Thursday 4 October 2018


As in most aspect of medicine, it is imperative that treatment of any medical disorder must be preceded by a well conducted consultation with the doctor, when an appropriate diagnosis would have been made.

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One of the purposes of making a diagnosis is to find out if a specific, known cause such as general ill-health or mental exhaustion can be found. If found, this can then be specifically treated. 

If not found, then a psychosexual history of both partners, interviewed separately is very essential. Remember, known (organic) causes of male sexual problems account for only 5% of male frigidity (Lack of libido) and impotence. It is therefore a mistake to over-investigate these men with hormone assays and other high profile laboratory tests. What is needed is a proper, well conducted psychonalysis using techniques which employ behavioural approach.

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The couple may need up to about 8-weekly sessions with the personnel handling their treatment and each session could last up to one hour. The couple should, at the end of session be given 2 or 3 home-assignments per week.

Sexual counseling is an integral part of treatment and has the following principles
(a)              Mutual responsibility: - i.e. the woman for instance may be a contributor to her husband’s partial impotence. She on the other hand may not accept this blame or responsibility because it may imply that she is inadequate. Hence, the emphasis is on shared responsibility, rather than on blame.
(b)              Education:- A fair knowledge of the human anatomy and physiology enhances a couples appreciation of what is normal and what is abnormal. For instance, it is necessary for the man to wait for his partner to get wet before penetration to avoid painful intercourse. The mere presence of penile erection during fore-play does not mean that the woman too is ready.
(c )       Attitude Change:-  For instance a negative attitude to sexual expression may result from parental or religious influence on past experience. Such a desired change may be achieved through discussions and the use of appropriate literature.
(d)        Permission giving :- An important principle of counseling is to give the couple permission to enjoy their sexuality and to experiment and discover what is pleasurable to them.
(e)        Reducing performance anxiety:- Anxiety about one’s performance interferes with one’s sexual responses to the extent that erection and orgasm may not occur. Sometimes, even this anxiety is communicated to the partner who too would become affected. Therefore, it is my practice to initially discourage couples (with problems in this area) from being GOAL-orientated, for example on coitus or orgasm. Instead, they should learn to enjoy the sensations resulting from the various stimulations that abound. This method is similar to the FLAG-ship of management of sexual problems called SENSATE FOCUS in which sexual intercourse is temporarily banned and allow the man with erectile difficulties to FOCUS and enjoy the kissing and fondling without worrying about an erection sufficient for intercourse.

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