Despite the enthusiasm engendered by the recent publicity in the popular and medical press, not all men who suffer from impotence are entirely happy about treating themselves with self-injections into the penis with a drug which causes an erection which last for hours. Much of the initial research was carried out using a preparation of phenoxybenzamine.
But this drug was abandoned for the treatment of most cases about four years ago and papaverine is now usually used instead; whatever the details of the technique, it can have disadvantages: the erection, once induced, can be embarrassingly slow to recede, occasionally painful and sometimes so long lasting that it needs an antidote. However the treatment is being used successfully in some selected cases.
Dr Pru Tunnadine, of the Institute of Psychosexual Medicine in London, has a different approach. Having excluded the physical causes of impotence, she prefers to try counselling. In her view the problem for many younger men is due to lack of courtship, an art which she hopes may return with the changes in sexual behavior induced by Aids. This, she feels, may herald the end of an era when sex was a compulsory reward for the first hamburger bought on a night out. Such expectation, Tunnadine says, not only places a heavy burden on the woman, which is generally acknowledged, but also on the man too, who fears failure; in consequence they will fail, and may establish a pattern so that attempt after attempt at sexual intercourse ends in disaster.
Young men, in her view, increasingly see women as terrifying monsters to be satisfied, rather than shy virgins to be cherished, a role which enhanced rather than eroded their sense of manhood. Nor does Tunnadine have much time for agony aunts’ advice to wives of impotent older men; the suggestion that they should change into black stockings and light the candles would, Tunnadine feels, frighten most failing men out of their wits.
Many of these men have a naturally diminishing libido, which may be partly physiological and partly due to familiarity with a long-established partner and increasing responsibilities at work.
In her opinion, to return from a hard day’s work to find that their wives have been persuaded to turn themselves into scarlet women, would have a disastrous effect on most of these men.
Whether a doctor prefers to prescribe repeated injections or kindly reassurance from a skilled counselor, which may be all that is needed, it is generally agreed that the essential first step in treatment is to exclude the organic causes of impotence, which may respond to medical or surgical treatment.