Categories
Men's Health

Impotence In Young Man

Impotence Male

There are innumerable classic examples in the literature of maternal dominance contributing to secondary impotence. Thirteen such instances reflecting maternal dominance have been referred to the Foundation for therapy. Since the picture is so classic, a composite history can be provided to protect anonymity without destroying categorical effectiveness.

Impotence In Young Man

Maternal dominance primarily depreciates the young male’s security in his masculinity and destroys confidence in his socio cultural role-playing by eliminating or at least delimiting the possibility of a strong male image.

When the father is relegated to the role of second-class citizen within family structuring, the teenage boy has no male example with which to identify other than that of a devalued, shadowy, sometimes even ludicrous male allowed access to the home but obviously subject to control of the dominant maternal figure.

Mr. B, 34 years old
was referred with his wife for treatment of secondary impotence. He could remember little in family structuring other than a totally dominant mother making all decisions, large or small, controlling family pursestrings, and dictating, directing, and destroying his father with harsh sarcasm.

He remembered the paternal role only as that of an insufficient paycheck, and of a man sitting quietly in the corner of the living room reading the evening newspaper.

When he reached midteens, the parental representative at school functions was always the maternal figure, for both the young male and his younger sister (two siblings only). The same situation applied to church attendance and, eventually, to all social functions. The family matured with the concept that only three people mattered.

Masturbatory onset was in the early teens with a frequency of two or three times a week during the teenage years. As would be expected in a maternally dominated environment, dating opportunity for the boy was delayed, in this case until the senior year in high school.

Through college there were rare commitments to female interchange, all of them of a purely social vein. The young man was insecure in most social relationships, particularly those having orientation to the male sex.

He had been forbidden participation in athletics by his mother for fear of injury. He rarely pursued male companionship, feeling himself alternatively totally insecure in, or intellectually superior to, the male peer group.

Premarital sex in youth
Finishing college, the young man, particularly interested in actuarial work, joined an insurance firm. Although mainly withdrawn from social relationships, at age 28 he met and within three months married a 27 year old divorcee with a 2 year old daughter.

The divorcee, a dominant personality in her own right, was the mirror image of his mother. The two women were, of course, instant, bitter, and irrevocable enemies. The marriage, accomplished in spite of his mother’s vehement objections, was a weekend justice-of-the-peace affair.

The sexual experience of the courtship had been overwhelming to the physiologically and psychologically virginal male. The uninitiated man literally was seduced by the experienced woman, who manipulated, fellated, and coitally ejaculated him within three weeks of their initial meeting.

The hectic pace of the premarital sexual experience continued for the first 18 months of the marriage, with Mr. B awed by and made increasingly anxious by his wife’s sexual demands.

Intercourse occurred at least once a day. Following the pattern established during the courtship, opportunities, techniques, positions, procedures, durations, and recurrences, in fact, all sexual expression in the marriage, was at his wife’s able direction.

For the first year of the marriage the wife thoroughly enjoyed overwhelming her fully cooperative but naive and insecure husband with the force and frequency of her sexual demands. As the marriage continued unwavering in the intensity of her insistence upon sexual and social dominance, his confidence in his facility for sexual functioning began to wane.

He sought excuses to avoid coital connection, yet when cornered tried valiantly to respond to her demands. Finally, there were three occasions when sudden demand for coital connection forced failure of erection for the satiated male. Her comments were harsh and destructive, and the sarcasm struck a familiar chord.

The fourth time he failed to satisfy her immediate sexual needs, his wife’s denunciations reminded him specifically of his mother and of her verbal attacks on his father. For the first time in his life he identified with the man sitting in a corner of the living room reading the newspaper, and within a month’s time he had withdrawn to a similarly recessive behavioral patterning within his own home.

Successful erection
There is only one subsequent recorded episode of erection sufficiently successful for intromission with his wife. Aside from this, the man was totally impotent and had been so for three years when seen in therapy.

On an occasion when his wife was out of town, he followed the time-honored response pattern of the secondarily impotent man. There was attempted sex with a prostitute to see whether he could function effectively with any other woman.

For the first time in several months there was a full erection, but when he attempted to mount, the concept of his mother’s disapproval of his behavior disturbed his fantasy of female conquest. He immediately lost and could not recover the erection. This was his only attempt at extramarital sexual functioning.

Categories
Women's Health

Woman Sexuality

Woman Sexuality

A separate discussion of female sexuality is necessary primarily because the role assigned to the functional component of a woman’s sexual identity rarely has been accorded the socially enforced value afforded male sexuality.

While the parallel between sexes as to physiological function has gained general acceptance, the concept that the male and female also can share almost identical psychosocial requirements for effective sexual functioning brings expected to protest.

Only when a male requests treatment for symptoms of sexual dysfunction, and possible contributing factors are professionally scrutinized in the clinical interest of symptom reversal, are the psychosocial influences noted to be undeniably similar to those factors which affect female responsivity.

Then such factors as selectivity, regard, affection, identity, and pride (to name a few of the heterogeneous variables) are revealed as part of the missing positive or present negative influence or circumstances surrounding the sexual dysfunction.

Woman Sexual Dysfunction

Man has had society’s blessing to build his sexual value system in an appropriate, naturally occurring context and woman has not. Until unexpected and usually little understood situations influence the onset of male sexual dysfunction, his sexual value system remains essentially subliminal and its influence more presumed than real.

During her formative years, the female dissembles much of her developing functional sexuality in response to societal requirements for a “good girl” facade.

Instead of being taught or allowed to value her sexual feelings in anticipation of an appropriate and meaningful opportunity for expression, thereby developing a realistic sexual value system.

She must attempt to repress or remove them from their natural context of environmental stimulation under the implication that they are bad, dirty, etc.

She is allowed to retain the symbolic romanticism which usually accompanies these sexual feelings, but the concomitant sensory development with the symbolism that endows the sexual value system with meaning is arrested or labeled for the wrong reasons, objectionable.

The reality of female sexual function today aside from its vital role in reproduction, still implies shame, although such a dishonorable role has been rather difficult to sustain with objectivity.

The arbitrary:
The social assignment of the role of sin to female sexuality has not contributed a desirably consistent level of marital harmony. Nor has society always found it easy to eliminate recognition of female sexuality while still supporting and maintaining the male’s role of tacit permission to be sexual with honor, or even praise. If you are looking for bracelet. There’s something to suit every look, from body-hugging to structured, from cuffs to chain and cuffs.

Especially is this true of a society that continues to celebrate events before and after the fact of sexual expression (marriage, birth, etc.), and mourns the female menopause because it is presumed to signify the demise of sexual interest.

Since, as far as is known, elevated levels of female sexual tension are not technically necessary to conception, the natural function of a woman’s sexuality has been repressed in the service of false propriety and restricted by other unnecessary psychosocial controls for equally unsupportable reasons.

In short
The negation of female sexuality, which discourages the development of an effectively useful sexual value system, has been an exercise of the so-called double standard and its socio-cultural precursors.

Residual societal patterns of female sexual repression continue to affect many young women today. They mature acutely aware of repercussions from sexual discord between their parents and among other valued adults, so they grope for new roles of sexual functioning.

Discomfort in the communication of sexual material still prevails between parents and their children.

The young frequently are condemned, by lack of information about what is sexually meaningful, to live with decisions equally as unrewarding sexually as those made by their parents.

In other words, because of cultural restraints, the members of younger generations must continue to make their own sexual mistakes, since they, like previous generations, rarely have been given the benefit of the results of their parents’ past sexual experience; good, bad, or indifferent as that experience may have been.

The necessary freedom of sexual communication between parents and sons and daughters cannot be achieved until the basic component of sexuality itself is given a socially comfortable role by all active generations simultaneously.

Categories
Overall Health

How is Diabetes Treated?

The goal of diabetes treatment is to keep your blood sugar level as close to normal as possible–not too high (called hyperglycemia) or too low (called hypoglycemia).

The first step is to have a healthy diet and to exercise. This may mean you’ll need to change your current diet and exercise habits. You’ll also have to watch your weight (or even lose weight if you are overweight) to keep your blood sugar level as normal as possible. Your doctor will talk to you about the kinds of food you should eat and how much exercise you’ll need every week.

Regularly checking your blood sugar is a key to helping you control it. Blood sugar checks can help you see how food, exercise, and insulin or medicine affect your level. Checking your blood sugar also allows you and your doctor to change your treatment plan if needed.

Sometimes diet and exercise alone can’t keep your blood sugar at a normal level. Then your doctor will talk to you about other treatments, such as medicine or insulin.

Call your doctor if:

  1. You start feeling very thirsty and are urinating more often than usual.
  2. You are nauseous or vomit more than once.
  3. You lose a significant amount of weight.
  4. You start breathing deeper and faster.
  5. Your breath smells like nail polish remover.
  6. You start to tremble, feel weak and drowsy, and then feel confused or dizzy, or your vision becomes blurred.
  7. You feel uncoordinated.
  8. You have a sore, blister, or wound (especially on your feet) that won’t heal.
Categories
Women's Health

Woman Sexual Phrase

She responds physiologically to sex-tension elevation. The four phases of the female cycle of sexual response established in the 1960s will be employed to identify clinically important vasocongestive and myotonic reactions developing in the pelvic viscera of any woman responding to sexual stimulation.

Sex-tension increment, the first physical evidence of her response to sexual stimulation is vaginal lubrication.

Lubrication is produced:

By a deep vasocongestive reaction in the tissues surrounding the vaginal barrel. There also is evidence of increased muscle tension as the vaginal barrel expands and distends involuntarily in anticipation of penetration.

When sex tensions reach plateau phase levels of responsivity, a local concentration of venous blood develops in the outer third of the vaginal barrel, creating partial constriction of the central lumen.

This vaginal evidence of a deep vasocongestive reaction has been termed the orgasmic platform. The uterus increases in size as venous blood is retained within the organ tissues.

The clitoris evidence increasing smooth-muscle tension by elevating from its natural, pudendal-overhang positioning and flattening on the anterior border of the symphysis.

With orgasm, reached an increment peak of pelvic-tissue vasocongestion and myotonia, the orgasmic platform in the outer third of the vagina and the uterus contract within regularly recurring rhythmicity as evidence of high levels of muscle tension.

Finally, with the resolution phase, both vasocongestion and myotonia disappear from the body generally, and the pelvic structures specifically.

If the orgasmic release has been obtained, there is rapid detumescence from these naturally accumulative physiological processes. The loss of muscle tension and venous blood accumulation is much slower if orgasm has not been experienced and there is an obvious residual of sexual tension.

The presence of involuntary-muscle irritability and superficial and deep venous congestion that woman cannot deny, for these reactions develop as physiological evidence of both conscious and subconscious levels of sexual tension.

With the accumulation of myotonia and pelvic vasocongestion, the biophysical system signals the total structure with stimulative input of a positive nature.

Regardless of whether women voluntarily deny their biological capacity for sexual function, they cannot deny the pelvic, irritative evidence of inherent sexual tension for any length of time.

Once a month with some degree of regularity women are reminded of their biological capacity. Interestingly, even the reminder develops in part as the result of local venous congestion and increased muscle tension in the reproductive organs.

On occasion, the menstrual condition, through the suggestive sensation created by pelvic congestion, stimulates elevated sexual tensions.

The presence or absence of patterns of sexual desire or facility for a sexual response within the continuum of the human female’s menstrual cycle also has defied reliable identification.

Possibly, confusion has resulted from the usual failure to consider the fact that two separate systems of influence may be competing for dominance in any sexual exposure.

The necessity for such individual consideration can best be explained by example:

It is possible for a sexually functional woman to feel the sexual need and to respond to high levels of sexual excitation even to orgasmic release in response to a predominantly biophysical influence in the absence of a specific psychosocial requirement.

This freedom to respond to direct biophysical-system demand requires only from its psychosocial counterpart that the female’s sexual value system not transmit signals that inhibit or defer how erotic arousal is generated. In any situation of biophysical dominance, the effective sexual response requires only a reasonable level of interdigital contribution by the psychosocial system.

Conversely, it also is possible for a human female to respond to erotic signals initiated by the predominant psychosocial factors of the sexual value system, regardless of conditions of biophysical imbalance such as hormonal deficiency or obvious pathology of the pelvic organs.

A woman may respond sexually to the psychosocial system of influence to orgasmic response in the face of surgical castration and spite of a general state of chronic fatigue or physical disability. In any situation of psychosocial dominance, the effective sexual response requires only a reasonable level of interdigital contribution by the biophysical system.

Categories
Overall Health

How Do I Check My Blood Sugar Level?

Follow your doctor’s advice and the instructions that come with the glucose meter. In general, you will follow the steps below. Different meters work differently, so be sure to check with your doctor for advice specifically for you. 

  1. Wash your hands and dry them well before doing the test.
  2. Use an alcohol pad to clean the area that you’re going to prick. For most glucose meters, you will prick your fingertip. However, with some meters, you can also use your forearm, thigh, or the fleshy part of your hand. Ask your doctor what area you should use with your meter.
  3. Prick yourself with a sterile lancet to get a drop of blood. (If you prick your fingertip, it may be easier and less painful to prick it on one side, not on the pad.)
  4. Place the drop of blood on the test strip.
  5. Follow the instructions for inserting the test strip into your glucose meter.
  6. The meter will give you a number for your blood sugar level.

Tips on blood sugar testing

  1. Pay attention to expiration dates for test strips.
  2. Use a big enough drop of blood.
  3. Be sure your meter is set correctly.
  4. Keep your meter clean.
  5. Check the batteries of your meter.
  6. Follow the instructions for the test carefully.
  7. Write down the results and show them to your doctor.

How often should I check my blood sugar level?

Check your blood sugar as often as your doctor suggests. You’ll probably need to do it more often at first. You’ll also check it more often when you feel sick or stressed, when you’re changing your medicine or if you’re pregnant. People taking insulin may need to check their levels more often.

Keep track of your blood sugar levels by writing them down. You can also keep track of what you’ve eaten and how active you’ve been during the day. This will help you see how food and exercise affect your blood sugar level.

What should my blood sugar level be?

Talk with your doctor about what is a healthy blood sugar level range for you. A level of 80 to 120 before meals is often a good goal, but not everyone who has diabetes can get their blood sugar level this low.

Be sure to talk with your doctor about what to do if your blood sugar level isn’t within the range that’s best for you.

How does food affect my blood sugar level?

Anytime you eat, you put sugar in your blood. Eating the right way can help control your blood sugar level.

You need to learn how what you eat affects your blood sugar level, how you feel, and your overall health. As a general rule, just following a healthy diet is wise. Your doctor may suggest you meet with a dietitian who can teach you how to make healthier food choices. See the box below for some tips on eating right.

Categories
Women's Health

Sexual Values

Sexual Values

An interesting variation on this classification of repression should be mentioned. There were several primarily non-orgasmic women whose receptivity to the repressive conditioning was slightly different. Their own particular personality characteristics or their relationship to negatively directive authority was such that they fully accepted the concept of sexual rejection.

They developed pride in their ability to comply with sexual repression and did so with apparent social grace. Their selection of a mate in most cases represented a choice of similar background. The difficulty arose with marriage.

For example:

On the wedding night, a completely unrealistic, negative sexual value system usually was revealed during their attempt to establish an effective sexual interaction. These women reported either total pelvic anesthesia or isolation of sexual feelings from the context of psychosocial support.

Women entering therapy in a state of non-orgasmic return reflected the complete failure of any effective alignment of their biophysical and psychosocial systems of influence.

They had never been able to merge either their points of maximum biophysical demand or their occasions of maximum psychosocial need with optimum environmental circumstances of time, place, or partner response to fulfill the requirements of their sexual value systems.

Primary orgasmic dysfunction:

A condition whereby neither the biophysical nor the psychosocial systems of influence that are required for the effective sexual function is sufficiently dominant to respond to the psychosexually stimulative opportunities provided by self-manipulation, partner manipulation, or coital interchange.

If the concept of two interdigital systems influencing female sexual responsivity can be accepted, what can be considered the weaknesses and the strengths of each? Input required by either system for the development of peak response is, of course, subject to marked variation.

There may be some value in drawing upon the previously described psychophysiological findings returned from preclinical studies. As a human female response to subjectively identifiable sexual stimuli, reliable patterns of accommodation by one system to the other can be defined, and tend to follow basic requirements set by earlier imprinting.

Patterns of imprinting can be either reinforced or redirected by controlled experimental influence. They can also be diverted in their signaling potential by reorientation of a previously unrealistic sexual value system. The sexual value system, in turn, responds to reprogramming by a new, positive experience.

Variations in the human female’s bio-physical system are, of course, relative to basic body economy. Is the woman in good health? Is there a cyclic hormonal ebb and flow to which she is particularly susceptible? Are the reproductive viscera anatomically and physiologically within normal limits, or is there evidence of pelvic pathology? Is there evidence of broad-ligament laceration, endometriosis, or residual from pelvic infection?

Certainly, most forms of pelvic pathology would weigh against the effective functioning of the biophysical system. On the other hand, are there those biophysical patterns that tend to improve the basic facility of her sexual responsivity? Is there well-established metabolic balance, good nutrition, sufficient rest, the regularity of sexual outlet?

Each of these factors inevitably improves biophysical responsivity. There must be professional consideration of multiple variables when evaluating the influence of the biophysical system upon female sexual responsivity.

Overcome Sexual Difficulty

However, the system with the infinitely greater number of variables is that reflecting psychosocial influence. Most dysfunctional women’s fundamental difficulty is that the requirements of their sexual value systems have never been met. Consequently, the resultant limitations of the psychosocial system have never been overcome.

Many women specifically resist the experience of orgasmic response, as they reject their sexual identity and the facility for its active expression.

Often these women were exposed during their formative years to such timeworn concepts as sex is dirty, nice girls don’t involve themselves, sex is the man’s privilege or sex is for reproduction only.

There are also those whose resistance is established and sustained by a stored experience of mental or physical trauma, rape, dyspareunia which is signaled by every sexual encounter.

Again from a negative point of view, there may be extreme fear or apprehension of sexual functioning instilled in any woman by inadequate sex education. Any situation leading to sexual trauma, real or imagined.

During her adolescent or teenage years or her sexual partner’s, crude demonstration of his own sexual desires without knowledge of how to protect her sexually would be quite sufficient to create a negative psychosocial concept of a woman’s role in sexual functioning.

The woman living with residual of specific sexual trauma (mental or physical) frequently is encountered in this category.

Finally, there is the woman whose background forces her into automatic sublimation of psychosexual response. This individual simply has no expectations for sexual expression that are built upon a basis of reality. She has presumed that sexual response in some form simply would happen but has a little, idea of its source of expression.

In these instances, sexual sublimation is allowed to become a way of life for many reasons. Particularly is this reaction encountered in the woman who has failed to enjoy the privilege of working at being a woman.

The positive side:

The psychosocial value system can overcome physical disability with dominant identification that may be personal and/or situational in nature. In states of advanced physical disability, the strength of loved-partner identification can provide orgasmic impetus to a woman physically consigned to be sexually unresponsive.

When there has been a pattern of little bio-physical sexual demand, as in a postpartum period, sexual tension may be rapidly restored by the psychosocial stimulation of a vacation, anniversary, or other experience of special significance.

Again the biophysical and psychosocial systems of influence are interdigital in orientation, but there is no biological demand for their mutual complementary responsivity. It is in the areas of involuntary sublimation that the psychosocial system is gravely handicapped and would tend to exert a negatively dominant influence in contradistinction to any possible biophysical stimulative function.

Categories
Men's Health

Sex Therapeutic Procedures

In therapeutic procedure involving the dual-sex teams, the control within the team rests primarily with the silent cotherapist during treatment sessions. The silent cotherapist is literally in charge of each therapeutic session. He or she, as the observer, is watching for and evaluating levels of patient receptivity to therapeutic concept and to the educative and directive material presented by the active cotherapist.

The silent cotherapist’s role is to define, if possible, degrees of understanding, acceptance, or rejection of material and to identify immediate areas of concern in either member of the dysfunctional couple.

The silent observer really acts as the coach of the team. As soon as it is apparent that there is need for a situational change of pace, that the individual subject under discussion can be presented in a different, possibly more acceptable or understandable manner, or that it requires further clarification, the roles reverse and the cotherapist functioning previously as the observer, fortified and advantaged with the salient features of patient reaction to the on going situation, becomes the active discussant.

The previous discussant then assumes the role of observer. And so roles change back and forth as indicated by patient responses or the immediate need for a particular sex-linked definition or explanation of material. Much of the patient’s reaction can be identified by the observer that cannot be immediately apparent to any individual therapist simultaneously attempting to direct therapy and to evaluate levels of patient receptivity.

In the finite cooperative interaction between mutually confident cotherapists in any dual-sex therapy team, the currently dominant partner influence at any particular time is not being exercised by the one that is talking, but by the one that is observing.

Inevitably any sexually dysfunctional couple has, as one of its fundamental handicaps, insecurity in any and all sexual matters.

How often have the sexual partners asked themselves if they are really “complete” as individuals?
Has their functional efficiency been diminished in stressful situations other than in bed?
How do their patterns of sexual response compare to those of their peers?
How can a particular sexual situation or any confrontation with material of sexual content be handled without awkwardness or embarrassment?

The cotherapists encounter a multiplicity of these problems to which they can respond by holding up a professional “mirror” and helping the marital partners understand what it reflects. With the non-judgemental mirror available, constructive criticism can be accepted in the same non-prejudiced, comfortable manner in which it must be presented.

With this educational technique of reflective teaching, the distressed couple can be encouraged to take that first step that ultimately presages success in therapy for sexual dysfunction. The step consists of putting sex back into its natural context.

Seemingly, many cultures and certainly many religions have risen and fallen on their interpretation or misinterpretation of one basic physiological fact. Sexual functioning is a natural physiological process, yet it has a unique facility that no other natural physiological process, such as respiratory, bladder, or bowel function, can imitate.

Sexual responsivity can be delayed indefinitely or functionally denied for a Iifetime. No other basic physiological process can claim such male ability of physical expression.

With the advantage of this unique characteristic, sexual functioning can be easily removed from its natural context as a basic physiological response. Everyone takes advantage of this characteristic every day as he rejects or defers untimely or inappropriate sexual stimuli in order to comply with the social requirements of the moment.

Religions have found dedicated support from those willing to sacrifice their functional physical expression of sexuality as a devotion to or an appeasement for their god or gods. If the natural physiological process of human sexual response did not encompass this completely unique adaptability, the sacrifice of denying one’s sexual functioning for a lifetime could never have been made.

But the individuals who involuntarily take sexual functioning further out of context than any other are those members of couples contending with inadequacy of sexual function. Through their fears of performance (the fear of failing sexually), their emotional and mental involvement in the sexual activity they share with their partner is essentially nonexistent.

The thought (an awareness of personally valued sexual stimuli) and the action are totally dissociated by reason of the individual’s involuntary assumption of a spectator’s role during active sexual participation.

It is the active responsibility of therapy team members to describe in detail the psychosocial background of performance fears and “spectator” roles. This explanation is best accomplished by the cotherapist of the same sex as that of the individual whose performance fears are to be discussed. Again, education is the basis for therapeutic success, and the dual-sex team can best present this information by following a sex-linked guideline.

Sexual Dysfunction Treatment

In any approach to a psycho-physiological process, treatment concepts vary measurably from school to school and, similarly, from individual therapist to individual therapist. The Reproductive Biology Research Foundation’s theoretical approaches to the treatment of men and women distressed by some form of sexual dysfunction have altered significantly and, hopefully, have matured measurably during the past 11 years. There are founded on a combination of 15 years of laboratory experimentation and 11 years of clinical trial and error.

Sexual Response

When the laboratory program for the investigation in human sexual functioning was designed in 1954, permission to constitute the program was granted upon a research premise which stated categorically that the greatest handicap to successful treatment of sexual inadequacy was a lack of reliable physiological information in the area of human sexual response.

It was presumed that definitive laboratory effort would develop material of clinical consequence. This material in turn could be used by professionals in the field to improve methodology of therapeutic approach to sexual inadequacy. On this premise, a clinic for the treatment of human sexual dysfunction was established at Washington University School of Medicine in 1959, approximately five years after the physiological investigation was begun. The clinical treatment program was transferred to the Reproductive Biology Research Foundation in 1964.

When any new area of clinical investigation is constituted, standards must be devised in the hope of establishing some means of control over clinical experimentation. And so it was with the new program designed to treat sexual dysfunction. Supported by almost five years of prior laboratory investigation, fundamental clinical principles were established at the onset of the therapeutic program. The original treatment concepts still exist, even more strongly constituted today. As expected, there were obvious theoretical misconceptions in some areas, so alterations in Foundation’s policy inevitably have developed with experience.

Categories
Men's Health

Sex Therapist

If there are to be dual-sex therapy teams, what roles do the individual cotherapists play? What guidelines do they follow? What therapeutic procedures ensue? What should be their qualifications as professionals in this sensitive, emotionally charged area? These are all pertinent questions, and, as would be expected, in some cases they are difficult to answer.

The major responsibility of each cotherapist assigned to a husband and wife problem is to evaluate in depth, translate for, and represent fairly the member of the distressed couple of the same sex. This concept should not be taken to suggest that verbal or directive interaction is limited to wife and female cotherapist or to husband and male cotherapist far from it. The interpreter role does not constitute the total contribution an individual cotherapist makes in accepting the major responsibility of sex-linked representation. The male cotherapist can provide much information pertaining to male-oriented sexual function for the wife of the distressed couple; and equally important, female-oriented material is best expressed by the female cotherapist for benefit of the husband.

Acute awareness of the two-to-one situation frequently develops when a sexually distressed couple sees a single counsellor for sexual dysfunction.

For example, if the therapist is male and there is criticism indicated for or direction to be given to the wife, the two-to-one opposition may become overpowering.

Who is to interpret for or explain to the wife matters of female sexual connotation? Where does she develop confidence in therapeutic material she cannot express her concepts adequately to the two males in the room?

Exactly the same problem occurs if the therapist is female and contending with a sexually dysfunctional couple. Who interprets for or to the husband?

Dual Sex Team

Avoids the potential therapeutic disadvantage of interpreting patient complaint on the basis of male or female bias. Experience has established a recognizable pattern in the various phases of response by a female patient to questioning by a male cotherapist.

As a rough rule of thumb, unless the distress is most intense, the wife can be expected to tell her male therapist first what she wants him to know; second, what she thinks he wants to know or can understand; and not until a third, ultimately persuasive attempt has been made can she consistently be relied upon to present material as it is or as it really appears to her. With the female cotherapist in the room, although the wife may be replying directly to interrogation of the male cotherapist.

During the first exposure to questioning she routinely is careful to present material as she sees it or as she believes it to be, for she knows she is being monitored by a member of her own sex. The inference, of course, is that “it takes one to know one.” The “presence” usually is quite sufficient to remove a major degree of persiflage from patient communication.

When the sexually dysfunctional male patient is interviewed by a female therapist, it is extremely difficult to elicit reliable material, for cultural influence inevitably will prevail. Many times the male tells it as he would like to believe it is, rather than as it is.

Sexual Dysfunction and Male Ego

His ego is indeed a fragile thing when viewed under the spotlight of untempered female interrogation. Not infrequently his performance fears, his anxieties, and his hostilities are magnified in the face of his concept of a prejudiced two-to-one relationship in therapy, when he presumes that his wife has the advantage of the therapist’s sexual identity.

The participation of both sexes contributes a “reality factor” to therapeutic procedure in yet another way. It lessens the need for enactment of social ritual designed to gain the attention of the opposite-sex therapist, an unnecessary diversion which often produces biased material in its effort to impress.

These hazards of interrogation and interpersonal misinterpretations can be bypassed through use of the dual-sex team. Certainly, during history-taking there is a session devoted to male cotherapist interrogation of the wife and female cotherapist interrogation of the husband, but in each instance within the method there is built-in protection to avoid the previously mentioned pitfalls.

First
The husband has had an extensive discussion with the male cotherapist the previous day (as has the wife with the female cotherapist); thus, the pattern for same-sex confrontation and information interchange has already been introduced, concomitantly establishing greater reliability of reporting.

Second
Both members of the sexually disturbed couple are aware that four persons are committed to a common therapeutic goal and that all parties will be brought together the next day for the roundtable discussion. Hence, any tendency of the patient to provide the cotherapist with inaccurate clinical material in the opposite-sex interrogative session usually is curbed in advance by the dual-sex team environment and the previously described progression of the treatment program.

Equal partner representation in a problem of sexual dysfunction is a particularly difficult concept to accept for those patients previously exposed to other forms of psychotherapy. When either partner has been accustomed to being the principal focus of therapy, he or she finds it strange indeed that neither partner holds this position. Rather it is their interpersonal relationship within the context of the marriage that is held in focus.

An additional fortunate therapeutic return from the presence of both sexes within the therapy team is in the area of clinical concern for transference. There always is transference from patient to therapist as a figure of authority. There is no desire to avoid this influence in the therapeutic program, but, beyond both patients’ and therapists’ need to establish the authority figure, every effort is made in the brief two-week acute phase of the therapy program to avoid development of a special affinity between either patient and either cotherapist .

Instead of generating emotional currents, especially those with sexual connotation, from one side of the desk to the other, the therapeutic team is intensely interested in stimulating the flow of emotional and sexual awareness between husband and wife and encourages this response at every opportunity.

For example, if the team were to observe the wife becoming intensely attentive to the male cotherapist, directing all questions to him, accepting or even prompting answers only from him, in short, replacing the husband with the cotherapist as the male figure of the moment. The team would take steps to counteract this distracting, potentially husband-alienating trend.

The male cotherapist would begin to direct questions only to the husband, and all material pertinent to the wife (even including basic information pertaining to male sexual response) would be presented by the female member of the team until it was obvious that the wife’s incipient tendency to establish special interpersonal communication with the male cotherapist had been counterbalanced by team intervention. Attempted recruitment of special rapport with the female cotherapist by the husband is handled in a similar manner.

To create further emotional trauma for either sexually insecure marital partner by encouraging or accepting such alignment, however deliberately or naively proffered, is not only professionally irresponsible, but also can be devastating to therapeutic results.

It cannot be emphasized too vigorously that the techniques of transference, so effective in attacking many of the major psychotherapeutic problems over the years, are not being criticized. The Foundation is entirely supportive of the proper usage of these techniques as effective therapeutic tools.

However, from the start of the clinical program, the Foundation has taken the specific position that the therapeutic techniques of transference have no place in the acute two-week attempt to reverse the symptoms of sexual dysfunction and establish, re-establish, or improve the channels of communication between husband and wife.

Anything that distracts from positive exchange between husband and wife during their time in therapy is the responsibility of the therapeutic team to identify and immediately nullify or negate.

Positive transference of sexual orientation can be and frequently is a severe deterrent to effective reconstitution of interpersonal communication for members of a couple, particularly when they are contending with a problem of sexual dysfunction.

Categories
Men's Health

Impotent and Sexual Performance

Regardless of the particular form of sexual inadequacy with which both members of the couple are contending.

Fears of sexual performance are of major concern to both partners in the marital bed.

The impotent male’s fears of performance can be described in somewhat general terms. With each opportunity for sexual connection, the immediate and overpowering concern is whether or not he will be able to achieve an erection. Will he be capable of “performing” as a “normal” man? He is constantly concerned not only with achieving but also with maintaining an erection of quality sufficient for intromission

His fears of sexual performance are of such paramount import that in giving credence to or even directing overt attention to his fears, he is pulling sexual functioning completely out of context. Actually, the impotent man is gravely concerned about functional failure of a physical response which is not only naturally occurring, but in many phases involuntary in development.

To oversimplify, it is his concern which discourages the natural occurrence of erection. Attainment of an erection is something over which he has absolutely no voluntary control. No man can will, wish, or demand an erection, but he can relax and allow the sexual stimulation inherent in erotic involvement with his marital partner to activate his psycho-physiological responsivity. Many men contending with fears for sexual function have distorted this basic natural response pattern to such an extent that they literally break out in cold sweat as they approach sexual opportunity.

Impotence

Not only does the husband contend with fears of performance when impotence is the clinically presenting complaint, but the wife has her fears of performance as well. Her constant concern is that when her husband is given adequate opportunity for sexual expression, he will be unable to achieve and/or maintain an erection. She has grave fears for his ability to perform under the stress of the psychosocial pressure which both partners have unwittingly contrived to place upon this natural physical function.

Additionally, wives of impotent men are terrified that something they do will create anxiety, or embarrass, or anger their husbands. All of these crippling tensions in the marital relationship are gross evidence that two people are contending with sexual functioning unwittingly drawn completely out of context as a natural physical function by their fears of performance.

An exactly parallel situation can be a factor in female sexual inadequacy. Fifty years ago in this country the non orgasmic woman was led (or under the pressure of propriety, forced) to believe that sexual responsivity was not really her privilege. Sexual pleasure was considered an unnatural physical response pattern for women, and any admission of its occurrence was unseemly to say the least.

The popular magazines, with their constant consideration of the subject, have brought to the non orgasmic female a realization that in truth she is a naturally functional sexual entity.

Unfortunately they have also provided her with real fears of performance by depicting, often with questionable realism, the sexual goals of effectively responsive women.

Sexual Stimuli

Her frequently verbalized anxieties when she does not respond to the level of orgasm (at least a certain percentage of time) are: “What is wrong with me? Am I less than a woman? I certainly must be physically unappealing to my husband,” and so on. These grave self-doubts and usually groundless suspicions are translated into fears of performance.

It should be restated that fear of inadequacy is the greatest known deterrent to effective sexual functioning, simply because it so completely distracts’ the fearful individual from his or her natural responsivity by blocking reception of sexual stimuli either created by or reflected from the sexual partner.

Therapy concepts place major emphasis on the necessity for familiarizing the marital partner of a dysfunctional patient with details of the fear component. There must always be real awareness of the fears of performance by the marital partner attempting to support his or her mate in the distress of sexual inadequacy.

The husband of the non orgasmic woman may well have his own fears of performance. He worries about why he, as a sexually functional male, cannot give her the “gift” of response. Why is his wife non responsive to his sexual approaches? What really is wrong when he cannot satisfy her sexual needs?

The husband’s fear of performance when dealing with a non orgasmic wife reflects anxieties directed as much toward his own sexual prowess as to his wife’s inability to accomplish relief of sexual tensions. It is the influence of our culture, expressed in the demand that he “do something” in sexual performance, that gives the man responsibility for the woman’s sexual effectiveness as well as his own.

If his wife is non orgasmic, more times than not he worries about his inadequate performance rather than lending himself with personal pleasure to the mutual sexual involvement that would lead to release of his wife from her dysfunctional status. Together, these frightened people manage to take not only sexual functioning from its natural context, but also keep it in its unnaturally displaced state indefinitely.

One of the most effective ways to avoid emphasizing the patient’s fears of performance during any phase of the therapy program is to avoid all specific suggestion of goal oriented sexual performance to the couple.

Regardless of the length or the intensity of the psycho therapeutic procedures, at some point the therapist usually turns to his or her patient and suggests that the individual should be about ready for a successful attempt at sexual functioning, immediately the fears of performance flood the psyche of the individual placed so specifically on the spot to achieve success by this authoritative suggestion.

Rarely is this suggestion taken as an indication of potential readiness for sexual function, as intended, but usually is interpreted as a specific direction for sexual activity. If there is a professional suggestion that “tonight’s the night,” the individual feels that he has been told by constituted authority that he must go all the way from A to Z, from onset of sexual stimulation to successful completion.

In many instances, regardless of the duration or effectiveness of the psychotherapeutic program, the fears of performance created by this authoritative suggestion for end point achievement are of such magnitude that sensate input is blocked firmly, and there will be no effective sexual performance regardless of the degree of motivation.

Removal of such goal-oriented concept, in any form or application, is necessary to secure effective return of sexual function. This can be achieved by moving the interacting partners, not the dysfunctional individual, on a step-by-step basis to mutually desirable sexual involvement.

Sexual Discussion

Four way verbal exchange is maintained at an open, comfortable level during therapy. Communication is first developed across the desk between patients and cotherapists. Within a few days, verbal exchange is deliberately encouraged between patients.

The cotherapists are fully aware that their most important role in reversal of sexual dysfunction is that of catalyst to communication. Along with the opportunity to educate concomitantly exists the opportunity to encourage discussion between the marital partners wherein they can share and understand each other’s needs.

If the therapy team functions well, its catalytic role in marital communication, which initially is of utmost importance, becomes a factor of progressively decreasing importance over the two week period. If the catalytic role is well played, the marital partners will be communicating with increasing facility at termination of the acute phase of therapy; by then communication between the marital partners should be well established.

Categories
Men's Health

Sex and Pelvic Infection

When considering intense pain elicited during coital functioning as opposed to vaginal aching or irritation, the therapist generally should look beyond the confines of the vaginal barrel for existent pathology involving the reproductive viscera.

Acute or chronic infections and endometriosis are pathological conditions involving the reproductive viscera; uterus, tubes, and ovaries that consistently may return a painful response as the female partner is sharing coital experience.

Although these two entities will be discussed separately, they do have in common similar physiological creation of painful response patterns during intercourse.

In both instances the response arises from peritoneal irritation resulting in local adhesions not only between folds of peritoneum but also involving tubes, ovaries, bowels, bladder, and omentum.

The combination of involuntary distention of the vaginal barrel created by female sex-tension increment and active male thrusting during coital connection places tension on relatively inelastic pelvic tissues stabilized by minor or even major degrees of fibrosis resulting from the infection or the endometriosis.

In short:
Any clinical condition that creates an untoward degree of rigidity of the soft tissues of the female pelvis, so that they do not move freely during sexual connection can return a painful response to the female partner involved.

Infections in the reproductive organs start with chronic involvement of the cervix (endocervicitis). By drainage through lymphatic channels, long-maintained endocervicitis can involve the basic supports of the uterus (Mackenrodt’s ligament) in a chronic inflammatory process. The resultant low-grade peritoneal irritation initiates painful stimuli when the cervix is moved in any direction, particularly by a thrusting penis.

The uterus itself can be involved with infection in the uterine cavity or endornetritis, or with a residual of infection throughout the muscular walls (myometritis) to such an extent that any pressure upon the organ is responded to with pain.

Retrograde involvement of the peritoneal covering of the uterus and its supports is quite sufficient to cause distress if the uterus is moved, either with involuntary elevation into the false pelvis with female sex-tension increment or during a male thrusting phase in coital connection.

Obviously there are many sources of infection of the oviducts (tubes). Any infections that originate in the cervix have opportunity to spread through the uterine cavity and into the tubal lumina.

The major infective agents are:
Gonococcus, streptococcus, staphylococcus, and coliform organisms. First infections in the tubal lumina frequently spill into the abdominal cavity, causing at least localized pelvic inflammation and at most generalized abdominal peritonitis.

Subsequently, as the acute stage of the infection subsides those areas involved in the infectious process remain open to the development of adhesions between loops of bowel, the omentum, and the pelvic viscera.

There even may be abscess formation involving the tubes and ovaries. In all these situations there is tension on and tightening of the peritoneum and rigid fixation of the pelvic soft-tissue structures to such an extent that vaginal distention and coital thrusting create a markedly painful response for the woman.

In no sense does this brief clinical description of pelvic inflammatory processes imply that whenever any woman acquires infection in the pelvic viscera she is committed thereafter to pain during coital connection.

With early and adequate medical care most pelvic infections do not create a residual of continuing pain with coital exposure. The degree of residual pelvic pain depends upon the severity of the occasional sequelae of the infectious process.

Where are the adhesions and how extensive are they? To what extent is natural expansion of the vaginal barrel restricted by filling of the cul-de-sac with an enlarged tube, by an ovary firmly adhered to the posterior wall of the broad ligament, or by a uterus held in severe third degree retroversion by adhesions? Any of these situations may create painful stimuli with penile thrusting.