Issues:
(1) Is the anxiety the cause of the sexual dysfunction or secondary to it?
(2) Is the patient's performance normal or abnormal? Are the man's expectations set too high?
(3) Is the anxiety a manifestations of unresolved emotions (anger, depression, stress, etc)?
(4) Is there something about the sexual situation that contributes to the anxiety?
(5) Does the man's relationship to his partner contribute to the problem?
Situations where anxiety is common:
(1) honeymoon impotence, with sexual dysfunction during the first few nights of marriage
(2) widower's syndrome, with problems related to an interval of sexual abstinence and/or unresolved grief and/or issues of advancing age
(3) widow or divorcee syndrome, with anxiety about being compared to the woman's former lovers
Some men may have an issue that resolves quickly, while others may have a long-term problem.
An evaluation may include"
(1) A complete medical examination to identify any underlying medical problems or medications that may be contributing to the problem.
(2) A psychiatric interview to identify unresolved emotional issues.
(3) An assessment of the man's sexual capabilities and his expectations.
(4) An assessment of problem situations in order to identify contributory factors.
Interventions may include:
(1) Treatment of underlying medical conditions contributing to the sexual dysfunction.
(2) Change in medications.
(3) Psychiatric counseling with reassurances.
(4) Relaxation therapy.
(5) Couples therapy.
(6) Sex therapy.
(7) Consideration of therapy with sildenafil or other PDE5 inhibitor.
(8) Making a change in problem situations.
