Homosexual influence in the formative years is an important etiological factor in the onset of secondary impotence for men in the 30 to 40 year age group. However, the age group in which homophile orientation has greatest influence on the development of symptoms of secondary impotence appears to be the twenties.

Of a total number of 213 men referred to therapy for secondary impotence, 21 individuals found heterosexual functioning objectionable, repulsive, or impossible after making a marital commitment; 12 of these men were in their twenties, 7 in their thirties and 2 in their forties.

In most instances
Homophile interests developed in the early to midteens in similar pattern to those reported for the primarily impotent male. There was no history of overt hetero sexual experience prior to homophile orientation.

Recruitment usually was accomplished by an older male, frequently in his twenties, but occasionally men in their thirties were the initiators. When the homosexual commitment was terminated, in most instances, the relationship was broken by the elder partner.

With termination, the teenager was left with the concept that whether or not he continued as an active homosexual, he always would be homophile-oriented.

When positive homophile identification developed during the early teenage years, heterosexual dating in the mid or late teens was practically nil.

Aside from required attendance at school functions or episodes of group partying, any consistency in heterosexual dating patterns was rare.

Masturbatory patterns usually have been established by the early to midteens. In several instances, however, a history of masturbatory activity predated puberty. Fantasy patterns for these teenagers, usually male-oriented, revolve around high school heroes and/or athletics in shower rooms.

As the boy's grow older, they frequently develop some real or imagined identification with college athletic heroes.

The occasional heterosexual social relationship is classically that of the "big brother." In the late teens to early twenties these men are the understanding, friendly, sexually non demanding, gentle manly individuals whom mothers of eligible gifts dote on.

In college, dating patterns are established with more frequency than in secondary school, but usually are not of individual commitment as much as group function. Dating patterns are conceived by these men primarily as a diversionary measure to avoid peer group suspicion of homophile orientation, or as a personally protective mechanism designed to alleviate response to homosexual stimulation.

At college level, homosexual activity varies tremendously.

When active, it usually is confined to an occasional pick-up in bar-society atmosphere, but the majority of the men in the population ultimately to be referred to the Foundation did not have ongoing homosexual relationships after their teenage experiences.

In fact:
Only 25 percent of those men reporting homosexual activity during their teenage years describe any incidence of active homosexual function during college attendance. Professed reasons for marrying have varied tremendously.

In a few cases there has been the expression of a desire to reverse what they considered to be an established homophile orientation, even though active homosexual experience had been confined to the early teens or mid teenage years.

In most instances marriages were contracted purely as a matter of financial, social, or professional gain with no real identification with, interest in, or for that matter, attitudinal concern for the girls they married.

Once homosexual performance has been recorded and enjoyed before significant heterosexual exposure has been experienced, a pattern of heterosexual dysfunction may develop and generally follows one of two separate pathways. In the usual pattern, heterosexual performance fears are well defined during the courtship or in the immediacy of the marriage.

However, a well-established second pattern reports relatively little if any difficulty in heterosexual functioning during courtship or in initial years of the marriage. The husband's basic homosexual orientation surfaces at a later date.

The first pattern reflects difficulty in achieving or maintaining an erection during premarital sexual encounter. If direct premarital sexual expression is obviated, as it frequently is under the guise of protecting the wife-to-be until marriage, sexual inadequacy can and usually does arise immediately subsequent to marriage. This situation has been described in primary impotence.

The second pattern rarely reports difficulty with erective function in the initial months or even years of courtship and marriage. Typical histories report that somewhere in the course of from five to twenty years of marriage an overwhelming drive develops to return to homosexual functioning.

This reorientation usually is occasioned by exposure to a specific male (usually a young male) who attracts sexually. Not infrequently the sexual object is a teenage boy and, as occasionally happens, may be the man's own son. The revived demand for homosexual functioning, once acknowledged, is consuming.

Usually the drive is released initially by turning to the gay-bar society. However, many of these men, after years of repressed homosexual demand, are much more interested in relating to teenage boys than to the occasional pickups of the bar society.

Temporarily, the homosexually reoriented men attempt to lead both homosexual and heterosexual lives. Difficulties develop in several different ways: the individuals may be apprehended by the law, caught in or suspected of homosexual activity by their wives, or (most frequently) betrayed socially by their male friends or relatives.

If overt social labeling as a homosexual does not develop, these men frequently focus attention on themselves by being unable to meet the physical demands of bisexual functioning. When actively oriented to homosexuality, they usually lose what little interest they may have developed in sexual connection with their wives.

This loss of interest is evidenced to the wife by obviously increased intervals between sexual commitments, a multiplicity of excuses to dodge her sexual approaches, and by a coldly impersonal, coital performance when inescapably trapped.

Finally, pressured by the concerned wife, they fail to attain erection primarily because they have little or no psychosocial interest in and receive little or no biophysical stimulation from heterosexual functioning.

The initial erective failure usually is passed off as a result of not feeling well, pressures of work, or any other excuse that immediately comes to mind. However, once an episode of erective failure has occurred, the homosexually oriented male usually cannot consistently attain and/or maintain an erection quality sufficient for effective coitus.

His sexual value system is no longer attuned to heterosexual influence.

When referred to therapy these men occasionally may but usually do not deny their homosexual orientation in order to protect the psychosocial demands of their marriage. With denial of homophile orientation, therapy for secondary impotence may not progress successfully.

When their recommitment to homosexuality has been pinpointed, any sense of guilt or at least of over caution is removed. Usually they are quite free to discuss with their wives the concerns of their sexual reorientation. In most instances the wives are equally free to exchange their own vulnerabilities.

Rarely does the wife assume other than a supportive role when faced with the competition of her husband's revived homosexual orientation. Two of the wives have sought sexual release outside the marriage, not so much from revenge as from a personal need standpoint.

One woman moved toward lesbianism, both intrigued by her responsivity and determined to maintain the marriage in any way possible. Most of the wives, however, play a restrained, conservative waiting game in the hope of reconstituting the heterosexual component in their marriage.

Men moving into secondary impotence subsequent to failed bisexual functioning are primarily interested in maintaining some semblance of heterosexual connection to protect their professional situation, their social position, and their financial commitments.

For this reason, they visit the Foundation as a member of a distressed husband and wife. Although they may bring to therapy little or no current interest in their female partner from a physical point of view, there is a real demand for socioeconomic protection and usually warmth and affection for their wives.

This in itself is frequently motivation sufficient to stimulate their full cooperation with attempts to reconstitute effective heterosexual functioning.