Among psychotherapists, it is a widely held belief that women are more inclined to pursue psychotherapy than are men. While likely true, that is not always the case. When a man’s penis is no longer functioning as he would like, or as he thinks it should, he is highly likely to seek professional assistance. At first glance, this statement may seem like a ‘no-brainer.” It is commonly assumed that men crave sex for sex’s sake, and that men seek out sex in a purely physical, largely unemotional way. So of course, they would be upset if they were experiencing sexual difficulties. However, this assertion misses the existential importance of a functioning penis to many men.
Urologists will confirm that historically, men have gone to great pains (often literally) in order to restore penile functioning to its desired level. Vacuum pumps, penile implants, urethral suppositories, and injections directly into the penis are all highly sought interventions that men will endure in the quest to restore penile function. More recently, oral medications have become the first line of medical treatment, and while removing much of the physical discomfort of the more invasive methods, they don’t necessarily reduce the psychological unease.
A recent New York Times article (Study Maps “Uniquely Devastating” Genital Injuries Among Troops, https://nyti.ms/2iu1H9r), describes a recently reported study published in The Journal of Urology of men in the United States military who suffered severe injuries to their genitals. Injury to the penis was described as “one of the most dreaded war wounds,” placing it right up there with loss of limb(s), sight, & traumatic brain injury. Researchers reported that these men are at high risk for suicide. The article continues by reporting that researchers and surgeons at several medical centers hope to be able to offer penis transplants from deceased organ donors to these vets.
The pressing question is, “Why would men go to such an extreme in order to restore the utility of their penis? Is it really about sex? Is it really about wanting a family (especially for the younger men)? As an existentially oriented psychotherapist, I would suggest that these concerns merely scratch the surface of the angst of men with compromised penile function. Existential psychotherapy deals with people’s problems related to their existence. That is, what it means to them to be alive, live meaningful lives, and have strong, connected relationships. For many men, the penis is their path to living a life of such substance. A fully functional penis is central to their sense of wholeness, desirability, belonging, and connection. Many of the men I treat with erectile difficulties will lament, “I feel like less of a man,” or “I feel so broken,” or “I feel so weak.” To these men, their problematic erectile functioning wounds them at their core, and their feelings of vulnerability are palpable. The late existential psychologist Rollo May has written in his book, Man’s Search For Himself, “Certain values…are believed in as the ‘core’ of the person’s reason for living, and if such a value is destroyed, the person feels his existence as a self might as well be destroyed likewise.” I suppose there are those who would opine that I am giving the penis too much value, but I assure you this is not the case. Sit with men whose erectile functioning is gone, or severely compromised, after radical prostatectomy. Talk to the men who are in relationships and cannot understand what their penis is saying to them when they consistently lose their erection just prior to penetration. Observe the sense of humiliation, vulnerability, embarrassment, loss of self-esteem, and loss of sense of self from the men who fear that their breakdown in penile functioning will result in their being unwanted by a partner and their resulting fears of loneliness, isolation, and impotence. Psychiatrist Irvin Yalom, M.D. reminds us that sex is the vital life force, and, as such, often counters existential fears of death. Many aging men who find they are unable to functioning sexually with an erect penis experience severe bouts of death-anxiety as they confront the reality that they are aging and life is no longer a continuing spiral upward.
So does this mean that men who are unable to have erect penises cannot enjoy sex or live a meaningful life? Certainly not. We know that sex and existence is about more than just the penis. Men are perfectly capable of creating meaningful connections (sexual and otherwise), regardless of the manner in which their penis behaves. However, the existential importance of the penis needs to be considered when helping these men find this new meaning in their lives, and develop a new sense of self sexually. Treatments that only target the symptom and neglect to explore the meaning of the symptom will often not serve these men (and/or their partners) well. Working with these men, listening to the expression of the anxieties, and helping them find a renewed pathway to a meaningful existence, is among the greatest joys of being a psychotherapist.
Walter (not his real name—identifying details have been altered to preserve confidentiality) was a 58 year old, married man, who had undergone radical prostatectomy 3 years before our meeting. Much to his dismay, he never regained erectile functioning following surgery. He tried oral medications without much success, and found penile injections to be intrusive and unsatisfying. As a result of not being able to function sexually as he would like, Walter retreated from all affection with his wife. When queried about this, his response was, “Why start something I can’t finish?” Clearly, Walter suffered extreme embarrassment and frustration due to his erectile loss, and this created considerable distress for his wife and his marriage. Walter was angry that he wasn’t one of the fortunate men to undergo prostate cancer treatment and emerge with intact erectile ability. He also admitted feeling dreadfully broken and didn’t see how he would ever again be able to view himself as a fully functional man. He further described that even if he were able to regain erections by means of some assistive device, he would be unhappy because he would know that he was unable to sexually function autonomously. A therapy that focused solely on Walter’s presenting symptom (erectile dysfunction) would miss the underlying existential anguish that he was suffering. Therapy for Walter, and later with Walter and his wife, consisted of a deep exploration of his fears of death, isolation, and loss of ability to connect with his wife. Once these concerns were adequately addressed, Walter was able to find meaning and connection within the constraints of his physical limitations.
Men have deep concerns about a variety of complex existential issues. Anxiety regarding death, isolation, lack of meaning, freedom, responsibility, and connection resonate loudly for the men that I work with. Despite its appearance, sex, penile functioning, and the psychology of men are anything but simple.
About the Author:
Dr. Daniel N. Watter is a founding partner of the Morris Psychological Group, P.A. located in Parsippany, New Jersey. His primary areas of practice focus on the treatment of individuals and couples experiencing sexual and/or relationship problems.
Dr. Watter received his doctoral degree from New York University in 1985, and has also earned a post-graduate certificate in Medical Humanities from Drew University. He is licensed by the State of New Jersey as both a psychologist and a marital and family therapist. In addition, he is Board Certified in Sex Therapy by the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), and the American Board of Sexology (ACS), of which is also holds Fellowship status. Dr. Watter is an AASECT certified sex therapy supervisor, and has been elected to Fellowship Status in the International Society for the Study of Women’s Sexual Health (ISSWSH).
Dr. Watter is a member of several professional organizations, and has been elected to leadership positions in many. He is the current president of the Society for Sex Therapy and Research (SSTAR), and has recently completed two terms on the New Jersey Psychological Association’s Ethics Committee where he spent two years as the Committee’s chairperson. Dr. Watter is also the former chair of the Diplomate Certification Committee for the American Association for Sexuality Educators, Counselors, and Therapists (AASECT). He is the author of several professional articles and book chapters, including the chapter, Ethics and Sex Therapy: A Neglected Dimension, in the second edition of Peggy Kleinplatz’ book, NEW DIRECTIONS IN SEX THERAPY: INNOVATIONS AND ALTERNATIVES. In 2009, Dr. Watter was appointed by New Jersey Governor Jon Corzine to the State Board of Psychological Examiners
Dr. Watter is the current President of the Society for Sex Therapy and Research (SSTAR).