Tom is a 38 year-old married man. He lives with his wife, Melanie, and he works in the information technology department in a general hospital. Tom has gained weight over the years and he has been taking medication for blood pressure. Melanie always insists it isn’t a big deal for her, but Tom has grown increasingly frustrated with what he sees as his sub-optimal sexual performance. He has become more irritable and refuses to talk to Melanie about their sexual life. His self esteem is low, and even his energy and interest in things has declined lately.