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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