Sexual Dysfunction, Male
From Encyclopedia of Sex and Sexuality
Prior to the rise of modern sex therapy research, the sex life of the male of our species was often mythologized as that of a “sexual beast” or “great lover,” always ready to woo, seduce, and conquer women and gifted with the a priori knowledge of how to accomplish all this. Women, of course, often knew the truth. Rarely did male sexual problems of obtaining and maintaining an erection and performing as lovers appear in medical literature—and certainly not in the literature of the popular culture. Within recent decades much of the veil of secrecy and shame has been lifted, and sex therapists are now learning that a considerable number of men—the true percentage has still to be researched—suffer from some form of sexual dysfunction either on a temporary or chronic basis.
We can classify male sexual dysfunction difficulties into four main categories:
- Premature ejaculation
- Retarded ejaculation
- Erectile difficulties
- Lack of sexual interest
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[edit] Premature Ejaculation
Premature ejaculation means different things to different people. Essentially, it is any situation in which a male believes his ejaculation occurs too soon. However, “too soon” can have a variety of meanings:
- The man may be so excited by foreplay and the thought of making love that he ejaculates before he can penetrate his partner
- The man ejaculates just as he is attempting penetration
- The man ejaculates seconds after penetration, even though he does not move
- The man may penetrates his partner, begins thrusting, and ejaculates after very few movements
- The man is thrusting in and out and though he does not want to climax yet, his reflex actions produce an ejaculation
What is common to all of these scenarios is that the man is not in control over the timing of his ejaculation. His body is in control, not his will, and his mistimed ejaculation—and it does not matter whether it occurs before, during, or after penetration—leaves him with feelings of inadequacy or frustration. However, sex therapists have devised fairly simple techniques for the treatment of this problem—with a very high rate of success—by teaching men to recognize the moment of inevitability just prior to the beginnings of the ejaculatory response and learning how to delay the orgasm.
[edit] Retarded Ejaculation
Retarded ejaculation occurs when a man cannot achieve orgasm within a reasonable time after he decides to achieve it. While some may think that prolonged intercourse is always desirable, retarded ejaculation often results in no ejaculation at all.
This is not an enviable condition. It often brings with it physical and emotional frustrations, discomfort, and loss of interest. Men who suffer from it may experience anger, and they may question their masculinity or sexual orientation. What some men do, therefore, is to turn a disturbing problem into a virtue. By bragging about their “staying power,” they can more easily avoid facing their problem, while appearing to be experienced lovers. Some men “advertise” to their female acquaintances that they do not climax quickly because they are great lovers. Unfortunately, this may be a cover for a deeply rooted psychological problem.
There are many men who can choose to delay their ejaculation until their partner has had an orgasm. This is perfectly normal if that is what both partners want. But the key word here is “choose.” Someone experiencing retarded ejaculation is just as sexually out of control as the premature ejaculator. Only honest discussion by males with their partners about when they would like him to climax and the expression of their own honest feelings about when they want to ejaculate will start the partners on a path to fulfillment. Consultation with a sex therapist is in order if a man is often disappointed with the timing of his ejaculation and cannot begin to exercise control over it.
[edit] Erectile Difficulties
How long should it take before a man develops a firm erection once he is stimulated by his partner’s touch? Should a man always get an erection by just thinking about a sexy person or a sexy scene? How long should a man be able to maintain an erection while he is engaged in foreplay? And, what about maintaining the erection after penetration and movement? Should a man get an erection when kissing his lover? How hard should his erection be? Can a man have an erection while he is asleep but not when awake?
As commonly as these questions are addressed to sex therapists, the answers are necessarily less than specific because, as with premature ejaculation, erectile difficulties may be highly subjective. Basically, as long as a man is concerned about the hardness, frequency, or duration of his erection, he has a problem that is real to him. Whether the problem is due to a physiological problem that affects the erection, to psychological factors, or merely to sexual illiteracy or misinformation, must be determined in each individual case. Since this problem can indicate a medical difficulty, one should rule out physiological problems first. Before even considering possible psychological or situational causes with sex therapists, a man should get a thorough examination from a physician or urologist.
Men are often the victims of a Catch-22 situation when it comes to erectile difficulties. They are worried that they are not performing satisfactorily, and the stress this worry produces may cause them to perform poorly: stress is itself often the cause of erectile problems. In other words, the concern that they may have difficulty with erections can actually cause the difficulty. This is sometimes called a “self-fulfilling prophecy” or anticipatory anxiety.
Different kinds of situations may lead men to think that they might have a problem with their erections:
- The weakening of visual stimulation—not getting erect from seeing nude women, viewing suggestive photos, or watching erotic movies
- The weakening of physical stimulation—not obtaining an erection from either self-stimulation or physical stimulation by others
- A firm erection takes much more time and effort to achieve than it once did
- An erection requires far more “exotic” kinds of stimulation—either in fantasy or in behavior—than before
Some men report that they never get an erection and that they must, therefore, be “sexless” or “impotent.” These two words are more misleading and frightening than useful. Men who experience great difficulties obtaining an erection—or who cannot experience one—may have a physiological problem requiring treatment by a urologist. In some cases it may be due to medications taken for other health reasons. If a man is taking medications and experiences an erectile difficulty or loss of libido, he should consult his physician as soon as possible.
But in many cases there are nonsexual life-style factors that may inhibit an erection, for example, stresses from work or money shortages, problems with a partner’s hygiene or weight gain, or just plain boredom with the same partner. Even though these men may have difficulty with an erection when attempting intercourse, they may be perfectly capable of having a full-blown erection while asleep. To argue that an erection while asleep is not real because it is stimulated by bladder pressure or something else is nonsense. As long as the body’s apparatus works, a man is probably just as capable of having his erection in a sexual situation. If he wants a simple but not necessarily fool-proof test to see if he does have erections in his sleep, he can try the stamp test.
A second class of erectile difficulties is found in men who are able to obtain erections, but find their erections are not as strong, as rigid, and as long-lasting as they once were. In ways similar to those who cannot obtain an erection, these problems may be due to the natural process of maturation and aging, in which repeated exposures to stimulations seem to weaken the desired response.
A third class of erectile difficulties involves an all-too-brief erection before ejaculation. That is, the man complains that his penis gets soft before he has his climax, and that the orgasm occurs during the period in which his erection is waning. Often such men, though they have achieved an erection, begin to worry that they may lose their “hardness.” As with those unable to obtain an erection, therapists surmise that stress and worry are often the real culprits. Learning how to “relax and enjoy it” is of vital importance.
[edit] Lack of Sexual Desire
Understanding the role of culture in our lives helps us more clearly understand and define the problems a male might have with sexual desire. For example, a male might reach manhood, get married, father children, and soon find himself having little sexual desire or interest. This does not mean that he does not love his wife, that he is latently homosexual, or any other simplistic explanation. This is often a lack of desire that would probably be unaffected by a different partner. Although he may appear to be bored with his wife, he is not ready for an extramarital affair. In some cases, weeks or even months may pass before the husband and wife engage in any sexual activity. The wife may want sex, but she might feel uncomfortable about initiating it due to his apparent loss of interest. The man might even feel that he would have sex, but his desire is too weak to motivate him.
These are not situations in which loss of desire has resulted from a change in the relationship: rather, there still is love but no desire. In some cases, the man may never have experienced much “horniness,” or physical desire, while in others there has been a marked loss of desire over the years. There are cases in which an operation or a touch of heart trouble has elicited enough fear to drive a husband’s desire away. In one case, a man had one testicle which had not descended and another which did not develop properly. He was perfectly capable of having sex, but he believed that no woman could be interested in him. Shame and self-doubt just pushed sex out of his mind. His case is similar to those of women who have lost sexual interest after a mastectomy or some other such operation. They now feel they could not possibly be attractive to men, so they defensively avoid intimacy and the possibility of rejection.
We know that these men and women are not sexually dead. The same men and women can show an interest in sex—in romantic novels, erotic movies, and in talking or thinking about it—but they have no real desire to initiate and complete a sexual act. They are lacking “horniness”—that sense of urgency to have sex. Their problems can often be helped by sex therapy or even by “self-help” books that offer suggestions for revitalizing sexual relationships.
Sometimes, men (and women) may have such strong negative images or feelings of disgust about the sex organs that they do not want to think about or visualize sex. Others were taught as children, and still believe as adults, that the sex organs are dirty or dangerous, or tools of the devil. Some have an irrational fear that the vagina may injure the penis. These deeply rooted problems are best treated by a psychotherapist, who must try to uncover the patient’s unconscious, severe emotional blocks against sex. A sex therapist can only help to suggest if this course of action is needed, but will not usually attempt to directly treat severe psychological blocks without coordinated help from other therapists.
