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Erectile dysfunction, manhood and mental health

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Dr Adeoye Oyewole

Sigmund Freud remains one of the most creative, dramatic and significant contributor to the field of modern psychiatry especially through his famous theory of psychoanalysis in explaining varied forms of abnormal behaviour.

Of particular relevance to this discourse is the dual – drive theory in relationship to human sexuality. He described sexual drive as the ultimate premise of biological motivation for human behavior just as instincts serve similar purpose for animals. Under the dominance of the sexual drive and guided by the primary process thinking; the libido exerts an ongoing pressure towards gratification operating in accordance with the pleasure principle.

The aggressive or ‘death’ drive which is profoundly self-destructive is responsible for the development of depression and suicide and runs counter the pleasure principle of the libido. A basic inference from this theory is that the sexual drive is the energy of life and when it is frustrated could result in unconscious self- destructive psychological strategies that may end up in depression and suicide. This explains the central role that mental health experts play in sexual dysfunction. Men and women have always been curious about sexual life; its inherent mysteries, drives, intentions, oddities and common sexual problems. Treatment rituals, folk remedies, advice, and sex manuals have been discovered among the writings of the ancient Greek physicians, Islamic and Talmudic scholars, and Chinese and Hindu practitioners. Even today the public’s insatiable curiosity about sexual life, especially how to enhance,improve,restore,or cure problems, is the focus of every monthly women’s magazine, television and radio programmes,books and videos.

Biographers have observed that most of our great leaders and inventors have been peculiarly endowed with enormous libidinal energy creatively harnessed and plugged into their particular creative outlets rather than wasteful dissipation in consonance with the concept of sexual transmutation. For the love of a woman; a man can perform essentially animated by the energy of the libido.

I think it is in agreement with Freud’s theory of libido that guided our culture to define manhood among other qualities in the context of sexual agility. The African society is essentially patriarchal and sexual agility is considered a resource for man to take full control of his emotional and psychological territory just as the women are expected to derive security in the enjoyment of this facility. However changes in the dynamics of the modern marriage with the attendant psychological challenges may explain an apparent increase in incidence of sexual dysfunction among men especially erectile dysfunction and their patronage of local culturally compliant remedies. The women because of the cultural and religious inhibitions may never admit to their sexual dysfunction.

From basic psychology; the sexual response cycle can be divided into 4 phases of functioning: desire, arousal, orgasm and satisfaction. Sexual dysfunction in clinical practice follows this theoretical model including the sexual pain disorders. Erectile dysfunction is a disorder of sexual arousal characterised by persistent or recurrent inability to attain or to maintain erection until completion of the sexual activity. The dysfunction may occur as full erection occurs in the early stages of love -making but declines when intercourse is attempted; or erection does occur, but only when intercourse is not being considered; or partial erection, insufficient for intercourse occurs but not full erection. And for women; there is the persistent inability to attain or sustain adequate lubrication-swelling response of sexual excitement Significant enough to cause distress and interpersonal difficulty. Couples or individuals who discover that they do not have optimum sexual satisfaction should seek medical advice since some medical conditions like diabetes, hypertension, some surgical conditions and some medications like the antihypertensive. Depressive illness presenting with reduced libido, antipsychotics and some drugs of abuse may be cause erectile dysfunction.

However, strong cognitive and emotional factors may be responsible for most cases. Until recently; clinicians used to consider performance anxiety to be responsible for the development and maintenance of life long and acquired erectile dysfunction. However, recent findings are showing that the cognitive processes interacting with anxiety are responsible for sexual dysfunction.

The challenge for the mental health expert is to elicit deep seated psychological and relational barriers usually fed by faulty cultural and religious paradigms and defective communication patterns. The African man’s definition of manhood as sexual conquest of his partner readily makes him vulnerable to sexual dysfunction especially when his partner demands to be treated with respect rather than conquered. The quality of the couple’s non- sexual relationship is examined such as conflicts emanating from work, finances, partner’s health, and difficulties with parents and children. Partners could provide useful information that the client is concealing like bereavement, indebtedness, not getting promotion or a son’s drug problem. The goal of therapy is to assist couples to accept changes in their lives such as menopause, disability, and other life stresses.

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