A man who develops a sexual problem tends to concentrate his energy on his recalcitrant penis, which does not become erect when it should. But riveting attention on the penis is not the best way to resolve the problem.
The inability to achieve an erection is most commonly traced to a specific problem in three of the six phases (libido, erection, ejaculation) of the normal male sexual response cycle (see Chapter 6). Psychiatrists, psychologists, and sex therapists use a language that differs slightly from the terminology used elsewhere in this book. In their vernacular, sexual desire takes the place of libido; arousal is used instead of erection; and orgasm is substituted for ejaculation.
There are several avenues through which these individual areas of sexual vulnerability can be explored. Only by teasing apart the individual components of the male sexual response cycle can the cause of ongoing sexual failure be revealed. Then a focused treatment plan can be formulated.
Two desire-phase problems, low sexual desire and aversion to sex, are now recognized. When psychologists and sex therapists talk about low sexual desire, they do so in a global fashion. If a man complains of reduced desire, it is important to know whether it is partner specific. Has the man lost interest in having sex only with his partner? Does he have any interest in, or fantasize about, having sex with other partners? Is he having erotic dreams? Does he have any sexual fantasies? Do spontaneous erections occur under any circumstances?
If the answer is yes to any of the above, the diagnosis is not low sexual desire. That diagnosis is reserved for men who answer "no" to all these ques