First, candidates for sex therapy must have at least a minimally functional relationship, while candidates for dyadic or family therapy can have an almost completely dysfunctional relationship. Whether the pathology is interpersonal or intrapsychic, the most severe cases will be evaluated as inappropriate for sex therapy. To some extent, the relative lack of complications encountered in sex therapy may be attributed to the patient selection process, which presumably leads only relatively healthy patients to the sex therapists, reserving the sick patients for the dyadic or family therapist.

On the other hand, it is unlikely that these accounts for more than a small minority of cases, since the majority of couples visiting a marital or family therapist usually are at least minimally functional also. Sex therapists will occasionally treat extremely disturbed patients (Witkin). The more plausible explanation for the relatively uncomplicated course of successful sex therapy is in two characteristics of the therapy itself, in its speed and the nature of a successful outcome.

It should be noted that negative feedback can come from three sources: from the person being treated for the dysfunction (in which the negative feedback is in effect another name for intrapsychic resistance), from the partner of the person under treatment (dyadic homeostasis), or from the child or children of the couple seeing the sex therapist (family homeostasis). We now must consider how the process of therapy, its speed, and the attributes of success affect these three types of homeostasis.

The process of sex therapy itself considers intrapsychic resistance and dyadic feedback, and attempts to resolve problems as they occur. Not all resistances are resolved, however; many are bypassed in the interests of the rapid alleviation of symptoms. It seems logical that these bypassed resistances would re-emerge later as negative, homeostatic feedback.

In most cases, one reason why they do not is in the result of successful, pleasuring sex. When the treatment is successful, the relationship usually is heightened and intensified to a degree that overwhelms the resistances. It is not merely that new patterns of relating are established; the new patterns receive such powerful reinforcement from the pleasures of the newly rewarding sexual relationship so as to preclude the re-emergence of the old patterns. In brief, dyadic and intrapsychic resistances are dissipated or preempted by the new, sexually heightened relationship.

Within the larger family, the speed of the process is of great importance. The resistant, homeostasis-seeking child seeks to alter his or her behavior so as to reinstate the old family patterns, but this takes time and he or she has not time to experiment with new patterns or work them into the family functioning. In a sense the child is caught unprepared; the change in the parents is so rapid so as almost to present the child with a fait accompli. Interference with the process becomes much less likely; the child must now interfere with the results.

But the results usually are a strongly relating, communicating, revitalized set of parents who not only has every incentive to continue in the new patterns and not lapse back, but also has learned that problems are solvable and change is possible. Their tendency now is not to feel helpless in the face of the child’s reaction but to do something about it, with professional help if necessary. With parents in a strong relationship, the resistant child will almost always fail to restore the previous homeostasis.

The attempt itself rises out of anxiety. When it fails, it leaves the child no real recourse except to adjust. The adjustment to the new patterns brings such rewards of warmth and understanding that the resistance soon disappears and the new relationship begins. The above case history of the couple with the ten-year-old son is a good example.

In summary, when the couple returns to the dyadic or family therapist or continues with the holistic therapist after having undergone successful sex therapy, homeostatic problems generally will have been understood and will be relatively easy to manage.

*258/187/5*

In focusing specifically on the dynamics of homosexuality, the general paradigm of the perversions is applicable, but we will have to note the peculiar factors in patterns of homosexual behavior. The first important point is that there is not one form of homosexuality but many forms, so that one can speak more accurately of homosexualities in the plural rather than in the singular. The patterns of homosexual behavior express varying patterns of underlying motivations that differentiate the early developmental vicissitudes characterizing each individual’s early sexual experiences and maturation.

Second, it is important to realize that even relatively normal individuals are capable, under certain forms of stress, frustration, and disappointment, of developing patterns of perverted behavior, for example, an isolated episode of homosexual behavior after a threat to the patient’s father’s life, or the emergence of homosexual behavior in prison or barracks life. In such circumstances we cannot maintain that the individual has developed a new pathological propensity, but rather that some latent disposition in the organization is the personality has been activated by specific external circumstances or forms of psychic stress. For sexual orientation, it is a basic postulate which Freud embraced and which has been maintained consistently in analytic thinking since, that human beings are essentially bisexual, that is, that they have as inherent components of their libidinal organization both heterosexual and homosexual inclinations. These inclinations are shaped, modified, reinforced, and directed progressively through the years of development by important developmental experiences, particularly those relating to the child’s parents.

While analysis has consistently maintained that the normal developmental progression leads toward establishing a mature and mutually satisfying heterosexual relationship, it also has strongly maintained and insisted that homosexual elements even in the most successful development of heterosexual capacity remain as an inherent and abiding component of the personality. This applies equally to both sexes. Consequently, only homosexuality in the homosexual is regarded as reflecting a failure in the essential steps leading toward that heterosexual resolution. In the analytic view, to the extent that heterosexual adjustment is not achieved, it is a form of developmental failure or psycho-pathology. This does not in any sense infer that homosexuals are incapable of orgastic experience, nor does it mean that they are incapable of affectionate relationships with other human beings. That is to say, the dynamics of perversion simply as such do not exclude these capacities, but the question of how frequently such capacities are actually attained by homosexual individuals remains a matter of doubt and debate.

The available data on the quality of homosexual relations are by no means satisfactory. Certainly the frequency of pick-ups and one-night stands among homosexuals is not reassuring. However, if one chooses to make a comparative argument, the data from the heterosexual side are not altogether reassuring either. The level of casual sexual encounters, the current epidemic of venereal diseases, and the alarming divorce rate all are cause for concern and reflect a general defect in the capacity for enduring, mutually satisfactory, and fulfilling relationships. Those who argue for the normalization of homosexuality tend to emphasize that a homosexual libidinal disposition does not necessarily exclude more mature forms of affectionate involvement and expression. But the fact remains that homosexuality is a perversion and as such, rides on a substructure of some kind of developmental defect. The degree of psychopathology in any given homosexual obviously reflects the extent to which early fixations have come to dominate developmental experience. The earlier such fixations take place, generally the more severe the degree of pathology and the greater the incapacity to sustain satisfactory relationships.

*222/187/5*

There are many circumstances for which that generalization does not hold. For example, boredom with erotica may set in very rapidly Howard, and others exposed normal healthy males to pornographic materials for ninety minutes per day for fifteen days and found that “pornography is an innocuous stimulus which leads quickly to satiation and that public concern is misplaced”.

In a study which had married couples view erotic movies once per week over a twelve-week period, Mann, Sidman, and Starr found that a relatively high level of sexual activity occurred on movie-viewing nights, although the average amount of sexual activity over the three months changed only slightly: “Completing daily checklists [of sexual behavior] appeared to facilitate sexual activity more than viewing erotic films. Results appeared most concordant with social learning theory and failed to support the position that viewing erotic films produced harmful social consequences”. Mann and others reanalyzed these data to determine if there was a satiation effect with repeated exposure to erotic films. “The findings indicated that these movies had become less and less effective elicitors of sexual reactions with successive presentations”. These data agree with a limited but somewhat similar study by Brown, Amoroso, and Ware, which showed similar transient increases in normal sexual behavior.

A brief report by Diener and others of a study using noninvasive observation methods and the “dropped-wallet” technique measured altruism and honesty in relation to exposure to erotica. The authors compared returns from a pornographic bookstore and a general bookstore. More patrons returned wallets discovered while leaving the stores than did those who discovered a wallet while entering the stores. The authors concluded that “these data do indicate that exposure to erotic stimuli did not lead to an increase in the antisocial behavior of stealing”.

In summary, the variation of methods and study designs limits the conclusions one may draw from currently available studies. It is safe to say, however, that there are no data which suggest that erotic arousal per se leads to antisocial behavior and many data which suggest its effect is minimal, benign, and transient.

*184/187/5*

Women were not only subjugated but also brainwashed into a docile acceptance of their subordinated role. They were told that to be feminine meant not to compete with men in intelligence, industry, initiative, maturity, and courage. The “ideal woman” as prescribed by men was supposed to represent a strange mixture of infant and mother. When men were in one of their artificially fanned domineering or heroic moods, their women were expected to be as soft, gentle, submissive, and obedient as infants. When men were tired, defeated and hurt, their women were expected to be sympathetic, affectionate, soothing, ever-present and ever-caring mothers.

This brainwashing encompassed every aspect of a girl’s life from cradle to grave. A little girl was told she must not act in the free, self-expressive manner as her brothers did. As she was growing up, the male-controlled educational systems trained her for her future role as the man’s toy and joy, or nurse and caretaker. She was not allowed to express her own desires and ambitions, and her thinking was as constricted as the toes of Chinese girls; obviously the ruling class of men feared that free-thinking and ambitious slaves might rebel and run away.

Woe to the woman who dared to express sexual desires! Pious medieval monks, who secretly masturbated, invented perversely sadistic tortures for “women-witches” who were believed to have slept with Satan himself. The famous “Malleus” (The Witches’ Hammer) is an infamous historical document of masculine perversions, combined with pornography, perversions, and saintly rationalizations.

*148/187/5*

Why there are differences in male and female patterns of sexuality in adulthood and old age has not been answered. Variables affecting sexuality at all ages can be categorized as physical (general health, state of the nervous system, hormones) and psychosocial (experience, learning, and societal factors). Many researchers have suggested that experiential antecedents are important in determining sexual behavior for both males and females in old age. The level of sexual activity and interest of the older person is strongly related to his or her activity and interest in earlier years. Men who were sexually active as young and mature adults tend to be sexually active in old age (Newman and Nichols; Freeman; Rubin). Women who have regular sexual activity before old age are likely to enjoy sexual activity in old age (Masters and Johnson). Those who as young and middle-aged adults are more sexually active than their same-age cohorts also will be more active than their cohorts in old age.

Kaplan and Sager suggest that as early as puberty and throughout the mature years, males are more dependent than females upon physical factors. Males probably also need less specific learning for fully functioning sexual responsiveness or at least they have earlier opportunities for learning. The fact that males are most sexually active and responsive in adolescence but females are, in their thirties and forties (Kinsey; Masters and Johnson) lends some support to this hypothesis.

Young males are extremely sexual; they are highly genitally oriented and masturbate earlier than females do. The male peer-support system in adolescence reinforces early sexual experimentation, and societal mores suggest that seeking sexual satisfaction with a variety of partners is not only permissible but desirable. Parents are less restrictive with sons than with daughters in dealing with adolescent sexual experimentation (Wake). Parents also are more likely to emphasize to daughters than to sons that love is an integral part of sexual relationships (McCary).

There are basic differences in the perception of sex early in development which continue throughout life. Females tend to view sexual activity as it is associated with romantic relationships. For females, sexual involvement is preceded by emotional or romantic attachment, but for males sexual attraction precedes emotional involvement (Calderone; Ehrmann; Kronhausen and Kronhausen). Females at puberty are less interested in sex per se than in boys and romantic relationships (Kaplan and Sager). Females at all ages tend to be more interested in relationships than in genital sex, and sexual contact represents the meaning of a relationship. Females are more likely to measure the success of a marital relationship by factors other than sexual satisfaction (Adams), but males place more importance on sexual gratification. In one study (Bell and Bell), when married females were asked from which aspect of sexual activity they derived the most satisfaction, the most frequent response was closeness or feeling of oneness with the partner.

*111/187/5*

Jane, a 48-year-old self-described “retired Mom” who’s been married 20 years, is also satisfied with the results of her husband’s surgery. “I’m definitely pleased. It’s 90 percent as good as when he was in his 20′s, and that’s terrific. And no more premature ejaculations! Even if he does ejaculate, he can go longer. You do have to change positions. The woman-on-top works better because of the bend of the prosthesis.” The only change Jane noticed is a slight reduction in the circumference of the erect penis. “Thaf s where he loses about 10 percent,” she says.

For Jane, a clear-headed look at the potency problem and the solution was helpful. “We’ve adjusted. Ifs like false teeth, or a false arm. I look at it like this: You lose something, you replace it.”

Studies have found that, generally, women are satisfied with the results of the implant. Not surprisingly, there is a correlation between the partners’ satisfaction: Usually, when one is happy, so is the other. And the more involved the partner is from the beginning, the more likely she is to be pleased with the results.

Getting Used to the New You

Ifs normal to have some adjustment problems after implant surgery. Most couples solve these without much difficulty. Just knowing what to expect can make it easier.

Each couple is different but ifs not uncommon to:

• Have some anxiety about being able to have intercourse.

• Notice that the penis looks somewhat different.

• Take some time to adjust to the fact that erection is no longer physical evidence of arousal—that desire can be shown in other ways.

• Need to try out different positions.

• Need to spend time getting comfortable to the point where the implant is no longer an issue.

*167\184\8*

Some of the take-home tests have a beeper that goes off when an erection registers, so the man or his partner can check the firmness. One home NPT test monitors the rigidity itself. But many of these tests do not test firmness, which is certainly an important factor.

Other at-home tests, while useful, can only measure one erection per night. There are essentially two types: the Snap-Gauge and the stamp test. The Snap-Gauge is a piece of Velcro which is placed around the penis. As the penis expands and becomes rigid, little plastic bands on the gauge will break, indicating that a firm erection has taken place. However, it can’t measure how long the erection lasts. Like all other types of NPT tests, this one doesn’t hurt. And it is easy to use.

Another alternative is the use of commercially available stamps, called PotenTest, made specifically to test erection capability. Like the other methods, you place the stamps around your penis and go to sleep. The stamps break along the perforation when you have an erection.

Both the Snap-Gauge and the stamps have drawbacks. They don’t measure the length or the frequency of erections. Most men normally would have several erections during the course of a single night, and this information is not collected by these methods. Furthermore, if you roll over or are a very active sleeper, both the stamps and the gauge may falsely indicate an erection.

There’s one method that requires no equipment at all—you just need a willing partner who will observe you while you sleep to see if you have any erections. If you do, she can feel the penis to determine rigidity. For this test to be accurate, your partner has to stay awake all night. You have to lie on your back or side—this won’t work for stomach sleepers! Trying this once should be enough. If it doesn’t work, you can use another technique to get the same information. Not all partners want or are able to stay up all night, but finding out that you have just one normal erection is an important piece of information to share with your doctor.

*128\184\8*

At his next visit I recommended that he switch to prescription niacin (which is not found in health food stores). While this proved to be an effective treatment for both his cholesterol and erection problems, there were other unpleasant side effects to confront: abnormal liver function and facial flushing. Fortunately, there was another alternative. Harold began to take Cholestid, a bile-acid resin, and in a couple of months his cholesterol stabilized at 210, and his HDL levels rose to a much-improved 41. His liver function was normalized, and the new cholesterol-lowering drug did not produce any erection problems.

*100\183\8*

The two adrenal glands, which are located just above the kidneys, can also wreck potency if they produce too much or too little of cortisone-like substances. Once this condition is corrected by surgery or medication, adrenal patients will find their potency restored. No permanent damage to potency take a place.

*71\184\8*

Many men try to prolong intercourse during the plateau to make the lovemaking last longer. Mike may deliberately slow down his thrusts and movements in order to stave off his orgasm and increase his and his wife’s pleasure. Twenty years ago, staying in the plateau phase was more difficult for Mike, but now in his 40′s he finds it easier to do. Sometimes the plateau is very brief, leading to early ejaculation. Mike’s plateau lasts for several minutes before he reaches the next stage, orgasm. Orgasm lasts for only a few, extremely pleasurable, seconds, and it usually signals the end of the erection. Still, orgasm has little else to do with erection because it is controlled by a different part of the nervous system. Remember, a man can have an erection without an orgasm, and an orgasm without an erection.

Though brief, orgasm actually has two distinct stages. During the first part, emission, the fluid from Mike’s seminal vesicles, prostate and testicles flows into his urethra. The sphincters which prevent this fluid from traveling back up into the bladder also close down. These sensations are experienced by Mike as ejaculatory inevitability—he feels that any second he will ejaculate and he won’t be able to stop it.

The second part of the climax is Mike’s actual ejaculation. The muscles around Mike’s urethra contract every 0.8 seconds, combining with contractions from muscles in his pelvis and anus. This generates a great amount of force that pushes the semen in his urethra out of his penis. Mike experiences a powerful feeling of release. The excitement he feels gives way to relaxation. His desire to continue thrusting disappears. Mike is now in the resolution phase (which also happens if stimulation stops before orgasm and ejaculation). The increased blood flow to his penis, which caused the erection, stops. The sinuses become smaller, and the veins open up to their normal levels, allowing the extra blood to drain out of Mike’s penis. His scrotum becomes less tense, and the testicles drop to their normal, lower position. Mike loses his erection.

When Mike was younger, there were occasions in which he did not lose his erection even after an ejaculation. This is not uncommon in men of high school or college age, but ifs much less typical for older men. As a man ages, he loses his erection more easily during the resolution phase. Once the penis becomes flaccid, Mike enters the final stage of the erection cycle, the so-called refractory period. This is the period of time after resolution when Mike is unable to enter the excitement phase and get an erection, although he may still feel desire. Typically, this period lasts longer as a man ages. Some young men have virtually no refractory period at all, but ifs not uncommon for a man in his 40′s, like Mike, to have this period last hours.

Why does the body have this enforced rest from intercourse? Scientists do not fully understand why nature has programmed this time for a sabbatical from intercourse. Maybe ifs to allow time for sperm to move into position where they can be ejaculated. (Sperm are made in the testicles, travel to the epididymis, which has a remarkable 15 feet of tubing, all wound up, and then move into the vas, the tubes which carry the sperm to the urethra where they can be ejaculated.)

Desire may return before the body’s ability to get an erection is restored, causing a certain amount of frustration, but this situation is not impotence.

*35\184\8*