CategoriesMale Sex & Vaginismus

Male sex and Vaginismus

Male sex and vaginismus is a psycho physiological syndrome affecting women freedom of sexual response by severely, if not totally, impeding coital function. Anatomically this clinical entity involves all components of the pelvic musculature investing the perineum and outer third of the vagina.

Physiologically, these muscle groups contract spastically as opposed to their rhythmic contractual response to orgasmic experience. This spastic contraction of the vaginal outlet is a completely involuntary reflex stimulated by imagined, anticipated, or real attempts at vaginal penetration.

Vaginismus is a classic example of a psychosomatic illness.

Vaginismus is one of the few elements in the wide pattern of female sexual dysfunctions that cannot be unreservedly diagnosed by any established interrogative technique.

Regardless of the psychotherapist’s high level of clinical suspicion, a secure diagnosis of vaginismus cannot be established without the specific clinical support that only direct pelvic examination can provide. Without confirmatory pelvic examination, women have been treated for vaginismus when the syndrome has not been present.

Conversely, there have been cases of vaginismus diagnosed by pelvic examination when the clinical existence of the syndrome had not been anticipated by therapists. The clinical existence of vaginismus is delineated when vaginal examination constitutes a routine part of the required complete physical examination.

CategoriesMale Sex & Vaginismus

Male Painful Sex

Vaginismus occasionally develops in women with clinical symptoms of severe dyspareunia (painful intercourse). When dyspareunia has firm basis in pelvic pathology, the existence of which escapes examining physicians, and over the months or years coition becomes increasing painful, vaginismus may result.

The patient is not reassured by console that “it’s all in your head” or equally unsupportive pronouncements, when she knows that it is always severely painful for her when her husband thrusts deeply into the vagina during coital connection.

As examples of this situation, vaginismus has been demonstrated as a secondary complication in two cases, of severe laceration of the broad ligaments. Also recorded are two classic examples of onset of vaginismus, the first in a young woman with pelvic endometriosis, the second in a 62 year old postmenopausal widow (without sex-steroid replacement therapy) who through remarriage sought return to sexual functioning after seven years of abstinence.

The two women developing a syndrome of vaginismus subsequent to childbirth laceration of the broad ligaments supporting the uterus (universal-joint syndrome) have similar histories. A composite history will suffice to demonstrate the pathology involved.

Mr. And Mrs. D
was seen with the complaint of increasing difficulty in accomplishing vaginal penetration developing after 6 years of marriage. There were two children in the marriage, with onset of severe dyspareunia oriented specifically to the delivery of the second child. The second child, a post mature baby of 8 pounds 14 ounces, had a precipitous delivery.

There is a positive history of nurses holding, the patient’s legs together to postpone delivery while waiting for the obstetrician. As soon as sexual activity was reconstituted after the delivery the patient experienced severe pain with deep penile thrusting. During the next year the pain became so acute that the wife sought subterfuge to avoid sexual exposure.

The intercourse frequency decreased from two to three times a week to the same level per month. On numerous occasions the patient was assured, during medical consultation, that there was nothing anatomically disoriented in the pelvis and that pain with intercourse was “purely her imagination.”

Supported by these authoritative statements, the husband demanded increased frequency of sexual function. When the wife refused, the unit separated for serveral months. During these month period, the woman assayed intercourse on two separate occasions with two different men, but with each experience the pelvic pain with deep penile thrusting was so severe that her obvious physical distress terminated sexual experimentation.

The couple was reunited with the help of their religious adviser, but with attempted intercourse vaginal penetration was impossible. After 8 months of repeatedly unsuccessful attempts to reestablish coital function, the unit was referred for therapy.

Couple E
married 8 years when seen in the Clinic. They mutually agreed that coital connection had not been possible more than once or twice a month in the first two years of marriage. Each time, the wife had moaned or screamed in pain as her husband was thrusting deeply into her pelvis. After the first two years of marriage, every attempt at vaginal penetration had been unsuccessful.

Both had been under intensive psychotherapy, the husband for three and the wife for four years, when referred to the Foundation. During the routine physical examinations, advanced endometriosis was discovered, and severe vaginismus was demonstrated.

In due course the wife underwent surgery for correction of the pelvic pathology. After recovery from the surgery she returned with her husband for therapeutic relief of the vaginismus which, as would be expected, still existed despite successful surgical correction of the endometriosis.

Couple F
a 66 year old husband and his 62 year old wife, were seen in consultation. When the wife was 54 years old, her first husband died after a three-year illness during which sexual activity was discontinued. She remarried at 61 years of age, having had no overt sexual activity in the interim period.

She had never been given hormone-replacement therapy to counteract the natural involution of pelvic structures. First attempts at coital connection in the present marriage produced a great deal of pain and only partial vaginal penetration.

With reluctance the wife sought medical consultation. Her physician instituted hormone-replacement techniques. After a 6-week respite, further episodes of coital activity also resulted in pain and distress.

Despite the fact that by this time the vaginal walls were well stimulated by effective steroid replacement, the new husband found it impossible to attain vaginal intromission. The wife had developed obvious psychosocial resistance to the concept of sexual activity in the 60 plus age group based on the pain that had been experienced attempting to consummate her new marriage.

And a real sense of embarrassment created by the need for medical consultation and the necessity of admitting that she had been indulging in coital activity at her age.

As a result of the trauma that developed with attempts to renew sexual function subsequent to almost ten years of continence, she developed involuntary spastic contraction of the vaginal outlet. Judicious use of Hegar dilators and a detailed, thorough, and authoritative refutation of the taboo of aging sexual function (based on the belief that sexual activity in the 60, 70, or even 80 year age groups represents some form of perversion) were quite sufficient to relax and relieve the vaginal spasm.

CategoriesAging Male Sex

Male Sex Steriod

Little is known of the male climacteric.

When does it occur, if it develops? Is it a constant occurrence? What is the specific symptomatology? Should sex-steroid-replacement techniques be employed? What, if any, are the patterns of sexual responsivity engendered by these replacement techniques? So little is known of the male climacteric.

Now that these definitive laboratory studies can be done with some confidence, relative rapidity, and at not too staggering a cost, much more will be known of the male climacteric within the next few years.

There will be more basic information on the effects of steroid replacement not only upon the aging male’s sexual response cycle per se but also, and infinitely more important, upon the total metabolic function of the climacteric male.

Without the gross advantage of fully supportive laboratory data, tentative clinical conclusions have been drawn regarding the influence of steroid-replacement techniques upon the aging male’s sexual functioning.

These conclusions may have to be restarted or even possibly abandoned in the not-too-distant future as more definitive information is accrued from the healthy combination of clinical and laboratory evaluations.

When the male notices alteration of his orgasmic response pattern from the usual two-stage to a one-stage process, when he consistently responds during the orgasmic experience with the loss of seminal fluid volume without significant ejaculatory pressure, when the average ejaculatory volume is cut at least in half, and when none of these reactions develop under the extenuating circumstances of a long-continued plateau phase of voluntary ejaculatory control, he may be experiencing the physiological expression of reduced production of male sex-steroid to metabolically dysfunctional levels.

Occasionally prostatic pain develops from spastic contractions of the organ during the ejaculatory process.

These spastic contractions create a continuing sense of ejaculatory urgency that may last through the entire orgasmic experience until full expulsion of the seminal-fluid bolus has occurred.

With the subjectively painful evidence of physiological prostatic spasm recurring with most ejaculatory experiences and no obvious pathology of the prostate gland demonstrable to adequate urological examination, sex-steroid replacement also may be indicated.

Until there is a more reliable laboratory definition of a general metabolic need for testosterone replacement and until the clinical existence of the male climacteric can be defined with security during treatment of older men for sexual dysfunction, individual eases must be treated empirically.

If the sexually dysfunctional male describes physiological or psychological symptomatology that appears to indicate the clinical need for the sex-steroid replacement and if the general physical and laboratory evaluations are negative, there is no professional hesitancy to institute such replacement techniques.

However, sex-steroid-replacement techniques are not employed routinely for the 50 to 70 year age group man referred for therapy.

Steroid replacement concepts and specific techniques, together with indications and contraindications for the aging male will be presented in more complete form by the Foundation in monograph format in the future.

Erection Response In Aging Male

The sexual myth most rampant in our culture today is the concept that the aging process per se will in time discourage or deny erective security to the older-age-group male. As has been described previously, the aging male may be slower to erect and may even reach the plateau phase without full erective return, but the facility and the ability to attain erection, presuming general good health and no psychogenic blocking, continues unopposed as a natural sequence well into the 80 year age group.

The aging male may note delayed erective time, a one-stage rather than a two-stage orgasmic experience, reduction in seminal-fluid volume, and decreased ejaculatory pressure, but he does not lose his facility for erection at any time.

Sexual Advantages

If this concept can be presented to and accepted by the general population, one of the great deterrents to the sexual functioning of the aging male will have been eliminated. When the conceptive ability is no longer important and reduction in seminal fluid volume and total sperm production no longer is of consequence, the aging male is potentially a most effective sexual partner.

He needs only to ejaculate at his own frequency and not based on uninformed socio-cultural demand.

There are even some sexual advantages that accrue as the male ages.

He has increased ejaculatory control and can; if he wishes, serve his female partner deftly and with full erective security. His sexual effectiveness is based not only upon his prior sexual experience but also upon the specific element of increased physiological control of the ejaculatory process.

If the aging male does not succeed in talking himself out of effective sexual functioning by worrying about the physiological factors in his sexual response patterns altered by the aging process, if his peers do not destroy his sexual confidence, if he and his partner maintain a reasonably good state of health, he certainly can and should continue unencumbered sexual functioning indefinitely.

CategoriesAging Male Sex

Aging Male Sex

The natural aging process creates a number of specific physiological changes in the male cycle of sexual response. Knowledge of these cycle variations has not been widely disseminated.

There has been the little concept of a physiological basis for differentiating between natural sexual involution and pathological dysfunction when considering the problems of male sexual dysfunction in the post-so age group.

If all too few professionals are conversant with anticipated alterations in male sexual functioning created by the aging process, how can the general public be expected to adjust to the internal alarms raised by these naturally occurring phenomena?

Tragically, yet understandably, tens of thousands of men have moved from effective sexual functioning to varying levels of secondary impotence as they age, because they did not understand the natural variants that physiological aging imposes on previously established patterns of sexual functioning.

Sexually Impaired at 50

From a psychosexual point of view, the male over age 50 has to contend with one of the great fallacies of our culture. Every man in this age group is arbitrarily identified by both public and professional alike as sexually impaired.

When the aging male is faced by unexplained yet natural involutional sexual changes, and deflated by widespread psychosocial acceptance of the fallacy of sexual incompetence as a natural component of the aging process, is it any wonder that he carries a constantly increasing burden of fear of performance?

Before discussing specifics of sexual dysfunction in the aging population, the natural variants that the aging process imposes on the established male cycle of sexual response should be considered.

For sake of discussion, the four phases of the sexual response cycle excitement, plateau, orgasm, and resolution will be employed to establish a descriptive framework. Also for descriptive purposes, the term older man will be used in reference to the male population from 50 to 70 years of age and the term younger man used to describe the 20 to 40 year age group.

In recent years the younger man’s sexual response cycle has been established with physiological validity and will serve as a baseline for comparison with the physiological variations of aging.

If an older man can be objective about his reactions to sexual stimuli during the excitement phase, he may note a significant delay in erective attainment compared to his facility of response as a younger man.

Most older men do not establish erective response to effective sexual stimulation for a matter of minutes, as opposed to a matter 9f seconds as younger men, and the erection may not be as full or as demanding as that to which previously he has been accustomed.

It simply takes the older man longer to be fully involved subjectively in acceptance and expression of any form of sensate stimulation.

If natural delays in reaction time are appreciated, there will be no panic on the part of either husband or wife. If, however, the aging male is uninformed and not anticipating delayed physiological reactions to sexual stimuli, he may indeed panic and responding in the worst possible way to try to will or force an erection.

The unfortunate results of this approach to erective security have been discussed at length in treatment of impotence.

Aging Male Erections

As the aging male approaches the plateau phase, his erection usually has been established with fair security. There may be little if any testicular elevation, a negligible amount of scrotal-sac vasocongestion, and minimal deep vascular engorgement of the testes.

Most older men who have had a pre-ejaculatory fluid emission (Cowper’s gland secretory activity) will notice either total absence of, or marked reduction in, the amount of this pre-ejaculatory emission as they age.

From the aspect of time-span, the plateau phase usually lasts longer for an older man than for his younger counterpart. When an aging male reaches that level of elevated sexual tension identified as thoroughly enjoyable, he usually can and frequently does wish to maintain this plateau-phase level of sensual pleasure for an indefinite period of time without becoming enmeshed by ejaculatory demand.

This response pattern is age-related; the younger man tends to drive for early ejaculatory release when plateau-phase levels of sexual tension have accrued. One of the advantages of the aging process with specific reference to sexual functioning is that.

Generally speaking, control of ejaculatory demand in the 50 to 70 year age group is far better than in the 20 to 40 year age group.

In the cycle of sexual response, the largest number of physiological changes to come within objective focus for older men occurs during the orgasmic phase (ejaculatory process). The orgasmic phase is relatively standardized for younger men, varying minimally in duration and intensity of experience unless influenced by the psychosexual opposites of long-continued continence or high level of sexual satiation.

For younger men, the entire ejaculatory process is divided into two well-recognized stages. The first stage, ejaculatory inevitability, is the brief period of time (2 to 4 seconds) during which the male feels the ejaculation coming and no longer can control it before ejaculation actually occurs.

These subjective symptoms of ejaculatory inevitability are created physiologically by regularly recurring contractions of the prostate gland and, questionably, the seminal vesicles. Contractions of the prostate begin at o.8-second intervals and continue through both stages of the male orgasmic experience.

The second stage of the orgasmic phenomenon consists of the expulsion of the seminal-fluid bolus accrued under pressure in the membranous and prostatic portions of the urethra, through the full length of the penile urethra.

Again, there are regularly recurring 0.8-second inter-contractile intervals. This specific interval lengthens after the first three or four contractions of the penile urethra in younger men.

Subjectively, the sensation is one of flow of a volume of warm fluid under pressure and emission of the seminal fluid bolus in ejaculatory spurts with pressure sufficient to expel fluid content distances of 12 to 24 inches beyond the urethral meatus.

As the male ages he develops many individual variants on the basic theme of the two-stage orgasmic experience described for the younger man. Usually his orgasmic experience encompasses a shorter time span.

There may not be even a recognizable first stage to the ejaculatory experience, so that an orgasmic experience without the stage of ejaculatory inevitability is quite a common occurrence.

Even with a recognizable first stage, there still may be marked variation in reaction pattern. Occasionally, the older man’s phase of ejaculatory inevitability lasts but a second or two as opposed to the younger man’s pattern ranging from 2 to 4 seconds.

In an older man’s first-stage experience, there may be only one or two contractions of the prostate before involuntary initiation of the second stage, seminal-fluid expulsion.

Alternatively, the first stage of orgasmic experience may be held for as long as 5 to 7 seconds. Occasionally the prostate, instead of contracting within the regularly described pattern of 0.8-second intervals, develops a spastic contraction, creating subjectively the sense of ejaculatory inevitability.

Inadequate Testosterone

The prostate may not relax from spasm into rhythmically expulsive contractions for several seconds, hence the 5-7-second duration of the first-stage experience. In addition to objective variants in a first-stage orgasmic episode, there may be no possible objective or subjective definition of the first stage of orgasmic experience at all.

The stage of ejaculatory inevitability may be totally missing from the aging male’s sexual response cycle. A single-stage orgasmic episode develops clinically in two circumstances.

The first circumstance is that of clinical dysfunction developing as the result of inadequate testosterone production.

Actually the lack of a recognizable first stage in orgasmic experience can result from low sex-steroid level for the male just as steroid starvation in the female may produce an orgasmic experience of markedly brief duration.

The second occasion of an absent first stage in the orgasmic experience develops after there has been prior denial of ejaculatory opportunity over a long period of intravaginal containment in order to satisfy the aging male’s coital partner sexually.

There also are obvious physiological changes in the second stage of the orgasmic experience that develop with the aging process.

The expulsive contractions of the penile urethra have onset at 0.8second intervals but are maintained for only one or two contractions at this rate:

The expulsive force delivering the seminal fluid bolus externally, so characteristic of second-stage penile contractions in the younger man, also is diminished, with the distance of unencumbered seminal-fluid expulsion ranging from 3 to 12 inches from the urethral meatus.