Sexual failure expectation syndrome is a psychogenic disorder of sexual behavior characterized by anxiety, fears and erectile dysfunction. It is manifested by obsessive thoughts and emotional tension caused by the fear of the impossibility of performing a full-fledged sexual act. The patient predicts a disorder of erectile function, strives for hypercontrol of penile tension. Diagnosis of the syndrome is carried out with the help of conversations, specific questionnaires. Treatment includes psychotherapy, sex therapy, the use of antidepressants and tranquilizers.
F52.8 Other sexual dysfunction not caused by organic disorder or disease
The full name of the disorder is the syndrome of anxious expectation of sexual failure (SAESF). In accordance with the International Classification of Diseases 10 revision, it can be classified as Phobic anxiety disorders (F40) or Obsessive-Compulsive disorder (F42). The prevalence of the syndrome among patients who turn to a sex therapist is 30%. Cases of erectile dysfunction of psychogenic origin are reported by up to 90% of men. According to statistics, SAESF most often develops at the age of 18 to 30 years, when the risk of physiological impotence is minimal. Sometimes symptoms appear before the first sexual experience.
The probability of developing the syndrome as a pathological reaction to stress is determined by two factors: personal characteristics, the nature and intensity of the traumatic effect. It was found that men with psychasthenic traits, a tendency to hypochondria, increased emotivity, and low self-esteem are more susceptible to the disorder. Among the external provoking causes are:
- A bad first experience. The expectation of sexual failure often occurs during the first sexual intercourse with a more experienced partner. Similar experiences may occur if the girl is less experienced and psychologically not ready for sexual contact.
- Partner’s incorrectness. Authoritarianism, excessive demands, sarcastic remarks about a man’s appearance and behavior become a cause of uncertainty. The closer the partners are emotionally, the stronger the influence of these factors.
- Overwork. Physical and mental fatigue causes a lack of erection. A man is not always aware of this connection, a fear of failure is formed, which prevents sexual contact even after rest and recuperation.
- Feeling unwell. General weakness, headache, fever and other somatic symptoms prevent a man from performing sexual intercourse, despite the desire and willingness of a woman. Self-doubt is transformed into the expectation of failure.
- Intoxication. A man’s ideas about his own sexual possibilities during intoxication do not correspond to reality. With alcohol abuse, failures are repeated, increasing the feeling of sexual failure.
- Stress. The cause of erectile dysfunction may be a situation that is not related to sexual life, but has caused emotional tension. Experiences due to the likelihood of repetition lead to the development of SAESF.
- Passion for porn products. Distorted ideas about sex, getting an orgasm as a result of masturbation reduce a man’s real sexual capabilities. Judgments about sexual relations change, the ability to establish and maintain contact with real women suffers.
SAESF is formed and develops according to the type of neurotic disorder. Sexual function in men is given a high social and physiological significance. Non-compliance of sexual intercourse with certain generally accepted or individually significant criteria is regarded by men as a stressful situation that poses a threat to personal well-being, successful maintenance of love, marital relationships. Natural physiological rhythms, a mismatch of sexual temperament, a difference in the capabilities of partners are mistakenly interpreted as manifestations of pathology, cause anxiety before the next intimacy.
At the physiological level, stress is accompanied by a violation of integrative processes in the brain. Emotional stress, anxiety, fear change the production of neurotransmitters, hormones, provoke dysfunctions in the work of the autonomic nervous system and internal organs. In combination with neurotic experiences, this contributes to the formation of psychogenic impotence. Thus, fixation on a negative experience increases the likelihood of its repetition, strengthens neurotic experiences.
Sexual failure expectation syndrome has several stages similar to the stages of development of neurotic disorders: the first appearance of the experience, its consolidation, systematization and development of restrictive behavior. Determining the stage of the syndrome allows you to assume a prognosis, choose the most effective treatment tactics. The development of fear of sexual failure is divided into:
- Primary concerns. The only unsuccessful experience of sexual intimacy forms complexes. Depending on the personality traits, they can be successfully overcome or fixed in behavior.
- Secondary failures. Low stress resistance, the anxious and hypochondriacal nature of a man provokes stable destructive thoughts and emotions (“I can’t”, “it won’t work again”).
- Systematic fear. Periodic failed attempts to perform sexual intercourse contribute to the development of a persistent expectation of sexual failure. Emotional experiences include fear, panic, depression.
The key feature of the syndrome is the expectation, prediction of erectile dysfunction in a situation of intimacy. Patients concentrate on sensations in the penis, strive to establish control over tension and relaxation, but to no avail. Psychogenic erectile dysfunction, changes in gender-role behavior, obsessive-compulsive neurosis are formed. Confidence, initiative and self-esteem decrease. Every intimacy with a woman becomes a stressful situation, generating anxiety and anxiety. Involvement in sexual foreplay and sexual contact is superficial – a man is concerned about the expected failure, seeks to control the process without distracting from the “plan” or “scenario” thought out in advance. Natural relaxation and enjoyment are impossible.
Constant anxiety is compensated by avoiding sexual relations. Men find reasons that prevent intimacy (fatigue, malaise, lack of time, unsuitable environment) or completely terminate relationships with women, justifying their behavior with other priorities – the need to devote time to career, travel, professional sports, spiritual search. The motive for avoiding is not the desire to reject a partner, but the need to preserve one’s own dignity. Sexual desire persists, increasing tension, irritability, dissatisfaction with oneself. Thoughts about sexual insolvency acquire the character of obsessions.
A prolonged course of SAESF without medical and psychological intervention develops into a more persistent disorder – coitophobia. It manifests itself as an obsessive fear of sexual intercourse, is more difficult to treat, often provokes sexual and social maladaptation – patients refuse to enter into love relationships, do not create families. Complications of the syndrome of expectation of sexual failure are depression, obsessive-compulsive or anxiety disorder, sleep disorders, behavioral deviations of the compensatory type – the sharpening of stenic character traits (aggressiveness, despotism), workaholism.
Psychotherapists are engaged in the examination of patients with suspected SAESF. Diagnosis is aimed at identifying the characteristic symptoms of the syndrome and its differentiation with coitophobia. The main difference is that with a pathological fear of sexual intercourse, a man is not just alarmed by a possible failure, but experiences a persistent fear that forces him to completely abandon sexual contacts and any forms of behavior that contribute to the development of intimacy – flirting, courtship, invitations to dates are rejected. The complex of diagnostic procedures includes:
- Clinical conversation. Among the patient’s complaints, the leading symptoms are emotional disorder – anxiety, tension, fear of repeating unsuccessful sexual contact. The critical attitude to the disorder is relatively intact, the man understands the psychogenic nature of his condition, does not avoid communication with representatives of the opposite sex.
- Questionnaires. For a preliminary assessment of the state of the sexual sphere, the questionnaire Sexual Formula male (SFM) is used. There is a marked decrease in the indicators of the “mood before intercourse” scale, a relative decrease on the scales of “sexual enterprise”, “frequency of sexual acts”. Additionally, methods of personality and sexual life research are used (A. Lazarus Marital Satisfaction Questionnaire, L. Berg-Cross Sexual Satisfaction Questionnaire).
- Consultation of an andrologist. Examination by a narrow specialist is necessary to exclude persistent physiological causes of impotence. Physical examination is carried out, laboratory tests are prescribed (blood and urine test, identification of specific markers), ultrasound of the penis.
The main goals of therapy are the elimination of anxiety and emotional tension, the restoration of normal sexual relations with a partner. Treatment is carried out by a psychotherapist, a sex therapist, a psychiatrist. The greatest efficiency can be achieved with the involvement of a partner in the process. The patient care program includes the following methods:
- Individual psychotherapy. The method of conversation, training in relaxation and self-regulation skills is used. Sessions are aimed at removing negative emotional experiences, increasing self-esteem and self-confidence, changing perceptions about the role of sexual contact in relationships.
- Sex therapy. This method refers to marital psychotherapy. The use of behavioral techniques aimed at obtaining a positive sexual experience is widespread. On the recommendation of a specialist, the couple practices flirting techniques, stimulation of erogenous zones, “imaginary prohibition” with active petting.
- Pharmacotherapy. Medical correction is necessary to eliminate pronounced emotional disorders (anxiety, depression) and increase sexual desire. Tranquilizers, adaptogens and antidepressants are prescribed, most often SSRIs.
Prognosis and prevention
With complex psychotherapeutic and pharmacological correction, the syndrome has a favorable prognosis, but in some cases there is a high risk of relapse in the event of interpersonal conflicts in a couple. The main way of prevention is to maintain trusting, open relationships between partners. It is recommended to practice various ways of obtaining sexual pleasure, without focusing solely on coitus. A variety of foreplay, the use of oral techniques, special toys increases a man’s confidence, making the couple less dependent on having an erection.