Tag: Male Sex

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Sexual Dysfunction

Male Sex & Religion

Male Female Sexual Response, Inadequate,Orgasm,Inadequate Orgasm, impotent, inexperience sexual male, sexual response, male libido, sexual dysfunction, orgasmic dysfunction, woman sexuality, sex drive

While the multiplicity of etiological influences is acknowledged, the factor of religious orthodoxy still remains of major import in primary orgasmic dysfunction as in almost every form of human sexual inadequacy.

Investigation of 193 women who have never achieved orgasmic return before referral to the Foundation for treatment, 42 were products of rigidly channelized religious control. Eighteen were from Catholic, 26 from Jewish, and 7 from fundamentalist Protestant backgrounds.

It may also be recalled that 9 of these 42 primarily non orgasmic women reflecting orthodox religious backgrounds also were identified as having the clinical complaint of vaginismus, while 3 more women with orthodox religious backgrounds had to contend with situational orgasmic dysfunction and vaginismus simultaneously.

A history reflecting the control of orthodox religious demands upon the orgasmically dysfunctional woman and her husband is presented to underscore the Foundation’s professional concern for any orthodoxy-influenced imprinting and environmental input that can and does impose severely negative influences upon the susceptible woman’s psychosocial structure relative to her facility for sexual functioning.

Mr. A and His Wife
After 9 years of a marriage that had not been consummated, Mr. and Mrs. A were referred to the Foundation for treatment. He was 26 and she 24 years old at marriage. Mrs. A’s family background was one of unquestioned obedience to parents and to disciplinary religious tenets.

She was one of three siblings, the middle child to an elder brother by three years and a younger sister by two years. Other than her father, religion was the overwhelming influence in her life. The specific religious orientation that of Protestant fundamentalism encompassed total dedication to the concept that sex and sin were synonymous words.

Mrs. A remembers her father, who died when she was 19, as a Godlike figure whose opinion in all matters was absolute law in the home. Control of dress, social commitment, educational direction and in fact, school selection through college were his responsibility.

There were long daily sessions, of family prayer interspersed with paternal pronouncements, never family discussions. On Sunday the entire day was devoted to the church, with activities running the gamut of Sunday school, formal service, and young people’s groups.

The young woman described a cold, formal, controlled family environment in which there was complete demand for dress as well as toilet privacy.

Not only were the elder brother and sisters socially isolated, but the sisters also were given separate rooms and encouraged to protect individual privacy.

She never remembers having seen her mother, father, brother, or sister in an undressed state. The subject of sex was never mentioned, and all literature, including newspapers, available to the family group was evaluated by her father for possibly suggestive or controversial material. There was a restricted list of radio programs to which the children could listen.

Mrs. A had no concept of her mother except as a woman living a life of rigid emotional control, essentially without a described personality, fully dedicated to the concept that woman’s role was one of service. She considered it her duty and her privilege to clean, cook, and care for children, and to wait upon her husband.

There is no recall of pleasant moments of quiet exchange between mother and daughter, or, for that matter, of any freedom to discuss matters of moment with either her brother or her sister.

As a young girl she was totally unprepared for the onset of menstruation. The first menstrual period occurred while she was in school she was terrified, ran home, and was received by a thoroughly embarrassed mother who coldly explained to the young girl that this was woman’s lot.

She was told that as a woman she must expect to suffer this “curse” every month. Her mother warned her that once a month she would be quite ill with “bad pains” in her stomach and closed the discussion with the admonition that she was never to discuss the subject with anyone, particularly not with her younger sister. The admonition was obeyed to the letter.

The mother provided the protective materials necessary and left the girl to her own devices. There was no discussion of when or how to use the menstrual protection provided.

Menstrual cramping had its onset with the second menstrual period and continued to be a serious psychosocial handicap until Mrs. A was seen in therapy. She also described the fact that her younger sister was confined to bed with monthly frequency while maturing.

During the Teenage Years

Dating in groups was permitted by her father for church-social activities and occasionally, well-chaperoned school events. College, selected by her father, was a coeducational institution which was described by her as living by the “18-inch rule,” i.e., handholding was forbidden and 18 inches were required between male and female students at all times.

Her dating was rare and well chaperoned. After graduation she worked as a secretary in a publishing house specializing in religious tracts. Here she met and married a man of almost identical religious background.

The courtship was completely circumspect from a physical point of view. The couple arrived at their wedding night with a history of having exchanged three chaste kisses, which not only was the total of their physical courtship but also represented the only times she remembered ever being kissed by a man. Her father had felt such a display of emotion unseemly.

The only time her mother ever discussed a sexual matter was the day of her wedding. Mrs. A was carefully instructed to remember that she now was committed to serve her husband. It would be her duty as a wife to allow her husband privileges.

The Husband Privileges
were never spelled out. She also was assured that she would be hurt by her husband, but that “it” would go away in time. Finally and most important, she was told that “good women” never expressed interest in the “thing.” Her reward for serving her husband would be, hopefully, in having children.

She remembers her wedding night as a long struggle devoted to divergent purposes. Her husband frantically sought to find the proper place to insert his penis, while she fought an equally determined battle with nightclothes and bedclothes to provide as completely a modest covering as possible for the awful experience.

The pain her mother had forecast developed as her husband valiantly strove for intromission.

Although initially there were almost nightly attempts to consummate the marriage, there was total lack of success. It never occurred to Mrs. A that she might cooperate in any way with the insertive attempts.

And since this was to be her husband’s pleasure, it therefore was his responsibility.

She evidenced such a consistently painful response whenever penetration was attempted that frequency of coital attempt dwindled rapidly. The last three years before referral, attempts at consummation occurred approximately once every three to four months.

For 9 years this woman only knew that she was physically distressed whenever her husband approached her sexually, and that for some reason the distress did not abate, Her husband occasionally ejaculated while attempting to penetrate, so she thought that he must be satisfied.

Whenever Mr. A renewed the struggle to consummate, she was convinced that he had little physical consideration for her. Her tense, frustrated, negative attitude, initially stimulated by both the pain and the “good woman” concept described by her mother, became in due course one of complete physical rejection of sexual functioning in general and of the man involved in particular.

When seen in therapy, Mrs. A had no concept of what the word masturbation meant. Her husband’s sexual release before marriage had been confined to occasional nocturnal emissions, but he did learn to masturbate after’ marriage and accomplished ejaculatory release approximately once a week, without his wife’s knowledge. There was no history of extramarital exposure.

Of interest is the fact that Mrs. A’s brother has been twice divorced, reportedly because he cannot function sexually, and her younger sister has never married. As would be expected, at physical examination Mrs. A demonstrated a severe degree of vaginismus in addition to the intact hymen.

In the process of explaining the syndrome of involuntary vaginal spasm to both husband and wife, the procedures described were followed in detail. When vaginismus was described and then directly demonstrated to both husband and wife.

It was the first time Mr. A had ever seen his wife unclothed and also the first time she had submitted to a medical examination.

There obviously were multiple etiological influences combining to create this orgasmic dysfunction, but the repression of all sexual material inherent in the described form of religious orthodoxy certainly was the major factor.

Under Foundation direction, the process of education had to include reorientation of both the sexual and social value systems. The influence of the psychosocial system was turned from a dominant negative factor to a relatively neutral one during the acute phase of treatment.

This alteration in repressive quality allowed Mrs. A’s natural biophysical demand to function without determined opposition, and orgasmic expression was obtained. Obviously, the husband needed a definitive psychosexual evaluation as much as did his wife.

Categories
Sex & Dyspareunia

Male Sex Distress

Problems,Dyspareunia,Male,Sex,Distress,Male Sex,Male Distress,Sex Distress,Male Sex Distress,Curve,Penis,Curve Penis, distress, dyspareunia, penis, pelvic infection, sex, Sexual,Lubrication,Sexual Lubrication

Among the most distressing of the many factors in dyspareunia are the complaints of burning, itching, or aching in the vagina during or after intercourse. The existence of chronic vaginal irritation frequently robs women of their full freedom of sexual expresssion, for they are well aware that any specific coital connection may be severely irritative rather than highly stimulative.

Presuming adequate production of vaginal lubrication, rarely, if ever, does a woman complain of burning, itching, or aching during coition or describe these symptoms immediately after or even in a delayed postcoital time sequence without concomitant evidence of established pathology in the vaginal barrel.

This form of dyspareunia registered as a complaint by the female partner should have an important connotation to the cotherapist. This specific response pattern is not described by women who are subjectively impelled to register an excuse to avoid impending or threatened coital connection.

When women use the complaint of pain to avoid or delay the necessity for submitting to psycho genically unappealing coital experience, their most frequent complaint is one of severe pain with penile thrusting, “a hurting” deep in the pelvis.

When considering the complaints of burning, itching, or aching in the vagina, initially clinical concern is focused on infectious vaginal invaders. The primary sources of vaginal infection are coition and rectal contamination; secondary sources are manual contact, clothing material, insertion of foreign material, and functional disuse.

Support of and control of the acidity of the vaginal environment is the fundamental means of protection against the bacterial pathogens that can create symptoms of burning, itching or aching. The vagina naturally maintains a strongly acid environment as a protective mechanism against all forms of infectious invasion.

With an experimentally controlled environment, vaginal acidity has been established as varying clinically from pH 3.5 to pH 4.0. Thus, there is a rather wide margin for error in vaginal protection against concurrent infectious agents, for acidity must be sufficiently neutralized to raise the pH level to five or above, before bacterial invaders can flourish freely in the vaginal environment.

The one time that natural vaginal protection against infection breaks down is during the period of established menstrual flow. For many women vaginal acidity consistently registers in the neighborhood of pH 5 or above during menstrual flow, particularly if vaginal tampons are employed.

The neutralizing effect of blood serum constrained to the vaginal tract by retentive tampons directs vaginal acidity into pH 5 levels routinely. It is not surprising, then, that most vaginal infections either have clinical onset or flourish during menstrual flow.

Bacteria

The infective organisms most constantly encountered in vaginal infections, yet trichomonal and fungal forms of infection are seen frequently enough to provide additional causes for clinical concern. Probably the most persistent vaginal-tract invader in any woman’s lifespan are the coliform organisms (Strepto coccus faecalis, Escherichia coli, and the type of Streptococcus viridans), which are the basic contaminants of bowel environment.

From the point of view of patterns of sexual functioning alone, a persistent vaginitis, from which pathogenic organisms repeatedly are cultured in the adult, sexually functioning woman, should always make the therapist question the possibility of occasions of rectal intercourse.

A popular technique employed during rectal intercourse includes the expected format of initial rectal penetration during the excitement phase and repetitive thrusting during the plateau phase of the male sexual response cycle.

Infected Penis

But many men withdraw from the rectum and plunge the bacterially contaminated penis into the vaginal barrel just before or during the stage of ejaculatory inevitability, terminating the orgasmic phase of their sexual cycle by ejaculating intravaginally. Recurrent coliform vaginal infections that are resistant to treatment may have origin in this coital technique.

When rectal intercourse is practiced, the ejaculatory episode should be confined to the lumen of the bowel. There should never be penetration of both rectal and vaginal orifices during any single coital episode, if the woman wishes protection against the probability of recurrent vaginal infections.

If coliform vaginitis persists despite both adequate treatment and patient denial of rectal intercourse, a direct rectal examination frequently will solve the therapist’s diagnostic dilemma. If a woman is experiencing rectal intercourse with some regularity, there may be a specific involuntary reaction of the sphincter to the rectal examination.

When the examining finger is inserted, the response of the rectal sphincter at first will be one of slight to moderate spasm, following the expected reactive pattern of most men or women undergoing routine rectal examinations. But if the examining finger is retained rectally for a few seconds, the sphincter may relax quite rapidly in a completely involuntary manner, as opposed to the routine response pattern of continuing in spastic contraction for the duration of the examination.

If involuntary sphincter relaxation develops, this response pattern, while certainly not reliably diagnostic, should make the cotherapist skeptical of the patient’s denial of rectal coital episodes.

The involuntary sphincter relaxation develops because the retained examining finger stimulates a pleasurable response for those women enjoying regularity of rectal coital exposure as opposed to those finding rectal examinations subjectively objectionable and objectively painful.

Clinical note:
The same type of involuntary sphincter relaxation may develop in male homosexuals whose preferred pattern of sexual expression includes interest in regularity of rectal penetration. Again, the involuntary sphincter response pattern has been used by the Foundation’s professional staff as a clinical diagnostic aid when dealing with homosexual male patients employing the rectum as the means of providing ejaculatory release for sexual partner or partners.

When the cotherapist can be reasonably certain by both history and examination of some regularity of rectal intercourse, techniques to avoid vaginal contamination with fecal material should be discussed at length with the women involved.

Although the basic premise of the clinical advice is to avoid recurrent episodes of coliform vaginitis if possible, there is an accrued secondary effect of reducing dyspareunia during occasions of intravaginal coitus.

Uncircumcised Penis

When trichomonal vaginitis is suggested by direct inspection of the vaginal barrel and confirmed by adequately stained vaginal smear or hanging-drop preparation of the vaginal discharge, which may be profuse and irritating.

The husband also should be suspected of harboring the trichomonads, possibly beneath the foreskin if he is uncircumcised, but more frequently in the prostate gland, the seminal vesicles, or the urinary bladder.

If both husband and wife are not treated simultaneously for this particular distress, the infection may become a source of chronic dyspareunia, as it may be exchanged frequently between marital partners during repeated opportunity at coital connection.

It does little good to treat the wife for trichomonal vaginitis and then have her reinfected by her husband. And it obviously does little good to treat the husband individually and have him reinfected by his wife. With chronic trichomonal vaginitis there may be recurrent bouts of dyspareunia, particularly with coital connection of any significant duration.

Fungal vaginitis is seen clinically more and more frequently. Incidence of this particular infectious entity used to be primarily confined to the late spring, summer, and early fall months, but now such pathogens as Monilia and Candida albicans are encountered regularly throughout the year.

Chronic fungal infection creates a debilitating situation for the recipient woman. Burning and itching is intense and swelling and weeping of soft tissues are frequent complications. Coital connection is virtually impossible due to the pain involved when a fungal infection dominates in the vaginal environment.

Infections with antibiotics frequently will protect women from the complications of fungal vaginitis.

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Male Sex & Vaginismus

Male sex and Vaginismus

sexual, male, impotence, vaginismustrauma, sex, lesbian, vaginismus, marital, sex ,solition

Male sex and vaginismus is a psycho physiological syndrome affecting women freedom of sexual response by severely, if not totally, impeding coital function. Anatomically this clinical entity involves all components of the pelvic musculature investing the perineum and outer third of the vagina.

Physiologically, these muscle groups contract spastically as opposed to their rhythmic contractual response to orgasmic experience. This spastic contraction of the vaginal outlet is a completely involuntary reflex stimulated by imagined, anticipated, or real attempts at vaginal penetration.

Vaginismus is a classic example of a psychosomatic illness.

Vaginismus is one of the few elements in the wide pattern of female sexual dysfunctions that cannot be unreservedly diagnosed by any established interrogative technique.

Regardless of the psychotherapist’s high level of clinical suspicion, a secure diagnosis of vaginismus cannot be established without the specific clinical support that only direct pelvic examination can provide. Without confirmatory pelvic examination, women have been treated for vaginismus when the syndrome has not been present.

Conversely, there have been cases of vaginismus diagnosed by pelvic examination when the clinical existence of the syndrome had not been anticipated by therapists. The clinical existence of vaginismus is delineated when vaginal examination constitutes a routine part of the required complete physical examination.

Categories
Male Sex & Vaginismus

Male Painful Sex

sexual, male, impotence, vaginismustrauma, sex, lesbian, vaginismus, marital, sex ,solition

Vaginismus occasionally develops in women with clinical symptoms of severe dyspareunia (painful intercourse). When dyspareunia has firm basis in pelvic pathology, the existence of which escapes examining physicians, and over the months or years coition becomes increasing painful, vaginismus may result.

The patient is not reassured by console that “it’s all in your head” or equally unsupportive pronouncements, when she knows that it is always severely painful for her when her husband thrusts deeply into the vagina during coital connection.

As examples of this situation, vaginismus has been demonstrated as a secondary complication in two cases, of severe laceration of the broad ligaments. Also recorded are two classic examples of onset of vaginismus, the first in a young woman with pelvic endometriosis, the second in a 62 year old postmenopausal widow (without sex-steroid replacement therapy) who through remarriage sought return to sexual functioning after seven years of abstinence.

The two women developing a syndrome of vaginismus subsequent to childbirth laceration of the broad ligaments supporting the uterus (universal-joint syndrome) have similar histories. A composite history will suffice to demonstrate the pathology involved.

Mr. And Mrs. D
was seen with the complaint of increasing difficulty in accomplishing vaginal penetration developing after 6 years of marriage. There were two children in the marriage, with onset of severe dyspareunia oriented specifically to the delivery of the second child. The second child, a post mature baby of 8 pounds 14 ounces, had a precipitous delivery.

There is a positive history of nurses holding, the patient’s legs together to postpone delivery while waiting for the obstetrician. As soon as sexual activity was reconstituted after the delivery the patient experienced severe pain with deep penile thrusting. During the next year the pain became so acute that the wife sought subterfuge to avoid sexual exposure.

The intercourse frequency decreased from two to three times a week to the same level per month. On numerous occasions the patient was assured, during medical consultation, that there was nothing anatomically disoriented in the pelvis and that pain with intercourse was “purely her imagination.”

Supported by these authoritative statements, the husband demanded increased frequency of sexual function. When the wife refused, the unit separated for serveral months. During these month period, the woman assayed intercourse on two separate occasions with two different men, but with each experience the pelvic pain with deep penile thrusting was so severe that her obvious physical distress terminated sexual experimentation.

The couple was reunited with the help of their religious adviser, but with attempted intercourse vaginal penetration was impossible. After 8 months of repeatedly unsuccessful attempts to reestablish coital function, the unit was referred for therapy.

Couple E
married 8 years when seen in the Clinic. They mutually agreed that coital connection had not been possible more than once or twice a month in the first two years of marriage. Each time, the wife had moaned or screamed in pain as her husband was thrusting deeply into her pelvis. After the first two years of marriage, every attempt at vaginal penetration had been unsuccessful.

Both had been under intensive psychotherapy, the husband for three and the wife for four years, when referred to the Foundation. During the routine physical examinations, advanced endometriosis was discovered, and severe vaginismus was demonstrated.

In due course the wife underwent surgery for correction of the pelvic pathology. After recovery from the surgery she returned with her husband for therapeutic relief of the vaginismus which, as would be expected, still existed despite successful surgical correction of the endometriosis.

Couple F
a 66 year old husband and his 62 year old wife, were seen in consultation. When the wife was 54 years old, her first husband died after a three-year illness during which sexual activity was discontinued. She remarried at 61 years of age, having had no overt sexual activity in the interim period.

She had never been given hormone-replacement therapy to counteract the natural involution of pelvic structures. First attempts at coital connection in the present marriage produced a great deal of pain and only partial vaginal penetration.

With reluctance the wife sought medical consultation. Her physician instituted hormone-replacement techniques. After a 6-week respite, further episodes of coital activity also resulted in pain and distress.

Despite the fact that by this time the vaginal walls were well stimulated by effective steroid replacement, the new husband found it impossible to attain vaginal intromission. The wife had developed obvious psychosocial resistance to the concept of sexual activity in the 60 plus age group based on the pain that had been experienced attempting to consummate her new marriage.

And a real sense of embarrassment created by the need for medical consultation and the necessity of admitting that she had been indulging in coital activity at her age.

As a result of the trauma that developed with attempts to renew sexual function subsequent to almost ten years of continence, she developed involuntary spastic contraction of the vaginal outlet. Judicious use of Hegar dilators and a detailed, thorough, and authoritative refutation of the taboo of aging sexual function (based on the belief that sexual activity in the 60, 70, or even 80 year age groups represents some form of perversion) were quite sufficient to relax and relieve the vaginal spasm.

Categories
Aging Male Sex

Male Sex Steroid

male sex

Little is known of the male climacteric.

When does it occur, if it develops? Is it a constant occurrence? What is the specific symptomatology? Should sex-steroid-replacement techniques be employed? What, if any, are the patterns of sexual responsivity engendered by these replacement techniques? So little is known of the male climacteric.

Now that these definitive laboratory studies can be done with some confidence, relative rapidity, and at not too staggering a cost, much more will be known of the male climacteric within the next few years.

There will be more basic information on the effects of steroid replacement not only upon the aging male’s sexual response cycle per se but also, and infinitely more important, upon the total metabolic function of the climacteric male.

Without the gross advantage of fully supportive laboratory data, tentative clinical conclusions have been drawn regarding the influence of steroid-replacement techniques upon the aging male’s sexual functioning.

These conclusions may have to be restarted or even possibly abandoned in the not-too-distant future as more definitive information is accrued from the healthy combination of clinical and laboratory evaluations.

When the male notices alteration of his orgasmic response pattern from the usual two-stage to a one-stage process, when he consistently responds during the orgasmic experience with the loss of seminal fluid volume without significant ejaculatory pressure, when the average ejaculatory volume is cut at least in half, and when none of these reactions develop under the extenuating circumstances of a long-continued plateau phase of voluntary ejaculatory control, he may be experiencing the physiological expression of reduced production of male sex-steroid to metabolically dysfunctional levels.

Occasionally prostatic pain develops from spastic contractions of the organ during the ejaculatory process.

These spastic contractions create a continuing sense of ejaculatory urgency that may last through the entire orgasmic experience until full expulsion of the seminal-fluid bolus has occurred.

With the subjectively painful evidence of physiological prostatic spasm recurring with most ejaculatory experiences and no obvious pathology of the prostate gland demonstrable to adequate urological examination, sex-steroid replacement also may be indicated.

Until there is a more reliable laboratory definition of a general metabolic need for testosterone replacement and until the clinical existence of the male climacteric can be defined with security during treatment of older men for sexual dysfunction, individual eases must be treated empirically.

If the sexually dysfunctional male describes physiological or psychological symptomatology that appears to indicate the clinical need for the sex-steroid replacement and if the general physical and laboratory evaluations are negative, there is no professional hesitancy to institute such replacement techniques.

However, sex-steroid-replacement techniques are not employed routinely for the 50 to 70 year age group man referred for therapy.

Steroid replacement concepts and specific techniques, together with indications and contraindications for the aging male will be presented in more complete form by the Foundation in monograph format in the future.

Erection Response In Aging Male

The sexual myth most rampant in our culture today is the concept that the aging process per se will in time discourage or deny erective security to the older-age-group male. As has been described previously, the aging male may be slower to erect and may even reach the plateau phase without full erective return, but the facility and the ability to attain erection, presuming general good health and no psychogenic blocking, continues unopposed as a natural sequence well into the 80 year age group.

The aging male may note delayed erective time, a one-stage rather than a two-stage orgasmic experience, reduction in seminal-fluid volume, and decreased ejaculatory pressure, but he does not lose his facility for erection at any time.

Sexual Advantages

If this concept can be presented to and accepted by the general population, one of the great deterrents to the sexual functioning of the aging male will have been eliminated. When the conceptive ability is no longer important and reduction in seminal fluid volume and total sperm production no longer is of consequence, the aging male is potentially a most effective sexual partner.

He needs only to ejaculate at his own frequency and not based on uninformed socio-cultural demand.

There are even some sexual advantages that accrue as the male ages.

He has increased ejaculatory control and can; if he wishes, serve his female partner deftly and with full erective security. His sexual effectiveness is based not only upon his prior sexual experience but also upon the specific element of increased physiological control of the ejaculatory process.

If the aging male does not succeed in talking himself out of effective sexual functioning by worrying about the physiological factors in his sexual response patterns altered by the aging process, if his peers do not destroy his sexual confidence, if he and his partner maintain a reasonably good state of health, he certainly can and should continue unencumbered sexual functioning indefinitely.

Categories
Aging Male Sex

Aging Male Sex

aging male, sex, aging male sex

The natural aging process creates a number of specific physiological changes in the male cycle of sexual response. Knowledge of these cycle variations has not been widely disseminated.

There has been the little concept of a physiological basis for differentiating between natural sexual involution and pathological dysfunction when considering the problems of male sexual dysfunction in the post-so age group.

If all too few professionals are conversant with anticipated alterations in male sexual functioning created by the aging process, how can the general public be expected to adjust to the internal alarms raised by these naturally occurring phenomena?

Tragically, yet understandably, tens of thousands of men have moved from effective sexual functioning to varying levels of secondary impotence as they age, because they did not understand the natural variants that physiological aging imposes on previously established patterns of sexual functioning.

Sexually Impaired at 50

From a psychosexual point of view, the male over age 50 has to contend with one of the great fallacies of our culture. Every man in this age group is arbitrarily identified by both public and professional alike as sexually impaired.

When the aging male is faced by unexplained yet natural involutional sexual changes, and deflated by widespread psychosocial acceptance of the fallacy of sexual incompetence as a natural component of the aging process, is it any wonder that he carries a constantly increasing burden of fear of performance?

Before discussing specifics of sexual dysfunction in the aging population, the natural variants that the aging process imposes on the established male cycle of sexual response should be considered.

For sake of discussion, the four phases of the sexual response cycle excitement, plateau, orgasm, and resolution will be employed to establish a descriptive framework. Also for descriptive purposes, the term older man will be used in reference to the male population from 50 to 70 years of age and the term younger man used to describe the 20 to 40 year age group.

In recent years the younger man’s sexual response cycle has been established with physiological validity and will serve as a baseline for comparison with the physiological variations of aging.

If an older man can be objective about his reactions to sexual stimuli during the excitement phase, he may note a significant delay in erective attainment compared to his facility of response as a younger man.

Most older men do not establish erective response to effective sexual stimulation for a matter of minutes, as opposed to a matter 9f seconds as younger men, and the erection may not be as full or as demanding as that to which previously he has been accustomed.

It simply takes the older man longer to be fully involved subjectively in acceptance and expression of any form of sensate stimulation.

If natural delays in reaction time are appreciated, there will be no panic on the part of either husband or wife. If, however, the aging male is uninformed and not anticipating delayed physiological reactions to sexual stimuli, he may indeed panic and responding in the worst possible way to try to will or force an erection.

The unfortunate results of this approach to erective security have been discussed at length in treatment of impotence.

Aging Male Erections

As the aging male approaches the plateau phase, his erection usually has been established with fair security. There may be little if any testicular elevation, a negligible amount of scrotal-sac vasocongestion, and minimal deep vascular engorgement of the testes.

Most older men who have had a pre-ejaculatory fluid emission (Cowper’s gland secretory activity) will notice either total absence of, or marked reduction in, the amount of this pre-ejaculatory emission as they age.

From the aspect of time-span, the plateau phase usually lasts longer for an older man than for his younger counterpart. When an aging male reaches that level of elevated sexual tension identified as thoroughly enjoyable, he usually can and frequently does wish to maintain this plateau-phase level of sensual pleasure for an indefinite period of time without becoming enmeshed by ejaculatory demand.

This response pattern is age-related; the younger man tends to drive for early ejaculatory release when plateau-phase levels of sexual tension have accrued. One of the advantages of the aging process with specific reference to sexual functioning is that.

Generally speaking, control of ejaculatory demand in the 50 to 70 year age group is far better than in the 20 to 40 year age group.

In the cycle of sexual response, the largest number of physiological changes to come within objective focus for older men occurs during the orgasmic phase (ejaculatory process). The orgasmic phase is relatively standardized for younger men, varying minimally in duration and intensity of experience unless influenced by the psychosexual opposites of long-continued continence or high level of sexual satiation.

For younger men, the entire ejaculatory process is divided into two well-recognized stages. The first stage, ejaculatory inevitability, is the brief period of time (2 to 4 seconds) during which the male feels the ejaculation coming and no longer can control it before ejaculation actually occurs.

These subjective symptoms of ejaculatory inevitability are created physiologically by regularly recurring contractions of the prostate gland and, questionably, the seminal vesicles. Contractions of the prostate begin at o.8-second intervals and continue through both stages of the male orgasmic experience.

The second stage of the orgasmic phenomenon consists of the expulsion of the seminal-fluid bolus accrued under pressure in the membranous and prostatic portions of the urethra, through the full length of the penile urethra.

Again, there are regularly recurring 0.8-second inter-contractile intervals. This specific interval lengthens after the first three or four contractions of the penile urethra in younger men.

Subjectively, the sensation is one of flow of a volume of warm fluid under pressure and emission of the seminal fluid bolus in ejaculatory spurts with pressure sufficient to expel fluid content distances of 12 to 24 inches beyond the urethral meatus.

As the male ages he develops many individual variants on the basic theme of the two-stage orgasmic experience described for the younger man. Usually his orgasmic experience encompasses a shorter time span.

There may not be even a recognizable first stage to the ejaculatory experience, so that an orgasmic experience without the stage of ejaculatory inevitability is quite a common occurrence.

Even with a recognizable first stage, there still may be marked variation in reaction pattern. Occasionally, the older man’s phase of ejaculatory inevitability lasts but a second or two as opposed to the younger man’s pattern ranging from 2 to 4 seconds.

In an older man’s first-stage experience, there may be only one or two contractions of the prostate before involuntary initiation of the second stage, seminal-fluid expulsion.

Alternatively, the first stage of orgasmic experience may be held for as long as 5 to 7 seconds. Occasionally the prostate, instead of contracting within the regularly described pattern of 0.8-second intervals, develops a spastic contraction, creating subjectively the sense of ejaculatory inevitability.

Inadequate Testosterone

The prostate may not relax from spasm into rhythmically expulsive contractions for several seconds, hence the 5-7-second duration of the first-stage experience. In addition to objective variants in a first-stage orgasmic episode, there may be no possible objective or subjective definition of the first stage of orgasmic experience at all.

The stage of ejaculatory inevitability may be totally missing from the aging male’s sexual response cycle. A single-stage orgasmic episode develops clinically in two circumstances.

The first circumstance is that of clinical dysfunction developing as the result of inadequate testosterone production.

Actually, the lack of a recognizable first stage in orgasmic experience can result from low sex-steroid level for the male just as steroid starvation in the female may produce an orgasmic experience of markedly brief duration.

The second occasion of an absent first stage in the orgasmic experience develops after there has been a prior denial of ejaculatory opportunity over a long period of intravaginal containment in order to satisfy the aging male’s coital partner sexually.

There also are obvious physiological changes in the second stage of the orgasmic experience that develop with the aging process.

The expulsive contractions of the penile urethra have onset at 0.8second intervals but are maintained for only one or two contractions at this rate:

The expulsive force delivering the seminal fluid bolus externally, so characteristic of second-stage penile contractions in the younger man, also is diminished, with the distance of unencumbered seminal-fluid expulsion ranging from 3 to 12 inches from the urethral meatus.