CategoriesMale Sex & Vaginismus

Sex with Lesbian

Two case histories illustrate the occasional effect of homosexual orientation upon the female partner. Couple G was composed of a 26-year-old woman married to a man 37 years old. The wife had been actively homosexual since seduction by an elder sister when she was 12 years old.

There had been no history of heterosexual function before meeting her husband. He was a successful professional man and offered the woman much in the form of social status and financial security. He had been previously married and divorced.

Sexual exposure during the short engagement had been restricted, by female edict, to multiple manipulative approaches. There was total inability to penetrate on the wedding night or to consummate the marriage thereafter. When the unit was seen after 18 months of marriage, the wife’s hymen was not intact but there was evidence of severe vaginismus.

Once all of her pertinent history was obtained and shared with her marital partner, there was little further resistance to penile penetration. She was orgasmic with intercourse within two weeks after termination of the acute phase of therapy. Couple H had been married for 7 years. There were two children.

The husband became an alcoholic, lost his job, and left his family without warning. He was out of the home for 3 years before he could be persuaded to seek professional help. There was another year spent in treatment before he could return to family and social position.

Fortunately, there was sufficient financial resource, so no great financial hardship was suffered by his family. The wife, distraught at first, sought support from her best friend, also married and living in the neighborhood.

Marrying A Lesbian

Within a year an overt homosexual relationship developed. Mrs. H had no prior history of homophile orientation. Two years after her husband left the home, Mrs. H attempted sexual intercourse on several different occasions with two different men, but neither man could penetrate.

There was no further heterosexual exposure after these failures until her husband was released from institutional control to return to normal activity. When attempting intercourse, Mr. H could not penetrate, nor was he able to during the subsequent two years before the couple was seen in therapy.

The vaginismus was obvious at physical examination. The probable cause of her involuntary rejection of coitus was explained and accepted by both partners. Dilators were used effectively and coital functioning was reestablished quickly.

One marriage had existed in a sexual successful state for almost 10 years when the husband was detected in an extramarital affair. There was a 4-month period of continence while marital fences were mended with help from clergy. Although verbally forgiving his transgressions, the wife evidenced vaginal spasm during subsequent attempts at coital connection.

The marital unit’s inability to reestablish a successful coital pattern continued for almost 18 months until, consumed with fears for performance, feelings of guilt, and finally of personal rejection, the husband became secondarily impotent. When seen in therapy, both vaginismus and impotence were presenting systems.

There have been 7 more instances of vaginismus treated by Foundation personnel. Onset of symptoms has ranged from evidence of involuntary vaginal spasm with a first coital opportunity to dysfunction secondary to physiological or psychological trauma. There seems little need for further illustration of the onset of the syndrome.

Regardless of onset, an effective therapeutic approach is to establish the etiological influences by careful history-taking, and then to approach treatment confidently. With adequate dissemination of information so that full appreciation of onset of the sexual dysfunction is acquired by couple involved, and the sexual partners’ mutual cooperation in therapy, reversal of the syndrome of vaginismus is accomplished with relative ease.

CategoriesMale Sex & Vaginismus

Marital Sex Solution

The initial and most important step in the treatment of vaginismus is physical demonstration of the existence of the involuntary vaginal spasm conducted to the clinical satisfaction of both marital partners.

Anatomical illustrations of the involuntary constriction in the outer third of the vagina is made available to the marital partners and the specific anatomical involvement explained in detail. Then the basic aspect of clinical therapy is accomplished in a medical treatment room with the female partner draped and placed in the gynecological examining position.

Vaginal Insertion

The obvious presence of involuntary vaginal spasm, demonstrated by any attempt at vaginal insertion of an examining finger, frequently is more of a surprise to the female partner than it is to her husband. She may be completely unaware of the existence, much less the severity, of the involuntary spastic constriction of her vaginal outlet.

The chaperoned pelvic examination is not terminated before the husband also has been gloved and encouraged to demonstrate to his’ and to his wife’s satisfaction the Severity of the involuntary constriction ring in the outer third of the vagina.

Once the clinical existence of vaginismus has been demonstrated to the satisfaction of both marital partners, resolution of this form of sexual inadequacy becomes relatively easy. Hegar dilators in graduated sizes are employed in the privacy of the marital bedroom.

The actual dilatation of the vaginal outlet is initiated and conducted by the husband with the wife’s physical cooperation, at first with her manual control and then verbal direction. Again, the rationale behind the Foundation’s demand for availability and cooperation of both marital partners.

Increase Sex

When attempting to alleviate varying forms of human sexual inadequacy, is underscored. After the larger-sized dilators can be introduced successfully, it is good policy to encourage intravaginal retention of the larger dilators for a matter of several hours each night. Usually a major degree of the involuntary spasm can be eliminated in a matter of 3 to 5 days, presuming daily renewal of dilating procedures.

To date there has not been a failed attempt to relieve the involuntary spasm of vaginismus, once the clinical existence of the outlet contraction has been demonstrated to both husband and wife and the cooperation of both partners in the dilatation therapy has been elicited.

When coitus is attempted during the first month or six weeks after initial relief of the involuntary vaginal spasm, preliminary dilatation of the vaginal outlet occasionally may be indicated.

In many instances, however, the simple clinical demonstration of the existence of the vaginal constriction and the subsequent controlled usage of the dilators for a few days is quite sufficient to remove permanently this involuntary obstruction to vaginal penetration.

While physical relief of the spastic constriction of the vaginal outlet is usually accomplished without incident, the psychosocial trauma that contributed to the involuntary constriction must not be ignored. When physical symptoms of sexual dysfunction are relieved or removed, the tensions that have led to onset of the symptoms usually become much more vulnerable to treatment.

For a couple contending with vaginismus, an explanation of the psychophysiology of the distress, what it is, how it developed, and assurance that relief is possible are all important factors in the therapeutic program. As stated previously, the first and most important step in symptomatic relief is to demonstrate to both husband and wife the clinical existence of the dysfunction. Thereafter, the therapist is dealing with a receptive, if somewhat surprised, audience.

Relieve Sex Tensions

The easiest way to relieve the sexual tensions, the sexual misconceptions, even the established sexual taboos, is through direct dissemination of information. Women handicapped sexually by the influence of religious orthodoxy, married to men with sexual dysfunction, victimized by rape, contending with unexplained dyspareunia, frustrated by aging constriction of the vaginal barrel, or confused by homosexual and heterosexual conflict all have one thing in common.

They all exhibit almost complete lack of authoritative information from which to gain some degree of objectivity when facing the psychosocial problem evidenced by the symptoms of their sexual dysfunction.

With no knowledge of what to expect sexually, no concept of natural levels of sexual responsivity, and even real distrust for authority, theirs is a desperate need for definitive information. Education to understand the psycho physiological aspects of the problem is a point of departure for these traumatized women.

Confidence comes slowly from a gradually increasing degree of objectivity that develops from their psychosocial acceptance of the basic concepts of the naturalness of human sexual functioning.

With pertinent sexual information absorbed, with the physical dysfunction illustrated, explained, and relieved, women with resolution of involuntary vaginal spasm have been reoriented to lives of effective sexual functioning.

Of the 29 women referred for relief of their sexual dysfunction, all have recovered from the vaginismus, and 16 were orgasmic for the first time in their lives during the two-week attendance at the Foundation.

Four more women have reported orgasmic return during the follow-up period after termination of the acute phase of their treatment. Six women were previously orgasmic before onset of the secondarily acquired symptoms of vaginismus.

Their orgasmic responsivity returned spontaneously after treatment. Three women remained non orgasmic, despite clinical relief from their involuntary vaginal spasm.

Vaginismus, once diagnosed, can be treated effectively from both psychological and physiological points of view, presuming full cooperation from both members of the sexually dysfunctional.

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.

CategoriesImpotence Cure

Stimulate sex

Sexual input can be blocked by any negative influence in the psychosocial system that distracts the male. If there has been a recent quarrel and his antagonistic wife plays a passive role in their next sexual encounter, evincing no pleasure from her husband’s sexual approach, he receives no projection of her sensual interest and therefore half his input of sexual stimuli will be blocked.

There is little sexual return for the husband or wife who feels as if he or she were approaching a wooden indian when attempting to excite a partner sexually.

The impotent male also denies himself potential biophysical input if, as his wife approaches him with manually or orally stimulative activity, he casts himself, in the spectator role.

As he mentally stands in the corner observing her activity, impersonally watching and waiting to see if full erection can be attained, he obviously is blocking a major degree of the sensate input created by her direct stimulative approaches.

The Same Principle Applies

If he assumes the spectator role while approaching his wife in a stimulative manner. If he “pleasures” his wife with physical skill while remaining aloof and uninvolved as an impersonal spectator, waiting to approve of any degree of erective response resulting from her obvious sensual pleasure, he again blocks the psychosocial input created by her pleasure state.

It is important to emphasize, however, that an impotent man should never attempt to give pleasure to his wife with only the concept of receiving pleasurable stimuli from her in return.

He must give of himself to his wife primarily for her pleasure, and then must allow himself to be lost in the warmth and depth of her response, and in so doing divest himself of his impersonal spectator’s role. In brief, if a man is to get the essence of a woman’s sensual warmth, he must give of himself to her. This concept has been dubbed the “give-to-get” principle.

When the male loses himself in the giving, the female’s sensate return will be reflected by positive interdigitation of his biophysical and psychosocial influences, and the erection he has tried time and again to force will develop freely when least expected.

The husband and wife is assured that no attempt ever will be made to teach a husband to achieve an erection. Emphasis is placed on the fact that erective attainment is a natural physiological process and that every man is born with the facility to erect when responding to a definitive set of biophysical and psychosocial influences.

Production of vaginal lubrication

A descriptive parallel is employed for members of the couple by suggesting to the husband that the wife’s facility for vaginal lubrication follows the same natural initiative mechanism as does erective attainment.

She cannot will, wish, or demand the production of vaginal lubrication. However, she can relax, approach her husband and be approached by him, allowing input of sensate focus from both sources while she concentrates only on the sensual pleasure arising from the mutuality of their sexual expression.

When any woman achieves this state of involvement, lubrication develops spontaneously.

In many instances it helps to point out to the husband that exactly the same anatomical tissues, the same blood supply, and the same nerve supply that are involved in penile erection for the male produce vaginal lubrication for the female.

Full penile erection is, for the male, obvious physiological evidence of a psychological demand for intromission.

In exact parallel, full vaginal lubrication for the female is obvious physiological evidence of a psychological invitation for penetration. In a comparison of male and female sexual function, it always should be emphasized that in sexual response it is the similarities of, not the differences between, the sexes that therapists find remarkable.

The Foundation has taken the position that the secret of successful therapy is not to treat the symptoms of impotence at all.

Instead, methodology consists of a direct therapeutic approach to causation. The husband and wife combines to contribute the necessary ingredients, for when approaching problems of impotence, whether primary or secondary, symptoms are not treated as they are obviated by successfully treating the marital relationship.

The marital state is under therapy at the Foundation. Never are the impotent husbands or the directly involved and frequently non orgasmic wife considered separately as patients and never as non responsive, pathological entities separate from the marital union.

CategoriesErectile Dysfunction

Volunteered Sex Partners

Over that 11 years, 13 women have been accepted from a total of 31volunteers for assignment as partner surrogates. Their ages ranged from 24 to 43 years when they joined the research program. Although all but two of the women had been previously married, none of the volunteers were married when living their role as a partner surrogate.

The levels of formal education for the partner surrogates were high-school graduate, additional formal secretarial training, college matriculation, college graduates, and postgraduate degrees in biological and behavioural sciences. Nine of the 13 women had a child or children before joining the program.

Ten of these women also were committed to full-time employment outside of their role as partner surrogate; one did part time volunteer work and the remaining two were caring for very young children.

Every effort has been made to screen from this section of the total research population women with whom the cotherapist did not feel totally secure attitudinally or socially, and approximately 60 percent of those women volunteering for roles as partner surrogate were not accepted.

Of the 13 women accepted, 6 had previously served as members of the study-subject population during the physiological investigative phase of the research program, and 7 volunteered their services for this specific Clinical function.

The reasons expressed for such voluntary cooperation were varied but of real significance. During the screening process, each woman was interrogated in depth while the interviewers were acquiring medical, social, and sexual histories from which to evaluate the individual’s potential as a partner surrogate.

The investigation was conducted by male and female interrogators both singly and in teams. If interrogation indicated potential as a substitute partner, the three involved individuals (volunteer and interrogators) discussed this concept in detail, examining both the positive and the negative aspects of such a service.

No attempt ever was made to persuade any woman to serve as a partner surrogate. Volunteers who showed hesitancy or evidence of personal concern were eliminated from this potential role in the research program.

Of major interest was the fact that 9 of the 13 volunteers were interested in contributing their services on the basis of personal knowledge of sexual dysfunction or sex-oriented distress within their immediate family. Three women previously had contended with sexually inadequate husbands.

One man committed suicide, one died in the armed services, and the third, unable to face the psychosocial pressures of his sexual dysfunction, became an alcoholic. This man’s loss of security in his male role led to divorce, following which the woman volunteered as a partner surrogate.

In five instances there was positive history of sexually oriented trauma within the immediate family. The traumatic episodes varied from teenage gang rape of a younger sister to failure of a brother’s marriage due to his overt homosexual orientation. Of the remaining four volunteers, three women had more prosaic reasons for essaying the role of a partner surrogate.

The expressed needs were unresolved sexual tensions, a need for opportunity of social exchange, and an honest interest in helping dysfunctional men repair their ego strengths as sexually adequate males.

Finally, a physician, frankly quite curious about the partner-surrogate role, offered her services to evaluate the potentials (if any) of the role. When convinced of the desperate need for such a partner in the treatment of sexual dysfunction in the unmarried male, she continued as a partner surrogate, contributing both personal and professional experiences to develop the role to a peak of effectiveness.

Intelligent woman

The therapists are indeed more than indebted to this intelligent woman. Many of her suggestions as to personal approaches and psychosocially supportive techniques are original contributions to therapeutic process. They are solidly incorporated in the total investigative effort directed toward relief of male sexual inadequacy.

Her contributions to the treatment program range far beyond substantiating the basic contribution inherent in the role of partner surrogate.

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.

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.