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I have written donkey times on the decrease in libido and sexual problems of male. The questions keep pouring in. The most ridiculous was that from a close friend. “Doc, what is the importance of sex outside procreation.” I paraphrased it. Again, he asked: “If one abstains from sex are there side effects?” I told him that the Catholics, especially their Reverend Fathers and Sisters (Nuns) do not marry. Did you ever hear that any of them died due to sexual starvation?
Male sexual disorders are very diverse, I intentionally chose this topic based on a plethora of questions that flood my phone weekly; after reading my Sunday column in Dr. Sun.
Male sexual disorders are very encompassing. They range from pain during intercourse of which there are several causes which may include: inflammation of the foreskin, chronic prostate infection, scars in the urethra, due usually to untreated gonorrhoea, over-tight foreskin, that makes erection painful, and allergy of the penis to vaginal fluids or contraceptive chemicals.
An occasional incidence of impotence is quite normal as I have stated ad infinitum. It should only be thought of as a problem if it is a regular occurrence.
With regards, to impotence as I have stated in my several write ups on impotence over the years, nine cases in 10 are psychological – as is often shown by an ability to have erection and orgasm, from self – masturbation or during sleep, but not in sexual relationship.
Such impotence typically involves men who have experienced intercourse to orgasm as the norm, at a past stage in their lives, and who may eventually return to this.
However, in a few cases of deep psychological disturbance, a man may never have had an erection in any circumstances.
The psychological causes of impotence can arise from various levels of motivation. Conscious or nearly conscious causes, can be a fear of the consequences of intercourse – pregnancy or veneral disease. Feelings of resentment, disgust, or dislike toward the partner, and especially – fear of sexual failure – the feeling that one is on trial. For example, fear that one will fail to “perform impressively” or fail to please the partner, especially, fear of premature ejaculation and of impotence itself.
Such fear may be set up by a single incident, or particular situation, or by the impact of one’s own or one’s partner’s sexual difficulties.
More deep- rooted causes are usually due to early experience, including, especially the relationship with one’s parents, or to traumatic experiences, when first attempting. Intercourse. They can result in: a distaste for sexual activity. feelings of resentment toward women in general – that is inability; inability to reconcile sexuality with an idealistic image of women, fear of unacceptable incest fantasies, through failure to progress beyond a childhood “Oedipus complex” – a desire to kill one’s father and have intercourse with one’s mother, fear of the vagina as a castration instrument ie belief that the vagina could amputate or chop off one’s penis, and general neurotic personality disorder – but by far the most common cause is simple fear of failure
Premature ejaculation for example, can set up a self-consciousness that eventually ends in impotence. Thereafter a vicious circle of impotence, and fear of impotence may be established.
Premature ejaculation – is when the man reaches ejaculation too quickly, for the woman to be sexually satisfied. Occasionally, premature ejaculation is normal, it can happen simply because of prolonged lack of sexual outlet.
Besides, few women are likely to reach orgasm at every intercourse. Consistent premature ejaculation is a serious problem that can lead to partner dissatisfaction, self-consciousness and impotence.
Sometimes, early experiences can set up conditioning in overrapid ejaculation. For example, intercourse with prostitutes, need for speed in semi-private places such as automobiles, and lack of concern for the partner during one’s sexual learning.
Even in maturity, possible causes of premature ejaculation can include real lack of consideration for the woman.
However, in our culture, and especially in stable relationships a man is likely to feel that the ability to satisfy his partner is as much a symbol of his sexuality as his ability to reach orgasm. As a result the major cause of premature ejaculation is simply anxiety that premature ejaculation will occur.
The situation is the same as with impotence. Once there is anxiety about one’s sexual performance, a vicious circle is set up, for anxiety immediately inhibits a true sexual response.
In addition, with premature ejaculation, the situation is likely to be complicated by bitterness between the sexual partners.
If the man is impotent, neither partner can find sexual releases. But if he ejaculates prematurely, he seems to have found it at the expense of his partner. So lack of consideration may be the accusation, even when it is not the cause.
Difficulties that have psychological causes are nevertheless amenable to physical therapy – if this is built on a basis of communication and love.
Master’s and Johnson’s basic principles are that sex is a form of communication, and that treatment can only occur in the context of a sexual partnership. Typically the married couple.
Successful therapy depends on the goodwill of both partners, their ability to learn to relax and their realization that sex is not primarily a matter of successful performance.
Ejaculatory incompetence is very rare. The man has no difficulty with erection, but cannot reach orgasm inside the vagina. As with other difficulties, it can lead to anxiety, self-consciousness, and finally impotence. The cause usually lies in the past, often in particularly traumatic incidents, and often against a background of a sexually restricted upbringing. The result is a psychological attitude that sees the woman as repulsive or contaminating or threatening. Especially if the woman in later years of marriage becomes the bread minor of the house, is richer than the husband, more educated than the husband, or more recognized in the society than the husband because of her status.
Where we notice this ejaculatory incompetence more is in men who are married to politically exposed women. The woman might inadvertently allow her position to get into her head, that she treats her husband like one of her subjects. This is a sexual killer in man. The woman calls the shorts including determining when they should make love, when was the husband’s rule before she rose to prominence.
The sensate focus exercises are simple but vital. The couple lie naked, stroking and feeling each other’s bodies – but not the breasts or genitals. No intercourses is allowed. The couple learn to relax and experience sensual pleasure free from any demand – whether if and – point release, self-explanation, reassurance or immediate return to pleasure received.
At first clumsiness, self-consciousness, and embarrassed humor are likely: but usually genuine enjoyment soon begins. This undermines the crippling tendency to sexual self-evaluation. Later sexual expression is allowed.
Breasts and genitals may be touched, and the couple guide each other and explain what is most pleasurable.
During these exercises a lotion is used to prevent roughness and also help some get more used to genital fluids. Rejection of the lotion, e.g. as immature, was found to be a very good guide to who would fail to benefit from therapy. Later specific treatment for the disorder begins. Where impotence exists as a result of another underlying disorder the impotence is treated first.
Psychological impotence is treated on the principles of communication and demand-tree activity are especially important. After sensate focus, the couple progress to more specific manual manipulation, with the man guiding the woman’s hand. There is still no attempt at intercourse; if erection occurs, it is allowed to go again, thereto re-establish itself.
Once erection is easily obtainable, the woman uses a position astride the man. First, she only tries to keep the penis within her vagina, later she begins gentle, non-demanding thrusting. Finally the man joins in slow thrusting, but with no goal of ejaculating, or satisfying his partner. Orgasm is just accepted if it happens.
In premature ejaculation the common techniques include: distracting the mind with mental tasks or physical pain, avoiding any touching of the male genitals before intercourse begins, use of anesthetic cream and jellies, tranquilizing drugs, and even excessive doses of alcohol. None of these necessarily work, and are anyway hardly symbols of a happy sexuality.
Masters and Johnson found this problem fairly easy to deal with in their therapy, the couple first use a sitting position – the woman leaning back against the bedhead, the man, between her legs, leaning with his back against her. The woman masturbates the man till he is too near to orgasm to stop himself (2 to 4 seconds before ejaculation). At his warning, she presses the penis tip. Firmly between her thumb and first two fingers for 3 to 4 seconds and the man loses the urge to ejaculate. This is repeated 4 or 5 times a session.
After thorough practice, the couple use a position of intercourse with the woman above. They remain motionless, with the man’s penis inside the woman’s vagina, and the woman intervenes with squeeze control if necessary. Also the husband thrusts if necessary to maintain erection.
Later a lateral position is used, so the woman still intervenes if the man’s orgasm begins too soon. Squeeze control is used regularly, for 6 months to a year, before at least one intercourse a week.
After that it is used as needed
In ejaculatory incompetence the Masters and Johnson therapy begins with masturbation of the man’s penis by the woman, discovering what the man finds stimulating and bringing him to orgasm. There should be no attempt to hurry this. Once the man can identify the woman with sexual pleasure, the couple use one of the positions with the woman above.
The man is again brought to imminent orgasm manually, and then the woman thrusts to take the penis into her vagina. The technique is repeated until the man gets used to ejaculating into the vagina. Later he also gets used to inserting his penis into the vagina, when his sexual excitement is low.
Moisturizing lotion prevents irritation during the stages of manual stimulation.
Always be medically guided.
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