Erectile Self-Efficacy and Responsive Sexual Desire

The essence of male sexuality was believed to be unselfconscious, totally reliable sex response—spontaneous erection, intercourse, and ejaculation. The great majority of men learn sex as autonomous and totally reliable. They experience this throughout young adulthood and into their middle years. However, after a sensitizing event (he does not have an erection sufficient for intercourse) he seldom returns to autonomous sex function. This sensitizing erectile experience commonly occurs between the ages of 35 and 55, although it can occur at age 16 or not until age 76.

The bio-medical treatment goal is to reestablish predictable erection and intercourse by using Viagra or penile injections. The assumption is that the key to overcoming erectile dysfunction (ED) is regaining predictable erectile function promoted by a stand-alone medical intervention. In contrast, the good enough sex (GES) model advocates a process focused on sharing pleasure rather than individual sex performance. The guideline: 85 percent, or more, of sexual encounters will flow from comfort to pleasure to arousal to erotic flow to intercourse and orgasm. When sex does not flow to intercourse, the psychologically healthy man says (without apologizing or panicking) this will not be an intercourse night. They transition to a sensual or erotic scenario that can be synchronous or asynchronous. Good, but better for one partner.

The man and his partner develop erectile self-efficacy by identifying the psychological, relational, and bio-medical factors that promote erectile function. Psychologically, this includes sexual anticipation, feeling he deserves sexual pleasure and a sense of challenge rather than performance anxiety. Relationally, he turns toward the partner as his intimate and erotic ally, not someone to perform for. They share sensual, playful, and erotic scenarios focused on pleasure. Bio-medically, in addition to utilizing pro-erection medications like Cialis or utilizing penile injections, he changes behavioral health habits including improved sleep, stopping smoking, reducing drinking, and practicing mindfulness. These changes enhance erectile self-efficacy, including the ability to accept pleasure without intercourse.

The traditional strategy was hierarchical, restoring erectile function first and then depend on spontaneous erection for desire. The new, motivating therapeutic strategy is a both-and approach, embracing responsive sexual desire and adopting erectile self-efficacy. Responsive desire is more genuine and changeable. Responsive desire is not contingent on an erection; he can begin a sexual encounter at neutral. As he gives and receives sensual and playful touch and is aware of his and his partner’s positive feelings and receptivity, he experiences sensations of 2-4 (subjective arousal with 10 being orgasm). Desire occurs after he experiences pleasure. He does not need an erection to feel desire. A major reason men fail with Viagra is that as soon as an erection begins (subjective arousal 4 or 5) he rushes to intercourse because he is afraid of losing his erection. A technique to promote erectile self-efficacy is to not transition to intercourse until he feels highly aroused, subjective arousal of 8.

Erectile self-efficacy does not promise a return to perfect sex performance. Instead, GES promotes sexual comfort and confidence with a broad-based, flexible repertoire involving sensual, playful, and erotic scenarios in addition to intercourse. Concepts of responsive desire, GES, broad-based sexuality, and sex as more than intercourse are much easier for women to accept than men. Men can learn that responsive desire and adopting broad-based sexuality while dropping the dependence on spontaneous erection and Sex=Intercourse is key to healthy male and couple sexuality throughout adulthood, especially with aging.