Erectile dysfunction (impotence) can be divided into "primary" and "secondary" divisions. A man who is primarily impotent has never had an erection that has lasted long enough for intromission. A man who is secondarily impotent is one who used to be able to get an erection and achieve an intromission but for one reason or another can't do so now.
Impotence may be due to disease, anxiety, physical or emotional stress, or what has kindly been called "untoward maternal influences." That's a nice way of saying that a domineering mama - whether she dominates with a strident voice, frequent headaches, or subtle sexual seduction - can cause her son to be impotent. It's scarcely a new idea.
Dr. Seymour L. Halleck, professor of psychiatry at the University of Wisconsin Medical Center, observed, "When a man begins to feel that his partner is dominating him or making inordinate demands upon him, he may also feet that it is absolutely essential to his self-image to be extremely potent. At this point, he is in danger of being impotent." To a man distressed by erectile dysfunction, of course, it doesn't immediately matter where the problem came from. It's what to do about it.
Even now, some men who seek treatment say they discovered their impotency when as male virgins in their early twenties they married virginal women. Loss of erection resulted apparently because neither knew how to be sexual and the man felt he was a failure. And became a chronic failure!
(In the days when sexual knowledge was not as widespread as today, many men were traumatized by early bad experiences with prostitutes. The Masters and Johnson clinical records pretty well eliminated the fanciful notion that a prostitute is a good and patient teacher for a young man having his first try at sex.)
Other failures at initial intercourse result from being drunk, or being under the influence of drugs, or just plain stressed out - but these reasons don't explain why men do not rather quickly recover from them. Few men are gold-medal winners on their first try at sex but most, even after some humiliation and dismay, are able to try again. But apparently for some, a disastrous first experience has permanent effects.
The most courageous treatment of ED involves the use of surrogate-partners to help out impotent men. As Masters and Johnson explained it, men seeking help with erectile dysfunction badly need a group of female "sex donors" -- women to relate to while their therapy takes place - women whose ease with their own sexuality, and sympathy for the man would help cure their erectile dysfunction. These female surrogates have been used by some therapists ever since, and they take part in the exercise of sensate focus and in the achievement of restoration of erection and intromission. The idea is to give a male client a partner with whom he will feel comfortable and, hopefully, become receptive.
What kind of women volunteer for such a task? It must be kept in mind that these are not women volunteering for a sexy experience. These women are voluntarily entering into a very intimate, complicated, emotional, and physical relationship with men who freely confess they are lacking a vital part of masculine sexuality. The women can't hope to get all that much out of it. Needless to say, all female surrogate volunteers are meticulously screened.
How does surrogate therapy work out? In one study, forty-one unmarried men were assigned surrogate partners. Their recovery score from their various ailments of erectile dysfunction was as good as those who went to the clinic with co-operative partners. Thirty-two of the unmarried males had their symptoms of sexual dysfunction reversed, and 24 of the 32 got married. Only one of the 24 newly married men reported that his ED returned.
Undoubtedly many men who are alarmed to find themselves impotent would like very much to be admitted to a medical examining room and told it comes from having the mumps. Doctors list many physiological reasons that may cause secondary erectile dysfunction - but the simple truth is that any physical dysfunction that lowers the body functions can be a cause of sexual problems.
However, in the case of work by Masters and Johnson, only 7 of 213 men referred turned out to be impotent because of physiologic dysfunction. Masters and Johnson divided the physical causes for erectile dysfunction into 10 categories. Most of them were incomprehensible to non-medically trained readers - the full list is in the Masters and Johnson textbook Human Sexual Inadequacy and intended for the guidance of doctors. Familiar to many of us, however, are: congenital deformities, various kinds of heart trouble, addictive drugs, alcohol, other drugs, Addison's disease, and obesity (getting too fat), prostatitis, and so on.....Patients who undergo surgery for prostate cancer should also be made aware that erectile dysfunction can and often does result.
The "authoritative put-down" was also blamed for inadequate treatment of erectile dysfunction. Some men related how they had been to a doctor and been firmly told there was nothing that could be done. Almost anyone will recognize that it takes a lot of nerve in the first place to come into your doctor's office and say, "I have this problem..." Some men were told their erectile dysfunction was the result of admitted adultery. Another married couple was told the man's erectile dysfunction was the result of his having agreed to his woman's having an abortion before they were married. In fact, what happened in most of the cases was that things got worse instead of better as soon as the patients got a "thumbs down" or scolding reaction from authority figures.
Dr. Masters, both in his writing and his response to questions, often retreated gravely and dignifiedly into five-syllable words. But no one can read Dr. Masters and Mrs. Johnson's analysis of secondary erectile dysfunction without getting the impression that there were other professionals of whom they took a dim view. But they made do with a subtle professional critique, which means, to put it crudely, that the doctor did it. Or at least heavily influenced it.
Dr. Masters and Mrs. Johnson believed very strongly that the onset of many sexual problems is the result of other impacts. Your boss bawls you out or fires you. Your neighbor upstages you. Your neighbor's kid gets a better report card than your kid. You can't pay your mortgage. Your daughter is dating a really wrong guy. Then the initial failure is reinforced by panic and more failure and becomes a permanent problem.
The contribution of the domineering mother as a cause of erectile dysfunction has been so well documented in plays, stories, and psychoanalytic literature that it scarcely needs reinforcing here, although Masters and Johnson presented some rather chilling case histories. Five cases of men who came for treatment of secondary erectile dysfunction turned out to be suffering from the effects of domineering fathers. Since this hasn't been very well spelled out in the literature it is worth describing the history of such a case which Masters and Johnson presented in Human Sexual Inadequacy.
Mr. C, 39 years old and his partner, 37, had been married 13 years when they went for treatment. They had three children. Mr. C. had been brought up in a family in which the mother was overwhelmed and subdued by her demanding and autocratic husband who made no secret of his frequent affairs with other women. Mr. C. recalls that he was disturbed as a youngster when he learned of his father's infidelities.
The father demanded excellence of performance from his son in academics and athletics. The son did his best to deliver, often feeling that he was doing more than he really could. Mr. C. began to masturbate at age 13 and had casual, rather meaningless sexual connections with several girls until he graduated from college. Then he met the right woman and got married. Three children were born during the first six years. Mr. C. was unhappy and unsuccessful at a number of jobs. In some he was plainly incompetent; in others he just quit. He got to feeling pretty up tight at home. He spent less time with his children and took to the bottle. He was chronically tired and irritable in the evening. His sexual interaction with his partner diminished.
Then he went to work for his father. He didn't like it although he was doing his job well. He was panicky at the idea of what his father would do to him if he failed. Then he did fail. A simple mistake of judgment made an important customer furious. The father turned on his son and bawled him out - reviewing all the failures of his son's childhood - as he would never have done to an ordinary employee or business associate. Mr. C. felt he lacked the guts that another employee would have had - to tell his father to stick it and walk out.
Masters and Johnson said, "His session with his father left him with a feeling of total inadequacy." Like many a man who has been clobbered in the office rat race, Mr. C. came home that night, probably had more than was wise to drink, strode angrily around the house, and finally took his woman to bed with the idea of restoring his ego. At least he could do the primeval thing. But as he mounted her, his mind was boiling with his father's angry reproaches. In bed, he achieved an erection but couldn't make it into her vagina.
He was impotent for three months. One night, however, he woke up - possibly after an erotic dream - and found that he had an erection. He quickly rolled onto his woman and made her pregnant. The pregnancy distressed her; it was unplanned, and her husband insisted that because she was pregnant they should not have intercourse. After the child was born they attempted to resume their sex life but his impotency was repeatedly confirmed. So eventually the couple made their way to the Foundation's front door.
In their chapter on secondary erectile dysfunction Masters and Johnson said a great many ultimately harsh words about the sexual damage that is done to a child when there is a single, strong parent or when there is no parent at all or one who is not more than a shadow. A boy is equally harmed by too little or too much father. He may have had a mother who was boss and a father who was little more than a wimp, or a father who drove his sons on to jump almost impossible hurdles with the admonition that it does no good to finish second.
In each situation, clinical records create the impression that to be forced to finish first tends to create secondary erectile dysfunction.....and no man hangs his head so low as the man with erectile dysfunction. Inwardly, he believes he is or could soon again be a properly functioning male if it weren't for his woman. She, on the other hand, keeps asking for assurances -"You can see it's not my fault!" Yet the woman may not have caused it but she has sometimes reinforced it by hinting about her man's inadequacy.
In some cases when a woman complains to her best friend that "My man can't make it in bed!" the friend may say sweetly, "Gee, honey, what's wrong with you?"
What's wrong is likely to be that she doesn't give enough of what Masters and Johnson described as "psycho-sexual input." She responds "like a log." Between the partners sexual input is blocked from both directions. When interviewed, she was directed to examine her egocentric attitude and understand how she was equally involved in her man's erectile dysfunction. If she really wanted it cured, she had to agree to work on herself, too. Her accusations had to be reversed just as surely as her man's fears.
It was also emphasized that the only way an impotent man can begin to recover his potency is to concentrate on making love with a woman. By acting as a lover, he rescues himself. The impotent man and his partner - hopefully made anger-free and cooperative by open discussions - participated first of all in pleasuring the woman. Pleasuring the woman? Dr. Masters and Mrs. Johnson had the (new for its time) idea that male erectile dysfunction is cured by getting the impotent man to excite a woman.
A man with erectile problems was placed under orders not to try to get an erection. He was supposed to let things go as far as they seemed to want to go and then let them taper off and not worry about it. It may have taken several days but eventually - in those cases which were ultimately successfully treated - an erection appeared while the man and woman were sensually pleasuring each other. Even in instances where an erection hadn't appeared in years or even if it never had, the couple were supposed to regard it casually. Neither cheers, nor grateful tears were in order. And absolutely no attempt at intromission. Just an optimistic report at discussion on the following day. "Take it easy" was the rule.
The Masters and Johnson system taught women to use "teasing" techniques to bring an impotent male partner to a functioning pitch. It's a difficult lesson to learn. When the first erection appears, both man and woman often think, "If we waste this one, who knows if well ever have another chance? But Masters and Johnson kept a firm hold on the reins. The woman was told to be calm and confident even if the erection disappeared and then, after the lapse of fifteen minutes to half an hour, to return to sex play and confidently anticipate another erection. If it happened once, it nearly always happened again.
You can use the same method today, working with yourselves. Here is how it went: There were initially five days of sensate focus and teasing. The women involved in the "teasing" phase usually reported that they enjoyed it. They were stimulated by the recurring penile erections. (Masters and Johnson commented, "This thought has seldom occurred to the man.")
On about the fifth day of sensate focus the woman takes the "superior coital position" that is, woman on top across her man's hips - before they begin the sex play which both of them now securely know will lead to erection.
When the erection occurs, the woman's role is crucial. She must appear pleased, yet detached - as though it happens every day. Moving slowly she leans forward and carefully slips his penis into her vagina. As she does so, she continues to use manual "teasing" techniques of stimulation.
Sometimes, at this point, the erection collapses. The couple are "under orders" not to get upset. Patiently, tenderly, they try again. Or put it off until tomorrow. If penetration is successful, the woman begins moving back and forth, casually sliding along the, penis. If the erection holds, she then quiets herself, and the man begins to thrust, also undemandingly.
It's obviously difficult for sexually fulfilled readers to imagine mutual pelvic and responsive penile thrusting that doesn't instantly gather steam and result very soon in an orgasmic crescendo. But these student lovers are to concentrate only on enjoying pelvic pleasuring and not to worry about anything, not even one another. The atmosphere is supposed to be dreamy and tender, like lovers lingering under an oak tree after a picnic of cheese and bread and wine. The relationship goes where it goes and stops where it stops, and at the next picnic things proceed further. Eventually, everything begins, progresses, and results emerge as they should.
Masters and Johnson have a moving paragraph in their text in praise of the partners of the impotent male patients. They point out that many of these women arrived at the Foundation frustrated, seeking revenge, and bitterly angry. Some were still quietly devoted to their men but felt helpless. However, more than 90 percent were able to cooperate with the therapists' instructions and "made all the difference" between success and failure.