IMPOTENCE

A male sexual disorder consisting of inability to achieve full gratification. In psychiatry impotence is classified as a psychophysiologic reaction of the genitourinary system.Impotence is not usually an all-or- nothing matter, but rather an impairment of function that can be expressed in a variety of ways. It may consist of partial or complete failure to achieve erection, periodic failure coupled with limited interest in sex, orgasm without experiencing pleasure, coitus without ejaculation, sexual ability only with prostitutes or in extramarital affairs, or —most frequent of all—premature ejaculation.There are many causes of impotence. A few cases are due to congenital defect, injury to the genitalia, or diseases of the nervous system. Alcohol reduces potency in some men but increases it in others, probably because it relaxes their inhibitions. In some cases fatigue, business tension, worry, or illness may temporarily decrease potency. On the other hand, when the condition is persistent and not due to organic defect, it is nearly always the result of emotional conflicts. Age is less a factor than is commonly believed: according to the Kinsey report, only 27 per cent of males become impotent by age seventy, and many of these cases, too, are psychological rather than physical. The conflicts that cause impotence are frequently associated with feelings of fear, guilt, or hostility. Parental warnings against the damaging effects of masturbation may lead to an unconscious fear of injury as a result of intercourse. Fear of detection during early sexual activities may affect later performance. Concern about venereal disease, or even the fear of dying as a result of the excitement of intercourse, also interfere with potency in some cases. So does self-consciousness about exposure of the body. Some men lose their potency because of fear of failure and doubts about their ability to play the male role fully. Psychoanalysts emphasize castration fears stemming from threats made by the father. The tension accompanying these anxieties may produce complete inability in some instances and premature ejaculation in others.A second group of causes centers around the relationship to the sexual partner. Frequent quarrels, irritations, and tensions between the partners may impair potency. Studies of premature ejaculation indicate that this condition may often originate in feelings of hostility, since the woman is denied her satisfaction. Some women express their own resentment by constantly criticizing their husband or by setting up strict rules about foreplay; as a result, they inhibit the husband’s gratification as well as their own. Strong attachment toward another woman, doubts about yhe choice of a wife, or conflicts over loss of independence may also have a marked effect. Excessive attachment to the mother may unconsciously arouse feelings of unfaithfulness that interfere with potency. Latent or overtt homosexuality undoubtedly plays a part in some cases. Some men with homosexual inclinations simply become disinterested in women while others have feelings of active revulsion toward them. Still others become sexually inadequate with women because they are using intercourse as a defense against unconscious homosexual fears—in other words, they are trying to force themselves to play the normal male role.When impotence stems from deeply unconscious sources, the most effective treatment is a penetrating form of psychotherapy. When its source lies closer to the surface, counseling techniques may be successful. A frank discussion of the sexual relation, the difference between the male and female response, and specific fears and inhibitions is often helpful. Where the disorder seems to arise out of a faulty relationship between the couple, the sources of friction and antagonism need to be explored, and it is often best for the therapist to meet the husband and wife together as well as separately. If their relationship improves to a point where they feel affectionate, accepting, and secure with each other, potency is almost certain to return