Do men with diabetes have special problems when it comes to sex? If so, are there special solutions as well? Bernie Zilbergeld, PhD, renowned sex psychologist and author of “Male Sexuality,” shares with us his extensive knowledge on the subject of male sexuality.

DH: What are some common misconceptions men have about sex?

Dr. Zilbergeld: One of the most popular misconceptions of sex derives from a fantastic and unrealistic model in which men must perform incredible sexual acts in order to please their partners. In other words, men believe that sex is a "job" that they must perform well. To perform well, many men feel they must have the right equipment, including a large penis and long staying power. Not only do men put enormous pressure on themselves, but they also put pressure on their partners to reach orgasm. As a result, studies have shown that women fake orgasm in epidemic proportions. Women often do not want to make their partners feel bad, and hence contribute to a man's feeling that they are succeeding in the sexual act.

Another misconception is that the man must orchestrate the whole sexual event, and that he is responsible for the outcome. Moreover, most men feel that intercourse is the main sexual act. Intercourse is nice, but unfortunately it is the one act that requires an erection. And it is commonly understood that the more pressure you put on the penis, the less likely it will stay erected.

In sum, our view of sex is skewed. One line I saw in a book said that a man gave his partner such a good time that she felt her "bones melting." This sort of writing puts a lot of pressure on the male to perform. What eventually happens is that everyone feels bad because no one has lived up to expectations.

DH: Many people believe that diabetes leads to impotence. Is this correct?

Dr. Zilbergeld: There is some evidence that diabetes can lead to impotence. However, impotence may be physically attributed to diabetes, or it might be psychologically attributed to diabetes. Or the impotence may have nothing to do with the diabetes. The important thing is to acknowledge that something is wrong and that help is needed. The hard part for most men is talking to someone about their problem.

DH: Why is it so hard for men to talk honestly about sex?

Dr. Zilbergeld: Mainly because so much is riding on it. For example, it can be devastating to a man's ego if news of his erection problems becomes public. A man will avoid embarrassment by not sharing this information, or denying it.

DH: What solutions are there to help diabetic men who are having sexual problems?

Dr. Zilbergeld: It is nice to know that virtually any man with an erection problem can be helped. On the medical side, there are two types of prostheses. First, is the placement of two silicon rods which keeps the penis in a permanent state of semi-erection. Second, is an artificial injection into the penis which can produce an erection for anywhere between 15 and 20 minutes. Ejaculation will not reduce the erection. On a side note, there is the vacuum pump. This plastic device is placed over the penis, and a pump withdraws all the air from the suction. Many people who use the pump are very satisfied with the results. The other option is to see a sex therapist. Behavioral therapy is usually short-term, and often successful. The therapist's job is to determine what the problem is, and what can be done about it. One technique that I suggest is to allow the patient's mind to fantasize about sex on a regular basis. These fantasies can be used to promote sexual arousal and increase interest when performing sex.

DH: What else do you do to help males with their sexual problems?

Dr. Zilbergeld: It depends. Some men need to relax more. Others need to figure out what excites them. While still others have to overcome fears of rejection. In addition, there are a number of touching and masturbating exercises. The most important thing for all men is to determine what is impeding their arousal and erection.

(Dr. Zilbergeld was interviewed on “Diabetes on the Dial,” a weekly radio show broadcast live in the San Francisco Bay Area.)