James and Yelena have been married for 22 years and have three grown children, now out of the house. Sex was never particularly enjoyable for Yelena, primarily because James was uninterested in much foreplay and Yelena felt it was unfeminine to make any sexual demands of her husband. However, because of her love for James, she accommodated his desire for sex two or three times a week, and consistently “faked orgasms.”

James also does not think “a real man” should receive any “help” from his wife to get an erection, even when his erections became less firm and less predictable. As a result, over the last two years, James rarely initiated sex and Yelena felt relieved, thinking she would now be “excused from sex.” Furthermore, she is in perimenopause, and has begun to experience increasingly uncomfortable penetration. SuIDenly, James’ vigor and sexual interest has returned with greater intensity than ever. Yelena discovered he was secretly taking Viagra, which he obtained over the Internet.

• • Discuss how effective you think Viagra will be for improving James’ sex life, and why?
  • Suppose Yelena’s discovery that James is using Viagra secretly is the “last straw” for her after years of not aIDressing her unsatisfying sexual life with him, and she demands that they seek marriage counseling and focus on their sex life.

    In this case:

    • What part of this dilemma should a counselor point out is Yelena’s responsibility to acknowledge and aIDress? AIDitionally, what special issues regarding her perimenopause will need to be aIDressed?
    • What part of this dilemma should a counselor point out is James’ responsibility to acknowledge and aIDress?

• Discuss specific treatment options for this couple that are supported by the research you learned about in your readings.