There is the recorded history of one man whose failed attempt at initial coitus developed while he was partially under the influence of drugs.
Two men (the exception mentioned above) failed in their first attempts at vaginal penetration under the influence of excessive alcohol consumption. In none of the 12 individual patterns among these 13 men is there specific evidence to support psychodynamic concepts of the dominant mother and the meek and docile father or the inadequate mother and the supremely dominant father.
The one common factor:
The men had restrictive input from an immature or even negatively disposed sexual value system. The psychosocial system certainly exerted overwhelmingly dominant influence on the biophysical component.
The interesting observation remains that, although there obviously are instances when primary impotence almost seems preordained by prior environmental influence, there frequently is a psychosexually traumatic episode directly associated with the first coital experience that establishes a negative psychosocial influence pattern or even a life-style of sexual dysfunction for the traumatized man.
The male with a meaningful, well-established homosexual orientation in his teenage years may be expected to experience varying strengths of conditioning against active heterosexual involvement. Similarly, a negative sexual value system can be anticipated from blind adherence to any form of religions orthodoxy.
Particularly does orthodox orientation develop as a psychosexual handicap when the wife-to-be has matured in similar religious environment. Aside from prescribed religious orthodoxy, there is little evidence that familial influence, so frequently held the primary suspect in the multiple etiologies of sexual dysfunctions, carries much statistical weight.
Certainly in the histories of primarily impotent males there are recorded instances of compulsively neurotic maternal influence, including forms of direct mother-son sexual encounter. But little is known of unopposed maternal dominance or direct mother-son sexual encounter relative to the anticipated percentage of resultant primary impotence.
What is known of the individual psychosocial characteristics of young men who are bent and occasionally broken almost beyond repair by the oppressive conditioning of unopposed maternal dominance, orthodox theological control, or homosexual orientation that another youth in similar circumstances might consider serious, but not of lasting moment?
Most men so traumatized in their teens or early twenties survive the stresses of their initial opportunity for heterosexual coition, whether or not successful, and move into a continuum of effective sexual functioning with facility and pleasure. As time passes they at least partially neutralize the negative psychosocial influences that have accrued as a combination of their environmental backgrounds and the trauma of their initial coital failures.
One cannot propose that environmental influence inflicts upon young males such a depth of psychosocial insecurity that statistically they must find themselves inadequate to react to the tension-filled demand of the initial coital occasion. For to make such an assumption would be to negate the influence of their biophysical system.
As an auxiliary to the Foundation's basic research concepts of evaluating sexual functioning in our culture, investigators continually record histories of young men sexually traumatized beyond any reasonably acceptable measure, indeed well beyond the scope of the acute episodes described here.
These men may have failed to:
Perform successfully during their initial coital exposure and for a considerable period of time thereafter may have continued sexually inadequate. Yet they have recovered from their experiences with sexual dysfunction without specific psychotherapeutic support.
As far as can be, ascertained from corroborative histories of husband and wife, have led effectively functional heterosexual lives. Regardless of the depth of the specific trauma resultant from a prejudicial sexual value system, ultimately it is the interdigital response patterns of the psychosocial and the biophysical systems and the individual characteristics of the men directly involved that predicate sexual survival or failure.
Of these characteristics we know so little. It is relatively easy for the cotherapist retrospectively to identify etiological influence in states of sexual dysfunction, but to generalize from such specific retroflection is statistically unsupportable and psycho dynamically unacceptable.
In brief, the etiology of primary impotence has a multiplicity of factors. In most of these instances, the unexplained sensitivity of the particular male to psychosocial influence adjudicates the specific failures of the virginal experience with sexual function into subsequently high levels of concern for performance.
Most of his peers would not perform inadequately under similarly combined pressures of prior environmental handicapping or the immediacy of sexual trauma. At present it not only is statistically inadequate but also psychotherapeutically inappropriate to attempt definitive correlation of etiological factors for primary impotence.
From an investigative point of view, it is infinitely healthier to admit that we really have no concept of the specific psychodynamic factors that render the young man failing in his first coital connection susceptible to continuing failure at sexual performance.
The approaches to reconstitution of male sexual function from secondary impotence are essentially similar to therapeutic considerations of primary impotence. Therefore, the erectile treatment techniques and program statistics for both primary and secondary impotence will be presented in a separate discussion considering the subject from a composite point of view.
Since there have been more unmarried men referred for primary impotence than for any of the other three distresses in the continuum of male sexual dysfunction (premature ejaculation, incompetent ejaculation, and secondary impotence), a discussion of use of replacement partners, or partner surrogates, in cooperation with authority will be presented as an integral part of this chapter.