AB022. The psyche of male sexual difficulties related to related to the partner

Abstract: Impression management for men aiming at courtship and love is cognitively taxing and is costly. Recent research suggests that when a man tries to impress an attractive woman his cognitive performance could be impaired and depleted. However, cognitive performance of a woman is not affected during her interaction with someone of the opposite sex (Karremans et al. 2009). By dictation of nature and anatomically too, men take an active and positive role in sexual performance; their failures in sexual performances will be revealed to the partner then and there. Men react negatively to such a failure when their confidence or self-esteems are at stake. Their psyche will strike it as a failure of life time, failure of their genetic spread and survival of the species. In subsequent sexual encounter their body and subconscious mind will switch to the physiology of anti-erectile transmission and limit the expansion of desire and arousal on other attempts. In general, we call this performance anxiety. Masters and Johnson’s pioneering work in the 70’s highlighted the negative impact of performance anxiety on sexual function. As a form of therapy, exercise such as Sensate Focus were designed for the couple to overcome the performance anxiety and phobic quality in man so that sexual arousal and penetrative erection can be practiced/achieved in a relaxed state. At the Fertility, menopausal and andrology settings of OBGYN, it is not uncommon to see male sexual dysfunctions that include lack of desire, psychogenic ED and ejaculatory dysfunctions. One of the main causes of complaints of unconsummated marriages is vaginismus (and dyspareunia) in the partner which causes psychogenic erectile dysfunction in husbands who fail to penetrate at the first or second attempts. Such couple tend to drift from sexual intimacy for months and years until there is an extended family pressure for conception. Another situation that compromises erectile capacity of otherwise a normal man with routine sexual performance is the demand from wife to perform at a fixed date during the ovulation time. Significant proportion of the sexual dysfunctions are also related to the interpersonal relationship issues. Desire and frequency of sexual episodes and erectile and ejaculatory functions suffer a dip when anger, emotional injury or disappointment and frustration accumulate and linger in the couples’ relationship. Resentment works against intimacy and trust. Some men are more sensitive and averse towards partners’ body image, odor and excessive lubrication or more frequent demands for sexual intimacy. Such men tend to avoid or may fail when attempting sex with the partner. Some others are able to get full erection during self-masturbation but could not achieve erectile capacity for intravaginal intercourse or ejaculation. Some men also shut off completely their interest for sexual engagement after witnessing a spontaneous abortion or a delivery of the baby. Some other situation where men buckled themselves from engaging in sexual activity include: after being belittled about sexual performance or hinted that penis is not up to the mark in size; wife being very shy and not reciprocating sexual desire or interest or dominant in the power play; chronic illnesses, pelvic prolapse and incontinence in partner, etc. Men who are used to unusual masturbatory technique and ejaculation also find themselves suffering from intravaginal anejaculation. Each and every couples are different. Treatment approaches should be individualistic and global with sex therapy, pharmacotherapy and hormonal adjustment if necessary.

Keywords: Psychogenic erectile dysfunction; sexual performance