeks.
—First, offer Erik a massage. It’s a nude, non-sexual massage, and you should tell him that to prevent anxiety. Genital touching is disallowed. (That’s a rule). He’s the “getter” who makes noises, lifts a finger, or in some way indicates when you do something he likes. You’re the “giver” who *avoids his Groin* while lovingly stroking other areas of his body. If he gets an erection, ignore it. (You are allowed to be secretly pleased.)
—Second, repeat step one exactly, but this time you receive and Erik gives. If he goes for your nether petals, gently guide his hands away and maintain focus on the rest of your body.
Repeat giving and receiving twice a week for at least two weeks; after that, the “getter” can guide the “giver’s” hand…just not to the Groin.
—Third, in another week or so, lift the Groin Ban. Continue trading off “giver-getter” roles a couple times per week, but add stroking one another’s genitals along with the rest of the body. If Erik gets an erection, that’s fine, but don’t continue touching it, don’t make a Deal out of it, and don’t give one another orgasms…yet. Just smile and touch him elsewhere.
—Fourth, when it feels right and you’re the “giver”, incorporate repeated teasing of Erik’s penis into your session (you might want to tell him you’re intentionally being A Tease). Get him hard—stop ‘til he’s soft again- and then repeat, repeat, repeat.
Without discussion, this shows Erik he can have an erection; confronts his possible fears that if he has one erection, he’ll never have another; and helps him enjoy feeling his own pleasure for its own sake.
—Fifth, if and when Erik’s erections become a matter of course, you can ask if he’d like to be inside you. If he says no, be okay with it—when you’re both ready, you can bring one another to orgasm orally or manually. If he says yes, have intercourse for a few very slow, woman-astride, non-demanding motions before “finishing off” some other way (*not* while he’s in; it’s a rule). If erection is lost, return to manual teasing until penetration can recur.
—Eventually, it’s very likely that both you and Eric will be oh-so-ready to have coitus to the point of orgasm. Go for it. Even then, though, it’s advisable to prevent an ED relapse by repeating the first two steps at least once per month.
Cassandra, occasional ED is an occasional fact of life for many men, especially as they age—nothing and no-one can guarantee the permanent end of ED. But this plan has a high success rate.
And it has near-100% odds of returning some form of sex with the man you love while bringing both of you pleasure and communication and comfort you haven’t had in a long, long time. Here’s to a Happy New Year.
Cheers,
Duana
*ED = erectile disorder: The inability to get or keep a desired erection
**penectomy = complete or partial removal of the penis
If this article surprised, enlightened, or made you squirm when the word “penectomy” was presented, please click “share article” below to distribute to your favorite social media.
Do you have a question for Duana? Contact her at Duana@lovesciencemedia.com.
Related Love Science articles:
Penis size—when it counts: http://www.lovesciencemedia.com/love-science-media/when-size-matters-penis-size-and-womens-satisfaction.html
Penis size Q&A: http://www.lovesciencemedia.com/love-science-media/comments-from-when-size-matters-penis-size-and-womens-satisf.html
The author wishes to thank the following scientists and sources:
—Janet Shibley Hyde and John D. Delamater, for Understanding Human Sexuality
—Inigo Saenz de Tejada’s thorough work on how the penis functions, as well as pathologies (such as diabetes) that cause dysfunction.
—Linda J. Waite and Maggie Gallagher, for proving that Nagging Saves Lives in their book The Case for Marriage
—William H. Masters and Virginia E. Johnson, of course. They invented sensate focus and changed the world for countless people with ED and other sexual problems way before Viagra™, Levitra™, or Cialis™, oh my. Their book Human Sexual Inadequacy
—Raymond Rosen, Sandra Leiblum, and Ilana Spector, for creating a comprehensive way to treat ED that includes sensate focus, education that combats false beliefs, sexual novelty to keep the fire burning, help with conflict-resolution strategies so you’ll still like one another enough to have sex, and (most brilliantly, I think) training to prevent ED relapses. If I were looking for a sex therapist, I’d click the link and call Dr. Leiblum.
—Paul Joannides’ The Guide to Getting It On
—And if you just want to read a quick, accurate overview of general sensate focus techniques on the Internet, this was the resource I found to be most clear: http://www.partnertherapy.com/node/365
All material copyrighted by Duana C. Welch, Ph.D. and Love Science Media, 2011.
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Reader Comments (28)
Well written, interesting and enjoyable discussion, Dr. D. Not to mention, quite witty.
Strangely, though, a song is now playin' in my head:
Little Willy, Willy won't go home
But you can't push Willy round
Willy won't go, try tellin' everybody but, oh no
Little Willy, Willy won't go home
At least it's from the classical era ;-)
As a male I find this incredibly difficult to read so I can easily understand Eric's discomfort and embarrassment. In Eric's defense, I think there are other contributing factors to having his body shut down the way it has. In relationships life becomes overwhelmingly busy, routines in the home that become patterned can be a threat to keeping the passion and intimacy alive for a couple. A colloquial phrase that comes to mind in terms of the aging process is "you gotta use it or loose it," and unfortunately this pertains to our sexual biology as much as it applies to other physical functions. Fortunately, as couples grow older together they have each other to witness signs of decline in each other's health. Since there is an overriding expectancy for males to be heros, leaders, and problem solvers for others it's very difficult for men to address their own needs for help. I admire Cassandra's tenacity in staying dedicated to her marriage outside of having her own needs met and out of true concern for her husband. Cassandra demonstrates bravery in not giving up amidst her frustrations and for stepping out on a limb to write and submit a letter asking for expert advise. The main factor that allowed me to read through such an uncomfortable article was the fact that there was so great compassion and support being offered as a solution to the problem. Luckily Cassandra's bravery met it's match in finding Dr. Welch's confidence in how to plot an effective recovery system complete with step-by-step instructions on how to win back pleasure that was lost. Aside from Dr. Welch's scientific training and Cassandra's strength as a wife, I have no idea how women intuitively sense what turns men on the most. This situation has been gradual in the time its had to subside and shut-down; I think the recovery strategy balances against that gradual slide by also maneuvering slowly in it's graceful approach guiding Eric back to life. Eric like most men feels striped of his power and bravado with what he's facing so I think it's clever to tease and hold out providing him room to engage as the aggressor as he regains his footing sexually. I wish we could fast-forward in time because this article leaves nothing to the imagination in how to seductively recapture passion after falling astray into a long dormancy. I might also suggest viagra for Eric. Viagra doesn't work all by itself but it would definitely help in the middle of getting a massage. I think it would be beneficial even as an experiment when the focus is directed away from the genital area.There's enough heartache and embarrassment involved here already I'm glad the therapy suggested offers playful participatory ways to toy around and have long-range fun bringing recreation back for both to share. I'm glad their's no expectation for Eric as well, it seems like everyone gets to enjoy the rewards that simple closeness and touch allows so everyone can sit-back allowing nature to undo what it's done while no one payed attention. Good catch on the wife's part Erick's lucky to have a partner who has not only his back but tackles his needs head on from the front as well. Sorry I'm a guy, but mean well, and hope for the best!
Dr. D. -- do we have any way of knowing how many couples actually go through this process as you have spelled it out? I can only imagine how hard it would be for a man to hold off after finally getting an erection, no matter how "unstable" it is. How often does one partner get too excited and blow the whole thing? Can jumping the gun become an issue in itself?
Wow!!! Beside the actual problem, I "loved" the details. :)
As a comment on the viagra or cialis, I agree with Dr D that you might want to check with your physician. I have know men to have heart attacks using them. Also, some high blood pressure meds can have the ED effect. It might be as simple as a med change.
Testimony: "jumping the gun" can be a problem for an inexperienced man. Not as much of a problem later on in our lives. One man's observation. Each man is different, yet strangely similar ;-)
When I hear of 80-yr-old men fathering children, my response is HOW?!! Guess I just assume that ED occurs in all men as they age. When my sweetie was in his mid-50's he began having problems. My first thought was Low Testosterone, thanks to the hilarious TV episode when Coach procured a testosterone patch. Hubby was terribly frustrated, and I asked when he'd had his last complete physical exam. 35 years. Honey, we should all get a complete physical once we turn 55...there may be something physical that's causing this problem. When he arrived home from his visit with the doc to discuss results, he said he was met with this question: "What the hell is going on with your blood?!!!" Turns out he was anemic. Long story, not relevant to this discussion. After a series of tests, all serious medical problems ruled out, his blood pressure med was changed and he began taking multivitamins. His stamina and vitality did improve, but some other medical problems began to surface.
When he was in his early 60's I began accompanying him to the Dr., which did not bother him at all. He finally told his urologist of the ED, which was occurring more often. Viagra was suggested, and he agreed. Long story short...4 yrs ago he was diagnosed with early-stage Parkinson's. We've gone through many adjustments involving our sex life because of this illness...trying Cialis (no help), then learning to enjoy our rolls in the hay without worrying about Results. He now uses Viagra and a pressure pump...I'm post-menopausal & use sensual jellies. We do massage, we massage all areas...if you get my drift...and have a wonderful time together. Fortunately he is a wise man who realizes his worth does not lie in his dick.
For those men who shut down emotionally when Johnny no longer obeys his instructions, Dr. Duana's advice is perfect. Communication is the Key, but when communication breaks down one must seductively sneak in the back door. In these cases, the Hands are more effective than the Voice. Subtly & seductively demonstrating to your sweetheart that he is desirable & turns you on is paramount. To you guys out there...this will very likely happen to you. Take it from a couple who has lived through it and still giggles w/joy between the sheets, it is not the end of the world.
Gillian finds the article and its comments to be most excellent. Earthy. And Vivid. However, being somewhat of a prude (she is working on that) she finds it warm it here, and has decided to open the window. Ah, much better.
I would like to know: Are there any studies about the frequency of married sex between mates for the middle-aged set? Say those of us 40- 55, or better?
Please keep these outstanding, thought-provoking and personal stories and comments coming (no pun intended...well, okay, maybe just a little). I will check back in with some responses very soon! Well done, Wise Contributors--can't wait to see what you write next.
Interesting article. Eric's age isn't given, but if he's over the hill it comes with the territory, hun. If he's young, consider the ears, as in what's between them. Some men think sex is dirty. Or at least they think the woman is too pure. Once upon a time a guy told me I was "Snow White" and that's why his ding didn't dong. True story. Nice article.
Well, if I was a Chevy I'd be a classic and probably in a Frankie & Annette movie. And all the original hydraulics still lift just fine. Yeah, with age comes an undeniably greater chance of failure but fortunately it's not a given.
There was one time that I experienced that letdown . . . it was the first time after my divorce. My female friend was more disappointed for me than I, I think. I was somewhat embarrassed, but fortunately I hadn't left her frustrated. A week later, I was as good as new and we went on to date and have fun for a few months.
My point: it was all in my mind at the time. Too many memories of being married, and too much self-imposed performance pressure. I had to learn to relax, slow down, focus on the person I'm with, and take myself and "performance" less seriously.
Being tired can put a guy at risk. That includes being "tired" . . . not having had enough of an interval since the last time. And that one varies per individual guy.
Ideal frequency: I know I'd be perfectly happy with a couple times a week, at my advanced age ;-) More often than that and I start feeling like I'm a quart low. It can be a good thing to be rested and eager.
Difficult subject, lots of variables. A morning erection indicates normal functioning, but fatigue, depression, or a lack of "excitement" can reduce or disable the sexual response when it may desired.
I read that those of who perform aerobic and anaerobic exercise regularly are increasing the lactic acid or lactates in our blood, acidifying the blood and inhibiting nitric oxide.
Nitric oxide allows our blood vessels to operate properly to fill and regulates them to help seal off the corpus cavernosum (the erectile tissue of the penis) once it is filled with blood.
Viagra (Sildenafil) helps with vasodilation and assists by providing a competitive molecule that binds to receptors that would otherwise remove or degrade nitric oxide and important transmitter chemicals in the blood that are used for getting and keeping an erection.
Turns out we men are a little bit complicated too.
Great topic as always. And the responses have been great as well. I think, like many responses, Eric's situation may not be one specific thing. It sounds as if it may be many. I don't think you can ever rule out physical challenges that may come with age or health but his reluctance to address it (or conclude he's fine) says a lot. I would think its natural to have some embarrassment if this is Eric's initial experience with dysfunction but just like with a woman an menopause, experiencing this probably comes with some internalizing reality setting in and could put someone in a shell. There's a sensitivity that comes with it.
But I think many men would agree, even in our youthful age when the smell of perfume in passing could trigger a semi, a relationship that is stagnant or personal issues that are weighing heavily in ones life could compound the issue. It may not be the partners fault but the partner is the face of that reality and there's no way to escape the issues to get motivated for passion. I've heard of young married couples in their late 2o's and early 30's who say they no longer have sex. Cheating would be an easy assumption but they claim to be embedded in their lives and have simply no energy or desire for that part of their relationship anymore. And to their proclamation, "They're fine!" We know they can't possibly be but if not addressed, like with anything, that part will atrophy. (No pun intended)
I was doing fine being all smug that this article is about men's problems until Quinn brought up the "M" word, menopause, and brought me back to reality that there's a female side to this, too :-). No offense, Quinn, reality is a good thing. But it got me to think - isn't ED actually the male equivalent of a woman's menopause? Calling it a "disorder" when every male is going to experience it at some point seems a little harsh to me.
I like Quinn's comment. Please write more about celibate marriages.
Dear SPC Horrigan, Tom, Vincent, B, Carmen, and Anon:
Thank you so much for your thought-filled letters (Tom, I particularly admire your bravery and Carmen’s in sharing your personal experiences).
This article was among the most difficult for me to write, for two reasons:
a) To state the obvious, I don’t have a penis, and therefore I don’t possess the psychology that comes with such ownership; the learning curve was larger than usual for me. So I really appreciate all the feedback from those of you in the trenches ;).
b) As you’ve all pointed out most correctly, there are *so many factors* that can cause ED. It was frustrating to describe just four in a 1,000-word article.
You each mentioned things that didn’t seem to play a role in Cassandra’s and Erik’s case, but which are *definitely* important for many men: age, medications, depression, stress, the refractory period, and lack of excitement (false beliefs such as those reported by Anon; performance pressure such as Tom experienced; illness as Carmen detailed; and others were covered in the original article).
It’s true that all of these and more contribute to ED.
AGE:
Age does not actually cause anything. But the passage of time permits the accumulation of plaque in the arteries, the progression of many chronic disease processes, the need for meds to control disease processes, and many other things (nicotine, alcohol, uncontrolled blood sugars) that mess with blood flow.
And since erections are about blood flow, anything that messes with that can quash The Hydraulics. Therefore, ED increases significantly with age.
In fact, ED is the most common sexual problem men report, and with age that only becomes truer; whereas 7% of men in their 20’s have had at least one time in the last year where they couldn’t get or keep an erection, the rate jumps to nearly 40% by age 60+ (as Carson and others found in 2002, and a helluva lot of other guys figured out in their bedrooms before that).
The truth is, ED is basically a normative thing. If you look at the lifespan, at some point, most men will experience a time when Willie won’t do his will.
Which makes me wonder: Should we call ED a “dysfunction” or “disorder” at all?
MEDICATIONS:
Some medications (for example, many that are used to treat high blood pressure) have the unfortunate side effect of causing ED.
Pharmacists--*not doctors*-- are generally the best-educated professionals regarding what meds do. If you want a professional opinion about whether your meds could cause ED, and whether there’s another med that could treat the health issue *without* limping your Noodle—take your meds list to a pharmacist. Usually, they’ll give you a free consult!
DEPRESSION:
Clinical depression is often referred to as the common cold of mental disorders, but it feels more like the aftermath of a train wreck. One of its possible symptoms is loss of interest in activities that used to be enjoyed…such as sex. ‘Nuff said.
STRESS:
Men may have the Ever-Ready reputation, but stress isn’t an aphrodisiac for either sex. And chronic stress, or stressors that attack a man’s sense of self-worth (such as long-term unemployment) are wood-busters.
THE REFRACTORY PERIOD:
Tom, this wouldn’t have made the list without your astute and brave personal assertions about tiredness between sexual encounters. So thank you for that.
I don’t know if you ever heard the claim that men are at their sexual peak in their late teens. ? But that claim is based on this fact: The time between a man’s orgasm and his ability to have his next erection—aka the refractory period—is at its shortest when guys are really young.
And this timeframe steadily increases over the lifespan. By the time a guy is in his 60’s, it may take a full 24-48 hours or longer before a guy can get wood after he’s had an orgasm. (It also takes more and more physical stimulation for an erection to appear even after the refractory period.)
Fortunately, a short refractory period is *not* how women define a guy’s sexual peak :). Simply watching It go up and down in rapid succession is not really a WooHoo for us.
In fact, studies of aging show that women and men become more similar sexually as they age—both taking more time to Get Aroused, more time to Get There, both becoming more about the Process than the Result, both becoming more into feeling With Their Entire Bodies.
And especially in long-term relationships, if men will let go of their Wrong Beliefs About Their Penises/Performance, the opportunity may never have been greater for sexual closeness and physical expression of intimacy. In fact, really intimate sex—the kind where you *have* to talk to one another and be attuned to a particular person and not just another body—almost becomes the only form of sex that’s available!
LACK OF EXCITEMENT/THE COOLIDGE EFFECT:
As B rightly observed, lack of excitement can play a role in ED. In fact, throughout the entire mammal world, young and healthy males—including humans—will often develop an erection right away in response to a new partner when their response to an established partner has ceased.
It’s called the Coolidge Effect due to an apocryphal story about the former US President and his wife. Apparently, while touring a chicken farm, Mrs. Coolidge asked if the roosters mounted the hens every day, and was told that indeed, roosters mated multiple times a day. “Tell that to Mr. Coolidge,” replied she. The President then enquired, “Always with the same hen?” When told that no, the rooster always chose a new hen, President Coolidge responded, “Tell that to Mrs. Coolidge.”
Anyway, the evolutionary reason behind the Coolidge Effect seems to be that males can sire a lot more offspring—casting a wider genetic net—if they fool around, since if they are utterly faithful, a wife can only produce a few children.
That said, the Coolidge Effect is not the only reason for Boredom. Sometimes, Boredom isn’t that at all—it’s Anger.
Although women are the ones with the reputation for sexual shut-downs if the quality of the relationship is poor, there are men who lose all sexual interest in a partner to whom they no longer feel close. Some men will end the sexual element of a marriage and stay for the childrens’ sake, for instance, so they can provide for their family without facing the false intimacy of sex with someone who is no friend.
Gillian, I am glad opening the window helped, lol.
Thanks for your question. I could not tell whether you were more concerned about how common ED is with age (if so, I've answered under "Age" in the comments above)...
or whether you were more worried about whether loving couples still continue to have sex as they age.
If your question is the latter, here's some news: The #1 reason middle-aged and older women don't have sex is the lack of a willing and able partner.
And if we eliminate Unwillingness (please see "Lack Of Excitement" in the comments above), then we're looking at disability. Which can equate ED, or physical immobility as from Parkinson's or MS or another issue with movement.
I'd like to add, though, that I think it's very important to consider the Big Picture when thinking about What Sex Is. If it's strictly penetration with a penis, then that rate declines over time even in the era of Viagra.
But if we're willing--as Cassandra was--to consider our sexuality in totality, then sex never needs to stop. Barring a really severe impairment, most of us will have hands or tongues that can tease and please a mate all our lives.
Aging, if anything, may gradually close the door (for many, though not all) on Penetration As The Only Form Of Sex...but it opens a whole lot of windows into the joys of touching and being touched, loving and being loved, in an abundance of Other Ways.
Go open that window again :).
Dear Monica,
Great questions. I want to thank you for asking for specifics about sensate focus, because I think it’s gotten short shrift ever since Viagra’s™ advent.
I don’t know—or even know if it can be accurately known—how many couples per year use the Masters & Johnson-developed process of sensate focus. I *do* know that M&J claimed a success rate of about 82% across multiple kinds of sexual disorders when couples used sensate focus, and that sensate focus “works” for everyone in the sense of restoring various levels of physical intimacy. For couples who haven’t touched one another in years, Day 1 of sensate focus is a breakthrough that no drug on its own could achieve.
And here’s my opinion: You can’t really screw up sensate focus. Even if a couple jumped on the first erection like a duck on a junebug, they could always treat it like any other lapse (such as lapses in dieting, alcoholism recovery, etc.):
Think to oneself, “lapses happen”; return to The Plan (or diet, etc.); and in sensate focus, continue to reconnect with the whole body in a gradual, pleasure-rather-than-goal-focused-way; and enjoy.
Carmen, what a fantastic, inspiring letter. I so admire your honesty and candor about an issue many people won’t discuss in even the most roundabout way. You’re a one-woman guru when it comes to showing us the path to Intimacy—damn the ED.
Before I go on with the details, this sentence of yours bears repeating: It’s “a wise man who realizes his worth does not lie in his dick.”
And a wise woman who helps lead him to that realization.
That said, I really like how you shared your process of reclaiming your sex life with your beloved husband, from going to doc appointments with him, to understanding what various meds and physical ailments were doing to his body—and how that was affecting his psyche—to ultimately, through a combination of approaches, mutually “learning to enjoy our rolls in the hay without worrying about Results.”
Which brings us to Levitra™, Viagra™ and Cialis™, Oh My!
I really appreciate that nobody took me to task because I skipped over these three wonder drugs in the article. It’s not that I fail to appreciate the impact they’ve had on many, many a couple’s lovelife.
But. As Vincent and Carmen pointed out, the drugs themselves can cause other problems, mask dangerous problems, or just plain not work for a given man.
For instance, for you and your husband, Carmen, it took a couple of years of trying out various meds (including Cialis™, which didn’t work, and Viagra™, which did) *plus* a penile pump, erotic massage, lubrications, honest discussion with compassion, and an understanding that an erection *still* might not occur.
And as SPC Horrigan pointed out above, for many couples, ED came on gradually and took its toll emotionally over a period of time; often, part of the fallout is an eventual and total cessation of *any* kind of physical contact, which can really get in the way of emotional connection. It’s said that men need to have sex to feel emotions, and women need to feel emotions to have sex, but any way you look at it, touch is important. For couples who haven’t touched one another in years, Day 1 of sensate focus is a breakthrough that no drug on its own could achieve.
There Is No Substitution For Getting Touched. Touch is a human need, not merely a want. Before there were drugs for ED, there was a bit more understanding that It’s Not ALL About Dick. ;)
Dear Quinn, Anon, and Author--
I'm sorry I didn't get to your letters until now. I was busily typing out my other responses when your cogent additions came along. Thank you!
Quinn, I agree on every point--and find that you and I were simultaneously underscoring many of the facets of ED's causes. Relationship quality (which I wrote about in these comments as "Lack Of Excitement") is indeed an issue at every age.
Anon, I think you're spot-on that ED needs a new label. We don't consider menopause a "disorder". It's a fact of life, yes; it can be a real irritation in some regards, yes; it can sometimes mean our bodies don't do what we want, when we want, yes. But because it happens to all women, It's Normal.
And so is ED, for at least some portion of most men's lives. Normal may not always be what we want. Normal may have many work-arounds that can and perhaps even ought be pursued. But Normal does not a disorder make.
And Author--I will take your request to write about celibate marriages under advisement! Currently, my knowledge base amounts to knowing they exist; knowing they exist for a great variety of reasons; and knowing that they are not invariably unhappy. But I need to know a lot more, and when I do, will post! Thanks for the request.