SEXUAL DYSFUNCTIONS AND DESIRE

On his first visit to our office, Al, a forty-seven-year-old divorced insurance agent, sadly sums up his feelings about sex. "If I can't do it right, why do it at all?" he sighs and waits for our response to a story we have heard many times before.
Broad-shouldered and of average height', Al has a receding hairline, although he tries to disguise it by combing some of his remaining hair over his bald spot. Once a promising middle-distance runner, he now works out at a local gym and lifts weights. "I didn't want to go to seed completely," he chuckles and pats a beer belly that is only partially concealed by his V-neck sweater with the alligator applique. Calling himself a "man's man, a very traditional guy," Al admits he has very traditional ideas and attitudes on sexuality.
Faithful to his wife during their twenty-two-year marriage, Al describes his sex life while married as "sometimes good, sometimes not so good—never what you'd call fantastic." He wonders if his wife would give it a less favorable evaluation, since she left him for another man, a family friend with whom Al had a very competitive relationship and who Al always thought outshined him.
Depressed following the divorce, feeling displaced, and already questioning his sexual prowess, Al found himself thrust into a world of dating where all the rules had changed. "I'm no Robert Redford," he says, "but you'd think I was, the way women started coming on to me when they found out I was available. I was a hot commodity."
Al was unprepared for what he encountered and confused by it. "I had a hard enough time figuring women out when they did what everybody said they were supposed to," he sighs. "But now, nothing that was happening made sense. It was a whole new ballgame." What he perceived to be aggressiveness on the part of women—including many women he had never dreamed would be attracted to him—simultaneously excited and frightened him. "One part of me didn't like it and another part did," he explains. "I was free to do anything I wanted and God knows I had plenty of opportunities. But these women, they seemed to expect so much."
And sometimes Al couldn't deliver. The first few times he had difficulty maintaining an erection, he made light of the situation, blaming it on drinking too much earlier in the evening, being tired after a long work day, or not "really" feeling attracted to his partner. But even with these plausible explanations, Al began to feel anxious and fearful, always anticipating the next "test" of his manhood and worrying that he would fail to perform up to par.
This set off a vicious cycle of expecting sexual encounters to end in humiliation and failure while at the same time hoping the next sexual encounter would be different. But it was never different. And Al's anxiety increased to the point where he not only had difficulty maintaining an erection, but had trouble even getting one. Increasingly he became a worried spectator, waiting for something to go wrong. Eventually, his anxiety doused his sexual desire as effectively as an ice-cold shower.
Soon he began to avoid sex because he felt he could not risk the humiliation of another disappointing sexual performance. "I missed it for a while," he says. "But I really don't anymore. A really sexy young girl could walk in here right now, sit down on my lap, and start undressing, and I wouldn't react. I wouldn't feel a thing or I'd just turn it off if I felt it."
Fearing future failures, Al has stopped dating, and in fact avoids social situations that might lead to sexual ones. "The way I figure it," he says with a shrug, "why enter a race that you know you can't win?"
A full discussion of sexual dysfunctions and difficulties other than ISD is beyond the scope of this book. However, because some ISD sufferers also experience these other problems—before or after the onset of ISD—and because we will refer to these difficulties by name throughout the remainder of this book, you need to know what they are. The following tables briefly describe the most commonly experienced dysfunctions.
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