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Sexual Dysfunction Treatment

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.

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Sexual Dysfunction

Male Sexual Dysfunction

In order to be diagnosed as having primary orgasmic dysfunction, a woman must report lack of orgasmic attainment during her entire lifespan. There is no definition of male sexual dysfunction that parallels in this severity of exclusion.

A Male Is Judged Primarily Impotent:
The definition means simply that he has never been able to achieve intromission in either homosexual or heterosexual opportunity. However, he might, and usually does, masturbate with some regularity or enjoy occasions of partner manipulation to ejaculation.

For the primarily non orgasmic woman, however, the definition demands a standard of total inorgasmic responsivity.

The edict of lifetime non orgasmic return in the Foundation’s definition of primary orgasmic dysfunction includes a history of consistent non orgasmic response to all attempts at physical stimulation, such as masturbation, male or female manipulation, oral genital contact, and vaginal or rectal intercourse.

In Short
Every possible physical approach to sexual stimulation initiated by self or received from any partner has been totally unsuccessful in developing an orgasmic experience for the particular woman diagnosed as primarily non orgasmic.

If a woman is orgasmic in dreams or in fantasy alone, she still would be considered primarily non orgasmic.

Foundation personnel have encountered two women who provided a positive history of an occasional dream sequence with orgasmic return and a negative history of physically initiated orgasmic release.

However, no woman has been encountered to date that described the ability to fantasy to orgasm without providing a concomitant history of successful orgasmic return from a variety of physically stimulative measures.

There are salient truths about male and female sexual interaction that place the female in a relatively untenable position from the point of view of equality of sexual response.

Of primary consideration is the fact of woman’s physical necessity for an effectively functioning male sexual partner if she is to achieve coitally experienced orgasmic return.

During coition the non orgasmic human female is immediately more disadvantaged than her sexually inadequate partner in that her fears for performance are dual in character. Her primary fear is, of course, for her own inability to respond as a woman, but she frequently must contend with the secondary fear for inadequacy of male sexual performance.

The outstanding example of such a situation is, of course, that of the woman married to a premature ejaculator. From the point of view of mutual responsibility for sexual performance, the woman has only to make herself physically available in order to provide the male with ejaculatory satisfaction.

The premature ejaculator in turn makes himself available, there usually is little correlation between intromission, rapid ejaculation, and female orgasmic return during the episode.

Married Premature Ejaculator

The biophysically disadvantaged female usually is additionally disadvantaged from a psychosocial point of view. Not only is there insufficient bio-physical opportunity to accomplish orgasmic return, but in short order the wife develops the concept of being sexually used in the marriage.

She feels that her husband has no real interest in her personally nor any concept of responsibility to her as a sexual entity. Many times the wife might be at a peak of sexual excitation with intromission. Without fear for her husband’s sexual performance she could be orgasmically responsive shortly after coital connection, displaying full bio-physical capacity for sexual response.

But as she sees and feels the male thrusting frantically for ejaculatory release, she immediately fears loss of sexual opportunity, is distracted from input of biophysical stimuli by that fear, and rapidly loses sexual interest.

With the negative psychosocial-system influence from the concept of being used more than counterbalancing the high level of biophysically oriented sexual tension she brought to the coital act, orgasmic opportunity is lost.

Brief attempt should be made to highlight the direct association of male and female sexual dysfunction in marriage, for there were 223 couples referred to the Foundation for treatment with bilateral partner complaints of sexual inadequacy. By far the greatest instance of a combined diagnosis was that of a non orgasmic woman married to a premature ejaculator.

Of the total 186 premature ejaculators treated in the 11 year program, 68 were married to women reported as primarily non orgasmic and an additional 39 wives were diagnosed as situationally non orgasmie. Thus, in 107 of the 223 marriages with bilateral partner complaint of sexual dysfunction, the specific male sexual inadequacy was premature ejaculation.

Since the in-depth descriptions of the premature ejaculator presented in earlier topic include full descriptions of the problems of female sexual functioning in this situation, there is no need for a detailed history representative of the 68 women primarily non orgasmic in marriages to prematurely ejaculating men.

Another salient feature in the human female’s disadvantaged role in coital connection is the centuries old concept that it is woman’s duty to satisfy her sexual partner. When the age old demand for accommodation during coital connection dominates any woman’s responsivity, her own opportunities for orgasmic expression are lessened proportionately.

If woman is to express her biophysical drive effectively, she must have the single-standard opportunity to think and feel sexually during coital connection that previous cultures have accorded the man.

The male
must consider the marital bed as not only his privilege but also a shared responsibility if his wife is to respond fully with him in coital expression. The heedless male driving for orgasm can carry along the woman already lost in high levels of sexual demand, but his chances of elevating to orgasm the woman who is trying to accommodate to the rhythm, depth, and power of his demanding pelvic thrusting are indeed poor.

It is extremely difficult to categorize female sexual dysfunction on a relatively secure etiological basis. There is such a multiplicity of influences within the biophysical and psychosocial systems that to isolate and underscore a single, major etiological factor in any particular situation is to invite later confrontation with pitfalls in therapeutic progression.

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Knowing Woman Sexuality

Sexual Dysfunction

The most common dysfunctions treated by sex therapists are:

    • Anorgasmia: The women has never, or only rarely, reached orgasm.
    • Delayed Ejaculation: The man can act sexually though seldom, if ever, climaxes in his partner’s presence.
    • Erectile Insecurity: Also called impotence, the condition is marked by difficulty in either getting or staying erect.
    • Inhibited Sexual Desire: A form of sexual apathy marked by infrequent sex, and a lack of thoughts and anticipation of sex.
    • Premature Ejaculation: The man climaxes more rapidly than he or his partner wishes, sometimes before intercourse begins.
    • Vaginismus: The woman desires sex, but her vaginal muscles contract involuntarily, preventing penetration.
    • Inappropriate Arousal: Being aroused by that which a culture deems inappropriate: children, animals, objects.

Most sex therapists find that when a couple finally summon the nerve to seek help, the problem is usually in an advanced stage, and can no longer be ignored, or endured. In nearly all cases, both partners need to be treated together.

The female problems such as anorgasmia and vaginismus are rare and psychological in origin. If mild, they can be solved by the woman herself with a vibrator. If severe, visit a sex therapist without delay. Male problems of ejaculatory control respond to self therapy and professional help. An erection problem can be the first sign of pre-diabetes, and the man should be tested for this promptly.

Inhibited Sexual Desire (ISD) appears to be a modern complaint amongst modern couples. Sex therapists say that it is by far the nation’s most common sexual dysfunction. For what are usually complex reasons, often including a past sexual problem, one or both partners have lost all desire for erotic intimacy.

Yet ISD is a philosophical concept, not a biological one. When and how often people wish to make love is a subjective issue. At its best, erotic love is an exquisitely sensitive bloom. Even when nurtured with the utmost love and tenderness, it can wax and wane, like the cycles of the moon.

It seems a very modern concept to regard the genitals as a set of engine parts which should be working. And that if one of these parts slows down or stops functioning, it should be taken to the auto body shop, and fixed. This mechanical way of perceiving what can be a most delicate interaction probably suits mechanical thinkers.

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Impotence Cure

Sexual Dysfunction in Husband & Wife

Of course, most wives would not consider public discussion of the sexual inadequacy in their marriages. For a variety of reasons, they choose to keep their own counsel.

They may feel that their husband’s dysfunction has origin in, or at least is magnified by, their own lack of physical appeal, or that they forced this inadequacy by their lack of competence of sexual functioning.

Most women identify completely with and suffer for, their husbands in sexual inadequacy. They feel warmth and sympathy and understand the psychosocial trauma created by his obvious failure in the marriage bed.

For a variety of reasons then, most women would not consider discussing their husband’s sexual dysfunction even with their closest friend.

But most women, whether they accuse publicly or support privately, do not comprehend the degree to which they have directly influenced their husband’s sexual inadequacy.

There is no such entity as an uninvolved partner in a marriage contending with any form of sexual inadequacy.

Sexual Dysfunction is A Couple’s Problem

not a husband’s or wife’s problem.

Therefore, husband and wife should be treated simultaneously when symptoms of impotence distress the husband and wife. The Foundation will not treat a husband for impotence or a wife for non-orgasmic return as single entities.

If not accompanied by his wife, the impotent husband is not accepted in therapy. Both marital partners have not only contributed to but are totally immersed in, the clinical distress by the time any unit is seen in therapy.

How best to treat clinical impotence? The first tenet in therapy is to avoid the expected, direct clinical approach to the symptoms of erective inadequacy.

The secret of successful therapy (for this dysfunction):
is not to treat the symptoms of impotence at all, for to do so means attempting to train or educate the male to attain a satisfactory erection, and places the therapist at exactly the same psychological disadvantage as that of the impotent male trying to will an erection.

Therapists cannot supplant or improve on a natural process and achievement and maintenance of penile erection is a natural process.

The major therapeutic contribution involves convincing the emotionally distraught male that he does not have to be taught, to establish an erection. He cannot be taught to achieve an erection any more than he can be taught to breathe.

Erections develop just as involuntarily and with just as little effort as breathing. This is the salient therapeutic fact the disturbed man must learn. No man can will an erection.

Every impotent man has to negate or neutralize a number of psychosocial influences which have helped to create his sexual dysfunction if he is to achieve erective effectiveness.

However, the prevalent roadblock is one of fear. Fear can prevent erections just as fear can increase the respiratory rate or lead to diarrhea or vomiting.

At the onset of therapy, the impotent man’s fears of performance and his resultant spectator’s role are described specifically by the co-therapists and must be accepted in totality by the distressed male if reversal of the sexual dysfunction is to be accomplished.

Every impotent male is only too cognizant of his fears of performance, and, once the point is emphasized, he also is completely aware of the involuntary spectator role he plays during the coital attempt.

The Three Primary Goals in Treating Impotence Are:

  1. remove the man’s fears for sexual performance
  2. to reorient involuntary behavioral patterning so that he becomes an active participant, far removed from his accustomed spectator’s role.
  3. to relieve the wife’s fears for her husband’s sexual performance.

Whenever any individual evaluates his sexual performance or that of his partner during an active sexual encounter, he is removing sex from its natural context. And this, of course, is the all-important factor in both onset of and reversal of sexual inadequacy.

Penis flaccidity
With any form of sexual dysfunction, sex is removed from its natural context. The man watching carefully to see whether he is to achieve erection sweats and strains to will that erection.

The more the male strains the more distracted he becomes and the less input of sensual pleasures he receives from his partner; therefore, the more entrenched the continued state of penile flaccidity.

Sexual Tension

In a natural cycle of sexual response, there is input to any sexually involved individual from two sources.

As an example, presume an interested husband approaching his receptive wife. There are two principal sources of his sexual excitation. The first is developed as the husband approaches his wife sexually, stimulating her to high levels of sexual tension.

Her biophysical response to his stimulative approach (her pleasure factor), usually expressed by means of nonverbal communication, is highly exciting to the male partner. While pleasing his wife and noting the signs of her physical excitation (increased muscle tone, rapid breathing, flushed face, abundance of vaginal lubrication), he usually develops an erection and does so without any direct physical approach from his wife.

In this situation, he is giving himself to his wife and getting a high level of sexual excitation from her in return.

The second source of male stimulation develops as the wife approaches her husband with direct physical contact.

Regardless of the technique employed, his wife’s direct approach to his body generally, and the pelvic area specifically, is sexually exciting and usually productive of an erection.

When stimuli from both sources are combined by mutuality of sexual play, the natural effect is the rapid elevation of sexual tension resulting in a full, demanding erection.

Often men move into a pattern of erective failure because they do not experience sensate input from both sides of the give-to-get cycle. Loss of supportive sexual excitation frequently develops not because wives are unavailable or uninterested but because one or both of the basic modes of input of sexual stimuli is blocked.

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Erectile Dysfunction

Impotence or Erectile Dysfunction

For clinical purposes the primary impotence man arbitrarily has been defined as a male or penis never able to achieve and/or maintain an erection quality sufficient to accomplish successful coital connection. If erection is established and then lost under the influence of real or imagined distractions relating to coital opportunity, the erection usually is dissipated without accompanying ejaculatory response.

NO man is considered primarily impotent if he has been successful in any attempt at intromission in either heterosexual or homosexual opportunity.

the 11 years of the investigative program in sexual inadequacy 32 primarily impotent males have been accepted for treatment. Of these, 21 were unmarried when seen in therapy; 4 of the 21 men have histories of prior marriage contracts with either an annulment or a divorce legally attesting to their failures in sexual performance. The remaining 11 primarily impotent men were married when referred to the Foundation with their wives in the hope of consummating their marriages. These unconsummated marriages have ranged from 7 month to 18 year duration.

Negation of the young male’s potential for effective sexual functioning has been thought to originate almost entirely in derogatory influences of family background. Without denying the importance of familial investment, the natural social associations of the adolescent as he ventures from his security base are also statistically of major importance.

The etiological factors that are in large measure responsible for individually intolerable levels of anxiety either prior to or during initial attempts at sexual connection are untoward maternal influences, psychosocial restrictions originating with religious orthodoxy, involvement in homosexual functioning, and personal devaluation from prostitute experience.

It always must be borne in mind that multiple etiological factors usually are influencing the primarily impotent male. Categorical assignment of a dominant etiological role is purely an arbitrary professional decision. Others might differ significantly were they to review the same material. Case histories have been kept at a didactic level for illustrative purposes.