CategoriesPenis Health

8 ways of Preventing Impotence!

Don’t take your erections or your potency for granted! Is the message men need to hear around their fortieth or fiftieth birthday. Some change was inevitable, but some men were experiencing too much change especially if they had it earlier. Learn to accept the fact that age does changes a lot of things including sex. Learn to be a better lover. If you aren’t getting erections, open your heart and talk to your partner, doctor or someone whom have gone through it. But that’s not the kind of thing men do. If so, why not take preventive measure before it approaches you?,/p>

Healthier lifestyles will most likely lead to healthier erections but as any man can expect to lose an erection during lovemaking on occasion. If he doesn’t let that bother him, he’ll likely get it back. The worst thing you can do about a subsiding erection is focus on it.

There are always ways to improve the quality of your erections, extend penis longevity and minimize the possibilities of losing an erection during lovemaking by adopting some following suggestions:

  1. Healthy eating habits. Eat a low fat diet and exercise regularly. Diet and exercise influence a man’s sexual desire and sexual performance.
  2. Stop or quit smoking. Smoking causes much of the vascular damage In the penis that could result in impotent. Long term and heavy smokers have a greater probability of becoming impotent than do non-smokers. One recent study found that men who smoked a pack a day for 20 years had a 60 percent greater chance of becoming impotent than non smokers.
  3. Have frequent sex. The more you make love, the more you will be able to make love. Erectile tissue becomes less supple with age. Without frequent erections, there is no regular flow of blood into the penis. After several months or a year of not having an erection, a man may have difficulty in achieving one.
  4. Don’t make ejaculation your goal of lovemaking. Once you take the pressure to ejaculate out of lovemaking, you will probably have more frequent erections, sustain them longer, and enjoy the experience much more.
  5. Expand your ‘sex.’ There is more to making love than having intercourse, especially during midlife. A man is also more likely to have erection difficulties if his lovemaking style is intercourse driven. The pressure to perform will be greater for him than for a man who enjoys satisfying his partner in a variety of ways. Don’t make love unless you want to.
  6. Share information with your partner. Explain your changing sexual response pattern to your partner. If intercourse has always ended in ejaculation until recently, she may think she has failed to excite you sufficiently. Let her know that your sexual patterns now more closely resemble hers. She has been able to enjoy intercourse without needing to reach an orgasm every time.
  7. Masturbation two or three times in a week helps in achieving erections for older male. This method is in the combination of two techniques. By having a sustained erection, you can take your mind off your penis because you will know that you are capable to sustained erection even if you ejaculate. This will allow you to enjoy sex without worry.
  8. Don’t take medications if you don’t need. Prescription drugs may produce negative effect on erections. If you keep your weight down and exercise regularly, you’re less likely to develop high blood pressure, mild depression or other conditions requiring continuing use of medications. When a doctor prescribes a drug, ask about its sexual side effects, if an alternative drug might not have the same side effects, and whether or not a lifestyle change would enable you to go off medication as soon as possible.
CategoriesPenis Health

Causes of Erectile Dysfunction, ED or Impotence

What is Erectile Dysfunction?

Previously known as impotence, erectile dysfunction as define by The National Institutes of Health is the consistent inability to achieve and/or maintain an erection satisfactory for the completion of sexual performance. Heard fondly joke and called ED as ‘the pencil with no lead’, ‘the drop’ or ‘having the software but no hardware”.

Is ED inevitable in the aging male?

By the time a man is 40 years old, 90 percent of them have experienced at least one erectile failure. This is a normal occurrence, but many men get “panic” at the first sign of erectile problems. They are likely to run to an urologist and ask for the highly publicized impotence pill, which they may not need and may or may not find effective. His lack of knowledge about the sexual aging process to set him up for performance problems and that might have led his wife to blame herself for his lack of interest in making love and caused her to withdraw from attempts to initiate sex. If he hadn’t received good advice and reassurance from someone he trusted, one might have “worried himself into impotence.”

When it is Not Impotence?

Most men, however, know that the occasional erectile problem is typically linked to fatigue, over consumption of food or drink, or a relationship issue. At midlife, a man may read a lot about impotence. He may see his future in a failed erection. How he and his partner handle these occurrences helps determine how frequent they will be. These common changes in sexual response at midlife aren’t indicators of impotence:

A man probably needs direct penile stimulation to have an erection, and he may no longer be able to get an erection just from thinking about sex or seeing his partner in an alluring pose. It may take him longer to achieve erection.

He may require more time for ejaculation and may not need to ejaculate every time he has intercourse. After a period of intercourse, he may find his erection subsides. After ejaculation, he also may find his erection subsides more quickly than it did. His erection probably won’t be as hard as it was when he was a teenager.

The recovery time of older a male between ejaculations are usually longer. These changes are gradual, and you shouldn’t be frightened by them. Changing response patterns enable a man to be a better lover than he was because he is now responding at a pace more similar to his partner’s. Lack of knowledge and refusal to accept the aging process as an erotic opportunity can prevent him from seizing the sexual moment. Anxiety also plays a major role in creating impotence dynamic. If a man misinterprets his responses and becomes anxious about his potency, he will be tense and fearful about lovemaking and convey those negative attitudes to his partner.

Some men do experience erection difficulties that are much more serious than the normal. Psychological factors ranging from performance and stress issues to intimacy conflicts can contribute to erection disorders. Physical problems can also cause impotence. Illnesses such as diabetes, vascular disease, urological or neurological conditions, and others, can lead to impotence. Heavy smokers and alcohol drinkers may suffer extensive damage to the small blood vessels in the penis, again leading to impotence. For some men, impotence stems from a combination of physical and psychological factors. They need to be treated from a multi disciplinary healthcare perspective, with a therapist and medical doctors involved. Injections or medication pill alone won’t solve their problem.

When ED is psychological

“I was terrified at the thought of having a penile implant,” says Sam. “but I’d been suffering bouts of impotence for almost a year and I thought it was probably time to do something about it, even if that turned out to be surgery.” Sam and his partner, Mary, 50s, were very discouraged about his erection problems by the time he sought help from his doctor. Though he sometimes had morning erections and sometimes was able to get an erection for masturbation, he was increasingly not able to become erect during lovemaking. Once he did get an erection, he would lose it quickly. And Mary was convinced she could ‘make’ him get up and keep a good erection. Both of them became worried and “obsessed” with the condition of his penis. They spent so much time watching his penis whenever they try to attempt to make love, so much so they’d turned sex into a spectator sport.

Sam’s “sometimes” experienced and his ability to get an erection “sometimes” during masturbation were indicators that his problem might not be entirely physical or, if it was largely physical, his condition probably wasn’t as far advanced as he feared. Routine medical tests showed that he had very high cholesterol levels, no surprise given his diet rich in saturated fats and diary cholesterol. The same substances that clog the arteries of the heart, his doctor explained; also clog the arteries of his penis. The damage done by a poor diet and high cholesterol levels had caused some problems with impotence for Sam. His doctor prescribed a diet and medication to bring down the cholesterol and recommended several sex-therapy sessions both alone and with his partner.

The above is rather common in elder health group. Both Sam and Mary are suffering from performance anxiety. Sam’s case of “sometime can” and “sometime can’t” may be referred as primarily impotent. The primarily impotent man arbitrarily has been defined as a male never able to achieve and/or maintain an erection quality sufficient to accomplish successful intravaginal connection. If erection is established and then lost under the influence of real or imagined distractions relating to intercourse opportunity, the erection usually is dissipated without accompanying ejaculatory response. No man is considered primarily impotent if he has been successful in any attempt at intromission in either heterosexual or homosexual opportunity. As Sam’s case illustrates, impotence has a psychological component even when the cause is physical.

Psychological impotent is usually found in the young adolescent male. It is erectile dysfunction in the mind. The young male usually try to make his ‘first attempt’ at his or her home, worried about his physics and performance, sometime religion background. Tried mounting into the vagina excitedly and clumsily. The fear of being caught by his parents and sometime rejection by his partner may cause him to lose his erection. The penis is weakening even before putting on the condom, thus, unable to penetrate the vagina successfully. This problem may happen again and again with the same or different partner. Technically, his unsuccessful attempts remain him as a virgin. This leave the poor young man feeling humiliated as resulted.

Fortunately, most young men whom failed to perform successfully during their initial coital exposure and for a considerable period of time remained sexually inadequate. But yet they have recovered from their experiences with sexual dysfunction without specific psychotherapeutic support and, as far as can be ascertained from corroborative histories of husband and wife, have led effectively functional heterosexual lives. Others manage to regain as time passes. They at least partially neutralize the negative influences that have accrued as a combination of their environmental backgrounds and the trauma of their initial failures.

If Sam and the young man, could learned how to make love without so much emphasis on an erection and intercourse. It’s really better and more sophisticated. However, if this psychological impotent is not treated soon, it may become physically permanent.

Psychological factors:

  1. Depression
  2. Sexual phobia
  3. Religious beliefs
  4. Performance anxiety
  5. Attitude towards sex
  6. Failure in relationship
  7. Traumatic sexual experience

Physically ED

Mr. Z has a habit of cocktails before dinner frequently wine with his meals, and possibly a brandy afterward. At business point of view he has moved progressively up the ladder to the point at which alcohol intake at lunch is an integral part of the business culture. In short, consumption of alcohol has become a way of life.

On a Saturday evening, the man and his wife attended a party where alcohol is available in large quantity. Somewhere in the course of the late evening or the early morning hours, the party comes to an end. Mr. Z has had entirely too much to drink, so his wife drives them home for safety’s sake. His wife retires to the bedroom quickly, and with a sense of vague irritation, a combination of a sense of personal rejection and a residual of her social embarrassment, prepares for bed.

However, Mr. Z has some trouble with the stairs, manages to arrive at the bedroom door. Suddenly he decides that his wife is indeed fortunate tonight, for he is prepared to see that she is sexually satisfied. It never occurs to him that all she wants to do is go to bed, hoping to sleep and avoid a quarrel at all costs. He approaches the bed, moves to meet his imagined commitment and nothing happens. He has simply had too much to drink. Dismayed and confused both by the fact that no erection develops and that his wife obviously has little or no interest in his gratuitous sexual contribution, he pauses to resolve this complex problem and immediately falls into deep slumber.

The next day, he is further traumatized by the symptoms of an acute hangover. He surfaces later in the day with the concept that things are not as they should be. The climate seems rather cool around the house. He can remember little of the last evening’s festivities except his deeply imbedded conviction that things did not go well in the bedroom. He is not sure that all was bad but heal so is quite convinced that all was not good.

Obviously he cannot discuss his predicament with his wife. She probably would not speak to him at this time. So he kept mute throughout the evening and goes to bed early to escape. He sleeps restlessly only to face the new day with a vague sense of alarm, a passing sense of frustration, and a sure sense that all is not well in the household the Monday morning. He thinks about this over a drink or two at lunch and another one during the afternoon. On the way home from work, decides to check out this evening the little matter of sexual dysfunction, which he may or may not have imagined.

If the history of this reaction sequence is taken accurately, it will be established that Mr. Z does not check out the problem of sexual dysfunction within 2 days of onset, as he had decided to do on his way home from work. He arrives home, finds the atmosphere still markedly frigid, makes more than his usual show of affection to the children, retires to the security of the cocktail hour and goes to bed totally lacking in any communicative approach to his frustrated irritated marital partner.

On Tuesday morning, while brushing his teeth, Mr. Z has a flash of concern about what may have gone wrong with his sexual functioning on Saturday night. He decides unequivocally to check the situation out tonight. Instead of thinking of the problem occasionally as he did on Monday, his concern for “checking this out” becomes of paramount importance. On the way to work and during the day, he does not think about what really did go wrong sexually because he does not know either. Needless to say, there is resurgence f concern for sexual performance during the afternoon hours, regardless of how busy his schedule is

Mr. Z leaves the office in relatively good spirits, but thoroughly aware that “tonight’s the night.” He does have vague levels of concern which suggest that a little relaxation is in order; so he stops at his favorite tavern for a couple of drinks and arrives home with a rose only to find not only a forgiving, but an anticipatory, wife, ready for the reestablishment of both verbal and sexual communication that a drink or two together before dinner can bring.

Probably, for the first time in his life, he approaches his bedroom in a self conscious ‘Till I show her attitude. Again there has been a little too much to drink–not as much as on the party night, but still a little too much. And, of course, he does show her. With his conscious concern for effective sexual function and the onset of his fears of performance, that, aided by the depressant effect of alcoholic intake, he simply cannot “get the job done.” When there is little or no immediate erective reaction, he tries desperately to force the situation in turn, anticipating an erection, then wildly conscious of its absent, and finally demanding that it occur, of course, he got no erection.

While in an immediate state of panic, as lie sweats and strains for his weapon to function, he simultaneously must contend with the added distraction of a frightened wife trying to console him in his failure and to assure him that the next night will be better for both of them. Both approaches are equally traumatic. He hates both her sympathy and blind support which only serve to underscore his “failure,” and reads into his wife’s assurances that probably he can do better “tomorrow” a suggestion that no longer can he be counted on to get the job done sexually when it matters “today.” A horrible thought occurs to him. He may be developing some form of sexual incompetence. He has been faced with two examples of sexual dysfunction. He is not sure what happened the first time, but he is only too aware this night that nothing has happened. He has failed, miserably and completely, to conduct himself as a man. He cannot attain or maintain an erection.

Further, Mr. Z knows that his wife is equally distressed because she is frantically striving to gloss over this marital catastrophe. She has immediately cast herself in the role of the soothing, considerate partner who says, “Don’t worry dear, it could happen to anyone,” or “You’ve never done this before, so don’t worry about it, dear.” In the small hours of the morning, physically exhausted and emotionally spent from contending with the emotional bath her husband’s sexual failure has occasioned, she changes her tune to “You’ve certainly been working too hard, you need a vacation,” or “How long has it been since you have had a physical checkup?” Similarly heard wifely remarks which supposed to soothe, maintain, or support are interpreted by the panicked man as tacit admission of the tragedy they must face together: the progressive loss of his sexual functioning.

From the moment of second erective failure (72 hours after the first such episode), this man may be impotent. In no sense does this mean that in the future he will never achieve an erection quality sufficient for intromission. In brief, fears of sexual performance have assumed full control of his psychosocial system. Mr. Z thinks about the situation constantly. He occasionally asks friends of similar age group how things are going, because, of course, any male so beleaguered with fears of sexual failure is infinitely desirous of blaming his lack of effective function on anything other than himself, and the aging process is a constantly available cultural scapegoat.

He finds himself in the position of the woman with a lifetime history of non orgasmic return that contends openly with concerns for the effectiveness of her own sexual performance and secretly faces the fear that in truth she is not a woman. In proper sequence, he does as she has done so many times. He develops ways and means to avoid sexual encounter. He sits fascinated by an x-rate movie, in order to avoid going to bed at the usual time with a wife who might possibly be interested in sexual contact. He fends off her sexual approaches, real or not, with excuses; “I don’t feel well,” or “it’s been a terrible day at the office,” or “I’m so tired.” He jumps at anything that avoids confrontation.

His wife immediately notices his disinclination to meet the frequency of their routine sexual intercourse. In due course she begins to wonder whether he has lost interest in her, or if there is someone else, or whether there is truth in his most recent assertion that he couldn’t care less about sex. For reassurance that she is still physically attractive, the concerned wife begins to push for more frequent sexual encounters, the one approach that the self pressured male dreads above all else. Obviously, neither marital partner ever communicates his or her fears of performance or the depth of their concerns for the sexual dysfunction that has become of paramount importance in their lives. The subject either is not discussed, or, if mentioned even obliquely, is hastily buried in an avalanche of words or chilled by painfully obvious avoidance.

Within the next two or three months, Mr. Z failure to erect for a time or two begin to make both husband and wife panic. She decides independently to avoid any continuity of sexual functioning, eliminate any expression of her sexual needs, and be available only should he express demand. And because she also has also developed fears of performance, her fears are not for herself but for the effectiveness of her husband’s sexual functioning. She goes to great lengths to avoid anything that might be considered sexually stimulating, such as too-long kisses, handholding, body contact, caressing in any way. In so doing she makes such sexual encounter much more of a pressured performance and therefore, in much less of a continuation of living sexually, but the thought never occurs to her.

Over the centuries, the male sexual dysfunction has been the level of ‘cultural’ demand for effectiveness of male sexual performance. Most men feel that they must accept full responsibility for establishing successful intercourse connection, has placed upon every man the psychological burden for the lovemaking process and has released every woman from any suggestion of similar responsibility for its success. Well, there has never been an impotent woman anyway.

When a male loss the ability to achieve and to maintain an erection, it can cast a shadow of doubt upon the effectiveness of his sexual performance and this disturbed the state of his masculinity. Once a shadow of doubt has been cast, it will be registered at his mind for awhile or even longer. He may become more anxious about his next potential sexual encounter. Failure to attempt coital or intercourse connection continuously might lead to a subsequent pattern of erection failure to be established. Some men whom experience more serious than normal erection difficulties (example absence of nocturnal or nighttime erection, morning erections, no erection when stimulated,) associated with aging and chronic illness for instance:

Heart disease.

Any disease process that can affect arteries may likely affect the arteries that supply the penis. Men contracted with coronary artery disease or pain in the chest, cerebro vascular disease, peripheral vascular disease, high blood pressure and high cholesterol. Accidents that cause severe pelvic fracture or direct injury to the penis are at risk for erectile dysfunction.


A major physical cause of impotence, diabetes can also accelerate other causes like penile artery damage from cholesterol may become significant in a shorter period of time than it would if not complicated by diabetes.

High cholesterol.

Impotence research in the past several years has led a few authorities such as the New England Male Reproductive Center at Boston University Medical Center to conclude that high cholesterol is “probably one of the leading causes of impotence in America. The penis is a vascular organ, made up of layers of venous tissue and blood vessels. High cholesterol adversely affects erectile tissues.

Prostate problems.

Chronic pain and swelling in the prostate area can affect sexual functioning in an indirect manner if a man finds erection or ejaculation painful or uncomfortable. Although studies show 80 per cent of men can return to sexual functioning after prostate surgery, many don’t, indicating a possible psychological barrier.

Radiation therapy.

The administration of radiation to kill cancer cells for colon cancer or prostate cancer can cause damages to the blood vessels supplying to the penis.

Neurology Conditions.

The most common are spinal cord injury, stroke, multiple sclerosis, lumbar disk disease, pituitary disease, Parkinson’s and Alzheimer’s disease.


This is another major cause of impotence. A study reported by the Journal of the American Medical Association showed that 25 per cent of all sex problems in men were caused or complicated by medications and other drugs. Tranquilizers, antidepressants, some high-blood-pressure drugs, corticosteroids (taken for arthritis), analgesics (for pain), alcohol, tobacco, and illegal drugs such as cocaine and marijuana affect libido and performance in men.


Surgery or other factors unrelated to disease can also cause erectile dysfunction. Take for example; long distance biking with small hard seats has been implicated as a cause of impotency, possibly by nerve compression. Habitual lifestyle like alcoholism, tobacco, eating habit and diet that causes malnutrition and lead to obesity.

Sam’s case may seems psychological but as his doctor go in depth, it got more than it meets. Consider his age, at 50 plus, the onset and period of his problem, his medical background, the severity of the problem and other factors which may involve.

CategoriesMale Sex & Vaginismus

Impotence Trauma

Here is illustrative of an etiological factor frequently encountered in vaginismus, that of the influence of channel visioned religious orthodoxy upon the immature and adolescent girl. When the couple was first seen in consultation, couple A’s marriage had existed unconsummated for 4 1/2 years.

The wife, from a sibling group of four females and one male, was the only one not to take the vows of a religious order. Her environmental and educational backgrounds were of strictest parental, physical, and mental control enforced in a stringent disciplinary format and founded in religious orthodoxy.

She was taught that almost any form of physical expression might be suspect of objectionable sexual connotation.

For example:
She was prohibited when bathing from looking at her own breasts either directly or from reflection in the mirror for fear that unhealthy sexual thoughts might be stimulated by visual examination of her own body. Discussions with a sibling of such subjects as menstruation, conception, contraception, or sexual functioning were taboo.

Pronouncements on the subject were made by the father with the mother’s full agreement. Her engagement period was restricted to a few chaste, well-chaperoned kisses, for at any sign of sexual interest from her fiance, the girl withdrew in confusion.

Couple A
Mrs. A entered marriage without a single word of advice, warning, or even good cheer from her family relative to marital sexual expression. The only direction offered by her religious adviser relative to sexual behavior was that coital connection was only to be endured if conception was desired.

Mrs. A’s only concept of woman’s role in sexual functioning was that it was dirty and depraved without marriage and that the sanctity of marriage really only provided the male partner with an opportunity for sexual expression. For the woman, the only salvation to be gained from sexual congress was pregnancy.

With the emotional trauma associated with wedding activities, and an injudicious, blundering, sexual approach from the uninformed but eager husband, the wedding night was a fiasco quite sufficient to develop or to enhance any preexisting involuntary obstruction of the vaginal outlet to a degree sufficient to deny penetration.

The husband, of the same orthodox background, had survived these traumatic years without developing secondary impotence. His premarital experience had been two occasions of prostitute exposure, and there was no reported extramarital experience.

He masturbated occasionally and was relieved manually by his wife once or twice a week. His wife had no such outlet. Her only source of effective relief was well-controlled psychotherapy.

With an incredible number of thou-shalt-nots dominating Mrs. A’s environmental background, it is little wonder that she was never able to develop a healthy frame of reference for the human male in general and her husband in particular as a sexual entity. Her sexual value system reflected severe negative conditioning.

Couple B
The presenting complaint for couple B upon referral to the Foundation was that of secondary impotence. The husband’s history was one of successful response to coital opportunities with three women over a period of 18 months before meeting his wife.

An eight-month courtship followed without attempted coital connection or, for that matter, any physical approach, as the man was overwhelmed by the multitude of restrictions placed upon courtship procedure by the girl’s religious control. The husband-to-be was of the same faith, but his background was not orthodox.

Following a chaste engagement period, failure to consummate the marriage occurred on the wedding night. Religious orthodoxy, although of major import, was not the only factor involved in this traumatized marriage.

With both husband and wife tired and tense, he unfortunately hurried the procedure. All too cognizant of prior coital success and totally frustrated by lack of sexual exposure to his wife, he attempted penetration as soon as erection developed.

While attempting rapid consummation, his wife, unprepared for the physical onslaught, was hurt. She screamed; he lost his erection and could not regain function. By mutual agreement, further attempts at consummation were reserved for the seclusion of the wedding trip.

Attempts at coition were repeated during the honeymoon and thereafter almost daily for the first five to six months of the marriage and two to three times per week for the next year, but there was no success in vaginal penetration. Eighteen months after the wedding the husband developed marked loss of erective security.

He rarely could achieve or maintain an erection quality sufficient for intromission.

When there was erective success, frantic attempts at vaginal penetration stimulated pain, fear, and physical withdrawal from his female partner.

During the remaining two years before consultation, attempts at coition gradually became less frequent. The husband’s history included a report of eight months of psychotherapeutic support without relief of the symptoms of secondary impotence. No consideration had been given to the possibility of coexistent female pathology.

The involuntary vaginal spasm certainly could have been present before marriage, invalidating the initial attempt at intromission. Also, it is possible that over a few year period, the severe degrees of frustration resultant from multiple unsuccessful attempts to penetrate could initiate involuntary vaginal spasm.

If a moderate degree of spasm were present at marriage, the sexual ineptitude of the husband and the episodes of pain with attempted penetration would tend to magnify the severity of the syndrome well beyond any initially existent level. Secondary impotence resulting from long-denied intromission is not at all uncommon.

CategoriesMale Sex & Vaginismus

Impotence and Vaginismus

The presence of involuntary muscular spasm in the outer third of the vaginal barrel, with the resultant severe constriction of the vaginal orifice, is obvious. The literature has remarked on an unusual physical response pattern of a woman afflicted with vaginismus.

She reacts in an established pattern to psychological stress during a routine pelvic examination that includes observation of the external genitalia and manual vaginal exploration.

The patient usually attempts to escape the examiner’s approach by withdrawing toward the head of the table, even raising her legs from the stirrups or constricting her thighs in the midline to avoid the implied threat of the impending vaginal examination.

Frequently this reaction pattern can be elicited by the woman’s mere anticipation of the examiner’s physical approach to pelvic examination rather than the actual act of manual pelvic investigation.

When vaginismus is a fully developed clinical entity, constriction of the vaginal outlet is so severe that penile penetration is impossible.

Frequently, manual examination can be accomplished only by employing severe force, an approach to be decried, for little is accomplished from such a forced pelvic investigation, and the resultant psychosexual trauma can make the therapeutic reversal of the syndrome more difficult.

The Diagnosis:
vaginismus can easily be established by a one-finger pelvic examination. If a non traumatic pelvic exploration is conducted, and a markedly apprehensive woman somewhat reassured in the process, the first step has been taken in therapeutic reversal of the involuntary spasm of the vaginal outlet.

Vaginismus may be of such severity that a marriage cannot be consummated. Medical consultants frequently have mistaken unrecognized involuntary vaginal spasm for the presence of a pressure resistant hymen.

As the result of this clinical confusion, surgical excision of the presumed resistant hymen has been recommended and conducted on many occasions without providing the patient and her husband with the expected relief from physical obstruction to effective coital connection.

The possibility of coexistent vaginismus should be explored in depth by means of an accurate psychosexual-social history as well as a definitive, but not forced, pelvic examination before surgical excision of a presumed all-resistant hymen is conducted.

Vaginismus has been encountered frequently in marriages with rarely occurring coitus as well as in non consummated marriages. Interestingly, the syndrome has a high percentage of association with primary impotence in the male partner, providing still further clinical evidence to support procedural demand for simultaneous evaluation and treatment of both marital partners when sexual dysfunction within a marital unit is the presenting complaint.

Impotence and Vaginismus

In retrospect, when primary impotence and vaginismus exist in a marriage, it is difficult to be sure whether there was involuntary spasm of the vaginal outlet prior to the unsuccessful attempts at coital connection or whether the vaginismus emerged from the wife’s high levels of sexual frustration developing secondary to the male partner’s lack of erective security.

Primary impotence and vaginismus probably antedate one another with equal frequency, but when either exists a marriage cannot be consummated, and sexual dysfunction is likely to appear in the other partner.

If severe vaginismus exists prior to attempted consummation of a marriage, primary or secondary impotence can result from repetitive failures at intromission. Of course, within many marital units involuntary vaginal spasm has existed for years without resulting in any symptoms of male sexual dysfunction.

In such cases either the husband is satisfied with ejaculatory release with minimal or partial penetration or the degree of involuntary spasm is sufficient only to delay and not to deny vaginal penetration.

Past Cases
29 cases of vaginismus have been diagnosed and treated over 11 years. While etiological factors are multiple, the syndrome is frequently identified in association with male sexual dysfunction.

Equaling male dysfunction as an etiological agent is the psychosexually inhibiting influence of excessively severe control of social conduct inherent in religious orthodoxy. Third in etiological frequency are the symptoms of involuntary vaginal spasm which have been identified as related to specific episodes of prior sexual trauma. Fourth in order of occurrence is the stimulus toward vaginismus derived from attempted heterosexual function by a woman with prior homosexual identification.

There are in the clinical files 12 examples of religious orthodoxy as a major etiological factor in the onset of vaginismus. The presence of this syndrome contributed to 9 non consummated marriages and 3 in which coitus was infrequent.

Of the female partners with vaginismus 4 were oriented to a restrictive orthodox Jewish background, 6 were products of a psychosexually repressive Catholic background, and 2 had the religious orientation of stringent Protestant fundamentalism.

In these 12 cases in which religious orthodoxy was a factor in vaginismus, 5 male partners were primarily impotent and also had similar orthodox religious backgrounds; 2 husbands who had been successful in coital connection with other women before meeting their wives-to-be became secondarily impotent after repetitively unsuccessful attempts at vaginal penetration.

Another 2 husbands had not been able to penetrate their wives more than three times during marriages of five and eight years although they were potent prior to and after marriage and additionally potent during marriage with other partners; in the two years before referral to the Foundation.

These husbands reported increasing frequency of erective failure and, although not completely impotent, were well on their way toward that status when seen in therapy. There were 2 husbands who continued potent despite marriages of fourteen and two years without successful vaginal penetration. Neither described sexual activity outside of the marriage.

Male partner tension relief usually was obtained from manipulation by the wife. The wives were not responsive to similar approaches.

In one marriage, the male partner was a severe premature ejaculator. Intromission rarely occurred during the first four years because the husband could not control his ejaculatory process sufficiently to accomplish vaginal penetration. It must be pointed out, however, that a heavy burden had been placed upon this premature ejaculator by the extremely difficult vaginal penetration.

The excessive stimulation returned to the male by difficult penetrative efforts contributed to the husband’s acknowledged rapid ejaculatory tendencies. When seen in therapy, the wife, denying coital experience before marriage, had involuntary vaginal spasm.

Whether spasm was present at marriage is debatable, but the marital combination of premature ejaculation and vaginismus was insuperable sexually for both husband and wife.

Of specific interest is the fact that 6 primarily impotent males with religious orthodoxy as the major etiological factor influencing their sexual dysfunction have been treated at the Foundation.

Five of these men married women who have been categorized as evidencing vaginismus. For the wives as well as the husbands, the indisputable etiological factor in both partners’ sexual inadequacy was the overwhelming influence of religious orthodoxy.

Clinical histories illustrative of the potential sexual difficulties inherent in marriages between orthodox partners have been presented in the discussion on primary impotence and primary orgasmic dysfunction and will not be repeated.

Histories describing direct association of vaginismus with male sexual inadequacy are made available to underscore the fact that sexual dysfunction, regardless of whether originally invested in the male or the female partner, is a marital-unit rather than an individual problem.

CategoriesImpotence Cure

Impotence Cure

Impotence is not a naturally occurring phenomenon. Yet there are men who never experience intromission regardless of available coital opportunity; they have been identified as primarily impotent.

There are men, having succeeded in coital opportunity on single or multiple occasions, who develop erective inadequacy and ultimately cannot achieve or maintain an erection quality sufficient for intromission regardless of opportunity. They have been termed secondarily impotent.

But are there naturally impotent men, men born without the slightest facility for effective sexual function?

The answer must be a hesitant yes, but they are encountered so rarely as to be of no statistical significance.

There is a rare male never able to have intercourse for anatomical or physiological reasons.

For example:
Men born with an endocrine dysfunction, such as Klinefelter’s syndrome, may never be able to achieve sufficient steroid balance to develop an effective erection. These genetic misfortunes do occur, but with adequate knowledge and control some of their untoward clinical sequelae, such as impotence, may be reversed.

CategoriesErectile Dysfunction

Sex Partner and Impotence

While developing therapy concepts and procedural patterns at onset of the clinical investigative approach to sexual dysfunction in 1959, there were many severe problems to be faced. One of the most prominent concerns was the demand to develop a psychosocial rationale for therapeutic control of unmarried men and women that might be referred for treatment.

During 11 years of treatment, 54 men and 3 women were unmarried when referred by their local authority with complaints of sexual dysfunction. In a statistical breakdown relative to intake diagnosis, 16 men were premature ejaculators, one was an incompetent ejaculator, 21 were primarily impotent, and 16 were secondarily impotent.

The three women were orgasmically dysfunctional, one primarily and two situationally (coital orgasmic inadequacy).

The immediate problem to be faced was the obvious clinical demand for a female partner a partner to share the patient’s concerns for successful treatment, to cooperate in developing physically the suggestions presented during sessions in therapy, and most important, to exemplify for the male various levels of female responsivity.

All of these factors are essential, if effective sexual functioning is to be returned to the sexually inadequate man. In brief, someone to hold on to, talk to, work with, learn from, be a part of, and above all else, give to and get from during the sexually dysfunctional male’s two weeks in the acute phase of therapy.

The term replacement partner is used to describe the partner of his or her choice brought by a sexually inadequate unmarried man or woman to share the experiences and the education of the clinical therapy program.

Partner surrogate has been reserved to indicate the partner provided by the cotherapists for an unmarried man referred for treatment who has no one to provide psychological and physiological support during the acute phase of the therapy.

The final listing, that of marital partners, includes not only husband and wife units, but also former husbands and wives, divorced or legally separated, who choose to join each other in mutual hope of a reversal of the sexual dysfunction that was a major contributor to the legal dissolution of the marriage.

Nine such units legally separated at intake have been seen in therapy in the last 11 years. Statistically, these units have not been treated separately from the legally married units referred for therapy.

Thirteen of the 54 non married men brought replacement partners of choice who were most willing to cooperate with the therapists to enable their sexually dysfunctional men to establish effective sexual performance. The three unmarried women also brought replacement partners of their choice to participate in therapy.

These replacement partners were men with whom they had established relationships of significant duration, as well as the personal warmth and security that develops from free exchange of vulnerability and affection.

Partner surrogates have been made available for 41 men during the 11 years. This situation has involved basic administrative and procedural decisions. Should the best possible climate for full return of therapeutic effort be created for the incredibly vulnerable unmarried males referred for constitution or reconstitution of sexual functioning, or should there be professional concession to the mores of society, with full knowledge that if a decision to dodge the issue was made, a significant increase in percentage of therapeutic failure must be anticipated?

Unmarried Impotent Men

Whose dysfunctional status could be reversed to allow assumption of effective roles in society would continue sexually incompetent. From a clinical point of view there really was only one alternative. Either the best possible individual return from therapeutic effort must be guaranteed the patient, or the Foundation must refuse to treat unmarried men or women for the symptoms of sexual inadequacy.

Either every effort must be made to meet the professional responsibility of accepting referrals of severely dysfunctional men and women from authority everywhere in or out of the country, or admission to clinical procedure must be denied. It would have been inexcusable to accept referral of unmarried men and women and then give them statistically less than 25 percent chance of reversal of their dysfunctional status by treating them as individuals without partners.

This figure has been reached by culling the literature for material published from other centers, since it is against Foundation policy to treat the sexually dysfunction individual as a single entity. If the concept that therapy of both partners for sexual inadequacy has great advantage over prior clinical limitations to treatment of the sexually dysfunctional individual without support of marital partner, then partners must be available.

Statistically there no longer is any question about the advantage of educating and treating men and women together when attacking the clinical concerns of male or female sexual inadequacy.

For these reasons the therapeutic technique of replacement partners and partner surrogates will continue as Foundation policy:

It should be emphasized that no thought was ever given to employing the prostitute population. For reasons that will become obvious as the contributions of the replacement-partner and partner-surrogate populations are described, so much more is needed and demanded from a substitute partner than effectiveness of purely physical sexual performance that to use prostitutes would have been at best clinically unsuccessful and at worst psychologically disastrous.

CategoriesErectile Dysfunction

Primary Impotence

Usually it is impossible to delineate, without reservation, untoward maternal influence as a primary etiological factor in primary impotence. However, there have been three specific instances of overt mother son sexual encounters in the histories of the 32 primarily impotent males.

In all three instances the father was either permanently removed from or rarely encountered in the home. In two of the three instances the young male was the only child in the home and in the third, he was the youngest of three children by 11 years.

In all three instances the young man slept in the mother’s bedroom routinely before, during, and after puberty. Two slept in their mothers’ beds until they were well into their teenage years. Attempted incestuous coition has not been reported in this series of primarily impotent men but there is a positive history from one of the three males of awakening on several occasions to maternally manipulated ejaculatory experiences during the early teenage years.

The second man, though reporting no instance of overt sexual advance from his mother, described his mother’s sleeping nude with him.

In the third instance the mother insisted upon washing the boy’s genitals when he was bathing. The practice, apparently continued from the diaper stage, was established so early that the man cannot remember otherwise. Maternal demands for adherence to such a behavioural pattern continued into the teenage years with occasions of violent scrubbing until ejaculatory episodes interposed in the bath.

The maternal reactions varied initially from presumed anger and administration of physical punishment to specifically conducted manipulative episodes when the young man was in his mid teens. There was obvious maternal pleasure in her son’s ejaculatory response to her manipulation. Ultimately she assured her son that “no other girl will be able to please you as Mother can.”

Impotent History

There are six histories among the 32 primarily impotent men relating the tribulations of virginal men restricted from any form of overt sexual activity during the teenage courting years by family adherence to demanding forms of religious orthodoxy. The six men grew up in households (two Jewish and four Catholic) where strict religious orthodoxy was a way of life.

These men, struggling with the repressive weight of an incredible number of behavioural “thou-shalt-nots,” were supported by a negligible number of “thou-shalts.” They uniformly approached their wedding nights tragically handicapped by misinformation, misconception, and unresolved sexual taboos.

To prejudice further any opportunity for developing an immediately successful sexual relationship, the new wife in five of the six marriages was equally physically and mentally virginal, as would be expected of a product of similarly strict religious orthodoxy.

The wives’ inadequacies of sexual knowledge, their misconceptions and their inevitable post marital psychosocial adherence to premarital theological sexual taboos only contributed additional performance tensions to those placed by our culture upon the anxious, frightened, virginal males during their first attempts to consummate their marriages.

Impotent and Premarital Sex

When premarital sexual expression has been restricted to handholding, the first fumbling, bumbling, theologically and legally acceptable attempts at sexual connection are often unsuccessful. This psychosocial diversion of the natural biophysical process may evolve into the disastrous combination of a severely shredded male ego further traumatized by the unreasonable, but so understandable, female partner’s virginally blind insistence that he “do something.”

This semi hysterical supplication first whispered, then suggested, eventually demanded, and finally, screamed, “Do something,” renders the equally virginal and equally traumatized male incapable not only of effective sexual function but also of situational comprehension.

His wife’s emotional importuning creates such a concept of frustration, failure, and loss of masculine stature that the husband and wife’s frequently repeated, obviously frantic attempts at sexual connection usually are doomed to failure.

Severe religious orthodoxy may indoctrinate the teenager with the concept that any form of overt sexual activity prior to marriage not only is totally unacceptable but is personally destructive, demoralizing, degrading, dehumanizing, and injurious to one’s physical and/or mental health.

Perhaps even more unfortunate, the psychosocial expectations, if any, for the sexual relationship in marriage are given no honourable factual support. Varying combinations of these precepts have become an integral part of the sexual value systems of the six men for whom religious orthodoxy was defined as a major etiological factor in their primary impotence and have been recited in parrot like style to the cotherapists during intake, interviews.

Virgin Wife

It is fortunate that more virginal males of similar background, failing in their tension-filled initial exposures to the physical verities of marital sexual functioning, do not succumb to the pressures of these frightening initial episodes of failure by developing the relevant symptoms of primary impotence.

Each of the five virginal wives with orthodox religious backgrounds similar to those of their new husbands also had to be treated for vaginismus at the same time their husbands were faced with therapeutic concerns for clinical reversal of their primary impotence. There was no positive concept of effective sexual functioning or confidence in sexual performance expressed by any of the 10 individuals involved in these traumatized marriages.

One of the wives did not have a background of religious orthodoxy paralleling that of her husband, although she was of similar faith. Reflecting more freedom of sexual expression, which included four instances of coital experience with an earlier fiance, she accepted her future husband’s orthodox religious concepts during their engagement period.

At marriage she was as psychologically virginal as any of the other five wives. Although she could have helped immeasurably during her husband’s first fumbling attempts at coital connection, she dared not suggest alternatives to his unbelievably untutored sexual approaches for fear she would evidence a suspicious degree of sexual knowledge.

She thought that she had to protect his concept of her physically virginal state at all costs. In this case the cost was high. It amounted to 11years of unconsummated marriage.

CategoriesErectile Dysfunction

Impotence, Homosexual and Heterosexual

Commitment to an overt pattern of homosexual response in the early to middle teenage years also emerged as a major etiological factor in failed coital connection during initial and all subsequent heterosexual exposures for another 6 of the 32 primarily impotent men seen in therapy.

Homosexual Relationships

For four of these men relationships were established in the 13 to16 year age bracket and were specifically meaningful to the involved teenagers. One relationship was with a peer and three others with older men (early twenties to mid thirties). The fifth in this group of six primarily impotent men voluntarily established a semi permanent association at age 20 with a man in his early thirties.

These five histories reflected homosexual relationships ranging in duration from nine months to more than three years. Although all relationships were discontinued before there was serious thought of establishing permanent heterosexual alliances, it is of interest that they were terminated by the partners of the young men.

When initially seen in therapy all five of these heterosexually dysfunctional men considered themselves basically homophile in orientation and felt that a lifetime commitment had been made through their initial indoctrination into homosexual functioning.

None of these five men provided a history of attempted rectal intromission, although three of the five had submitted to rectal penetration. Since there was no mounting attempt on their part, the clinical diagnosis of primary impotence has not been challenged.

Had they been successful in anal intromission, they would Not have been classified as primarily impotent.

The remaining instance of homosexual identification as a plausible etiological agent in primary impotence was that of a virginal man of 21 years referred to psychotherapy for nervous tension, intermittent periods of depression, and compulsive lack of effective academic progress.

The therapist convinced the young man that his unresolved tensions were derived from the natural frustrations of a latent homosexual and introduced him to the physical aspects of mouth genital functioning in a patient-therapist relationship.

This homosexual relationship lasted for 18 months, only to be terminated abruptly when the patient’s family no longer could afford the cost of the twice-weekly sessions.

Anal sex was not attempted.

In three of these six instances of homophile identification, the totally dominant mother was in full control of family decisions in social, behavioural, and financial. The father was living in the home but was allowed no other role except provider.

The remaining three young men described a relatively well-balanced family life. The religious aspects of the six backgrounds ranged from atheism to family demand for regularity of church attendance. There was no strict orthodoxy.

Two of these six young men had married but neither was successful in consummating the union; nor had psychotherapeutic procedures, instituted some months after failed consummation, provided the men with confidence to think and feel sexually in their newly established heterosexual relationship.

One marriage was dissolved legally; the other was ongoing at therapy. When first seen, each of these six men stated unequivocally their basic interest in and desire for facility of heterosexual functioning. In only two instances, however, was there also the collaterally expressed desire to withdraw permanently from any form of homosexual functioning.

Normal Impotent

There are four recorded primarily impotent male histories from the series of 32 impotent men with basically stable family, religious, and personal backgrounds whose initial failure at coital connection was specifically associated with a traumatic experience developing from prostitute involvement with their first experience at coition.

Three of these virginal young men (two late teenage and one 32 year old) each sought prostitute opportunity in the most debilitated sections of cities in which they were living and were so repulsed by their neophyte observations of the squalor of the prostitute’s quarters, the dehumanizing quality of her approach, and the physically unappetizing, essentially repulsive quality of the woman involved that they could not achieve or maintain an erection.

The fact:

Their own poor judgment had rendered them vulnerable to a level of social environment to which they were unaccustomed and for which they were unprepared never occurred to them. In two of these instances their frantic attempts to establish an erection amused the prostitutes and their obvious fears of performance were derided.

The third young man was assured that “he would never be able to get the job done for any woman if he couldn’t get it done here and now with a pro.”

In the fourth instance initial sexual attempt, also prostitute-oriented, took place during a multiple coital episode in which the same woman was being shared. The young man (age 19) was the last member of the group of five friends scheduled to perform sexually with the same prostitute.

No sexual experience

With no previous sexual experience, his natural anxieties were markedly enhanced and quickly compounded into fears of performance by the enforced waiting period while his predecessors in line returned to describe in lurid detail their successes in the bedroom.

Overwhelmed by the rapidly multiplying pressures inherent in these circumstances, the young man predictably had difficulty attaining an erection when his turn finally arrived. There were verbalized demands to hurry by his restless, satiated peers and from the impatient prostitute.

Faced with a performance demand measured by a specific time span and a concept of personal inadequacy (he carried the usual virgin male’s concern for comparative penile size into the bedroom), the young man was pressured beyond any ability to perform and unable to regard the pressured circumstances with objectivity.

Inevitably, this initial failure at sexual functioning resulted in markedly magnified fears of performance. Subsequent attempts at coital connection both with members of the prostitute population and within his own social stratum also proved unsuccessful.

Not all instances of failed attempts at initial coital connection have an established etiological patterning that possibly predisposes to failure.

In the histories of primarily impotent men seen in therapy, there is a wide variety of other factors associated with each man’s ego, destructive episode of failure at his first coital opportunity.

n fact, among the remaining 13 men from the 32 males referred with the complaint of primary impotence, there are (with one exception) no duplicates in the patterns of their initial traumatic sexual episodes.

CategoriesErectile Dysfunction

Impotence or Erectile Dysfunction

For clinical purposes the primarily impotent man arbitrarily has been defined as a male or penis never able to achieve and/or maintain an erection quality sufficient to accomplish successful coital connection. If erection is established and then lost under the influence of real or imagined distractions relating to coital opportunity, the erection usually is dissipated without accompanying ejaculatory response.

NO man is considered primarily impotent if he has been successful in any attempt at intromission in either heterosexual or homosexual opportunity.

the 11 years of the investigative program in sexual inadequacy 32 primarily impotent males have been accepted for treatment. Of these, 21 were unmarried when seen in therapy; 4 of the 21 men have histories of prior marriage contracts with either an annulment or a divorce legally attesting to their failures in sexual performance. The remaining 11 primarily impotent men were married when referred to the Foundation with their wives in the hope of consummating their marriages. These unconsummated marriages have ranged from 7 month to 18 year duration.

Negation of the young male’s potential for effective sexual functioning has been thought to originate almost entirely in derogatory influences of family background. Without denying the importance of familial investment, the natural social associations of the adolescent as he ventures from his security base are also statistically of major importance.

The etiological factors that are in large measure responsible for individually intolerable levels of anxiety either prior to or during initial attempts at sexual connection are untoward maternal influences, psychosocial restrictions originating with religious orthodoxy, involvement in homosexual functioning, and personal devaluation from prostitute experience.

It always must be borne in mind that multiple etiological factors usually are influencing the primarily impotent male. Categorical assignment of a dominant etiological role is purely an arbitrary professional decision. Others might differ significantly were they to review the same material. Case histories have been kept at a didactic level for illustrative purposes.

CategoriesEjaculatory Incompetence

Ejaculation Incompetence and Impotence

The most effective communication of all, a functional marriage bed, has been made immediately available and the security of intravaginal ejaculatory response has been established for both partners. The fact of an ongoing consummated marriage in itself immeasurably facilitates marital communication.

Symptoms of Secondary Impotence

Five men diagnosed as incompetent ejaculators developed symptoms of secondary impotence as their ejaculatory dysfunction continued without symptomatic relief over an average period of eight years. Three of the five men were handicapped by the psychosocial dominance of severe religious orthodoxy.

Symptoms of Erective Incompetence

Also developed for the man refusing ejaculatory experience to his wife in order to prevent the possibility of pregnancy and accomplish revenge against a dominant mother. The man whose marriage had been annulled because he was afraid to bring himself to ejaculate intravaginally, was the fifth male with symptoms of impotence developing as an involuntary component to longstanding ejaculatory incompetence.

Inevitably, when impotence develops as a complication of either premature ejaculation or ejaculatory incompetence, the concerns of the impotent state must be treated before those of the ejaculatory dysfunction. When therapy for the impotent state is successful and erective adequacy is secured, the individual male again returns clinically to his prior status as premature ejaculator or incompetent ejaculator.

Symptoms of Sexual Dysfunction

Must be treated in their turn, but always secondary to the primary attack on the state of impotence.

In all five instances, the symptoms of impotence developing secondary to those of an incompetent ejaculator were relieved with application of standard therapeutic techniques. Again, it is interesting to note the parallel between premature ejaculation and ejaculatory incompetence when existent for long periods of time. When a man’s sexual competence is questioned over an extended period by a woman demanding sexual satisfaction, symptoms of ejaculatory dysfunction may retrogress toward impotence under the pressure of fears of performance.

Ejaculation Treatment

There were three episodes of failure to reverse the symptoms of ejaculatory incompetence among the 17 cases referred to the Foundation. This is a failure rate of 17.6 percent, which certainly should be improved with more experience in dealing with this relatively rare syndrome.

The first failure was that of the orthodox Jewish male overwhelmingly traumatized in his premarital years by his one fall from grace during which he sexually approached a menstruating woman. The symptoms of secondary impotence that had developed after years of ejaculatory incompetence were relieved during therapy and have since continued under control, but he has not been able to ejaculate intravaginally.

His haunting fear of vaginal menstrual contamination and his reflex response of ejaculatory rejection could not be neutralized.

The second couple to fail to reverse the symptoms of ejaculatory incompetence was that of the husband surprising his wife in the physical act of adultery. Subsequently, whenever attempting to ejaculate intravaginally, he was faced with the vivid but castrating mental picture of the lover’s seminal fluid escaping his wife’s vagina.

Therapeutic effort could not reduce the rigidity of this man’s concept of the intravaginal ejaculatory process as a personally demeaning event. To ejaculate intravaginally during coition with his wife carried with it an implication that he was voluntarily mixing his seminal fluid with that of his wife’s lover. He could not or would not, forgive and forget.

The final clinical failure to reverse the symptoms of ejaculatory incompetence involved the man with no personal regard for, no interest in, and no feeling for his wife. His refusal to ejaculate intravaginally was a direct decision to deprive her of the pleasure of consummating the marriage.

This man historically had numerous successful sexual encounters outside marriage. This unit had escaped the culling protection of the screening process as described. They should not have been seen in therapy, as there really was no specific ejaculatory dysfunction. This was only a case of a man’s complete rejection of the woman he married.

Once the depth of the husband’s personal rejection of his wife was recognized, the unit was discharged from therapy. Divorce was recommended to the wife, but her immediate reaction was to hold on to her concept of a marriage.

Of interest is the fact that of the 17 men with ejaculatory incompetence, there were only 3 cases in which steps toward legal separation were taken, and in one of these 3 cases therapy reunited the marital partners. One of the men had been divorced for a period of eighteen months before both former husband and wife agreed to be seen as a unit in therapy.

His wife remarried him shortly after termination of a successful therapeutic experience. This husband and wife currently has two children. The man with a year-old marriage plagued by the symptoms, of ejaculatory incompetence leading to an annulment was treated with the aid of a partner surrogate. This man ultimately married another woman, and for the past three years has conducted himself as a sexually functional male in a successful marriage.

Those with religious orthodoxy as an etiological handicap (4 of the 5 men) acquired intravaginal ejaculatory function. Follow-up records report pregnancies for three of these five couples. There was no increase in the levels of sexual responsivity of the three non orgasmic wives in this group.

Two of the three units with male rejection of his female partner as the primary factor in the development of ejaculatory incompetence were reversed in therapy. Of interest in this group is the husband and wife with the homosexually oriented husband.

Successful Intravaginal Ejaculation

Once intravaginal ejaculation was accomplished, the husband continued to function effectively in this manner with his wife while also maintaining his own homosexual commitment with her full knowledge and consent. There have been two children born of this marriage.

Three of the four men developing ejaculatory incompetence after years of successful sexual functioning in marriage were returned to effective ejaculatory performance during therapy. These marriages have continued in a successful vein after termination of the acute phase of the therapy. One pregnancy has ensued.

It is obvious that the incompetent ejaculator can be treated effectively if both husband and wife wish reversal of this clinical dysfunction. This clinical syndrome of ejaculatory incompetence will be explored in depth in years to come as more material becomes available.

Previously, ejaculatory incompetence has been considered a variant of erective inadequacy. Now there is sufficient knowledge to categorize the syndrome as the direct counterpart of premature ejaculation. Neither of these forms of ejaculatory dysfunction should be considered an integral part of the clinical picture of impotence because neither is necessarily associated with erective incompetence.