To a limited extent, homeostatic forces may appear in the course of sex therapy. They then manifest themselves in two situations, one involving the “healthy” (or at least, untreated) partner of the dysfunctional patient, and the other involving the children of the dysfunctional but improving couple.

Witkin summarized homeostasis in the dyad as follows:

With regard to the couple per se, frequently, improvement of the dysfunctional partner is seen as a threat by the “healthy” partner. The most obvious source of the threat lies in the “healthy” partner’s sense of his or her own inadequacy and worthlessness. The wife of a premature ejaculating man, for example, may feel that the only reason her husband tolerates her “faults” is that she tolerates his dysfunction and that once he is cured, he may leave her. Men have similar fears. The husband of an anorgastic wife may fear that once his wife can experience orgasms, his own inadequacy as a sexual partner will be revealed. Other men, knowing that some women can be multiorgastic, may fear that if the wife ever becomes able to have a single orgasm, she will become sexually “insatiable” (Sherfey), he will be unable to satisfy her, and she will seek other partners.

Within the family, children may behave in various ways in attempting to maintain the accustomed homeostasis. If the parents have visited a family therapist with the child as the identified patient, that child may tend at first to continue or even intensify his or her disruptive behavior; other children may persist in moderately dysfunctional patterns or adopt new roles aimed at restoring the familiar and therefore non-threatening, dysfunctional intrafamilial relationships. These occurrences are in every way consonant with the findings of the dyadic and marital/family therapist.

On the other hand, in sex therapy the homeostatic forces, dyadic and familial, are usually relatively weak. In the dyad, the sex therapist can usually deal with the negative feedback responses as they arise during the normal course of the therapeutic sessions. Similarly with the family: if the relationship between the parents can remain steady, and this is usually the case, the sabotaging efforts of the children almost always fail, and the children readily adapt to the new patterns of behavior.

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There is also a negative oedipal complex. This consists of positive loving (sexual) feelings directed toward the same-sex parent and feelings of rivalry and antipathy toward the opposite sex parent. The little boy wishes for approval and affection from his father and competes with his mother for his father’s love. The little girl wishes for closeness, love, and affection from her mother and competes with father for her mother’s affection. The negative oedipal complex exists in all children alongside of the positive oedipal complex. When the bal-lance of instinctual forces is shifted toward the negative complex, the likelihood of homosexuality is increased.

The key in this process is castration anxiety. Castration anxiety arises from the fantasized fear that the father will retaliate against the little boy for his sexual wishes to possess the mother and get rid of the father. The balance of oedipal forces may be shifted as a result of this threat to the negative oedipal configuration, in which the son’s loving attachment and submission to the father serves to defend against castration fears. In the little girl, the castration complex takes a different form because of her genital anatomy. She has no external organ and may feel envious and deprived on this account. This normally leads her to turn to the father who has a penis. The little girl is more threatened by lack of love than by castration. If turning to the father does not satisfy her need for love and approval, she must cling to her mother—the safer and more infantile love object.

In the perversions, infantile sexuality becomes predominant over adult sexuality. Consequently, there must be something in adult sexuality which is threatening or frightening as well as something that is inherently attractive about infantile sexuality. In the perversions, it is almost universally the fear of castration that interferes with the capacity to express full genital sexuality. Because of such castration fear, the individual regresses to that part of the infantile sexuality at which he is developmentally fixated. At what developmental level, and what parts of the instinctual capacities are fixated, are often influenced by an individual’s developmental experience. The dynamic aspects of the genesis of perversion have been described quite succinctly by Fenichel:

Among fixating experiences at the basis of perversion, one type is prominent: experience of sexual satisfaction which simultaneously gave a feeling of security by denying or contradicting some fear. The pervert, when disturbed in his genital sexuality by castration fear, regresses to that component of his infantile sexuality which once in childhood had given him a feeling of security or at least of reassurance against fear, and his gratification was experienced with special intensity because of this denial or reassurance. To put it schematically, the pervert is a person whose sexual pleasure is blocked by the idea of castration. Through the perversion he tries to prove that there is no castration. Insofar as this proof is believed, sexual pleasure and orgasm become possible again.

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Abel and others studied the erectile response of rapists and non-rapists to sexual scenes (audio presentation) of rape and found that the rapists tended more often than non-rapists to respond with erections to this material. Rapists with the highest frequency of rape, those who had injured their victim and those who chose children as victims also were distinguished. Some rapists also developed erections to non-erotic violent descriptions indicating a commonality—for rapists—between purely violent and sexually violent scenes. Erectile response to nonviolent, mutually enjoyable intercourse scenes was minimal for these rapists.

These data suggest that normal individuals are not turned on by sexual violence or by violence alone, and that response is a characteristic of the viewer rather than of the material per se. Advocates of censorship take an antithetical viewpoint and assume that, for example, sadomasochistic material can produce arousal in anyone, contrary to the findings of Abel and others and Goldstein.

The question of whether sexual arousal is a general state facilitating many types of behavior or a specific state facilitating only sexual behavior is somewhat open. There are few persuasive data for the general arousal hypothesis, although psychoanalytic theory might support such a position.

Three studies discussed below examined the inhibiting and instigating effects of sexual arousal. The data seem to suggest that sexual arousal does not lead to aggressive behavior in normal adults. Baron, for example, found that “heightened sexual arousal was highly effective in inhibiting subsequent aggression by [angered] subjects but failed to influence significantly the strength of such behavior on the part of subjects in the non-angered condition”.

Donnerstein and others found “that mildly erotic stimuli had an inhibiting effect on aggression . . . whereas highly erotic stimuli tended to maintain aggression at a level similar to non-erotic exposure”. What would seem to be required is an experimental design which included a variety of conditions such as 1) varying order of presentation of erotic and aggression inducing stimuli, 2) varying levels of stimuli and, most important, 3) varying the choice of available responses to subjects.

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In its earliest gloomy, hungry, and danger-fraught origins, the human species had good reasons for fostering the myth of male pride and male supremacy. Eunuchs, impotents, and sexually passive males were ridiculed and ostrasized, because they were of little help to their tribe which badly needed the speedy and abundant production of workers and warriors. Troubadours and poets described the hero who fought bravely against enemies and conquered (that is, fertilized) many women. Sexual achievements were praised for economic and military reasons, and many primitive religions adored the Gods-Fathers with erected penises ready for action.

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A survey by Harris indicates that both old people (over sixty-five) and younger people have similar views on sexuality for people over sixty-five. Although 41% of the general public (all ages) saw most people over sixty-five as very physically active, only 5% saw them as very sexually active. When asked how they perceived themselves, males were more likely than females to say that they were very sexually active. Fifty-one percent of the respondents from eighteen to fifty-four and 27% from ages fifty-five to sixty-four characterized themselves as having a high level of sexual activity. After the age of sixty-five, this figure declined to 11% (16% for males and 7% for females).

Snyder and Spreitzer investigated attitudes of 1,020 respondents under sixty-five and 235 sixty years and older toward so-called nontraditional sexual behavior (premarital and extramarital sex and homosexuality). Responses to questions on these topics were put on a four-point scale ranging from always wrong to not wrong at all. The percentage differences between age groups on the always wrong response (indicating the highest degree of intolerance) were tabulated for six demographic variables: sex, education, occupation, number of children, marital status, and church attendance. In general, older people were less permissive and less approving than younger people for all behaviors. The difference in proportion of respondents disapproving of premarital sex was greater (30%) than for either of the other two behaviors (extramarital sex and homosexuality were 19% and 18%, respectively). Age was a stronger predictor of attitudes than any of the other variables, but age did not account for all of the intersubject variability. There were wide variations among people sixty-five and older which could be explained by social background characteristics. As in any cross-sectional study, some of the differences which appear to be age-related may in fact be generational.

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• Is there any other treatment which will help? If yes, should I try that first?

• What types of implants would you recommend for me? Why?

• Is there anything special about my physical condition that would make one type of implant better or worse?

• How much experience do you have doing implant operations? How about with this particular type of implant?

• Is there anything about my general health that makes me at higher risk than usual for certain complications? If so, which ones?

• How long will it take to recover from the surgery? How long a hospital stay do you expect? How long will I have to stay home from work?

• How much does the operation cost?

Preventing Infection

Infection is a concern with any surgery. But when a foreign object like an implant is involved, the risk increases. Serious infection after an implant operation is quite unusual. But because the body often can’t fight an infection as efficiently with the object in place, removal of the implant may be necessary.

To minimize the risk, pay careful attention to your doctor’s instructions regarding rest, care of the genital area and medication. In addition, if any of the following occur, contact your physician immediately.

• You develop a fever of more than 100 degrees.

• Increased swelling, redness or soreness occurs around the incision or the implant.

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Start with an easy stroll—about one to two miles an hour—and gradually work your way up to striding or race walking, which covers about five miles an hour. If you find that you can’t fit in a daily walk, go for a shorter one whenever possible. Quantity, not quality, counts here. You don’t have to walk nonstop for thirty minutes to get the full advantages. Even short five- and ten-minute intervals throughout the day will yield health dividends.

And don’t forget to include your partner in your walks, not only for the companionship, but also to enhance her sexual arousal. Intriguing new research from the University of Washington’s Human Sexual Psychophysiology Laboratory in Seattle has found that it’s exercise —by increasing heart rate and body temperature, priming a woman to respond to sexual stimulation—and not so much the fabled romantic candlelight dinner that leads to sexual arousal.

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So we suggest that you try remedying your erection problems by cutting down your alcohol intake. (If you need help, ask your doctor, or find a self-help group.)

These first three weeks involve cutting a lot of things out of your life, and here’s one more thing you should examine: medicine. Make a list of all medications you are taking—both prescription and over-the-counter. You may suspect that a drug deserves the blame for your sexual problems, and you could be right. In many cases, changing the medication, the dosage or the time you take it will help solve the problem.

In the interest of your health, never reduce, eliminate or change the way you take a prescribed drug without first checking with your physician. (A man who suddenly stops taking his high blood pressure medicine, for example, may find that a stroke is the first—and, possibly, last—sign that he has made a mistake. Obviously, such “mistakes” should be avoided.)

Recreational drugs can also wreck potency. It’s not uncommon for a man on street drugs to lose his sexual desire. Sometimes it’s a physical response. Other times the drugs just may become more important to the man than his sex life.

So if you want to regain your erections, try quitting these drugs—even if you indulge only occasionally. If you need help to quit, get it—quickly.

Hopefully, your potency will be restored after the third week of watching your medication and cutting out tobacco, alcohol and drugs.

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The important thing to remember is that all humans are innately sexual, and the need for intimate expression doesn’t evaporate when a disease occurs. If anything, the necessity for physical intimacy and human warmth increases. One’s sexuality is an ever-present facet of the quality of life.

I’m happy to report that Greg and Linda were able to move forward with their sex lives because they had a solid foundation to build on. The anxiety issues they dealt with included:

• discomfort in sexual situations

• concern that the partner wouldn’t accept physical flaws

• fear of harming the other person

Finally, there is the charming story of Jacob and Dorothy, who came to see me one day not long ago. Their story encompasses the range of sex in a relationship and merits telling. Having heard about the new medication, they wanted to see if it was right for them.

“I’m eighty-two and Dorothy is a few years younger,” Jacob said. “I’ll get right to the point. We have a fiftieth wedding anniversary coming up and we’re booked into the bridal suite of a very grand hotel. We still remember the first time, and how wonderful it was, even though I’ve been less successful as of late.”

“That’s something we’ve adjusted to, but we still touch each other all the time,” his wife added. “It would be wonderful if we could consummate our lovemaking more often.”

“If we can have it again—even one more time to celebrate in style —we’d be so grateful,” Jacob said.

Compatibility, a common sensibility, and mutual admiration are all markers of a successful partnership. As it turned out, Jacob responded extremely well to the medication, and they are still celebrating.

The emotional issues touched on here included:

• a remembered successful first sexual encounter

• a shared enthusiasm for a renewed sexual relationship

• communication, both physical and emotional

None of us is a mind reader, so I reiterate that you must communicate clearly what your sexual choices are. The first thing to do is define for yourself what satisfies you sexually. The next is to listen to what works for your partner. Adaptability and compromise are the markers of highly successful sexual relationships.

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