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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. remove the man's fears for sexual performance

2. to reorient involuntary behavioral patterning so that he becomes an active participant, far removed from his accustomed spectator's role.

3. to relieve the wife's fears for her husband's sexual performance.

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

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

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

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

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

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

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

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

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

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

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