The different medical problems that fall under the name IBD are a mysterious lot. Doctors know that the main ones are ulcerative colitis and Crohn’s disease, and that the symptoms can flare up for weeks then disappear for months or years. But experts have no clear idea how men get them in the first place.
“There are a lot of theories out there—and they vary from problems with the immune system to some sort of slow viral infection, but the fact is we don’t know for sure,” says Bernard Schuman, M.D., professor of medicine at the Medical College of Georgia in Augusta. Most experts think that IBD can start as some kind of infection. There’s also evidence that some men have a genetic tendency toward the disease—about 20 percent of IBD sufferers have family members with the same malady.
If you’re having occasional bouts of diarrhea or stomach pains, don’t immediately assume it must be IBD. Roughly one million men may suffer from IBD, but that’s a small fraction of the number of men in the United States. On the other hand, everyone gets diarrhea and vague intestinal distress now and again. As a rule, if you suffer these symptoms on a regular basis or you have bouts that last longer than a few days, it’s smart to see a doctor. Pain and diarrhea are symptoms of many health problems that men are more likely to develop, such as stress-related conditions like irritable bowel syndrome. The bottom line is you shouldn’t mistake /case of the runs for IBD.
Its origins may be uncertain, but the symptoms of IBD are distinct. With ulcerative colitis microscopic sores develop in the colon, resulting in diarrhea, abdominal pain and rectal bleeding. Ulcerative colitis is more common among men than Crohn’s disease.
With Crohn’s disease the entire digestive system, from the esophagus to the colon, can be affected, although the bowel is the most common target. Unlike ulcerative colitis, Crohn’s is somewhat more common in women. During flare-ups the affected part of your digestive system becomes inflamed, causing pain and either diarrhea or constipation. Sometimes Crohn’s disease is so severe that the bowel narrows. This can lead to a bowel obstruction, a serious complication that requires immediate attention. Other symptoms include fever, weight loss and skin irritations.
There is almost no way to predict your susceptibility to IBD. Nor could you prevent it even if you could detect that tendency. By the time you notice the symptoms, you have the disease. And IBD is chronic—once you have it, you likely have it for life. But you can learn to live with it—and you should. Left untreated, IBD could lead to more serious health problems such as cancer or even death.
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• The prostate is part of the sexual apparatus of a man so it is only sensible to look at sexual activity as a cause of prostatic problems. Clearly a man’s sexual habits must influence the workings of his prostate.

The prostate produces fluid all the time which, having built up, needs to be discharged by ejaculation. The build-up appears to take approximately three days in the average young and middle-aged man and longer in the older man.

Finding that younger men are experiencing prostate problems which in the past were confined to the elderly has led various experts in the field to suggest that prolonged sexual excitement without ejaculation is bad for the gland. This is rather akin to the pelvic congestion that occurs in women who are aroused repeatedly but don’t have an orgasm-they too suffer from all kinds of pelvic and lower-back symptoms. Also, it is proposed that when such a man does ejaculate his prostatic contractions are poor and that he has a poor-quality orgasm with incomplete emptying of the gland.

Residual fluids degenerate in the gland and cause inflammation and need more muscle power to expel them next time.

No single type of sexual activity necessarily produces prostatic damage, but both excessive masturbation or intercourse and too little could do so. The answer must be to find your own sexual rhythm and be guided by how you feel. Certainly, long periods of abstinence from sex may produce prostatic fullness, tenderness and eventually infection which can be difficult to treat. Zinc supplements and regular emptying of the prostate both help.

• Many animal experiments show that vitamin E deficiency causes all kinds of abnormalities and problems in the sexual life and reproduction of animals. It therefore makes sense to eat foods rich in the vitamin.

• Natural substances occurring in wheat germ oil have proved valuable in animal experiments. It is an old belief among the peasants of the Balkans of Eastern Europe that pumpkin seeds are of value for prostatic well-being. Analysis of these seeds shows that they are rich in all the nutrients known to be of value to prostatic health. Other valuable seeds are those of the sunflower. These seeds contain the amino-acids glycine, alanine and glutamic acid. A study in the US of forty men with benign prostate troubles found that in 32 per cent of them their prostates shrank to normal size and there was some reduction in size in 92 per cent when they were given these amino-acids. The need to get up at night was reduced or eliminated in 72 per cent and urgent urination was relieved in 81 per cent. Men who received placebo capsules had no similar improvements. This study, rather than stimulating further research, has been largely ignored. Foods that are especially rich in these amino-acids are brewers’ yeast, milk, eggs, beef, liver, lentils, nuts and corn.

• Unsaturated fatty acids have been shown to be of value in benign prostatic enlargement. In a study of nineteen men with this condition who were fed unsaturated fatty acids, all had less residual urine at the end of the treatment and twelve of them had none. For thirteen of the nineteen the dietary change meant they no longer wanted to get up at night to urinate. Cystitis cleared up. Dribbling was eliminated in eighteen of them and in nineteen the size of the prostate gland went down. Lecithin is a good source of unsaturated fatty acids.

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Treatment begins with a thorough evaluation, which has two purposes: to determine whether the patients are suitable candidates for sex therapy and to formulate the erotic sexual tasks appropriate to that couple. The evaluation interview includes a medical and psychiatric history of the patients and a thorough sexual history. The initial aim of the therapist is to obtain as clear a picture as possible of the “target” sexual dysfunction or dysfunctions and of the current sexual relationship of the couple. The patients are asked to describe their latest sexual experience together “as a video picture”; only when the therapist understands both the symptom and the context in which it appears will the next area be explored. An attempt is made to formulate both the immediate and the remote causes of the patient’s problem. To this end the experiential description of the sexual interaction, the “video picture,” is supplemented with a description of the history of the dysfunction, including the patient’s childhood experiences. The relationships among parents and siblings are explored, and the sexual functioning of each partner in childhood, adolescence, and premarital adulthood is ascertained. The etiology is completed with a discussion of the couple’s marital history.

During the initial evaluation interview, if profound intrapsychic or interpersonal difficulties are revealed which might preclude successful sexual therapy, the patients are referred to the appropriate individual or to conjoint therapy and are not accepted at that time for sex therapy. They are, however, encouraged to return, should they still need sex therapy after the resolution of their other conflicts. Contraindications to sex therapy lie in the intrapsychic and interpersonal domains. According to Kaplan, “Sex therapy is indicated only if . . . earlier problems are not insuperable nor screens for psychotic processes. With severely disturbed individuals or couples, sex therapy is usually not indicated”. Contraindications include significant medical illness, use of narcotics, or alcoholism, and major active psycho-pathologies (“florid schizoid reactions, blatant paranoia, and significant depression in either partner”). However, if these are remedied, successful treatment is still possible, “providing the therapist is sensitive to and careful not to tamper with the crucial defense against the emergence of open illness”. Interpersonal contraindications are a lack of caring and cooperation necessary to perform the sexual tasks together.

For patients who are marginally suited for sex therapy, the next few sessions are devoted to exploratory exercises intended to clarify their status. The “sensate-focus” exercise (Masters and Johnson) is frequently used as a “probe”; sometimes the couple is merely instructed to shower together, washing and drying each other (Witkin). Usually within three sessions, but sometimes requiring as many as four or five sessions, the prognosis is much clearer, and the patients will either continue in sex therapy or be referred to another treatment modality.

Once therapy proper begins, the average course of treatment lasts between six and sixteen weeks. In almost every case, persistence of the symptom beyond twenty weeks is considered an indication that this particular problem is not amenable to rapid sex therapy and calls for other forms of therapy.

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The stages of psychosexual development constituted the basic theory of psychoanalysis, particularly the primary theory of development within psychoanalysis, for most of the early period of Freud’s thinking. It was not until the emergence of a structural theory in The Ego and the Id and the subsequent emergence of a more developed ego psychology at the hands of Anna Freud, Heinz Hartmann, David Rapaport, Erik Erikson, and others, that the basic developmental schema provided by the stages of psychosexual development came to be modified to any great extent. The stages of psychosexual development even today remain one of the best understood and most firmly established dimensions of psychoanalytic theory. Although the schema has been considerably modified since Freud’s early thinking about it, it nonetheless has remained a fundamental dimension in the psychoanalytic assessment of personality and the pathology of disturbed states of functioning.

In discussing the role of psychosexual development in disorders of sexuality, it is of particular importance to keep clearly in mind the distinction between developmental characteristics derived from the respective psychosexual stages, and the levels of regressive fixation that may characterize one or other form of psycho-pathological expression. Thus, many aspects of reasonably well-integrated and well-functioning individuals may originate in the respective psychosexual stages, but this does not mean nor can it be used to infer that the behavior in question is an expression of that level of psychological functioning and psychosexual integration, nor that it necessarily reflects a fixation at that particular developmental stage. It is quite a different matter to say that a given individual manifests oral characteristics in his behavior and to say that the organization of his personality reflects fixation at the oral stage of psycho-sexual development. There has often been a basic confusion in the use of such terms and a failure to distinguish between regressive fixations and developmental attainments.

With these cautions in mind we can turn at this point to a brief description of the psycho-sexual stages and to a brief specification of some aspects of their implications, both for pathological functioning and for personality development. The following description of the psychosexual stages is based on Freud’s early formulations but reflects the contributions of later psychoanalytic thought to the understanding of psychosexual development. Of particular importance in these later contributions are the deepening of the developmental implications of the pre-genital stages, the mutual interaction of psychosexual dynamics with object relations, and finally the interplay of psychosexual and psychosocial developmental processes.

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Rosen and Jerdee found that women were thought to be out-of-role when they took a threatening approach in filing a job grievance. These same authors (Rosen and Jerdee) found that employees’ requests for released time from work because of family problems were perceived to be more acceptable coming from a woman than a man. There also is some evidence that the sex of a manager influences how descriptions of different managerial styles are evaluated (Bartol and Butterfield; Rosen and Jerdee). Generally, these studies suggest that both women and men are evaluated more favorably when their leadership activities consist of sex-appropriate behaviors, e.g., a female manager showing consideration and a male manager initiating structure. Evidently, conformity to traditional sex role standards is regarded favorably in work as well as in other settings.

Most jobs that carry with them authority and responsibility are thought to require behavior that is explicitly male. What are the consequences for women who take such jobs? How do others react to them and how might their performance be affected by these reactions? What are the implications of these reactions for their careers?

Costrich, Feinstein, Kidder, Maracek, and Pascale investigated the reactions to women’s out-of-role behavior in a series of laboratory studies utilizing three different experimental procedures. The results indicated that women who violate norms of feminine passive-dependency were penalized by the undergraduates serving as subjects. They were rated both as less popular and as more poorly adjusted than women who abided by the behaviors appropriate to their sex. These findings’ suggest that, paradoxically, women in nontraditional fields may be evaluated negatively if they do their jobs well.

Such reactions, if they occur in work settings, can impair the advancement opportunities of women. There have been a number of field studies that examined the reactions to females in previously male-dominated roles; however, they have focused on the reactions of subordinates to female and male supervisors. Although the reactions of subordinates clearly are not as critical for our purposes as are the reactions of those who have the power to take personnel actions, these studies are nonetheless instructive in understanding the by-products of incongruence between sex and job in actual organizational settings.

Two separate research investigations (Petty and Lee; Petty and Miles), investigated the correlations between subordinate perceptions of leader behavior and subordinate satisfaction. Both in the nonacademic divisions of a university and in a social service organization, the correlation between consideration behaviors and satisfaction with supervisors was greater for female supervisors than for male, In the social service organization study the correlation between initiating structure behaviors and satisfaction also was greater for male supervisors than for female. In fact, men with women supervisors had negatively correlated satisfaction scores and ratings of initiating structure. Satisfaction was thus found to be linked with perceptions of sex-role-consistent behavior.

Rousell conducted a field study in which, as Terborg has pointed out, greater care was taken to control adequately for factors in addition to sex, thus allowing for a more precise statement about supervisor sex and subordinate reactions than in the Petty studies. The effects of department-head sex on teacher ratings of department climate in ten high schools were investigated. The teachers were randomly selected from the four largest departments in each school. The twenty-five men and fifteen women department heads had few differences in background and virtually no differences in teacher ratings of professional knowledge, aggressiveness, or power—all potentially confounding variables. Results indicated that departments headed by men were rated as having a far more favorable climate than those headed by women.

The data from these studies have several pertinent implications. First, they suggest that women in supervisory positions are limited in the extent to which they can adapt a variety of supervisory styles to do their jobs effectively. Their flexibility is constrained and their ultimate performance may suffer. Second, they suggest that negative reactions to women in non-traditional roles are confined not only to the woman herself but influence the perceptions (and perhaps the realities) of the climate of the work setting. Each of these can have costly consequences for the woman striving to move up in the organizational ranks.

An additional and not unimportant point is the fact that the anticipation of negative reactions by organization members can prevent decision makers from placing women in nontraditional positions. Results of a 1965 Harvard Business Review survey of 1,000 men and 900 women executives indicated that over two-thirds of the men and almost 20% of the women said they would not feel comfortable working for a woman. Very few of either sex (less than 10% of the men and approximately 15% of the women) felt that men employees feel comfortable working for a woman. Beliefs of this sort make the prospect of placing women in high-level jobs seem risky. Surely this must enter into decisions about who to put in what position and who to put in charge of whom.

In reviewing the literature pertinent to on-the-job sex discrimination, it again is apparent that sex stereotypes are the basis for the differential treatment of men and women. There is indication that if a woman were to perform well on the job her success might not be acknowledged or even if it were, it might be interpreted as a result of temporary conditions. There also is indication that a woman, simply by her presence in an out-of-role position, can create low morale and dissatisfaction among others at the work place, thereby limiting her effectiveness and others’ perceptions of her potential. It seems clear that when competing with men in the work world, women face a tremendous disadvantage.

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In American culture, according to Schneider, sexual intercourse is “exclusive to and distinctive of the husband-wife relationship”. Schneider knows full well that sexual intercourse as behavior occurs outside of marriage, but his point is that it never occurs outside of the marital context. In an important footnote Schneider supports his contention and demonstrates the broad scope of husband-wife sexuality in defining the impropriety, illegitimacy, and immorality of other forms of sexual activity:

Sexual intercourse between persons who are not married is fornication and improper; between persons who are married but not to each other is adultery and wrong; between blood relatives is incest and prohibited; between persons of the same sex is homosexuality and wrong; with animals is sodomy and prohibited; with one’s self is masturbation and wrong; and with parts of the body other than the genitalia themselves is wrong. All of these are defined as “unnatural sex acts” and are morally, and in some cases, legally, wrong in American culture.

With this reasoning Schneider could define the symbolic system of American kinship, consisting of and in terms of the central symbol of sexual intercourse. In later publications Schneider widened his study to additional cultural domains grounded in the same symbolic process.

Schneider’s argument allows a cultural approach to such topics as adultery. If we expand upon Schneider’s argument, we learn that adultery is wrong because it extends to outsiders the order of law, which unites individuals through marriage. Americans also reckon relatives through tracing “blood” ties. The conjugal love of marriage is opposed in the cultural system by the cognatic love between persons related “by blood.” Schneider points out that the product of conjugal love provides the actors who partake of the “blood” relationship. Sexual intercourse, therefore, is instrumental and symbolic in both conjugal and cognatic love.

Adultery, in this analysis, breaks the symmetry and threatens the entire system. Because it is a pivotal symbol, sexual intercourse outside of marriage not only threatens that marriage but threatens personal relationships defined by the “blood” with which it is dynamically associated. Note that the epithet “homewrecker” used to disparage the proverbial “other woman” refers to the total damage done to relations defined both by blood and by law.

Of particular interest to anthropologists are the arrangements of polygamous marriages. Herskovits was somewhat surprised to find that Dahomean polygynyous marriages were not necessarily tense or jealousy-arousing. Cooperative co-wives make adjustments among themselves, should a husband’s four-day cohabitational visit coincide with a wife’s menstrual cycle. She will exchange places in the rotation with a co-wife and not be deprived. Herskovits concludes: “In essence, the great mass of Dahomean matings, either because of complacency, or of human ability to make the best of a situation, are permanent ventures which in terms of human adjustment cannot be called failures”.

Schapera, reporting on the Kgatla, is not as impressed with the way the system works for them, finding jealousy, suspicion and unhappiness among a Kgatla’s many wives. His conclusion differs from Herskovits’s: “Many women grow reconciled and manage to lead a tolerable existence with husbands who are not unduly inconsiderate, others find some sort of relief by being unfaithful themselves, and some are acutely miserable”.

We have a similarly indefinite perspective from the literature on polyandry. Linton reports that jealousy among co-husbands in the polyandrous Marquesas was considered “very bad manners”. This report is contradicted, however, by Suggs, who reports that “sexual jealousy is, and was, pronounced in the Marquesas”.

Little light will be shed on the topic of jealousy in marriage, plural or otherwise, unless some consideration is given to the larger context provided by native conceptions and explanations. One start in this direction is offered by Firth who finds that among the Tikopia, jealousy is something engendered by marriage and is a natural extension of the marital relationship:

Jealousy is a definitely recognized type of behavior in Tikopia, characterized by a special linguistic expression, masaro. It is particularly evident in newly-married people, the natives say, and they regard it as a kind of accompaniment to the recently-wedded state. One of the young pair excites jealousy of the other . . . [Firth asks, "Over what?"] We don’t know; there it is, the co-habitation of a newly-married pair. They dwell together, they become jealous.

For the Tikopians, jealousy is an expectable part of marriage, especially in its earlier stages. It stems from the marriage and not from the predispositions of either mate, either to incite jealousy by behaving in certain ways or to become jealous easily because of personality.

As might be expected, people in various societies seek evidence to substantiate their suspicions of infidelity about a marital partner. Evidence may be as highly conspicuous as the love scars Trukese inflict upon one another (Gladwin and Sarason), or as subtle as a change in eating habits, as among the Tapirape (Wagley). Tapirape men are known to get ill if they eat soon after an adulterous tryst, so a woman would know if her husband had been adulterous if he should eat sparingly on mornings. A recognizable footprint or buttock-print left in the forest surrounding a Mehinaku village can spell trouble for an adulterous couple (Gregor). Suspicious Dobuan men will time their wives when they leave the compound to urinate or defecate. Extremely suspicious husbands will insist on accompanying their wives to the bush just to make certain (Fortune). Tapirape husbands carefully watch the fathers of newborn infants, for these men are liable to consort with other men’s wives, owing to the postpartum sexual prohibition which denies them access to their own (Wagley).

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Both morning erections and nocturnal emissions occur less frequently with age. Kinsey reported the median frequencies of morning erections at two per week in the thirties, one per week by age sixty-five and two per month in the late sixties. In a Sexology study reported by Rubin, 57% of a sample of sixty-five to sixty-nine-year-old males who were being treated for impotence claimed to have some morning erections. Rubin used these data to suggest that in many of these men the etiology of impotence was psychological. Kinsey reported that 71% of single males in their early twenties had nocturnal emissions. For both married and single men, emissions declined in frequency after age thirty. By fifty, about 30% of males interviewed had emissions but less frequently than in earlier years. Maximum frequencies per week recorded by Kinsey were twelve in the teens, three in the thirties, and less than one (.5) in the fifties. Only 14% of the men over sixty were still having any nocturnal emissions.

Scrotal elevation which occurs for younger males in the late excitement or early plateau phase of the sexual response cycle is attenuated for men over fifty-five. Full scrotal elevation prior to ejaculation is not always observed, and testicular descent following ejaculation may be extremely rapid. Past age fifty-five, the testicles often do not show the usual 50% increase in size due to vasocongestion. Penile detumescence during the resolution phase often occurs extremely rapidly following ejaculation rather than in the two stages typical of younger men (Masters and Johnson).

Erectile impotence is quite rare in males under age thirty-five. In Kinsey’s sample less than .005% under twenty-five and 1% under thirty-five suffered from erectile failure. For these young men, the condition frequently was transitory. However, Kinsey observed an increasing proportion of erectilly impotent males at ages above fifty. These proportions at fifty, seventy, and seventy-five years were 8%, 27%, and 55%, respectively. The degree to which generally poor health and other physical factors contribute to the rising proportions of impotence is unknown.

A number of behavioral changes in sexual activity (increased latency to ejaculate, increased reaction time for penile erection, decreases in precoital mucus) suggest that aging males lose sensitivity to stimulation or that their thresholds for erotic stimulation increase with age. Alterations in collagen and elastic tissues of the skin may contribute to increases in the threshold of cutaneous sensitivity (Magladery). The loss of accessory structures’ ability to maintain recurring penile contractions probably contributes to a diminished sense of satisfaction at ejaculation. Kinsey’s erotic responsiveness ratings by age showed that with advancing years responsiveness (or sensitivity) decreased. The average indexed responsiveness figure for males thirty to thirty-five was about fourteen; this figure fell to six by the mid-fifties, to four by the late sixties, and went to zero for persons over seventy.

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While semirigid implants do seem to work miracles for some men, they also have drawbacks. If the implant is too long for the penis, the penis can curve, with painful results. Left uncorrected, the implant can actually work its way out of the corpora cavernosa, damaging the penis. And implants that are too short cause problems too. The head of the penis may bend down because it isn’t getting proper support—the result is often termed an SST deformity, after the jet airplane that’s famous for its turned-down nose. Obviously, too short a prosthesis can make intercourse difficult.

On a person with a very stretchy penis, selecting the right size can be a judgment call. In such a situation, the surgeon may opt for a little too short vs. a little too long because complications from too long an implant are the riskiest.

Men who have extensive scarring in their penises may have corpora cavernosa which resist implants, because the space where the prosthesis fits is scarred partially shut. In this case, a smaller (especially in diameter) prosthesis may be required.

A man who has very poor tissue surrounding the prosthesis is at risk for a “traveling” implant. Rarely, the implant may move out of the end of the penis into the urethra or out the back of the corpora cavernosa. Pressure from the implant just wears a hole in the weak tissue. A reasonably healthy man with a correctly sized implant needn’t worry about this complication, and even men with diabetes or other problems which may cause weak tissue should take comfort from the fact that this problem is quite rare.

Another rare complication is when a man finds his penis is less sensitive to pleasure and to pain after surgery. If the nerves on top of his penis are scarred and must be stretched during surgery to implant the prosthesis, they may be damaged. Normal sensations may return to this area after several months or the numbness may be permanent.

On the other hand, after recovery, a few patients continue to experience pain without any obvious cause. In such rare cases, removal of the prosthesis may be the only alternative.

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Your doctor should ask a lot of detailed questions about your general health habits, like how much you smoke or drink now, or if you were a heavy consumer in the past, it’s important for you to be as accurate with your answers as possible. Don’t underestimate your past consumption just because you want to “look good” to the physician.

Some physicians ask their patients to fill out a questionnaire. Your answers help your doctor determine what issues are particularly important. Something essential and unique to your situation may not be covered in detail on the questionnaire, so if you have concerns that aren’t addressed, write them down or tell the doctor directly.

You should always let your doctor know about any present or past medical illness, even if it’s not bothering you right now; any surgery you’ve had; and any injuries you’ve suffered, especially to the back or pelvic area.

You should expect to be asked in great detail about the specifics of your problem. This information can be crucial to making a correct diagnosis and providing the best treatment for you. That’s why if s vital that you feel comfortable talking with the doctor you select.

Your wife can also provide valuable information, and some doctors now ask or even insist that married patients bring their spouses. Your wife may recall certain details you forget, and she has a different perspective to offer. Making up a list of questions to ask the doctor can be a joint project that will help keep the lines of communication open between you and your wife.

If there is information you prefer not to share with your wife (for example, if you’re able to have an erection with another woman, you might not want your wife to know), make sure you do tell your doctor over the telephone or when you are alone with him. “My doctor knows things about me nobody else does,” one man told us.

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Sometimes a couple may decide to work on their relationship before they try to fix the man’s potency. If your doctor suggests that you go to a counselor, he might be giving good advice. If you fix the erection problem, but because of emotional difficulties in the relationship, your partner isn’t happy with the result, you might have taken the wrong approach. Howard did.

Howard, a 55-year-old successful businessman and former professional athlete, arrived at the doctor’s office with his fiancee, Christina, a slightly plump, attractive widow of 45. Howard and Christina looked like a happy couple about to embark on a second marriage after knowing each other for several years. But their facade crumbled within a very short period of time.

Howard explained with some hostility that he had come to see the doctor only at his fiancee’s insistence. She thought he had a problem. The short blonde woman smiled, but she refused to participate in the conversation, and all the doctor’s attempts to involve her yielded nothing. Finally, Christina excused herself.

Once his partner was out of the room, Howard reiterated that Christina was the problem, not him. He was perfectly satisfied with his ability to get and maintain an erection. Furthermore, he explained that he took great pains to sexually satisfy his fiancee. He appeared quite knowledgeable about male and female physiology and talked about many different ways to achieve sexual pleasure.

At this point, the confused physician decided he would talk with Christina alone. She was somewhat reluctant, but she agreed. First Christina double-checked the door to the doctor’s office to make sure it was securely shut. Then she sat down, looked the physician straight in the eye, and declared, “He doesn’t get a good erection. He thinks he does, but he doesn’t!” Christina’s shy, somewhat timid manner disappeared: She insisted that Howard was fooling himself about his ability to function; she was sure that her partner’s erections were not satisfactory.

The doctor decided that a complete physical examination of Howard was in order. Howard turned out to be in excellent physical condition. He had no chronic diseases which could cause erection problems; he had normal blood pressure, and wasn’t taking any medications which were known to cause potency difficulties.

To test Howard’s ability to get an erection, the doctor gave him a penile shot. Within a short period of time, Howard obtained a full, firm erection, demonstrating that his essential-to-erection blood-flow system was in good working order. “This is just like the erections I normally get,” Howard declared with obvious satisfaction.

The doctor was curious to see if Christina would agree with Howard’s assessment. But although she came into the room, Christina refused to look at the erection.

What was going on here? How could Howard and Christina differ so radically about what happened between them? The doctor was puzzled, but he was sure of one thing: Howard and Christina were not communicating, and that problem needed to be solved before any possible erection difficulty was addressed.

The doctor pointed out that since Howard and Christina had strong differences in perception they might benefit from some counseling. Somewhat to the physician’s surprise, they agreed this was a good idea. On the doctor’s recommendation, they made an appointment with a psychologist who was also a well-trained, experienced sex therapist.

The therapist saw Howard and Christina together, and separately. She also gave them some tests to determine their attitudes towards sex and gauge their sexual experience.

All the results pointed to much unresolved conflict between Howard and Christina that was due to problems other than sex. She was very upset at her fiancee, but she was unable to express it directly. Instead, even with the evidence of his erection, she denied that he was able to function sexually as he thought he did—something which was of great importance to him.

In this case, the physician was able to determine in fairly short order that Howard’s erections were not the major problem, but were just singled out as the target. If the doctor had concentrated his efforts on “fixing” Howard’s erections (which didn’t even seem to be “broken”), the communication problem would have remained unresolved, leaving Howard and Christina unhappy and at odds with each other. Instead, the couple agreed to see a professional counselor who would help them deal more directly with their anger.

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