Commitment to an overt pattern of homosexual response in the early to middle teenage years also emerged as a major etiological factor in failed coital connection during initial and all subsequent heterosexual exposures for another 6 of the 32 primarily impotent men seen in therapy.
For four of these men relationships were established in the 13 to16 year age bracket and were specifically meaningful to the involved teenagers. One relationship was with a peer and three others with older men (early twenties to mid thirties). The fifth in this group of six primarily impotent men voluntarily established a semi permanent association at age 20 with a man in his early thirties.
These five histories reflected homosexual relationships ranging in duration from nine months to more than three years. Although all relationships were discontinued before there was serious thought of establishing permanent heterosexual alliances, it is of interest that they were terminated by the partners of the young men.
When initially seen in therapy all five of these heterosexually dysfunctional men considered themselves basically homophile in orientation and felt that a lifetime commitment had been made through their initial indoctrination into homosexual functioning.
None of these five men provided a history of attempted rectal intromission, although three of the five had submitted to rectal penetration. Since there was no mounting attempt on their part, the clinical diagnosis of primary impotence has not been challenged.
Had they been successful in anal intromission,they would Not have been classified as primarily impotent.
The remaining instance of homosexual identification as a plausible etiological agent in primary impotence was that of a virginal man of 21 years referred to psychotherapy for nervous tension, intermittent periods of depression, and compulsive lack of effective academic progress.
The therapist convinced the young man that his unresolved tensions were derived from the natural frustrations of a latent homosexual and introduced him to the physical aspects of mouth genital functioning in a patient-therapist relationship.
This homosexual relationship lasted for 18 months, only to be terminated abruptly when the patient's family no longer could afford the cost of the twice-weekly sessions.
Anal sex was not attempted.
In three of these six instances of homophile identification, the totally dominant mother was in full control of family decisions in social, behavioural, and financial. The father was living in the home but was allowed no other role except provider.
The remaining three young men described a relatively well-balanced family life. The religious aspects of the six backgrounds ranged from atheism to family demand for regularity of church attendance. There was no strict orthodoxy.
Two of these six young men had married but neither was successful in consummating the union; nor had psychotherapeutic procedures, instituted some months after failed consummation, provided the men with confidence to think and feel sexually in their newly established heterosexual relationship.
One marriage was dissolved legally; the other was ongoing at therapy. When first seen, each of these six men stated unequivocally their basic interest in and desire for facility of heterosexual functioning. In only two instances, however, was there also the collaterally expressed desire to withdraw permanently from any form of homosexual functioning.
There are four recorded primarily impotent male histories from the series of 32 impotent men with basically stable family, religious, and personal backgrounds whose initial failure at coital connection was specifically associated with a traumatic experience developing from prostitute involvement with their first experience at coition.
Three of these virginal young men (two late teenage and one 32 year old) each sought prostitute opportunity in the most debilitated sections of cities in which they were living and were so repulsed by their neophyte observations of the squalor of the prostitute's quarters, the dehumanizing quality of her approach, and the physically unappetizing, essentially repulsive quality of the woman involved that they could not achieve or maintain an erection.
Their own poor judgment had rendered them vulnerable to a level of social environment to which they were unaccustomed and for which they were unprepared never occurred to them. In two of these instances their frantic attempts to establish an erection amused the prostitutes and their obvious fears of performance were derided.
The third young man was assured that "he would never be able to get the job done for any woman if he couldn't get it done here and now with a pro."
In the fourth instance initial sexual attempt, also prostitute-oriented, took place during a multiple coital episode in which the same woman was being shared. The young man (age 19) was the last member of the group of five friends scheduled to perform sexually with the same prostitute.
No sexual experience
With no previous sexual experience, his natural anxieties were markedly enhanced and quickly compounded into fears of performance by the enforced waiting period while his predecessors in line returned to describe in lurid detail their successes in the bedroom.
Overwhelmed by the rapidly multiplying pressures inherent in these circumstances, the young man predictably had difficulty attaining an erection when his turn finally arrived. There were verbalized demands to hurry by his restless, satiated peers and from the impatient prostitute.
Faced with a performance demand measured by a specific time span and a concept of personal inadequacy (he carried the usual virgin male's concern for comparative penile size into the bedroom), the young man was pressured beyond any ability to perform and unable to regard the pressured circumstances with objectivity.
Inevitably, this initial failure at sexual functioning resulted in markedly magnified fears of performance. Subsequent attempts at coital connection both with members of the prostitute population and within his own social stratum also proved unsuccessful.
Not all instances of failed attempts at initial coital connection have an established etiological patterning that possibly predisposes to failure.
In the histories of primarily impotent men seen in therapy, there is a wide variety of other factors associated with each man's ego, destructive episode of failure at his first coital opportunity.
n fact, among the remaining 13 men from the 32 males referred with the complaint of primary impotence, there are (with one exception) no duplicates in the patterns of their initial traumatic sexual episodes.