OUTPATIENT TREATMENT OF IMPOTENCE

Forty-four out of 57 patients (77 per cent), who presented in a psychiatric outpatient department with a primary (“psychogenic”) complaint of impotence (failure to sustain an erection sufficient to conclude the act of coitus to orgasm and ejaculation), or impotentia ejaculandi (inability to experience orgasm or to ejaculate in the presence of normal erection and desire), satisfied the “treated” criterion of attending for a minimum of 20 sessions during 1 year. Therapy, which was superficial and practically biased, whenever possible, included the active participation of both partners; it consisted of an optimum combination of: 1) training in muscular and concomitant mental relaxation; 2) the provision of optimum sexual stimulation from the female partner; 3) sex education; and 4) superficial psychotherapy. The results of treatment were comparatively poor: 19 subjects (43 per cent) were recovered or improved, while 25 (57 per cent) were unchanged or worse. A profile of the good responder to superficial, practically oriented therapy is drawn. He will be married and is likely to have developed acute onset impotence from previous coital competency, in response to anxiety or other psychophysical stress, such as recent engagement, marriage, disappointments, etc. He will have a positive emotional interest in sex generally; his potential to respond erotically may be evidenced by his successful continuation of masturbation to orgasm and ejaculation. He will have an affectionate relationship with his spouse, who is willing to cooperate fully in helping him overcome his problem; they will attend treatment sessions together and regularly. The poor responder, on the other hand, is likely to be older, with an insidious onset disorder of impotence, or absent ejaculation, which has developed in the setting of a gradual, but progressive decline in erotic interests and capacities over months or years. His relationship with his partner will be unsatisfactory; there will be considerable difficulties of communication between them. The patient will attend therapy erratically. © Williams & Wilkins 1969. All Rights Reserved.