Lack of Sexual Desire, Aggravated by Hypoerection Caused by the Neurosis of Expectation of Failure. Case from Clinical Practice
Authors: Kocharyan Garnik 
Published: February 2025

Hypoactive sexual desire is the commonest sexual complaint in women (33.4%). In men, this is revealed rather frequently too (15.8%) and takes the third place among such complaints. Anxious sexual failure expectation syndrome (ASFES) is the most universal sexopathological syndrome in men that most often manifests with erectile disorders. In order to treat absence of sexual desire and ASFES, in particular, different methods of psychotherapy are used, including hypnosuggestive one.
The article describes a clinical example of the successful therapy of the patient, whose main sexual dysfunction consisted in a loss of sexual desire, aggravated by hypoerection due to failure expectation neurosis. In that case hypnosis was the main method of therapy. Male patient B., aged 47, had been in a “common law marriage” during 10 months. He sought medical treatment solely on the initiative of his “common law wife” (CLW). As far as he was personally concerned, he was absolutely satisfied with his own state and did not feel any distress related to it. On presentation he reported absence/loss of sexual desire, mild hypoerection, presence of slightly expressed anxious expectation of sexual failure, absence of morning erections, having sexual intercourses once a week without any desire and solely on the initiative of his CLW. The disorder developed in him under the influence of stress caused by a divorce with his wife, who was unfaithful to him. In that connection he developed a negative attitude towards all women by the mechanism of generalization.
The diagnostic conclusion was examined from the viewpoint of 2 classifications: ICD-10 and ICD-11. The first case dealt with the following pathology: “Lack / loss of sexual desire” (F52.0), aggravated by hypoerection as result of slightly expressed failure expectation neurosis (“Social phobias” – F40.1 and “Predominantly obsessional thoughts or ruminations” – F42.0). The second case dealt with only the presence of sexual disharmony, and it is impossible to make a medical diagnosis taking into account the fact that the general characteristics of sexual dysfunctions in ICD-11 have the following criterion, which is worthy of being noted. In order to be considered as pathology sexual dysfunction should be associated with clinically significant distress that was not present in our patient. The following correction was made: (1) help in comprehension of the origin of his sexological symptoms by the patient; (2) hypnosuggestive therapy (10 sessions), aimed to increase resistance of the organism against stress-producing effects of the social and psychological character; increase of sexual desire for women in general and for his CLW in particular; elimination of anxious expectation of sexual failure and saturation with confidence in his sexual powers; programming of the normal course of coitus. Besides, (3) an apiproduct, that among other things, increases sex drive and (4) a physical exercise were administered for increasing his sexua l desire.
It should be pointed out that the first session of hypnosuggestive therapy, which was the main component of treatment, for the first time produced morning erection that had been absent three years before the beginning of the treatment. The above change persisted during the whole period of therapy. After the second session of hypnosis the patient’s sexual desire increased and he had two high-quality vaginal sexual intercourses on his own initiative. After all subsequent sessions of hypnosis high-quality vaginal contacts took place, which happened both on the initiative of one of the partners or on their joint initiative. Before the beginning of treatment the above intercourses happened only on the CLW’s initiative.
Also it should be pointed out that after the beginning of treatment the rate of sexual intercourses significantly increased. Anxious expectation of sexual failure was completely eliminated after a few sessions of hypnosis. The duration of intercourse also increased; this fact can be particularly explained by a significant increase in their frequency. This led to the fact that if before the start of treatment in CLW, orgasm occurred rarely, then in the course of it, it began to occur every time.
The therapeutic effect came extremely rapidly that was not expected by both the Investigator and the patient. Was it possible to limit ourselves to a smaller number of hypnotic sessions? Obviously, yes, it was, but the course of treatment should not be reduced to a very small number of them in order to prevent a possible “slipping down” of the patient to the state that had existed before. Apitherapy as well as the suggested physical exercise should be considered in this case as accessory therapeutic factors. The question arises as to whether it was necessary to treat the patient who was satisfywith his own state. But we should not forget that the above state did not satisfy his partner and caused sexual disharmony. In this case the answer is absolutely obvious, because both the patient and his CLW were completely satisfied with the results of treatment. It should be noted that the information received from the patient a month after the end of his treatment indicated that the achieved results were stable.