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Erective incompetence occasionally develops from physical causes at various stages in the life cycle. Anything from extremely low thyroid function in the third decade to a perineal prostatectomy in the sixth decade can and does result in secondary impotence.

But these obviously are pathological, not “natural,” causes. “Natural” is used in terms of usual or routine or to be expected from birth.

Impotence may not be a naturally occurring phenomenon, but susceptibility to combinations of etiological factors can push any man so far from his natural cycle of sexual response that he develops fears for effective functioning.

In turn, these fears can distract from or even obviate the possibility of a full erective response to any form of sexual stimulation.

Concepts of treatment for symptoms of primary and secondary impotence are so basically identical that the following discussion can be applied without reservation to either syndrome.

Concepts of treatment for symptoms of primary and secondary impotence are so basically identical that the following discussion can be applied without reservation to either syndrome.

Whenever an impotent man commits himself to therapy for sexual dysfunction, he does so with far more personal insecurity than the usual degree of trepidation seen in most new patients.

He approaches constituted authority with full conviction that nothing can be done to reverse his distress, yet he fantasies himself as a sexually effective male.

The impotent man is certain that he stands alone in his sexual inadequacy, that there rarely, if ever, has been a situation so involved, so frustrating, and so hopeless.

Frequently, he has begun to view his marital partner as a major liability. He is all too aware that she is fully knowledgeable of the dimensions of his sexual inadequacy and therefore of the degree of his presumed loss of masculinity.

Knowledge of his sexual inadequacy by anyone else is indeed threatening to sexual assurance for many men.

Impotent Psychological Confidence

For some men, this knowledge on the part of the wife also constitutes a threat to social confidence. Husbands are gravely concerned that wives will discuss the sexual inadequacy at the bridge table or the coffee klatch and, sadly enough, some wives do just that.

Unable to contend with their own severe levels of personal and sexual frustration, they find release in suggesting subtly or pointing out graphically that the men they have married are sexually incompetent.

Wives traumatize their sexually dysfunctional husbands just as husbands slight their sexually dysfunctional wives for a variety of reasons in addition to those of frustration or revenge.

Wives must find an explanation for their own lack of effective sexual functioning, but, above all, they seek reassurance that the state of sexual inadequacy in the marriage exists despite their every effort to resolve the difficulty and that it is not their fault.

The fact that the psychosocial aspects of the marriage are not progressing satisfactorily usually is painfully obvious to all reasonably close observers. But to take the humiliating step of public accusation is indeed almost unforgivable.

Inevitably this adds to the level of psychosocial trauma the man must bear. It further separates the marital partners from any hope of mutual support and certainly closes any remaining lines of communication.

The difficulties in the therapeutic reversal of the sexual dysfunction are thereby increased and, as a consequence, the percentage of positive return from any therapeutic procedure is reduced. For all these reasons, either partner’s discussion of marital-unit sexual dysfunction other than with selected authority is potentially destructive.