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Working with sexual problems requires specific knowledge of sexuality and sexual functioning. Scharff and Scharff (1991: 4) point out that, over the years, psychoanalytic therapies have struggled to address such problems without the benefit of the necessary knowledge about sexual functioning and dysfunctions. Sexual problems often bridge the artificial division that has been made between physical and psychological problems. This is a result of the way that sexual functioning and the personality as a whole interrelate, and the fact that sexual functioning is impinged upon by both internal and external factors. In the face of this complexity it is not surprising that the therapeutic approaches that have been developed to deal with sexual difficulties vary greatly in their focus.
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Do medical and sexual health professionals agree on an objective definition of ED? Not really. The traditional definitions focused on the percentage of intercourse failures. Masters and Johnson (1970) defined ED as failing at intercourse more than 25 percent of the time. But what if you have unsuccessful intercourse (that is, fail to maintain a sufficiently strong erection for intromission—insertion of the penis into the vagina—and intravaginal ejaculation) only 15 percent of the time, but when it occurs you feel a devastating sense of personal and sexual failure? Or what if you have strong erections, but you ejaculate and lose your erection before your penis enters her vagina? Or suppose you have good erections with oral sex or during masturbation, but not during intercourse? Or what if intercourse takes place for more than twenty minutes, but you experience ejaculatory inhibition and cannot come? Many men with ejaculatory inhibition eventually lose their erection and misdiagnose themselves as having ED.
It you seldom get an erection or you avoid trying to have sex because of fear, clearly you are suffering from ED. On the other hand, if you are usually successful with intercourse but sometimes fail—whether once every ten times, once a month, or once a year—this is well within the range of normal sexual response and is not considered ED. A comprehensive definition of ED centers on a lack of comfort and confidence with erection, which can involve a variety of contributing factors.