| In no sense does this mean that in the future he will never achieve an erection quality sufficient for intromission.
Occasionally he may do so and most men do. It does mean, however, that any suggestion of wifely sexual demand either immediate in its specific physical intensity or pointing coyly to future sexual expectations may produce pressures of performances quite sufficient to reduce Mr. A to and maintain him in a totally no erective state.
In brief, fears of sexual performance have assumed full control of his psychosocial system.
Mr. A thinks about the situation constantly. He occasionally asks friends of similar age group how things are going, because, of course, any male so beleaguered with fears of sexual failure is infinitely desirous of blaming his lack of effective function on anything other than himself, and the aging process is a constantly available cultural scapegoat.
He finds himself in the position of the woman with a lifetime history of non orgasmic return who contends openly with concerns for the effectiveness of her own sexual performance and secretly faces the fear that in truth she is not a woman. In proper sequence he does as she has done so many times.
He develops ways and means to avoid sexual encounter.
He sits fascinated by a third-rate movie on television in order to avoid going to bed at the usual time with a wife who might possibly be interested in sexual expression. He fends off her sexual approaches and jumps at anything that avoids confrontation as a drowning man would at a straw.
His wife immediately notices his disinclination to meet the frequency of their semi established routine of sexual exposure. In due course she begins to wonder whether he has lost interest in her, if there is anyone else, or whether there is truth in his most recent assertion that he couldn't care less about sex.
For reassurance that she is still physically attractive, the concerned wife begins to push for more frequent sexual encounters, the one approach that the self-pressured male dreads above all else.
Obviously, neither marital partner ever communicates his or her fears of performance or the depth of their concerns for the sexual dysfunction that has become of paramount importance in their lives. The subject either is not discussed, or, if mentioned even obliquely, is hastily buried in an avalanche of words or chilled by painfully obvious avoidance.
Within the next 3 months, Mr. A has to fail at erective attainment only another time or two before both husband and wife begin to panic.
She decides independently to avoid any continuity of sexual functioning, eliminate any expression of her sexual needs, and be available only should he express demand, because she also has developed fears of performance.
Her fears are not for herself, but for the effectiveness of her husband's sexual functioning.
She goes to great lengths to negate anything that might be considered sexually stimulating, such as too-long kisses, handholding, body contact, caressing in any way. In so doing she makes each sexual encounter much more of a pressured performance and therefore, much less of a continuation of living sexually, but the thought never occur to her. All communication ceases.
Each individual keeps his own counsel or goes his own way. The mutual sexual stimulation in the continuity of physical exposure, in the simple physical touching, holding, or even verbalizing of affection, is almost totally withdrawn.
The lack of communication that starts in the bedroom rapidly spreads through all facets of marital exchange: children, finances, social orientation, mothers-in-law, whatever.
In short :
Sexual dysfunction in the marital bed, created initially by an acute stage of alcoholic ingestion, supplemented at the next outing by ah "I'll show her" attitude and possibly a little too much to drink can destroy the very foundation of a marriage of 10 to 30 years duration.
As the male panics, the wife only adds to his insecurity by her inappropriate verbalization, intended to support and comfort but interpreted by her emotionally unstable husband as immeasurably destructive in subjective content.
The dramatic onset of secondary impotence following an in stance of excessive alcohol intake is only another example of the human male's extreme sensitivity to fears of sexual performance.
In this particular situation, of course, the onset of fears of performance was of brief but dynamic duration as opposed to those in the preceding example of the premature ejaculator whose fears of performance developed slowly, stimulated by continued exposure to his wife's verbal denunciation of his sexual functioning.
Discussed above are examples of combinations of psychological and circumstantial factors that contribute the highest percentage of etiological input to the development of secondary impotence. Continuing through the listing of major influences there remain environmental, physiological, and iatrogenic factors.
In the final analysis:
Regardless of listing category, secondary impotence is triggered by combinations of these etiological factors rather than by any single category with the obvious exception of psychosocial influence. Once onset of erective failure has been recorded, regardless of trigger mechanism, involved, the individual male's interpretation of or reaction to functional failure must be dealt with on a psychogenic basis.
The etiological factors recorded above are little more than categorical conveniences. From his initial heterosexual performance through the continuum of his sexual expression, every man constantly assumes a cultural challenge to his potency.
How he reacts to these challenges may be influenced directly by his psychosocial system, but of particular import is the individual susceptibility of the man involved to the specific pressures of the sexual challenge and to the influences of his background.
When considering etiological influences that may predispose toward impotence, it always should be borne in mind that most men exposed to parallel psychosexual pressures and similar environmental damage shrug off these handicaps and live as sexually functional males.
It is the factor of susceptibility to negative psychosocial input that determines the onset of impotence. These concepts apply to primarily as well as secondarily impotent men.
When considering environmental background as an etiological factor in secondary impotence, the home, the church, and the formative years are at center focus.
What factors in or out of the home during the formative years tend to initiate insecurity in male sexual functioning?
The preeminent factor in environmental background reflecting sexual insecurity is a dominant imbalance in parental relationships dominant, that is, as opposed to happen stance, farcical, or even fantasized battles for family control.
Secondary, but still of major import is the factor of homosexuality, which is to be considered in the environmental category. In no sense does this placement connote professional opinion that homophile orientation is considered purely environmental in origin.
Since homosexual activity may have derogatory influence upon the effectiveness of heterosexual functioning, the subject must be presented in the etiological discussion. The disassociations developing from homophile orientation are considered in the environmental category only for listing convenience.
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