"Sex and the City"-Shrink Talk

HBO presents

September 20, 2000

Dr. Perelman answers your questions about sex, relationships, and dating in relation to the latest episode of HBO's "Sex and the City."

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HBO: Dr. Perelman is unable to be online tonight, but he's made sure that you won't miss your shrink session! Check out his expert opinions on the relationship and sex issues brought up in the latest episode of "Sex and the City." Read on.

Dr. Perelman: First, I would like to remind our webcast audience that this broadcast is for purposes of education and entertainment only.

Harriet: Was Charlotte's suggestion that Trey consider taking Viagra a valid one, especially if Trey's problem is more emotional than physical?

Dr. Perelman: Yes, the suggestion is a valid one, as Viagra has an extremely high capacity to restore sexual health for men suffering from a psychologically-induced erectile dysfunction. However, the timing of her suggestion leaves something to be desired. And it remains unclear whether or not Trey's problem is more emotional than physical. Two interesting facts were revealed this past episode which would impact my potential diagnostic questions. One, Trey reports a family history of health problems. He erroneously notes that Viagra is a killer. It's not dangerous, but indeed a very helpful drug to restore sexual function, even in an individual with certain types of heart difficulties. (Always check with your cardiologist about this.) However, Viagra can be deadly if combined with nitrates, which may be prescribed for someone with a "heart condition." Never combine Viagra with nitrates! However, what we did learn is that the same risk factors for heart disease are risk factors for organically-caused erectile dysfunction. Therefore, whatever causes of heart disease are present in Trey's father's family may be adversely affecting his erectile functioning. He needs a thorough evaluation by a well-qualified sex therapist or a urologist/primary care physician who specializes in erectile dysfunction. We have already discussed the possible role masturbation and or errant fantasy may be playing in this situation. An amusing cause would be if it turned out that Trey's father "died in the saddle" of a heart attack, as a famous politician reputedly did. This, in reality, is a very unlikely scenario; but if true, might certainly explain a fear of sex and subsequent avoidance of helping Charlotte with her "itch." Statistically speaking, performance anxiety or inhibition would be a more likely culprit. However, we also learned that Trey is running multiple times per day in a compulsive attempt to maintain his health and possibly avoid sex. I once cured a man of his fatigue-induced erectile dysfunction by reducing his running regimen from 10 miles daily to 3 miles three times a week. Then again, that only happens in my office once every ten years. Therefore, in summary, Viagra may turn out to be an appropriate treatment in combination with sex therapy to help him with his avoidance behavior, as well as the relationship difficulties which are already occurring.

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