PART I – BASICS

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PART I – BASICS

WHAT ARE THE REASONS FOR POTENCY PROBLEMS?

Impaired potency is the most common male sexual malfunction.

We make a distinction between:

▶ the inability to have sex because the penis does not function

▶ the lack of sexual desire (libido)

▶ problems with the ejaculation or the orgasm; premature ejaculation (ejaculatio retardata) and the orgasm without an ejaculation (retrograde ejaculation) and

▶ problems with fertility.

The above mentioned problems can either appear individually or in a combination.

In the 1970s as psycho-therapeutic medicine started to become more established, it was said that 90% of all male sexual malfunctions were due to psychological problems. Because at this time neither the structure of the penis nor its function was understood, impotency was a white spot on the map. Courageous scientists started to discover at least parts of this spot. New examination techniques and therapeutic measures appeared, were given an ovation and were partly thrown away again. At the beginning of the 1990s it was thought that men had problems getting an erection due to organic causes.

During the course of their life, about 50% of all men experience a temporary episode of inability to have sex. 15-25% of all men who consult a physician talk about sexual problems. Chronic erection problems are significantly increasing when getting older. At the age of 60 one fourth already suffer from permanent impotence.

It is well known and almost trite to mention that a lot of different factors play a role with impotence. These symptoms can have totally different causes for the individual patient. In principle, primary malfunctions with potency can be differentiated from secondary. Primary malfunctions become obvious when first becoming sexually active. With secondary malfunctions there is a period of an undisturbed sex life and impotency does not become a factor until later on in life.

3.1 What is Impotence?

Impotence is a term bearing strong negative associations. It is looked at as a handicap of the man. Medically one speaks about an erectile dysfunction or impaired erection ability, a disorder, not a handicap. Impotency is defined as the inability to get a sufficient stiffness of the penis to have sex. This does not mean the short-termed “failure” of a man but the erectile dysfunction of a longer duration. Some men and couples can handle this situation really well. Only when the person concerned or the relationship of the two suffers from this condition one can talk about an impotence that has to be medically examined.

Problems with sexuality can harm an intact relationship and can even be the reason for split-ups. This especially is the case in new relationships in which sex often plays a more important role than it does in longer lasting relationships. Sexuality does not always take first part in relationships but often it plays an important part in a well-balanced, harmonic relationship. A constant lack of it can cause tension between the partners and be a strong burden on the relationship.

As mentioned before, impotence can have multiple reasons. Below the different possible causes are dealt with individually.

3.2   Mental (Psychogenic) Reasons

In the 1970s one assumed that almost all erection problems were due to mental problems. In the meantime one can determine very clearly between mental and organic problems as well as a mix of both. 15-60% of all men suffer from psychogenic problems. In many cases it becomes a mixture of both. When suffering from impotence due to physical reasons, usually the mental factors start to play a significant role, as well after “failing” a couple of times.

The detailed and skillful check of the medical history (anamnesis) of a patient suffering from erection dysfunction can often point towards the right direction whether there is an organic defect or a psychogenic dysfunction. If the patient talks about erections in the morning, this points towards a psychogenic reason. Furthermore, reports about good stiffening of the penis when watching erotic movies, pornographic photos or masturbating are pointing towards a mental problem for it seems that the penis is functioning well. This means that all organic functions needed for an erection are intact. Impotence is a complex clinical picture and sometimes it is possible only after detailed, intensive examinations to determine whether it is a psychogenic or physical dysfunction.

The causes of psychogenic impotence can include many factors, meaning it can be very different. In addition to psychogenic problems of the man concerned, partner-related factors, especially mechanism of fear of failure and defence because of fear as well as mechanisms of excessive control and self-observation play a decisive role.

In the following we will briefly consider the possible causes of the mental erection dysfunction.

3.2.1 The Problem with the Length of the Penis

Is the problem with the length of the penis not always a psychological problem? No, there are also organic cases. The medically defined micro penis or the strong curvature of the erected penis that can lead to a shortening of it, are organic problems. But we do not want to talk about this subject further.

Many men think that their penis is not long enough. Unfortunately this opinion is as widely spread as it is unfounded. Young people who are not successful during their first sexual experiences (for example if their partner does not get an orgasm) see the reason for this in their apparently too small penis.

Also many older patients complained that their sexual organs have shrunk in the past years. When putting on a lot of weight this can have the effect of a so-called abdominal apron. This does not lead to a shortening of the length of the erectile organ but when the penis is erected it seems to be smaller optically because the fat tissue covers part of it. Many men who consult a physician because of their too small penis know the length of it up to the millimetre. Unfortunately they do not know how the real length is measured. Some men are under such a strong pressure to perform that they consult a physician to get a surgical penis enlargement.

The length of a penis was determined in a study. The men pulled their penis at the glans as long as possible and the centimetres starting at the bony onset (symphysis) up to the external urethra opening were measured. The average penis length was 12.8 cm. Do you still think that your penis is too short? Using this method the lengths were between 10-18 cm. No connection between a person’s height and his penis’ length was found. Furthermore, there is no relation between potency and the size of the penis. Furthermore, it was found out by questioning women, that for most of them sexual satisfaction did not depend on the penis size of their sexual partner. There were only a few female exemptions that only can get a sexual climax if the partner has a big penis. But then again there are also men who can only get an orgasm if the partner wears “high heels”.

The length of the penis varies greatly and no conclusions to the virility can be made. It is of no importance for a harmonic sexual life how long the penis is. The wish to have a penis-enlargement that many men have, is not a wish of their partner but often comes from the self-made pressure to perform which is widely spread in our society that lives by the motto: “faster, higher, stronger”.

Only seldom, in cases of malformations of the genitals, a surgery of the penis is performed.

We men should keep in mind that it is not the length of the penis that is important but how we use it.

3.2.2 Fear of One’s Own Sexuality

Many men are restrained or feel guilty about doing or wishing something that they lust for. This means the open and honest handling of one’s own sexuality, not extraordinary sexual practises. Often the reason for getting this bad conscience is something acquired in childhood from the parents or the society. Some older couples have never seen their partner naked during full daylight and although they have been married for many years, they only have sex in the darkness. The older generation here has a disadvantage to the younger one since the younger one learns to be much more open about sexuality.

An excessive sense of shame makes it difficult or even impossible to speak about sexual wishes or act with according devotion. This mental conflict between the inner needs and the external surroundings can cause men to suffer from impotency and women to have trouble with orgasms.

3.2.3 Sexuality Under Pressure to Perform and Fear to Fail

The pressure to perform is very strong in today’s society, we all want to be successful with regard to our jobs and private lives. Expectations born from the society or the partner can be the reason for sexual problems. The media show the picture of a man that is always successful and always ready for sex, too. Similar symptoms to the 1970s, when the ideal of the women’s world was a Twiggy-figure which started an era of hysteric diets and many anorexic women, are developing in the men’s world now.

Many men do not see the world of feelings, which normally plays a big role, in the sexuality of showing performance at least 2-3 times a week....