Because it has been around for so long, the myth has grown that Viagra among all the PDE-5 inhibitors can solve all erectile dysfunction (ED) problems. But it is not true. You can take as many pills marked Viagra, Cialis or Levitra as you like but, if your mind does not associate sexual stimulation with the response of an erection, nothing will happen. The difficulty is that you may not have learned how to make the appropriate sexual response at all, or have unlearned the response.

One of the approaches is Cognitive Behavioural Therapy (CBT). This is a broad-based strategy intended to allow anyone to change the way they behave. In the case of ED, it aims to build sexual comfort with your partner. This may be the first time you have attempted to be intimate or you may wish to recapture the intimacy of your early relationship. Either way, the therapy focuses on developing your sexual skills and teaches you a number of different exercises to practice so that you can improve your general level of sexual performance. Once erections have begun to return, the use of Viagra, Cialis and Levitra will continue the trend.

The difficulty with maintaining or achieving erections may be purely psychological or secondary to a physical cause. Either way, the first resulting failures undermine confidence and produce a self-fulfilling prophecy, i.e. you become so afraid that your erection will fail that it does fail. These problems usually start among men who want to prolong intercourse by avoiding ejaculation. This is not unnatural. They are having so much pleasure, they want it to go on longer. To achieve this result, they have to reduce the level of arousal. When carried too far, the loss of arousal results in the loss of the erection. If this is not controlled, it can lead to the loss of erection occurring earlier and earlier until the man has difficulty in getting an erection at all and, through fear of embarrassment, begins to avoids sexual intimacy.

If this affects you, you have to confront the issue of performance anxiety and break the expectation of failure. Your therapist’s most likely first step will be prohibiting actual sexual intercourse and orgasm. You have to learn about the normal cycle of erections which naturally come and go during sexual activity. Clinical research (who gets these jobs?) shows that most men push for intercourse as soon as they get an erection. The point of this therapy is to teach you that you can enjoy sexual activity without having an erection. Pleasure continues and that pleasure is not conditional on rushing straight into intercourse and orgasm. If you and your partner know that intercourse is not allowed, you need not feel under so much pressure. You can experiment and find out what activities are most stimulating in co-operative sexual activity with your partner. Indeed, you will probably find intimacy more interesting if your partner is more actively involved. Listening and talking with her, learning about her needs should help you to see intercourse not as an end in itself but as part of a wider activity of generating mutual pleasure.

It is a fact that more men are prepared to come for sexual counselling than for any other kind of therapy. Yet many are actually resistant to change. They have a fixed criterion for measuring success, believing that they lack masculinity if their performance is not perfect. For these purposes, perfection is defined as a state achieved by a man without regard to his partner’s wishes or needs. If it was good for him, it must have been good for her. This means the counsellor has to get the man to understand that sex is about more than his penis. It should be about giving and sharing pleasure with the woman as an active partner. Rebuilding the idea of sexual intimacy overcomes the fixed performance criterion. So the counsellor addresses the anxieties, inhibitions, anger and guilt that may be blocking real emotional feelings, and aims to replace them with thoughts, images, sensations and fantasies that can underpin a successful sexual relationships. In this, both parties have to take responsibility for their sexuality and sexual needs.

CBT therapists are trained to deal with a wide range of problems including sex. They are very goal-oriented and provide techniques, advice and counselling. Usually, performance will improve after a few visits, and most couples require no more than a few months of treatment before seeing some definite results. Once you have been started on the track to learn better sexual habits, you can begin to take Viagra, Cialis or Levitra as a reinforcement to maintain progress. But, in this, you should take the advice of your therapist.