Impotence is often associated with latent homosexual drives, perhaps caused by environmental factors such as early sexual trauma, an adolescent homosexual experience, or some unfortunate sexual failure with a prostitute. Such factors, of course, should always be taken into consideration and discussed in detail with the patient. The support of the partner is important in this situation.
Sexual dysfunction in the female usually is exhibited by an individual either who has never had an orgasm or who has had orgasms only occasionally by some form of non-coital activity. Such problems are primarily psychological and usually the result of early environmental or situational factors. They also may be responsible for the development of vaginismus and dyspareunia, although such symptoms commonly are associated with some type of pelvic pathology. Since many of these problems are psychological, a psychological understanding and approach is basic to dealing with the difficulty.
It is vitally important for the couple to develop both a good verbal and nonverbal communication, since lack of communication is often a major reason for sexual dysfunction. The sensate-focus program is one way of helping to develop good communication.
It is important to emphasize that sexual function is as natural as most other body functions and should not be the source of feelings of guilt or shame, although this is a common reaction in some patients, based on their early life experience. The therapist who has a good knowledge of sexual physiology and psychology is in a position to give adequate instruction in the various phases of sexual function, which is very important as far as the patients are concerned.
In the final analysis, it is vitally important for both partners to understand the psychological factors which so often cause most instances of sexual dysfunction. The need for mutual cooperation must be stressed, with evidence of love and compassion on the part of both husband and wife.
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