Kocharyan G. S.


Kharkov Medical Academy of Postgraduate Education


The article informs on results of psychovegetative and psychosensory disturbances studies among men with fear of sexual failure. These disturbances take place during sexual situations. It is described new worked out by the author diagnostic test, which has allowed to reveal clinical symptoms that can not be found with help of traditional clinical diagnostic methods.

It should be noted that vegetative dysfunctions, caused by psychogenic effects, including the ones observed in neuroses, are in the field of view of researchers [1–8], but it cannot be said about the above disorders due to anxious sexual failure expectation syndrome (ASFES). But we revealed (after clinical examination of 254 males) that such patients had different disorders, which appeared in the situation of intimacy and resulted from a dysfunction in the autonomic part of the nervous system. These disorders were situational paroxysms and subparoxysmal states of the sympathetic-adrenal or mixed character.

Sympathetic-adrenal paroxysms and subparoxysmal states manifested themselves with tachycardia, chills and chill-like hyperkineses. Single cases reported unpleasant sensations in the region of their heart and behind the breastbone. One patient revealed throbbing headache of the temporal localization; the pain was caused by excitement, occurred several times a week and outside the situation of intimacy as the result of chronic influenza encephalitis. Thus ASFES only exposed the available somatic (in its broad sense) trouble, caused by  a neurological disease. One observation found out tachypnoea.

Cases of mixed vegetative paroxysms and subparoxysmal states revealed, besides the above manifestations, difficult inspiration accompanied with the feeling of shortness of breath. In one of these observations the respiration was so difficult that, according to the patient, even hoarseness developed. Only one patient reported difficult inspiration and expiration simultaneously. The results of the inquiry also included stomach rumble, increased perspiration, occasionally the sensation of fever and blush. One patient, who suffered from duodenal ulcer, immediately after the coitus or 10–15 minutes after its end developed pains in his epigastrium, this phenomenon being absent before the appearance of ASFES. The pains came on when he was nervous. Owing to a bad quality of the coitus he was always nervous. Another patient had gaseous eructation. Cases of activation in the parasympathetic part of the autonomic nervous system sometimes developed urges to urinate; in one of the patients whom we examined the above urges were accompanied with low intensity pains in the region of his bladder. In order to provide more detailed acquaintance with cases in which urges to urinate were associated with intimacy we would like to give some examples. Thus, patient Sh., aged 34, had the diagnosis of secondary pathogenetic titularization, which persisted after sanation of chronic prostatitis, and failure expectation neurosis; almost always in the preliminary period he developed urges to urinate (though immediately before intimacy he might urinate). During the coitus the urge became weaker, but immediately after the coitus the urge increased again. Patient S., who was diagnosed failure expectation neurosis against a background of weak sexual constitution, 15 minutes after the coitus in 80 % of cases developed weak urges to urinate too, in spite of the fact that not long before the coitus he might urinate. The amount of urine was small; the urge with passage of urine with a normal colour was single. The intensity of the urge was of such a degree that he even could refrain from satisfying the desire that appeared. In case when the structure of autonomic dysfunctions contains disturbances from the parasympathetic part of the autonomic nervous system, stomach rumble may be accompanied with urges to defecate. For example, patient D, aged 44, who was diagnosed to have failure expectation neurosis, found out that before every attempt to have coitus he developed stomach rumble and had to go to toilet “to do number two” (much less frequently “to do number one”). During this period the libido and small erection, which appeared at the time of caresses and kisses, disappeared. When he tried to ease himself, faeces went out in a small quantity, or sometimes only flatus passed. The patient also noted that every time he had a strong desire to defecate, but that desire was incomparable with its final result.

Very seldom the above disorders in the autonomic sphere were observed in their isolated form. More frequently they were combined like, in particular, in the following example.

Patient S., aged 49, single. Diagnosis: depressive neurosis (dysthymia) with ASFES against a background of weak sexual constitution, hypoerection sign; chronic sluggish prostatitis; oligophrenia at the degree of mild debility (mild mental deficiency). At the time of intimacy during the preliminary period the patient develops muscular tension of his arms, legs and trunk, chill-like hyperkinesis in the arms and contraction of some of their muscles as well as urges to urinate before the second attempt (though shortly before the coitus he might urinate), so for this reason he even has to discontinue caresses and satisfy the need, which has appeared. Besides he has difficult inspiration and increased perspiration.

Besides the sensations, which, as we found out during standard questioning, developed in ASFES patients in the situation of intimacy, we managed to reveal other sensations that appeared in the above cases in the same situations. The latter observation became possible owing to the fact that we asked the patients to present their fear kinaesthetically, visually and audially. In this case their right wrist was covered with the physician’s left hand (test with sensorization). This examination was carried out on 33 people. Besides the disorders, which we revealed in the process of simple questioning, the patients mentioned appearance of warmth in the occipital part of their head and cheeks, feeling of vacuum in the head, numbness in the anterior part of their neck, heaviness in the upper, middle and lower parts of the thorax, feeling of compression in the chest, numbness along the anterior surface of their chest as well as in its left half. They felt cold and numbness in their back, creepy sensations there, contraction of muscles in the whole abdomen, heaviness in its upper half, pressure, cold and numbness in its lower half, warm feeling rising from the solar plexus to the middle of the chest and descending backwards as well as compression of muscles in their perineum. The patients also mentioned numbness and cold in their penis, feeling of some collapse and vacuum in it, disappearance of feelings of their penis and testes (“as if they were absent”). They were troubled by heaviness, cold and numbness in their arms (this numbness reached the hands), numbness in the fingertips, creepy sensations on the posterior surface of their arms and heaviness in them, numbness and cold in their legs, constraint in the femoral muscles, creepy sensations in the patellae, weakness in their legs and knees as well as hot sensation in their feet. Besides the patients felt the sensation of excitement in their heart, cold or warmth in the whole body, weakness in the whole organism, the sensation as if their body went to their legs; they felt a single, double and triple (by its rate) pulse in the whole body.

The described sensations were significantly more frequently observed in different combinations. Sometimes any attempts to reveal them failed. Comparison with data of standard questioning, performed by us in the above cases, demonstrated that the patients felt exactly the same sensations in the situation of intimacy and they differed only by their intensity.

Patient S, aged 28, married. Diagnosis: failure expectation neurosis (sexual failure fear), chronic prostatitis against a background of weak sexual constitution, signs of hypoerection and accelerated ejaculation. During the described test for ASFES sensorization he reported that he had lost the feeling of his penis and testes (as if they were absent), as well as developed trembling in his knees, flushes in his cheeks and increased perspiration in his axillary regions. The latter was noticed during coituses before the development of the above sexual disorder too, but now its manifestation is somewhat higher. He states that all the above phenomena also take place in the situation of intimacy, but then they are more intense. The above situation develops trembling in the whole body rather than in his knees only.

It was not in rare cases that patients confessed that during intimacy they had only some of the feelings, which developed at the time of the described test.

Patient O., aged 41, married. Diagnosis: failure expectation neurosis (fear of sexual failure); signs of hypoerection and hypolibidaemia. During the test for ASFES sensorization he reported that he had a feeling of warmth in the whole body and appearance of perspiration on his forehead. He felt pulsation in his axillary regions and a flow of warm blood from the above regions to his hands. While the former sensations developed in the situation of intimacy too, he somehow did not feel in such a situation the latter ones, which were difficult to describe.

During the above test some patients had the feelings, which in their opinion were absolutely absent in sexual contacts.

Patient K., aged 20, single. Diagnosis: failure expectation neurosis (fear of sexual failure) in the personality, accentuated according to the psychoasthenic type with schizoid inclusions; hypoerection sign. During the test for ASFES sensorization he felt chills in his breastbone region and epigastrium as well as trembling of his knees. Such sensations as well as any others, besides mental stress (“butterflies in his stomach”), had never been felt by him during intimacy.

To our mind the sensations, which develop during the above test, in some cases may be simply left unnoticed by males at the time of intimacy, because in this situation even in the presence of anxious failure expectation these men are first of all executors rather than observers, this fact raising their perception threshold. At the same time it is not always that the above dissociation in felt sensations is caused by the mentioned factors (true or imaginary intimacy, chiefly executor’s function or the role of an observer). We believe that some cases deal with associative phenomena, when the negative mental state felt by the patients during their test for ASFES sensorization revives kinaesthetic sensations, which they develop during any other negative feelings.

Patient I., aged 30, single. Diagnosis: failure expectation neurosis (fear of sexual failure); sign of hypoerection; primary hypogonadism (resulting from cryptorchism) with damage of the tubular tissue and testicular hypoplasia. During ASFES sensorization besides the sensations, felt by him in sex contacts, he developed a single, double and triple pulse (by its rate), whose beating was felt by the whole body. That phenomenon was not caused by coituses, but sometimes appeared at night during sleep and could even wake him up. He attributed the appearance of the above sensations to the stories told by his father, who died from a heart disease. Those sensations developed immediately after his father’s death, or maybe even earlier.

Some sensations, which were revealed with help of the described test and observed during intimacy, were of the compensatory character and caused by other, negatively perceived sensations. Thus, for example, one of our patients felt some tension (“compression”) of his perineal muscles, which was of the compensatory character, because owing to the absence of feeling of his penis he nevertheless tried to feel it with help of contractions of the above muscles, check the degree of its tension as well as increase erection.

During our tests for ASFES sensorization we also received visually reproduced or constructed images and plots, which made it possible to judge what the patient thought about the given situation or, in his opinion, what his female partner thought about it. Thus, one of our patients saw a 30-year-old naked brown-haired woman. She was not telling him anything, but with her gestures and smiles inclining him to have intimacy, whereas he did not venture to do it as he was afraid to fail. Another man saw his naked female partner in the condition of intimacy. She looked at him reproachfully, as if dissatisfied with something, and after that turned away at all.

Like kinaesthetic sensations, the appearing visual images may be of the associative character too. In this case their emotional potential is negative. Thus, during the described diagnostic test one patient saw a dark immovable unshaven face and hair on that head actually growing from the eyebrows. He said that it corresponded to the image of I.V. Stalin, which had developed in him a day before, when he read for the night the story The Next Day by Alexander Beck.

Sometimes besides kinaesthetic sensations and visual images and plots, particularly when prompted by the experimenter, verbalization of what was going on took place. Thus, for example, during the test for ASFES sensorization one of our patients saw his wife naked. She was looking at him reproachfully and saying that she did not believe in any improvement of the situation, even in case of treatment (he began hearing her voice after I asked what she was saying). His wife used to tell him the same in reality too.

Thus, we should note that the test for ASFES sensorization, which we carried on, made it possible to reveal in patients with the studied syndrome those changes, which had not been revealed before, thereby enriching the available data about the clinical picture of the above syndrome as well as, in some cases, extending the knowledge about the patient.



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Bibliographic data about the article: Kocharyan G. S. Sindrom trevozhnogo ozhidaniya seksual’noy neudachi u muzhchin: kharakteristika psikhovegetativnykh i psikhosensornykh rasstroystv // Dermatologiya Kosmetologiya Seksopatologiya. – 2002. – 1-2 (5). – S. 69–72. [Kocharyan, G. S. Anxious sexual failure expectation syndrome in males: characteristic of psychovegetative and psychosensory disturbances (The Article was translated  from the Russian language). Dermatology Cosmetology Sexopathology. 2002; 1–2 (5): 69–72.]

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