SEXUAL DYSFUNCTIONS IN MALES AND
THEIR BEHAVIORAL CHANGES
CONNECTED WITH INTERCOURSES
G. S. Kocharyan, M.D., Ph.D., D.Sc., Prof. of
the Department of Medical Sexology and Medical Psychology
Diagnosing a sexual disturbance, a doctor, as a rule, is not interested, in full measure, in what happens to the patient during the intercourse, limiting himself only to ascertainment of some or other sexopathological symptoms. Therefore, psychic efforts made by the patients in order to improve their sexual functions remain outside the field of vision. It has resulted in lack of studying behavioural changes, related to sexual intercourses, in patients with sexological pathologies.
For solution of this problem, I have conducted special researches among 118 patients with various sexual disturbances. Only males with fear of sexual failure (FSF) were included into the group. These researches have produced the following results. Seventy-six patients (64.4%) have noted that thay ever used on their own initiative some psychic self-regulation techniques (PSRT) directly or indirectly (through FSF weakening) orientated to improving sexual functions. Analysis of all these techniques has shown that their following groups can be isolated: auto-suggestion, attention switching, erotic auto-sensitization. After a detailed division of these techniques within the above groups, their following classification has been devised.
I. Auto-suggestion: 1) directed at self-calming; 2) denying failure apprehension; 3) motivated or non-motivated self-persuasion in a good quality of the coition; 4) autosuggestion aimed at producing an indifferent attitude to the result; 5) stimulating «appeal to the penis»; 6) aimed at reduced perception of erotic stimuli.
II. Attention switching: 1) with use of stimuli of the current experience, including artificially created ones, sometimes involving various auxiliary means; 2) with help of planning; 3) with help of reproduced and designed plots: a) related to real positive sexual experience in the past or imagined one (with the given female partner or other women); b) related to non-sexual plots (leisure, daily round, job activity).
III. Erotic auto-sensitization (it is an increase of perception of specific stimuli during a sexual contact achieved due to concentration of the patients' attention on those pleasant sensations which they have; often this increase is auto-suggestion-mediated).
Auto-suggestion directed at self-calming could be expressed, e.g., with the following formulas: «Don't worry...», «I'm a normal man...», and auto-suggestion denying apprehensions of failure could be expressed with the statement «I won't think of it...». A motivated and non-motivated self-persuasion in a good quality of the sexual intercourse operated with the formulas «Here's the woman, whom I longed for, whom I wanted, now she is naked, and everything must be well...», «Everything will be well...», «Everything will be normal...». Auto-suggestion aimed at producing an indifferent attitude to the result was expressed through such mental phrases as «I don't care whether I'll succeed or fail...», «I shouldn't worry about anything... If I fail, the hell with it!; even if nothing happens, there won't be anything terrible in it, I don't care a bit...». A stimulating «appeal to the penis» was aimed at normalization of its erections and expressed through the following phrases said to the male himself mentally during the sexual intimacy: «Why don't you...?», «Come on, come on!», or «Erect!». Also sometimes there was auto-suggestion directed at reduced intensity of perception of erotic stimuli and aimed to postpone ejaculation: «It's not so pleasant for me ...».
Attention switching with use of stimuli of the current experience, including artificially created ones, and sometimes involving different auxiliary means, manifested itself in various techniques. Thus, one of the patients whom I examined made mental counting, another person spoke about something to his female partner, a third one looked aside at some point or his wife's head, while a fourth man averted his face during caresses either to look at a TV set or to watch any bright object, or concentrated on some music heard (he did not turn on any radio equipment especially for this purpose). For switching their attention, the patients also used counting of strikes of clocks, imagination of the process how the penis moves into the vagina, actions directed not to see their female partner, shifting of the stress on the thought about the sensations the woman feels, and how to give her pleasure. In order to be slightly distracted from sensations felt during his sexual contacts, one patient made them to the accompaniment of some quiet slow soft music, and sometimes turned on a TV set.
Attention switching with help of planning, made during intercourses, consisted of drawing up a program of actions which should be carried out on the job and/or at home next day or in the near future, thoughts about what must be bought, and what should be put on. Thus, e.g., one of my patients who worked as a locomotive-driver on railway, during a coition all the time recollected a lot of instructions and orders which he would have to learn. It should be noted that attention switching with help of planning is used both with and without involvement of visual plots.
Besides the above variants of attention switching, I stated its distraction with use of reproduced and designed plots related to real positive sexual experience in the past or imagined one with this female partner or other women, that in reality is nothing else but switching to resources which every person has. With this purpose, for instance, though in extremely rare cases, there can be reproduction of erotic scenes which before were imagined during masturbation. My patient, who did it, achieved restoration of a good erection. Males can also recollect successful coitions with this female partner before. It was not rare when with the purpose of sexual stimulation the patients imagined, during their intimate contact, that they were doing it with another woman, who was more attractive and younger but with whom they had had no coitions at all, and (or) with a woman with whom they had had successful sexual contacts. Thus, within a preliminary period one of my patients imagined that he was doing it with another woman with whom he had never had any intimate contacts. In general, bright images appeared. In 40 % of the cases, these imaginations produced an effect manifested by an improved tension of the penis and a prolonged duration of the coition, this duration in the given case being a derivative of the quality of erection. In subsequent coitions other sex female partners could be imagined. Another patient, during sexual contact with his female partner, reproduced visual plots from past experience of intimate contact with «... a nice girl who was more than a professor in such affairs...» and with whom everything always was well, no matter in what condition he was (sober or drunk). Sometimes there was a usage of sexual experience of other persons (photo and movie materials). Thus, one of the patients, whom I examined, imagined naked women and men whom he had seen before on pornographic cards, while another patient within the preliminary period reproduced scenes from erotic films which he had seen before.
Switching of attention can also operate reproduction and designing of
the plots related to leisure, daily round, job activity. It may be landscapes
related to rest in the country, fishing, scenes of sports competitions where
the patient acts as a participant or/and a fan. Thus, during intercourses one
of my patients purposefully imagined the following visual pictures. He saw a river,
trees, how he was fishing. Another patient, who every summer had rest on the
lake of Seliger near sources of the Volga, reproduced landscapes which included
this lake as their compulsory component, but it did not improve his sexual
functions at all. In order to prolong coition, sometimes the patients can
design landscapes and states which
produce a negative emotional effect. Thus, pursuing this goal, during a coition
one of the patients imagined a muddy road, bad cold weather. It is not in rare
cases that the reproduced and designed plots are connected with sports. For
instance, during his intercourses one man imagined himself as a player of the
Erotic auto-sensitization fulfills a stimulating function. Thus, in order to overcome anxious expectation of failure during a sexual contact with his wife, one of my patients tried to concentrate his attention on voluptuous sensations caused by caresses, kisses and frictions. To heighten the effect of the measures taken by him, he suggested himself at this time how she pleased him.
My analysis of the techniques used by the patients has shown that their phenomenology often depends upon the fact which function has been disrupted. Thus, for improvement of erection, various stimulating measures were taken («appeal to the penis», attention switching with use of reproduced and designed plots related to real positive sexual experience in the past or imagined one, erotic auto-sensitization which cultivates pleasant sensations during a current sexual contact), as well as autosuggestion aimed at producing an indifferent attitude to the result. If ejaculation was accelerated, on the contrary, the patients used techniques initiating self-depriving action. They include: auto-suggestions directed at reduced intensity of perception of erotic stimuli; all techniques for attention switching, except for the above variety used for improvement of erection. The variants of auto-suggestions which we have not mentioned as especially used for increasing tension of the penis or prolonging the coition, even in the case that the examined patients used them to improve any one of these functions, cannot be recognized as specific from the viewpoint of their effect on erection or ejaculation.
In order to reveal efficacy of using various psychological techniques for improvement of sexual functions and the general state on the threshold of and during the coition in 76 patients who used them, I have purposefully interrogated 73 persons. In one of them, we have failed to reveal any definite opinion about the effect. Of the other 72 patients, various degree in the results of the techniques used was ever observed in 38 persons (52.8 %), while its absolute and permanent absence was in 34 men (47.2 %). So, in 4 of the 38 cases (10.5 %) where a positive effect of using psychological means by the patients was observed, it concerned only improvement of their general state during intimate contacts, but exerted no influence on the quality of sexual functions.
Considering the problem of expediency of the patients' using the techniques of psychic self-regulation listed in the above classification, it should be noted that one of them namely a stimulating "appeal to the penis" must be excluded from the therapeutic arsenal. It is explained by the fact that fixation of attention on the penis (hypercontrol of its tension) is one of the factors participating in formation of the symptoms in patients with FSF. Using this kind of autosuggestion, the patients only strengthen the pathogenic protective mechanism of riveting. Concerning all other techniques, reflected in the above classification, the directions must be as follows. In addition to the common therapy, the patients can be given help in choosing individually effective means of psychic self-regulation, making appropriate correction, if necessary. In particular, it concerns recommendations to take into account the psychotherapeutic rule, according to which the formulas of auto-suggestion must be composed in such a way that they specified what the patient wants to acquire rather than what he would like to get rid of.
Notes: This is a fragment of my dissertation: Kocharyan G. S. Sindrom trevojnogo ojidaniya seksualnoy neudachi u mujchin (formirovaniye, patogeneticheskie mehanizmi, klinicheskie proyavleniya, psichoterapiya) [Anxious Sexual Failure Expectation Syndrome in Males (Formation, Pathogenetic Mechanisms, Clinical Manifestations, Psychotherapy)]. Dissertaciya doktora medicinskich nauk [Dissertation of Medical Science Doctor]. – Kharkov, 1992. – 414 s.
In 1991 year the data were published in the following article: Kocharyan G. S. Sindrom trevojnogo ojidaniya seksual’noy neudachi i povedencheskaya adaptaciya, sopryajennaya s intimnoy blisost’yu [Anxious sexual failure expectation syndrome and behavioral adaptation connected with intimacy] // Zdravoochranenie Belorussii [Health protection of Belorussia] (Minsk). – 1991. – №7. – S. 52–56.
The data also were reported (an oral–paper report) on 24th International Congress of Applied Psychology (San Francisko, USA, 1998) and published: Kocharyan G. S. Sexual dysfunctions in males and their behavioral changes connected with intercourses // 24th International Congress of Applied Psychology Abstracts Install Diskette 7/98. – P. 394.
Kocharyan G. S. Sexual dysfunctions in males and their behavioral changes connected with intercourses.*
*Note: This is a fragment of my dissertation: Kocharyan G. S. Sindrom trevojnogo ojidaniya seksualnoy neudachi u mujchin (formirovaniye, patogeneticheskie mehanizmi, klinicheskie proyavleniya, psichoterapiya) [Anxious Sexual Failure Expectation Syndrome in Males (Formation, Pathogenetic Mechanisms, Clinical Manifestations, Psychotherapy)]. Dissertaciya doktora medicinskich nauk [Dissertation of Medical Science Doctor]. – Kharkov, 1992. – 414 s.