In recent years the potential of volition to change the functioning of the autonomic nervous system has been increasingly explored. Treatment modalities including hypnosis, biofeedback, relaxation training as well as meditative techniques have indicated that bodily processes occurring below the level of awareness can surface into the area of conscious control with implications for self-management (Schwartz, 1973; Griffith, 1972).

Meditative treatment has been used successfully to modify arousal states and to induce altered states of consciousness (Deikman, 1963; Maupin, 1969). The early study of Indian yogis (Brosse, 1946) demonstrated their capacity for heart-rate control. Since then, studies of meditative practices have yielded information on their potential to slow respiratory rate, lower blood pressure, decrease oxygen consumption, lower skin conductivity, and induce EEG changes with increases in alpha wave preponderance and amplitude (Anand et al., 1961; Wallace & Benson, 1972; Benson et al., 1975).

The rationale for using a meditative technique for the treatment of sexual impotence came from different sources. During the course of evaluation, one patient in this study remarked that he had noted a virtual disappearance of sexual feelings in his genitals, especially marked at times when he attempted to have intercourse. He described it as sexual anaesthesia and contrasted it to the familiar sense of fullness and warmth he had experienced before his condition developed. Subsequently, all individuals in this study were screened for this phenomenon; six out of nine men reported an absence of genital feelings, and the remaining three men reported a partial decrease in their genital sensations.

The mechanisms leading to erectile response involve a relaxation of the vascular musculature with consequent engorgement of the penile spongiosum. When asked to introspect into the genital areas during in erectile response, individuals will invariably describe sensations of fullness and warmth.

A recent study of the male sexual response (Koshids & Sohado, 1977) making use of thermography showed increases in genital warmth occurring 2 minutes after exposure to an erotic movie.

It was hypothesized that some cases of secondary impotence may involve a deficit in those psychophysiological systems responsible for the expression of genital warmth and that training the individual to reexperience this sensation could reestablish sexual competence. Meditation seemed highly suited for this purpose because it can provide direct amplification of bodily sensations and bring about concentrated intervention into the locus of altered physiological mechanisms.

Method

Nine patients with secondary impotence and a mean age of 32 years were included in this study. All had this symptom for more than a month with a mean of 2-1/2 months. Five patients had experienced a relatively acute onset in response to a traumatic situation, while four others reported an insidious symptom progression. The former tended to have more than one sexual partner, and the latter related their difficulties to chronic discontent with one partner. Medical checkup revealed no abnormalities.

The rationale for using meditation in treatment was explained to each one as casually as possible to minimize suggestion effects. Instruction was given in the mechanics of the meditative process. Preliminaries to meditation include the choice of an appropriate setting as well as the adoption of a mental set where all outside events, concerns, fears and fantasies unrelated to the experience are disregarded. Instructions were given in the art of sidestepping intruding thoughts and in the task of maintaining clear awareness without drifting off to sleep. Each patient was asked to reach a baseline relaxation level by sitting and focusing attentiveness on the rhythm of breathing. This usually took about 3 minutes, and then respiratory rate, heart rate, and muscle tone dropped to a resting minimum. At that time patients were asked to shift their focus of attention to their genital area and to meditate on the experience of pleasant sensations of radiating warmth, taking care not to tense any pelvic muscles when so doing. After preliminary exercises in the office, each patient was asked to repeat the process twice daily for 15-minute periods.

Results

Five patients reported the experience of minimal genital warmth within 10 days, and two others after 2 weeks of practice. This sensation became stronger and could be elicited more quickly as training continued. The two remaining patients reported fleeting sensations but were continuously distracted by intruding thoughts and could not sustain a workable focus of attention. These patients, although motivated, did not consistently achieve genital warmth and did not develop erectile competence. One of these patients persisted for 7 days, and the other for 2 weeks before becoming discouraged with the technique.

Those who were able to bring about genital warmth were able to reproduce it consistently with subsequent meditative trials. The seven successful patients reported the return of erectile experiences within 2 weeks of the attainment of genital warmth. Coital performance was reported in these individuals to have returned to presymptom levels, and in three patients to have improved beyond that.

Two patients developed the ability to achieve erections at will while in the meditative state, usually after 10 minutes of exercising the technique.

Follow-up at 3 months after the achievement of erectile competence showed stability of therapeutic gains in five patients. One patient was lost to follow-up.

Discussion

The experience with this small group of patients suggests that certain modified meditative techniques may be helpful in the treatment of erectile incompetence. Individuals best suited for this modality are sufficiently motivated to set aside two 15-minute periods daily for meditative practice and have some ability to ease away from their thought streams in order to focus attention on an anatomical part, search for and amplify feelings of heat, and at the same time remain alert and relaxed. The 2 individuals who did not benefit from the technique seemed to have some difficulty with one or another aspect of this complex mental process.

In viewing the results of this study, it is helpful to note that in some studies the rate of spontaneous remission from secondary impotence has been reported to be high. Ansari (1976) found a 68% remission rate 8 months after initial evaluation.

Experienced meditators have been shown to process stress more efficiently as their experience increases (Goleman & Schwartz, 1976). It is possible that our successful subjects were able to handle sexual situations with greater calm than in their previous experience, and therefore less inhibition of sexual response. Interestingly, all successful individuals in this study reported increased feelings of inner peace in their daily lives, while the two men who did not respond to this treatment modality reported no change in their ability to cope with stress.

The efficacy of the technique may also rest on the specific learning of control pathways into the genital ANS. The fact that successful subjects reported genital warmth within a few minutes of exercising, whereas they could not do so before their treatment, and that two individuals reported an acquired ability to create erections voluntarily may support this hypothesis.

The therapeutic possibilities of this technique await further study but already lend some hope to selected individuals suffering from secondary erectile dysfunction.

References