Prognosis of disorders of sexual potency in the male

Fleeing the Body: A Terror Management Perspective on the Problem of Human Corporeality

From the perspective of terror management theory, the human body is problematic because it serves as a perpetual reminder of the inevitability of death. Human beings confront this problem through the development of cultural worldviews that imbue reality-and the body as part of that reality-with abstract symbolic meaning. This fanciful flight from death is in turn the psychological impetus for distancing from other animals and the need to regulate behaviors that remind us of our physical nature. This analysis is applied to questions concerning why people are embarrassed and disgusted by their bodies' functions; why sex is such a common source of problems, difficulties, regulations, and ritualizations; why sex tends to be associated with romantic love; and why cultures value physical attractiveness and objectify women. This article then briefly considers implications of this analysis for understanding psychological problems related to the physical body and cultural variations in the need to separate oneself from the natural world.

The neurobiological approach to premature ejaculation

PURPOSE

Data showing the neurobiological background of rapid ejaculation was reviewed. In addition, new hypotheses to integrate clinical symptomatology, psychopharmacotherapy and psychotherapy of rapid ejaculation with brain function are provided.

MATERIALS AND METHODS

A computerized MEDLINE search, and manual bibliographic review of cross-references and neurobiological animal studies were performed. These reports were analyzed, summarized and compared with the studies performed by the author.

RESULTS

The literature on premature ejaculation published between 1887 and 2001 was reviewed. It appeared that the various psychological hypotheses and psychotherapies have not adequately been investigated. In contrast, psychopharmacological treatment studies, animal research data and stopwatch assessments in men with rapid (premature) ejaculation indicate that lifelong rapid ejaculation is a neurobiological phenomenon related to central serotonergic neurotransmission and likely influenced by hereditary factors.

CONCLUSIONS

Basic and clinical psychopharmacological studies suggest that premature ejaculation is a not a psychological disturbance but a neurobiological phenomenon.

The effects of sympathetic activation on physiological and subjective sexual arousal in women

This investigation was designed to examine the effects of acute exercise on physiological and subjective sexual arousal in women. In Experiment 1, Ss participated in two experimental sessions in which they viewed a neutral film followed by an erotic film. In one of these sessions, Ss were exposed to 20 min of intense exercise prior to viewing the films. Subjective sexual arousal was measured with a self-report rating scale and physiological sexual arousal was measured with a vaginal photoplethysmograph. Acute exercise significantly decreased vaginal pulse amplitude responses to a neutral stimulus and significantly increased vaginal pulse amplitude responses to an erotic stimulus. Exercise marginally increased vaginal blood volume responses to an erotic film but had no significant effect on subjective perceptions of sexual arousal. In Experiment 2, Ss viewed two consecutive neutral stimuli preceded by 20 min of intense exercise. There were no significant differences in either vaginal blood volume or vaginal pulse amplitude between the two neutral films. Together, the data from Experiments 1 and 2 provide indirect support for a facilitatory role of sympathetic activation in female sexual arousal.

Experiences from a marital-sex therapy clinic in Nairobi

Out of 100 first referrals to a newly started family/marital - sex therapy clinic in Nairobi, 52 cases were studied for sociodemographic characteristics, help-seeking pattern for their sexual problems, presentation of the sexual problems, factors that might sustain the sexual problems, types of sexual problems and the treatment approaches. There was a male preponderance. Both married and non-married patients were seen. The problems tended to occur in relatively young people, and for those who were married in relatively early years of their marriage. The patients attributed the causes of the sexual problems to physical rather than psychological factors, although objective assessment found relatively very few possible physical causes. Elementary rather than subtle psychological causes were frequent. These formed fertile grounds for intervention. The findings are discussed in the light of the social-cultural context in which they were obtained.

The role of anxiety in sexual dysfunctions: a review

Studies are reviewed which (a) compare anxiety and other measures of psychopathology between normals and dysfunctionals ; (b) evaluate the effectiveness of anxiety reduction procedures for treating sexual dysfunctions; and (c) try to identify anxiety-related stimuli that alter sexual arousal. The studies, in general, suggest that (a) anxiety is common among people with sexual dysfunctions, but that the level and nature of the anxiety may vary greatly between individuals; (b) anxiety reduction procedures improve some, but probably not all, aspects of sexual dysfunctions; and (c) recent research has begun to identify some anxiety-related factors that can disrupt sexual arousal.

A long-term follow-up study of couples treated for sexual dysfunctions

A 5-8 year follow-up was conducted on 140 couples treated for sexual dysfunctions, of whom 88 couples (63%) actually participated. Differences between participant and nonparticipant clients were analyzed. Clients evaluated various aspects of their sexual and nonsexual functioning before and after therapy and in the follow-up period. The correlation between retrospective and original pre- and posttherapeutic data was determined. The effects of treatment for couples not divorced or given additional therapy, couples who separated, and couples given additional therapy were analyzed and compared. The treatments generally led to increased satisfaction about sexual and nonsexual interaction with the partner. The improvement was found to be fairly stable in the follow-up.

Psychological factors involved in impotence. A review of the literature

Recent developments in the treatment of impotence and studies on the results of psychological methods for its treatment seem to indicate that the number of individuals who suffer from impotence of purely psychogenic origin is less than was reported in literature of the last decade. It is undoubtedly true, however, that psychological factors play an important role in the pathogenesis of this disorder. This review looks at psychological factors involved in impotence from three perspectives. Beginning with a historical review, those theoretical bases which formed the premise for psychological therapies are described. Second, diagnostic issues are explored in some detail. Finally, the variety of treatment modalities which have been used, with varying degrees of success, is described. It appears that whatever psychological treatment method is used, the patients who have the best prognosis are those in whom the disorder has lasted for less than two years, who have a strong motivation for psychotherapy, persisting sexual desire, and who are without significant psychopathology.

Psychological characteristics of males with secondary erectile failure

This study was designed to obtain objective data on the personality profiles of two groups of males with a primary complaint of erectile failure and compare them to a group of psychiatric patients unselected for sexual dysfunction and to a sexually "normal" control group. Utilizing the Eysenck Personality Inventory, the Institute of Personality and Ability Testing Anxiety Scale, Symptom Checklist, and the Minnesota Multiphasic Personality Inventory, it was determined that males applying to a university/county hospital sex-dysfunction clinic appeared similar to patients seen in the same clinic who were unselected for sex dysfunction and more psychologically disturbed than patients with the same complaint applying for treatment at a private clinic. All three groups showed more psychopathology than sexually normal males. The implications of these findings are discussed.

Psychogenic impotence: a critical review

A critical review of the literature on psychogenic impotence is undertaken with special reference to recent advances in objective evaluation of erectile function and radiographic visualization of the penile arteries. Standardization of nomenclature, subclassification of acute versus insidious erectile dysfunction, insistence on objective criteria for declaring erectile dysfunction or a cure of the same, and the reestablishment of psychogenic impotence as a diagnosis of exclusion are to be encouraged.

Family constellation and psychosexual disturbances

In patients with psychosexual disturbances (impotence and ejaculatio praecox) the family constellation during childhood and the patients' occupations were compared with the Swedish population census. The parents of the patients were older, and the patients were more often the only son or the only child. A greater percentage of the patients had technical or office administrative professions than the inhabitants in Stockholm. The findings are discussed with references to a supposed focus on achievement in the upbringing of the oldest or only son. Focus on achievement may cause emotional restraint and subsequently psychosexual disturbances.

Impotence: prognosis (a controlled study)

Sixty-five patients primarily referred for erectile impotence were investigated and treated in a psychiatric out-patient department. Information was obtained from patients and wherever possible from their partners. Subjects were treated either with chemotherapy or with a modified form of Masters and Johnson's technique. A controlled group were not given any specific treatment. Results indicated that neither chemotherapy or behaviour modification (modified Masters and Johnson's technique) were in any way superior to no treatment. The prognosis was related to the clinical features of the subjects rather than to the form of treatment. Subjects in whom impotence was caused by a specific psychological or physical trauma showed a much better prognosis than those who had an insidious decline in sexual potency without any discernible psychological or physical factors. The decline in these latter subjects with a very poor prognosis was possibly due to inherent physiological factors.

A study of 65 impotent males

Sixty-five patients primarily referred for erectile impotence were investigated. Information was obtained from patients and their partners. The demographic data are compared with those from a non-impotent psychiatric out-patient group, matched for age. Results indicate that impotent cases do not form a homogeneous population and can be classified into three fairly distinct groups. These groups differ in age, marital status, sex drive, pre-marital and post-marital relationships, duration of illness, etc. Group 1 develop impotence because of anxiety in sexual situations. Group 2 react to the sexual response and personality of their partners, while Group 3 decline, perhaps from inherent constitutional causes. Factors such as religious restrictions, sexual taboos, alcoholism and homosexuality do not appear to be of any aetiological importance.

Psycho-sexual disorders and their treatment: Part II

In a previously published part of this review the historical and aetiological aspects of sexual inadequacy were considered and an account given of vaginismus. The main problems found in patients with erective and orgasmic dysfunction were also discussed. In this second part, the author considers the conditions of premature ejaculation and ejaculatory incompentance as well as discussing erective and orgasmic incompetence in more detail. Behavioural and other psychotherapeutic measures are considered and a brief review is made of the use and value of drug therapy in patients with sexual dysfunction.

The effects of clomiphene in impotence. A clinical and endocrine study

Hormone treatment for impotence and impotentia ejaculandi (delayed or absent ejaculation in the presence of normal erections and desire) (Johnson, 1965) is based on two assumptions: namely—that (1) potency in the male is androgen dependent and (2) impotency is due to relative androgen deficiency (Miller, 1968; Margolis et al., 1967; Sobotka, 1969). The synthetic preparations most frequently used are methyl testosterone, various esters, including the propionate, deconate, enanthate, etc. (Tuthill, 1955; Kupperman, 1967) and more recently a number of testosterone- ‘aphrodisiac’ combinations (Margolis et al., 1967; Cooper et al., 1971, etc.). Despite some claims of therapeutic success for the various regimes, the administration of exogenous hormones has several pharmacologic disadvantages. For instance methyl testosterone, which has to be taken sublingually or bucally, may be associated with severe toxic effects such as cholestatic jaundice, etc. (Goodman and Gilman, 1965). Parenterally administered testosterone esters, although less toxic and more certainly absorbed than methyl testosterone, have all the drawbacks of the intramuscular route; also their rate(s) of tissue release may not be optimal for metabolism. Additionally, all these synthetic compounds may inhibit endogenous testosterone formation and spermatogenesis by suppressing pituitary gonadotrophins. Long term administration may result in Leydig cell inactivity and even disuse atrophy. Recently Harkness et al. (1964, 1968) have observed that clomiphene (Fig. 1), a non-steroid triethylene derivative which in females stimulates the anovulatory ovary to secrete oestrogens (Bishop, 1970), significantly raised the levels of urinary steroid metabolites, including testosterone, in a proportion of ‘normal’ and corticosteroid deficient males. This unexpected testosterone elevating effect suggested its possible ‘experimental’ use as an alternative drug treatment in impotence. Accordingly a limited pilot study on five ‘primary’ (non-organic) impotent males was conducted: its main aims were (a) to assess the potential clinical utility of the drug and (b) to study its effects on the ‘pituitary-testes-axis' as reflected by plasma testosterone levels.

Treatment of phobic anxiety and psychogenic impotence by systematic desensitization employing methohexitone-induced relaxation

The technique of systematic desensitization employing methohexitone-induced relaxation was first described in 1966 (Friedman, 1966) and a review of results of treatment by this technique at six-month follow-up was encouraging since 15 of 18 patients continued to show marked improvement (Friedman and Silverstone, 1967). The present study reviews 124 patients treated by the same method.

Disorders of sexual potency in the male: a clinical and statistical study of some factors related to short-term prognosis

Although the literature relating to the prognosis of male potency disorders and the factors that influence this is vast, there is a dearth of factual data on the subject. Most of the opinions expressed, without supporting figures, are clinical impressions, and the majority indicate that the outcome of therapy in these disorders is generally favourable (Ellis, 1948; Jones, 1919; Rees 1935; Allen, 1962; Stafford-Clark, 1954; Gutheil, 1959). However, Johnson's (1965b) recent important contribution has challenged this consensus; he suggests that; with or without treatment, the prognosis in disordered potency is much worse than has hitherto been believed.

A factual study of male potency disorders

The literature on “psychogenic” potency disorders in the male is vast, and opinions abound on every aspect of these disorders. However, despite this abundance there is a dearth of factual data. The present author has been able to find only two major studies which have set out to study systematically and objectively facets of these conditions. El-Senoussi et al. (1959) undertook a statistical study to delineate psychological factors related causally to impotence; whilst Johnson (1965b) retrospectively studied male potency disorders to define their natural history.