NOTES for the SEXUAL THERAPIST
By its emphasis on a parental and environmental understanding
of sexuality, psychological theory and practice inadvertantly reinforce
the feelings of shame and social non-acceptance even rejection for
the sufferer of foreskin conditions.
The science of psychology shoulders great responsibility in the
understanding of sexuality and shows great compassion for men`s
doubts and worries about their sexual and self images, their castration
fears etc., However the actual reality of a non-functional erection
and its influences are ignored.
The accepted cliché - that one`s equipment is always "normal"
or that the man`s penis size shape or any other difference is irrelevant
to his being a man - has significant consequences for individuals
with anatomical problems. As every youth understands that penis
size and bends etc. should not affect his sexuality, the
isolated individual with actual (or imagined) physical problems
is under immense social pressure to forget or repress these embarrassing
socially unacceptable and even laughable ideas; instead of being
able to freely discuss the subject andreceive some specific treatment
(or be reassured). His guilt and shame magnify and compound his
Against the background of his many years training, the psychologist
at present when confronted with "foreskin problems" will deduce
that a psychological disturbance must lie at root, thus causing
the anatomical condition to become a problem in the first place.
It is necessary to correct this situation.
In contrast to worries about penis size and shape, foreskin
conditions are actually and manifestly painful or difficult during
sexual activity and this has a significant effect on the sexual
possibilities and behavioural development.
Against a background of repressed or accomodated anatomical genital
pain or difficulty there will be inevitable psychological repercussions
- it would be rather remarkable if this were not the case. And as
the painful erection is only one factor supporting and combined
with all the other factors in a personality, the consequent behavioural
and psychological patterns will inevitably be related to childhood
problems. But among these childhood problems it is important to
recognise that the anatomical predisposition to pain or difficulty
was often present since birth and the influence of an uncomfortable
and avoided erection is a fundamental influence in the psycho-sexual
development of an individual.
This overlooked phenomenon could excite considerable interest
Therapists should be aware that even if environmental problems
appear to predominate, a short conversation to confirm the patient
is aware of foreskin retraction will eliminate the possibility of
this extra hidden complication.
WABREK - The Therapists Responsibility
Students of sexual psychology are sometimes taught that if a man
reports pain during sex then they should send him to a Urologist (93), Wabrek made this mistake before concluding: "During the physical examination,
most males don't get an erection, so it is difficult to find out
if the foreskin will retract over the erect glans; therefore, this
must be elicitated by history."
Wabrek points out the responsibility of the sexual therapist
to discuss this uncomfortable subject with the patient and not simply
send the patient away to the Urologist. Diagnosis is sometimes only
possible during erection OR through dialogue.
Urologists do not give an erection stimulant and then test the
free movement of the foreskin - (at speed!) - Urologists diagnose
foreskin conditions in the flaccid state. They receive no training
on the point which Wabrek establishes "The teaching point is that just because the foreskin
slides over the flaccid penis does not mean it is going to slide
over the erect penis."
How To Ask
To ascertain if a foreskin condition could be causing problems the
therapist may first tentatively ask if the patient is circumcised
- this may eliminate the need for further questions or pave the
way for more detailed questioning: To ask if retraction take place
automatically during erection may be a tactful and informative step;
however after this it will be necessary to use the simplest and
most accurate method of enquiring directly - if it is enjoyable
to move the foreskin, alternately covering and uncovering the glans.
It is not enough to ask if the glans shows during masturbation,
men who expose only the tip of the glans will often believe that
this is sufficient, others will habitually hold the foreskin retracted
to avoid the ring scraping over the glans. If there is a foreskin
then this must be able to move freely not being held forward or
backward in any way.
To ascertain the exact nature of the problem, a brief discussion
about the sexual effects gives a far more accurate diagnosis than
Please read: Adult Info.
See also The Psychologists