Tag: Sex

Categories
Sexual Dysfunction Treatment

Sex Therapeutic Procedures

sexually transmitted diseases, impotent, sexual performance, sex, sexual dysfunction, sexual therapy, sexual intercourse

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 Lifetime. 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.

Categories
Sexual Dysfunction Treatment

Sex Therapist

sexually transmitted diseases, impotent, sexual performance, sex, sexual dysfunction, sexual therapy, sexual intercourse

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
Sexual Dysfunction

Sex Drive

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

For many women, a basic homophile orientation is a major etiological factor in heterosexual orgasmic dysfunction. For those women committed to homosexual expression, lack of orgasmic return from heterosexual opportunity is of no consequence.

But there are a large number of women with significant homosexual experience during their early teenage years that, in time, have withdrawn from active homophile orientation to live socially heterosexual lives.

When they marry, many are committed to orgasmic dysfunction by the prior imprinting of homosexual influence upon their sexual responsivity.

Prior homosexual conditioning acts to create a negatively dominant psychosocial influence. Their biophysical capacity, freely evidenced in homosexual opportunity, continues operant in their electively chosen heterosexual environment, but it may not be of sufficient quality to overcome the negative input from their psychosocial system.

It is difficult to evaluate homosexual influence upon heterosexual function. There can be no question that both means of sexual expression will always be an integral part of every culture. So it has been for recorded time.

The problems of sexual adjustment do not rest with those committed unreservedly to a specific pattern of response. Rather, it is the gray area dweller that creates for him or herself a sexually dysfunctional status.

When moving from one means of sexual expression to the other for the first time, the sexual value system must be reoriented if the desired transfer of sexual identification is to be completed. Such was the problem of Mrs. G who had not been able to adapt her sexual value system to her elected heterosexual world when seen in therapy.

Mr. and Mrs. G
were referred for treatment after seven years of marriage, she was 33, her husband 38 years old. The current marriage was his second, the first ending in divorce.

The presenting complaint was that Mrs. G had never been orgasmic in the marriage. Her childhood and adolescence were spent in-a small Midwestern town as an only child of elderly parents. Her mother was 41 when she was born.

Introverted as a teenager, the girl did well in school but had few friends and was not popular with male classmates. When she was 15 years old she formed a major psychosexual attachment to a high- school teacher, who seduced the girl into a homosexual relationship.

The courtship continued for six months before physical seduction was accomplished. Once fully committed to the homosexual relationship, the girl matured rapidly in personality and took a great deal more care with her dress and person. She vested total psychosexual commitment in her “teacher” throughout her high-school years.

Full responsivity in the sexual component of the relationship developed slowly for the teenager, although she was occasionally orgasmic with manipulation within a few months ‘of her first physical experience.

Initially, hers was primarily a receptive role, but as she matured in the relationship psychologically, mutual manipulation and oral-genital stimulation in natural sequence became part of the unit’s pattern of sexual expression.

During the girl’s last year in high school, mutual sexual tensions were maintained at a high level, and physical release was sought by either or both women at a minimum frequency level of three to four times a week. Both women were multi orgasmic. Mrs. G has no history of heterosexual dating in high school.

There was physical separation when Mrs. G went to college, but since the separation represented a distance of only fifty miles, she and the teacher spent many weekends together. However, toward the end of Mrs. G’s sophomore year in college, the high-school teacher was apprehended approaching other girls, was discharged, and left the geographical area.

This was a major blow to the girl. She had lost her love and at the same time was made aware that the teacher had sought other outlets. Her grades suffered and she became severely depressed and totally antisocial.

She dropped out of school for a semester, during which time she did very little but write long forgiving letters to her mentor, and even visited her for a ten-day period under the pretext of going to see friends.

It was not until Mrs. G graduated from college that the homosexual relationship was finally terminated. During the four college years she had only two dates, both involving attendance at school events and of no sexual portent.

After graduation Mrs. G took secretarial training and began working in a larger city in the Midwest. She still suffered from recurrent bouts of depression and finally sought psychiatric support. Helped by this counseling, she gradually enlarged her social circle, began heterosexual dating, and once more showed an interest in her dress and person.

While in college she had developed masturbatory patterns for tension release. The frequency throughout college and during her early years working as a secretary was several times per week. She usually was multi orgasmic, as she had been during her continuing homosexual relationship.

At age 25 Mrs. G deliberately took advantage of an available partner to attempt intercourse. This experience was sought purely from curiosity demand.

There were several coital exposures with this eager but relatively inexperienced young man.

She found herself repulsed by the man’s untutored, harsh approaches as opposed to those of her high school teacher. She was not physically responsive and found the seminal fluid objectionable.

Added to this general rejection of heterosexual interest was the fact that shortly after establishing the sexual relationship there was a 10 day delay in the onset of a menstrual period. Her fear of pregnancy only contributed to her rejection of any psychosocial concept of heterosexual functioning.

Shortly thereafter Mrs. G met her husband. He had been divorced six months previously for the stated reason that his wife had wanted to marry another man. There were two children of the marriage, both living with their mother.

They were both lonely people and gravitated to each other. There was warmth and affection between them and a number of mutual interests, so they married.

Mr. G was sexually well versed, kind, considerate, and gentle with his wife. She felt warmly toward him and enjoyed providing him with sexual release. In doing so she lost her incipient phobia for the seminal fluid.

However, she was unstimulated by his sexual approaches beyond that degree necessary to produce adequate vaginal lubrication. Both partners agreed they did not want children, so contraceptive medication was taken by the wife.

The marriage, though warm and comfortable, for several years was essentially one of convenience. However, as time passed, the two partners grew closer together, learned to communicate and to exchange vulnerabilities.

Yet there was no improvement in the wife’s sexual responsivity, and this became an increasingly important factor in their lives. Mrs. G had never told her husband of her homosexual experience and was guilt-ridden by the concept that her past sexual orientation might have precluded any possibility of effective response in her now desired heterosexual state. The husband and wife was referred for treatment at her insistence.

Categories
Sexual Dysfunction

Sex, Culture Influence

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

Increasing complaints of inadequacy of human sexual function, it would seem that the potpourri of cultures that influence the behavior of so many might designate some area less vital to the quality of living than sexual expression to receive and to bear the burden of the social ills of human existence.

As recently as the turn of the century, after marriage rites and advent of offspring were celebrated as evidence of perpetuation of family and race, woman was considered to have done her duty, fulfilled herself, or both, depending of course upon the individual frame of reference.

In reality:
Society honored her contribution as a sexual entity only in relation to her capacity for breeding, never relative to the enhancement of the marital relationship by her sexual expression.

In contradistinction to the recognition accorded her as a breeding animal, the psychological importance of her physical presence during the act of conception was considered nonexistent. It must be acknowledged.

However, that there always have been men and women in every culture who identified their need for one another as complete human entities, each denying nothing to the other including the vital component of sexual exchange.

Unfortunately, whether from sexual fear or deprivation (both usually the result of too little knowledge), those who socially could not make peace with their sexuality were the ones to dictate and record concepts of female sexual identity.

The code of the Puritan and similar ethics permitted only communication in the negative vein of rejection. There was no acceptable discussion of what was sexually supportive of marital relationships.

So far the discussion has focused on an account of past influences from which female sexual function has inherited its baseline for functional inadequacy.

Because this influence still permeates the current “cultural” assignment of the female sexual role, its existence must be recognized before the psycho physiological components of dysfunction can be dealt with comprehensively.

Socio Cultural Influence

More often than not places woman in a position in which she must adapt, sublimate, inhibit or even distort her natural capacity to function sexually in order to fulfill her genetically assigned role. Herein lies a major source of woman’s sexual dysfunction.

The adaptation of sexual function to meet socially desirable conditions represents a system operant in most successfully interactive behavior, which in turn is the essence of a mutually enhancing sexual relationship.

However, to adapt sexual function to a philosophy of rejection is to risk impairment of the capacity for effective social interaction. To sublimate sexual function can enhance both self and that state to which the repression is committed, if the practice of sublimation lies within the coping capacity of the particular individual who adopts it.

To inhibit sexual function beyond that realistic degree which equally serves social and sexual value systems in a positive way, or to distort or maladapt sexual function until the capacity.

And to function is extinguished, is to diminish the quality of the individual and of any marital relationship to which he or she is committed.

When it is realized that this psychosocial backdrop is prevalent in histories developed from husband and wifes with complaints of female sexual inadequacy, the psycho physiological and situational aspects of female orgasmic dysfunction can be contemplated realistically.

The human female’s facility of physiological response to sexual tensions and her capacity for orgasmic release never have been fully appreciated.

Lack of comprehension may have resulted from the fact that functional evaluation was filtered through the encompassing influence of socio cultural formulations previously described in this topic.

There also has been failure to conceptualize the whole of sexual experience for both the human male and female as constituted in two totally separate systems of influence that coexist naturally.

Categories
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

Sex, Pelvic Syndromes

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

One of the most obscure of pelvic pathological syndromes, yet one of the most psychosexually crippling, is traumatic laceration of the ligaments supporting the uterus. This syndrome was described clinically. Five women have been referred to the Foundation for relief of subjective symptoms of dyspareunia after referral sources had assured the husbands that there was no plausible physical reason for the constant complaint of severe pain with deep penile thrust.

These 5 postpartum women had severe broad ligament lacerations and were relieved of their distress by definitive surgical approaches, not by psychotherapy. Therefore, they do not represent a component of the statistical analysis of treatment for sexual dysfunction.

Three women reflecting onset of dyspareunia subsequent to criminal abortion techniques also have been seen in consultation and are not reflected in the statistics of the sexual inadequacy study. Three more women have been seen in gynecological consultation for acquired dyspareunia subsequent to gang-rape experiences.

They also have not been an integral part of the sexual-dysfunction study. These clinical problems will be mentioned in context. When first seen clinically, women with traumatic lacerations of the uterine supports, acquired with delivery or by specific criminal abortion techniques, present complaints that commonly accrue from pelvic vasocongestion, dyspareunia, dysmenorrhea, and a feeling of being excessively tired.

These complaints are secondary or acquired in nature. The traumatized women consistently can relate onset of their acquired dyspareunia to one particular obstetrical experience even from among three or four such episodes.

The basic intercourse distress arises with deep penetration of the penis. Women describe the pain associated with intercourse to be as if their husbands had “hit something” with the penis during deep vaginal penetration.

These involved women may note other physical irritations frequently seen with chronic pelvic vasocongestion, a constantly nagging backache, throbbing or generalized pelvic aching, and occasionally, a sense that “everything is falling out.”

These symptoms are made worse in any situation requiring a woman to be on her feet for an exceptional length of time, as a full day spent doing heavy housecleaning or working as saleswoman in a department store.

Most women lose interest in any regularity of sexual expression when distressed by acquired dyspareunia. Handicapped by constant anticipation of painful pelvic stimuli created by penile thrusting, they also may lose any previously established facility for orgasmic return.

The basic pathology of the syndrome of broad ligament laceration is confined to the soft tissues of the female pelvis. The striking features of the pelvic examination are the position of the uterus and almost always in severe third-degree retroversion and the particularly unique feeling that develops for the examiner with manipulation of the cervix.

This portion of the uterus feels just as if it were being rotated as a universal joint. It may be moved in any direction, up, down, laterally, or on an anterior-posterior plane with minimal, if any, correspondingly responsive movement of the corpus and body of the uterus.

Even the juncture of the cervix to the lower uterine segment is ill-defined. The feeling is one of an exaggerated Hegar’s sign of early pregnancy, in which the cervix appears to move in a manner completely independent of the attached corpus.

In addition to the “universal joint” feeling returned to the examiner when moving the cervix, a severe pain response usually is elicited by any type of cervical movement. However, pain is primarily occasioned by pushing the cervix in an upward plane.

In the more severe cases, either in advanced bilateral broad ligament laceration or in a presenting complaint of five years or more in duration even mild lateral motion of the cervix will occasion a painful response. During examination the retroverted uterus appears to be perhaps twice increased in size.

Pressing against the corpus in the cul-de-sac in an effort to reduce the third-degree retroversion also will produce a marked pain response. When the examiner applies upward pressure on the cervix or pressure in the cul-de-sac against the corpus, the patient frequently responds to the painful stimulus by stating, “It’s just like the pain I have with intercourse.”

A detailed obstetrical history is the salient feature in establishing the diagnosis of the broad ligament laceration syndrome. The untoward obstetrical event creating the lacerations may be classified as surgical obstetrics, as an obstetrical accident, or even as poor obstetrical technique.

Occasionally, women with both the positive pelvic findings and the subjective symptoms of this syndrome cannot provide a positive history of obstetrical trauma, but this situation does not rule out the existence of the syndrome.

Many women are unaware of an unusual obstetrical event because they were under advanced degrees of sedation or even full anesthesia at the time.

Precipitate deliveries, difficult forceps deliveries, complicated breech deliveries, and postmature-infant deliveries are all suspect as obstetrical events that occasionally contribute to tears in the maternal soft parts.

If these tears are established in the supports of the uterus (broad ligaments) the immediate postpartum onset of severe dyspareunia can be explained anatomically and physiologically. It is important to emphasize clinically that although a woman may not be able to describe a specific obstetrical misfortune in her past history, she well may be able to date the onset of her acquired dyspareunia to one particular obstetrical event.

Three cases have been seen in which a criminal abortion was performed by extensively packing the vaginal barrel, leading ultimately to dilation of the cervix and expulsion of uterine content.

These extensive vaginal-packing episodes created tears of the broad ligaments, completely parallel to those occasioned by actual obstetrical trauma. Each woman, although unaware of the etiological significance, dated the onset of the symptoms of acquired dyspareunia to the specific experience with the vaginal-packing type of abortive technique.

Categories
Sex & Dyspareunia

Sex and Pelvic Infection

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

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.

Categories
Sex & Dyspareunia

Sex and Dyspareunia

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

The term dyspareunia, difficult or painful coitus, has always been presumed to refer to coital distress in women. The word stems from the Greek, and somewhat freely translates into “badly mated.”

Since no comparable word reflecting or suggesting coital distress for men has been established, poetic license will be begged. Here is comprised of two separate sections devoted to consideration of individual complaints of female and male sexual dysfunction identified by the individuals involved as difficult or painful coitus. Men can be “badly mated” too!

That factor in the total of male and female sexual dysfunction perhaps most difficult for the therapist to define involves the psycho physiological complaint of dyspareunia. Diagnostic insecurity relates directly to the fact that dyspareunia has a varied number of both subjective and objective origins that frequently give rise to combinations of psycho physiological distress rather than complaints that can be categorized individually.

Avoid Sex

For years, woman’s complaint sex hurts when had intercourse has been an anathema to the therapist. Even after an adequate pelvic examination, the therapist frequently cannot be sure whether the patient is complaining of definitive but undiagnosed pelvic pathology or whether, as has been true countless thousands of times.

A sexually dysfunctional woman is using the symptomatology of pain as a means of escaping completely or at least reducing markedly the number of unwelcome sexual encounters in her marriage.

For it is true that once convinced that there is no recourse for reversal of his or her dysfunctional status, the sexually inadequate partner in any marriage manufactures excuse after excuse to avoid sexual confrontation.

As women have long since learned, a persistent, aggressive male partner can overwhelm, neutralize, or even negate the most original of excuses to avoid sexual exposure.

However, presuming any degree of residual concern for or interest in his partner as an individual, the husband is rendered powerless to support his insistence upon continuity of sexual contact when the wife complains of severe distress during or after sexual connection.

If the female partner complains and flinches with penile insertion, moans and contracts her abdominal and pelvic musculature during the continuum of male thrusting, cries out or screams with deep vaginal penetration, sheds bitter tears after termination of every sexual connection, or complains angrily of aching in the pelvis or burning in the vagina during or even hours after a specific coital episode.

The male sexual approach must be accepted as the probable potentiator of a physiological basis for his female partner’s evidenced sexual dysfunction. Thereafter, the husband has minimal recourse. There is little he can do other than to avoid or at least reduce marital-unit sexual exposure on his own cognizance, and/or to insist that his wife seek professional consultation.

Once consulted, the twofold problem that constantly baffles authority is first whether a specific physiological basis can be defined for the objective existence of pain. Second, if not, whether the existence of pelvic pathology should arbitrarily be ruled out, thereby defining the registered complaint of dyspareunia as subjective in origin. When a woman complains of pain during or after intercourse, there are very few diagnostic landmarks to follow for treatment, so that consideration of the etiology of the painful response seems appropriate.

As in vaginismus, a differential diagnosis cannot be established for a complaint of dyspareunia unless careful pelvic and rectal examinations are conducted. Even then there can be no sure diagnosis if the existence of pelvic pathology is denied purely on the basis of negative examinations by competent authority.

Yet, in a positive vein, there are obvious pelvic or rectal findings that can and do support objectively a woman’s subjective complaint of coital discomfort. The female partner’s persistent complaint of pain with any form of coital connection must not be authoritatively denied or, for that matter supported, purely on the basis of interrogation, regardless of how carefully or in what depth the questioning has been conducted.

There are many varieties of dyspareunia, varying from postcoital vaginal irritation to severe immobilizing pain with penile thrusting. Symptomatic definition relating not only to the anatomy of the vaginal barrel but also to the total of the reproductive viscera is in order.

In no sense will the discussion include all possible forms of pelvic distress. Considered, however, will be the major sources of pelvic pathology engendering painful response from the female partner during or after coital connection. The dyspareunia will be considered in relation to specific areas of the vaginal barrel, the reproductive viscera, and the soft tissue components of the pelvis, and to painful stimuli developing, in a time-related sequence during or after coital connection.

Sex and Painful Vagina

The complaint of pain with penile intromission should demand clinical inspection of the vaginal outlet and the labial (major and minor) area. Direct observation can easily delineate any of the following minor areas of concern, minor only in the sense of easy reversibility of physical distress by adequate clinical measures.

An intact hymen or the irritated or bruised remnants of the hymenal ring can and do cause outlet pain during attempted coital connection. Less obvious is an unprotected scar area just at the mucocutaneous juncture of the vaginal mucosa and the perineal body.

These scars, primarily residuals of episiotomies sustained during childbirth, occasionally have been observed to result from criminal abortion techniques or gang-rape episodes. The Bartholin-gland area in the minor labia should be carefully palpated for enlargement in the gland base, which can contribute to a locally painful reaction as the vaginal outlet is dilated by the penile glans at onset of intromission.

Finally, in postmenopausal women the labia and vaginal outlet may have so lost elasticity and become so shrunken in size that any penile insertive attempt will return a painful response.

Sex and Clitoris Irritation

With any complaint of outlet pain, the clitoral area also should be inspected carefully. Many women simply cannot define anatomically or are too embarrassed to discuss objectively the exact location of the outlet distress occasioned by attempts at coital connection.

Smegma beneath the clitoral foreskin can cause chronic irritation and burning that becomes severe as the penis is introduced into the vaginal orifice. Rarely adhesions beneath the minor labial foreskin anchoring the foreskin to-the clitoral glans can cause distress when the foreskin is moved or pulled from its specific pudendal-overhang position by manipulative approaches to the mons area or by intromissive attempts.

When the minor labial hood of the clitoris is pulled down toward the perineum by the act of penile intromission, an intense pain response from the presensitized clitoral glans or even the clitoral shaft may become of major clinical moment.

The same type of reaction can be elicited if foreplay in the clitoral area has been irritative rather than stimulative in character, as so often happens when the sexually uneducated male tries to follow “authoritative” directions in attempts to stimulate his partner sexually. Heavy handed manipulation or frequent masturbatory irritation can elicit painful responses from the clitoral-glans area. This irritative reaction may develop rapidly

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.

Categories
Secondary Impotence

Secondary Impotence and Sex

Physiological, Male, Impotent, Sex Life, secondary impotence, prostate, erection, drug, penis size, prostate, prostate disease, enlarged prostate

The most distressing etiological influence upon any dysfunction in the cycle of male sexual inadequacy is a derogatory effect of consulted therapeutic opinion. Careless or incompetent professionals inadvertently may either initiate the symptoms of sexual dysfunction or, as is more frequently the case, amplify and perpetuate the clinical distress brought to professional attention.

There have been 27 cases in the total 213 units referred for treatment of secondary impotence that has been told at the first consultation with selected authority for relief of symptoms that nothing could be done about their problem.

These cases are represented in all categories of etiological influence described previously in the chapter as prime initiators of the symptoms of secondary impotence. When the sexually incompetent male finally gathers his courage and reaches for the presumed security of authoritative consultation only to be told that nothing can be done about his problem, the psychogenic effect of this denial of salvation is devastating.

Of the 27 men denied hope of symptomatic relief by consultative authority, 21 individuals were so informed on their first and only visit to their local physician.

Among these 21 men, 11 were told that the onset of symptoms of secondary impotence was concrete evidence of clinical progression of the aging process and that they and their wives would have to learn to adjust to the natural distress occasioned by the sexual dysfunction.

Among these 11 men the eldest was 68, the youngest 42, and the average age was 53 years. These men and their wives experienced an average of 28 months of sexual inadequacy before seeking further consultation.

In the 10 remaining instances of authoritative denial of hope of reprieve from symptoms of impotence, there were 4 instances of negation of clinical support by the consulted theologian; in 2 of these instances the men were informed that symptoms of impotence were in retribution for admitted adulterous behavior.

One of the husband and wife was informed by a clergyman that the symptoms of secondary impotence developed as a form of penance because this particular unit had mutually agreed that a pregnancy conceived prior to marriage should be terminated by an abortion.

Finally
One unit was assured that the symptoms of impotence would disappear if there were regularity in church attendance for at least one year. Two years later, despite fanatical attendance at all church functions, the symptoms of impotence continued unabated.

In each of the 6 remaining couples there were individual patterns of authoritative denial of hope of symptomatic relief. They ranged from the statement that “once a grown man has a homosexual experience, he always ends up impotent,” to the authoritative comment that “any man masturbating after he reaches the age of thirty can expect to become impotent.” The authorities consulted were psychologists, marriage counselor, and lay analyst.

The incidence of erective failure progressed rapidly after authoritative denial of support.

Sexual Disability

Male fears of performance were magnified and marriages were shaken and even disrupted by projection by the professional sources of a black future with full sexual disability.

This mutually traumatic experience for husband and wife could easily have been avoided had the consulted authority figure accepted the fundamental responsibility either by admitting lack of specific knowledge in this area or by acquiring some basic understanding of human sexual response, or at least by not confusing personal prejudice with professional medical or behavioral opinion.

In addition to the 27 cases in which the presenting symptoms of sexual dysfunction were amplified or perpetuated by consultative authority, there were 6 instances in which consultative authority was directly responsible for the onset of symptoms of secondary impotence.

The susceptibility of the human male to the power of suggestion with reference to his sexual prowess is almost unbelievable. Two classic histories defining iatrogenic influence as an etiological agent in onset of symptoms of secondary impotence provide adequate illustration of the concept.

Vaginal Penetration

A man in his early thirties married a girl in her mid twenties. Both had rather extensive premarital sexual experience. His was intercourse with multiple partners, hers was mutual manipulation to orgasm with multiple partners, but never vaginal penetration. She had retained her hymen for wedding night sacrifice.

However, the honeymoon was spent in repetitively unsuccessful attempts to consummate the marriage. The husband and wife felt that the difficulty was the intact hymen, so she consulted her physician for direction. She was told that it was simply a matter of relaxation, to take a drink or two before bedroom encounters.

By relieving her tensions with alcohol she should be able to respond effectively. The drinks were taken as ordered, but the result was not as anticipated.

The marriage continued in an unconsummated state for three years, with the wife’s basic distress (in retrospect) a well established state of vaginismus. Throughout the three-year period, the husband continued penetration attempts with effective erections at a frequency of at least two to three times a week.

There usually was mutual manipulation to orgasm, when coitus could not be accomplished.

As a second consultant, her religious adviser assured the couple that consummation would occur if the husband could accept the wife’s (and the adviser’s) religious commitment. The husband balked at this form of pressure.

Hymen

Finally, a gynecologist, third in the line of consultants, suggested that the difficulty was an impervious hymen. The wife immediately agreed to undergo minor surgery for removal of the hymen. It is not only the human male that is “delighted to find some concept of physical explanation for sexual dysfunction.

When the physician spoke with the husband after surgery, the husband was assured that all went well with the simple surgical procedure and that his wife was fine. The physician terminated his remarks to the husband with the statement, “Well, if you can’t have intercourse now, the fault is certainly yours.”

Obviously, surgical removal of the hymen will provide no relief from a state of vaginismus, so three weeks after surgery, when coital connection was initiated, penetration was still impossible.

For two weeks thereafter, attempts were made to consummate the marriage almost on a daily basis, but still without success. By the end of the second week both husband and wife noted that the penile erections were no longer full or well sustained.

The symptoms of impotence increased rapidly over the next few weeks. Three months after the hymenectomy, the husband was completely impotent. Both partners were now fully aware that the inability to consummate the marriage was certainly the husband’s fault alone, for so he had been told by authority.

The problem presented in therapy two-and-a-half years later by this husband and wife was not only the concern for the wife’s clinically established vaginismus but additionally the symptoms of secondary impotence that were totally consuming for the husband.

In another instance:
The husband and wife in a three-year marriage had been having intercourse approximately once a day. They were somewhat concerned about the frequency of coital exposure, since they had been assured by friends that this was a higher frequency than usual.

Personally delighted with the pleasures involved in this frequency of exposure, yet faced with the theoretical concerns raised by their friends, they did consult a professional. They were told that an ejaculatory frequency at the rate described would certainly wear out the male in very short order.

The professional further stated that he was quite surprised that the husband hadn’t already experienced difficulty with maintaining an erection. He suggested that they had better reduce their coital exposures to, at the most, twice a week in order to protect the husband against developing such a distress.

Finally, the psychologist expressed the hope that the husband and wife had sought consultation while there still was time for his suggested protective measures to work.

Sexual Response

The husband worried for 48 hours about this authoritative disclosure. When intercourse was attempted two nights after consultation, he did accomplish an erection, but erective attainment was quite slowed as compared to any previous sexual response pattern.

One night later there was even further difficulty in achieving an erection, and three days later the man was totally impotent to his wife’s sexual demands with the exception of six to eight times a year when coitus was accomplished with a partial erection. He continued impotent for seven years before seeking further consultation.

When duly constituted authority is consulted in any matter of sexual dysfunction, be the patient man or woman, the supplicant is hanging on his every word.

Extreme care must be taken to avoid untoward suggestion, chance remark, or direct misstatement. If the chosen consultant feels inadequate or too uninformed to respond objectively, there should be no hesitancy in denying the role of authority. There is no excuse for allowing personal prejudice, inadequate biophysical orientation, or psychosocial discomfort with sexual material to color therapeutic direction from duly constituted authority.

There are innumerable combinations of etiological influences that can and do initiate male sexual dysfunction, particularly that of secondary impotence. It is hoped that the survey of these agents in this chapter will serve not only as a categorical statement but also render information of value to duly constituted authority.

Secondary impotence is inevitably a debilitating syndrome. No man, or, for that matter, no husband and wife emerges unscathed after battle with the ego-destructive mechanisms so intimately associated with this basic form of sexual dysfunction.

There must be support, there must be relief, and there must be release for those embattled husband and wifes condemned by varieties of circumstance to contend with male sexual dysfunction. As emphasized earlier in this chapter, most men are influenced toward secondary impotence by manifold etiological factors.

Although case histories have been held didactically open and brief for teaching purposes, it must be understood that frequently there was a multiple choice of determining agents. Other professionals well might make a different assignment if given an opportunity to review the material.

For example
there remain 12 cases referred for treatment that could not be categorized from an etiological point of view. No dominant factor could be established among a multiplicity of influences despite in-depth questioning by Foundation personnel.

It must be emphasized that, regardless of the multiplicity of etiological influences which can contribute to incidence of secondary impotence, it is the untoward susceptibility of a specific man to these influences that ultimately leads to sexual inadequacy. It is this clinical state of susceptibility to etiologic influence about which so little is known.

A statistical evaluation of the returns from therapy of secondary impotence will be considered as an integral part of the chapter on treatment of impotence. Present concepts of treatment for secondary impotence have been joined with those of the current clinical approaches to primary impotence in a separate discussion devoted to these therapeutic considerations.