Sexual Dysfunctions in Men

SEXUAL DYSFUNCTIONS IN MEN


Most books on human sexuality today distinguish between three male sexual dysfunctions: "impotence", "premature ejaculation", and "ejaculatory incompetence". Unfortunately, the average layman is not likely to find these strange Latin terms very helpful. Indeed, if he ever takes the trouble to consult his dictionary for their literal meaning, he is bound to be thoroughly confused.


The term "impotence" (literally, lack of power, from Latin impotens: powerless) sounds somber and threatening, but is also curiously vague. The term "premature ejaculation" seems to imply that there is an objective standard for timing ejaculations or, in other words, that there is such a thing as a "mature ejaculation" which occurs only after a fixed period of time. Finally, the expression "ejaculatory incompetence" seems to suggest that, when it comes to ejaculating semen, some men are more competent than others. However, in actual fact, competence has nothing to do with it. An ejaculation, like a sneeze, is a purely involuntary response. It may not occur at all, but when it does, nobody can suppress, delay, control, or modify it in any way. Furthermore, it must be remembered that ejaculations are only incidental to orgasms, and that a male can very well have an orgasm without ejaculating anything. Obviously, it would be foolish to consider such a male sexually inadequate. In other words, it is not the absent ejaculation but the absent orgasm which actually creates the problem. (For details, see "The Male Sexual Response.")


The traditional terminology has still another drawback: The terms used for male and female sexual problems are entirely different. As a result, many people are under the false impression that the physical reactions of men and women cannot really be compared. However, modern sex research has clearly demonstrated that such a comparison makes a great deal of sense. Indeed, we are now beginning to realize that, just as the sexual responses of males and females are quite similar, so are their sexual inadequacies. We therefore need new special terms that can be applied to both sexes. Both the male and female sexual responses can be dysfunctional in three ways:


1. Coitus cannot begin because the sex organs do not show the necessary initial reaction (lack of arousal in either sex and vaginismus in women).


2. Coitus is frustrating because, in the opinion of one or both partners, orgasm occurs either too early or too late (unsatisfactory timing of orgasm).


3. No orgasm is reached at all (absence of orgasm).


The following pages deal with these three basic inadequacies as they affect men.


Lack of Physical Arousal


A chronic lack of arousal, i.e. erection can, of course, be caused by a variety of bodily injuries, diseases, and disorders, from a severing of nerves to diabetes. Such cases must be treated by a physician. There are now several promising treatments (including silicone and inflatable prosthesis implants) which can greatly improve the condition. However, since these are strictly physical problems, they are not discussed in this section.


There are some physically healthy men who never in their lives had an erection of the penis when they attempted coitus. That is to say, their natural sexual response is so completely inhibited that they despair of ever finding satisfaction with a sexual partner. This depressing condition can have several possible causes. Usually, however, it is brought about by a combination of unfortunate circumstances. For example, a male may be raised by a possessive and highly seductive mother who just does not allow him to "be his own man", or he may learn to think of all sexual activity as sinful, dirty, or dangerous. If such a male then fails the first time he tries coitus, he may forever remain unable to overcome his negative conditioning. Another male may have strong homosexual tendencies, but may fear to come to terms with them. The unresolved inner conflict may then prevent his body from functioning properly. Obviously in these and similar cases, a man needs more help than he is likely to get from his girl friend or wife alone. Indeed, his best hope is intensive sex therapy.


Such therapy may also become necessary for a second much larger group of men—those who have been capable of coitus at some time in their lives, but who seem to have lost much or all of this capability. They either no longer have any erections at all, or fail to have them a great deal of the time. It has to be remembered, of course, that an occasional lack of erection is perfectly normal. After all, men are not machines. Sometimes, when they are tired, worried, distracted, or drunk, they may feel amorous, but their bodies simply refuse to respond. In such a case, frantic efforts, will power, or special acrobatics lead nowhere. Instead, the couple is well advised to accept the situation and to make the best of it. For instance, they might remember that a man does not need an erection to satisfy his partner. A limp penis can be "stuffed" into the vagina by hand and even if it then remains limp, the couple can go through some motions of coitus. It is not at all impossible for a woman to reach orgasm in this way. Furthermore, the man can also make love with his hands, lips, and tongue (see "Manual Intercourse" and "Oral Intercourse"). In any case, he can rest assured that, at another time when conditions are more favorable, the penis will easily become erect again.


However, some men are so insecure that they develop a fear of failure. Others just demand too much of themselves and begin to put their own responses to the test, thus turning every sexual encounter into a win or lose battle. Still others try to "stiffen their resolve" by drinking. Naturally, these stratagems only invite defeat, and thus the occasional problem turns into a chronic condition. The same fate may befall a man whose orgasm always occurs much sooner than that of his partner. (For details, see "Unsatisfactory Timing of Orgasm" below.) There are also some men who are unable to free themselves emotionally from the domination of one or both of their parents, and there are those whose puritanical upbringing has left them uncomfortable with their sexual feelings. Furthermore, certain men may have difficulty starting coitus because of homosexual interests, and others are simply overwhelmed by their sexual inexperience. All of these men may eventually find themselves unable to have or hold an erection that would allow them to engage in coitus. As a matter of fact, as soon as they regularly fail more than one-fourth of the time, their problem is serious enough to demand special therapy.


Treatment programs, such as that developed by Masters and Johnson, have been quite successful in restoring a man's normal sexual responses. This success depends, however, largely on the cooperation of both sexual partners. A woman whose male partner regularly fails to have an erection is bound to be negatively affected too, and it is therefore the whole sexual relationship that has to be treated.


The first therapeutic step usually consists of a couple's sexual reeducation. For example, they have to understand once and for all that an erection is an involuntary response. No man can will an erection; he can only allow it to happen. He can be certain, however, that it will happen if there is some sexual feedback between him and his partner, and if he is relaxed enough. Anxiety and apprehension, on the other hand, are likely to block his responses. In short, the couple learns that they have "nothing to fear but fear itself". Naturally, the underlying reasons for such fear have to be discussed also, and if one or both of the partners have negative and unrealistic attitudes toward sex in general, they must be corrected. In addition, the nonsexual aspects of the couple's relationship have to be considered. In the final analysis, it is the full human communication between man and woman that leads to their mutual happiness.


In order to further this communication, sex therapists have devised some simple exercises that the couple can practice together in the privacy of their bedroom. First, both the man and the woman have to learn to give and receive pleasure simply by touching each other's bodies. At that stage, they are not allowed to have coitus or even to try reaching orgasm any other way. Instead, they are encouraged to pleasure each other with gentle strokes and caresses. They are also told how to increase their pleasure by slowly guiding each other's hands. Often the use of some lotion or body oil is recommended. However, there is no specific area to be singled out, no specific goal to be reached, and thus there is no pressure to perform. Once the partners have practiced such pleasuring a few times, they usually begin to relax, lose their self-consciousness, and abandon themselves to their sexual feelings.


After several days of these exercises, the partners may concentrate their caresses on the sex organs and the woman's breasts. Again, guiding each other's hands can be very helpful. Both partners should also let each other know exactly how they like to be masturbated, and especially the man must tell the woman how he wants her to hold and stroke his penis. This kind of openness truly enables the partners to give each other pleasure. However, they still remain under the therapist's firm instruction not to aim for coitus or even for orgasm. If an erection of the penis occurs, the partners just stop playing for a while until it goes down. Then the man can allow himself to be masturbated again until he has another erection which he loses again, and so forth through several repetitions. This simple "teasing" of the penis wilI assure him that there is nothing frightening about losing an erection, and that he can always get it back.


About a week later, when the man has overcome his fear of failure and has begun to have confidence in his responses, the couple may proceed to coitus in a deliberate and nondemanding fashion. Again, the woman takes the initiative. While the man remains passive lying on his back, she sits on top of him and masturbates him until he has an erection. She then lowers herself onto the erect penis and inserts it into her vagina. After the insertion, she remains still for a while, so that the man can get used to the feeling of being inside her. Within a few minutes, she begins to move slowly, thus stimulating the penis and keeping it erect. Should the erection be lost, she simply moves off the penis and masturbates it again until it is hard. Usually, however, the man will be able to keep his erection as long as the woman avoids quick and vigorous movements.


Eventually, part of the initiative may be shifted to the man. That is to say, the woman remains in a position above her partner and she still inserts his penis into her vagina, but, after a while, she stops her gentle thrusting and allows him to move back and forth inside of her. Both partners stay under orders, however, not to aim for orgasm. When either of the partners does have an orgasm, it should be regarded as a pleasant surprise. Once a couple has learned to relax in this manner, they are usually also delighted to find that the penis can stay erect inside the vagina as long as either of them may wish. Finally, with their confidence strengthened, they are ready to make the most of each coitus and also to experiment freely with different coital positions,


Unsatisfactory Timing of Orgasm


Masturbation and sexual intercourse are among the greatest pleasures of life, and it is therefore only natural that people should try to enjoy them as often as they can. It is also understandable that they should want to make them last as long as possible.


In this latter respect, a woman has a certain advantage over a man. She can experience many orgasms in quick succession and thus can continue sexual intercourse as long as her partner is able to keep up with her. A man, on the other hand, can usually have only one orgasm at a time, after which his body needs a period of rest. (See "The Male Sexual Reponse." and "The Female Sexual Response.") In other words, in contrast to women, men who want to make their sexual activity last longer can do so only by delaying their orgasms.


In their younger years, men may not be much interested in such a delay because then they are often also capable of multiple orgasms. As a matter of fact, it is not unusual for adolescent boys to engage in masturbation contests in order to find out which member of their group can reach orgasm first. The "winner" of such a contest is usually much admired and even envied for his virility. It is only later, when the boy attempts coitus with a girl, that the speed of his sexual response suddenly turns into a disadvantage. He may then reach orgasm much sooner than she and thus leave her unsatisfied. When this happens, the boy may develop serious doubts about his sexual abilities, and eventually he may even become unable to have an erection in the girl's presence.


Fortunately, this problem can almost always be solved, if both partners are willing to cooperate. Indeed, it may already help them a great deal if they approach the matter with a little common sense.


First of all, the fact that the man reaches orgasm before the woman is, in itself, no reason why he should not continue sexual intercourse. All he has to do is switch from coitus to other forms of sexual stimulation. In other words, once his penis has lost its erection he can still use his hands or his mouth to bring the woman to orgasm. (See "Manual Intercourse." and "Oral Intercourse.") Once both partners realize that the man's "premature" orgasm does not have to deprive the woman of hers, much of their anxiety and frustration is bound to be relieved.


Secondly, it should be obvious that the ability to control the timing of one's orgasm is a matter of practice and experience. For example, males who enjoy masturbating in their adolescence often train themselves to delay their orgasms by interrupting or slowing down their movements. Girls, on the other hand, can learn through masturbation how to reach orgasm quickly. People first have to become familiar with their own sexual responses before they can gain some control over them.


Finally, it should be remembered that there is no such thing as an ill-timed orgasm for people who are alone. The problem arises only in relation to another person, and it can therefore always be defined from two different points of view: 1. "The man's orgasm comes too soon", and 2. "The woman's orgasm comes too late". Thus, a woman may find the timing of a man's orgasm unsatisfactory because it occurs several minutes before she herself is satisfied. However, the same man may very well be able to satisfy another woman with quicker responses. (Also see "Sexual Inadequacy in Women.")


All of these observations point to the same conclusion: The timing of orgasms is basically a matter of a couple's mutual adjustment, and, in many cases, it may well be the woman who can contribute most toward this goal. At any rate, she should know that, with her help, practically every man can learn to delay his orgasm as long as either of them want it delayed.


In recent years, sex therapists have developed some simple exercises which can help men and women make their sexual intercourse last longer. Occasionally, an especially frustrated and maladjusted couple may need professional guidance in learning and practicing these exercises. Still, many couples may also be able to make the adjustment on their own. The most important technique to be learned is the so-called "squeeze", which should be practiced in the following way: The man lies on his back with his legs spread apart. The woman sits between his legs with her feet on each side of his torso. This position gives her hands free access to his sex organs. Using some massaging oil or body lotion, she then gently strokes his penis until he gets an erection. While the man remains relaxed and passive throughout, the woman continues to masturbate him until he approaches orgasm. (In order to do this properly, she should ask the man for instructions as to tempo and firmness of grip. Some men are more easily excited by slow, firm strokes; others like them light and quick. Also, as arousal progresses, the man may want a change of rhythm. Open and explicit verbal communication between the partners is therefore essential.) As the man comes closer to orgasm, and just as he reaches his "point of no return", he signals the woman to apply the "squeeze". She then squeezes the penis firmly for 4-6 seconds by placing her thumb just below the glans on its underside and her first and second fingers above and below the ridge of the glans on its upper side. There is no need to fear that the penis will be hurt because it is relatively tough when it is hard. However, if the man should find a firm squeeze uncomfortable, the woman can squeeze more gently for 8-15 seconds. In both cases, the effect is the same—no ejaculation occurs, and the man begins to lose his erection. Once the penis has become soft, the woman repeats the stimulation and the squeeze three or four more times, each time bringing the man close to orgasm, but preventing it at the last moment by the pressure of her fingers around the ridge of the glans. This whole exercise should then be repeated in at least two more special sessions.


After three or four sessions devoted to the squeeze technique, the couple may proceed to the next step, the so-called stuffing exercise. In this session, the woman first repeats the squeeze technique as practiced before. However, after the first squeeze, when the man loses his erection, she leans forward and stuffs the limp penis into her vagina. Doing so, she sits on top of the man who remains completely passive lying on his back. She then remains still while he gets used to being inside her. After a few minutes, she slowly begins to move, thus giving him an erection. As he approaches orgasm, he gives her the signal, she moves off his penis, reaches down with her hand, and applies the squeeze as before. Once he loses his erection, she stuffs his penis again into her vagina and repeats the exercise. This stuffing and squeezing should also be repeated several times in at least three special sessions. As soon as these techniques have been mastered, the couple should continue to practice them regularly until they feel confident that they can control the timing of the man's orgasm. For the first few weeks, it is advisable to retain the coital position with the woman sitting on top of the man who lies on his back. In case of a relapse, they simply return to the first squeezing exercises. (The squeeze technique does not always work if the man applies it to himself.)


Some sex therapists believe that, during their practice sessions, neither man nor woman should aim for complete sexual satisfaction. Others think that an ejaculation can be allowed to occur at the end of a session, as long as it happens without any special effort. It is important for the success of these exercises that they should take place in an atmosphere of complete relaxation. There must be absolutely no pressure to perform. Another training program for men who want to "last longer" has been developed at the University of California School of Medicine in San Francisco. This program does not necessarily rely on the "squeeze technique". Instead, the man learns to delay his orgasm for 15 minutes masturbating himself (first without and then with lubrication). Once he has successfully completed these initial steps, he lets himself be masturbated by his partner (again first without and then with lubrication) until he can delay his orgasm for 15 minutes. Thereafter the couple can proceed to the undemanding coital forms described above. The "squeeze" may or may not be used. The man simply proceeds step by step until he can "last" 15 minutes in each case. The whole training is undramatic, but seems to work well.


Absence of Orgasm


Virtually all men who achieve an erection of the penis also achieve orgasm. That is to say, in contrast to many women who have difficulty going beyond the plateau phase, men can normally count on completing their sexual response cycle. (See "The Male Sexual Response" and "The Female Sexual Response".) However, there are some rare cases where men can reach orgasm only through masturbation or certain specific forms of sexual intercourse. For example, a man may be unable to have an orgasm as long as his penis is inside a woman's vagina or in her mouth. Thus, a woman who wants to become pregnant or who enjoys swallowing semen may find herself disappointed. Her partner can easily maintain an erection, but he reaches orgasm (and therefore ejaculates) only after he has either withdrawn from her body or completely removed himself for her presence. Quite obviously, this curious condition is caused by some mental or emotional block that prevents the man from letting himself go when he should. For instance, he may suffer from an overpowering and irrational fear of making the woman pregnant, or he may dislike her so much that he takes pleasure in frustrating her. In another case, the man may be the victim of a traumatic early experience. Thus, a boy who is punished by his parents for masturbating or having a "wet dream" may later find himself unable to have an orgasm during coitus. In still other cases, this inability is brought about late in life by an unpleasant sexual encounter in which the woman's vagina or mouth somehow appeared unclean or disgusting.


Like other sexual dysfunctions, this problem can be overcome by a nondemanding attitude of the partners toward each other, by full communication of their needs, wishes, and fears, and by appropriate exercises. For example, a woman who gradually manages to masturbate the man to orgasm may thereby succeed in breaking his phobic behavior pattern. As he begins to associate his sexual release with her presence, he may become able to accept the idea of ejaculating close to or even inside of her body. Here again, the joyful appreciation of noncoital forms of sexual intercourse can do much to put the partners at ease. In some cases, professional sex therapy may be advisable.


Still, it should be pointed out that not all couples confronted with this phenomenon feel the need for treatment. After all, a man who is simply unable to ejaculate into a woman's vagina or mouth can still bring her to orgasm. Once she is sexually satisfied, he can then reach orgasm himself by masturbating or by any other method that suits him. Thus, both partners can have a satisfying sexual relationship, and they may even enjoy the advantage of never having to worry about contraception. If, on the other hand, they decide to have a child, they can always resort to artificial insemination. (See "Infertility.")


It should perhaps also be mentioned that certain religious groups of the past actively encouraged men to practice coitus without ejaculation. This kind of coitus (also known as karezza or coitus reservatus) was often supposed to last many hours and to further a couple's spiritual growth. Needless to say, for such a couple the absence of the man's orgasm was never a problem.


 

[Title Page] [Contents] [Preface] [Introduction] [The Human Body] [Sexual Behavior] [Development of Behavior] [Types of Activity] [Sexual Maladjustment] [Sex and Society] [Epilogue] [Sexual Slang Glossary] [Sex Education Test] [Picture Credits]