SEXUAL DISORDERS: THE CONTENT OF THE PHOBIAS

Apr
07
2009

Posted by: admin in Categories: Men's Health-Erectile Dysfunction.
Using Tags: Men’s Health

The fear of dysfunction does indeed appear to be the most common phobic reaction in sexual dysfunction. Although it is easily identified, there often are many subtleties involved.

As sex usually involves two people, these fears occur within a social context. Sometimes a critical variable is not the patient’s fear of dysfunction but the partner’s fear of the patient’s dysfunction. One man, with sexual impotence, stated that the fear of dysfunction did not begin to appear until well after the impotence was established. Even at the time of consultation, that fear was not particularly strong. Further exploration revealed that his mate had had a series of experiences with sexually impotent men, that she was phobic to the thought that her current lover would become impotent, that because of this fear she was extremely anxious during sex. It was her anxiety, or rather his reaction to her anxiety, that brought about the dysfunction. Reduction of her fears relieved his impotence without any direct treatment of the man.

Sometimes the fear of dysfunction is combined with an assertive problem. The patient is usually an obsessive male who has great difficulty in saying “no” to a woman in a close relationship. This is especially true in the sexual area. Resentment builds up, and he begins to wish that he were impotent, as a means of gaining freedom. This wish is rapidly converted into a fear and then into an obsessive thought. Dysfunction follows. We have had only fair success in treating patients with this condition, several of whom also failed in couple sex therapy.

Finally, although not inclusive, is the fear of dysfunction as a mask for other fears. The core fear may be the partner’s reaction rather than the dysfunction itself, that the partner may become angry, frustrated, contemptuous, rejecting or even more common with women, pitying. In these conditions, even when reduction of the fear of the dysfunction is successful, there is a tendency for the dysfunction to return. Treatment cannot be considered complete until the fear of the partner’s reaction is removed.

Although the fear of dysfunction is the most common phobic reaction, many others do exist. Any part of the sex act or situation may become a phobic stimulus. Among phobic stimuli we have seen are parts of the partner’s body (especially the genitals), physiological sensations as

the person approaches climax such as change in breathing (in several patients with a history of childhood asthma) or rapid heartbeat, fear of performing specific sexual acts (which often include both the fear of being “perverted” and the so-called masturbation guilt), and the fear of not enjoying specific sexual acts (especially among young adults who are afraid of being “inhibited” or “uptight”).

Many of these fears are very subtle, and part of the art of behavior therapy is to identify them. One young woman could not have a climax in the presence of another person. The core fear turned out to be the fear of being ugly. She believed that during climax her face became contorted and that even in total darkness her partner might see it. One man had a history of losing all sexual interest in any long-term relationship. After a long investigation the problem turned out to be the fear of boredom. Reduction of this fear appeared to have changed the problem pattern.

Communication between the couple is especially important to attain a good sexual relationship. Hence, special note must be taken of those fears which inhibit such communication. However, regardless of what the specific fears are, usually the most effective method for reducing them is through the assertive training approaches rather than through phobic reduction methods.

Nonsexual phobic stimuli may also disrupt sexual functioning. Fear of darkness is but one example of the many that can be cited. As stated before, part of the art of behavior therapy is the identification of such specific phobias.