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Samuel came to the sexology clinic a devastated man. In his own words, his world was crumbling, life was meaningless and unless a quick solution was found, death was imminent.

“Whose death are we talking about here?” I asked, concerned. With the recent spate of deaths related to crimes of passion and involving powerful politicians and celebrities, I was not about to take anything for granted.

“My wife has threatened to leave me, my boss at worked yelled at me the other day and threatened to sack me… I feel hopeless, I feel like dying!” Samuel answered. He explained that his troubles started when he had premature ejaculation and before he could come to terms with it, his erections failed.

Samuel was a 37-year-old statistician working for a research organisation. He had been married to a 36-year-old business lady for six years and had two children.

After Samuel’s premature ejaculation and ED, he developed a fear of sex. He dreaded failing again. He could not face his wife in bed. They had not had sex for four months. His wife was now accusing him of having an affair. This only served to torture Samuel further, and he turned to alcohol for consolation. He also watched TV until late and only went to bed when he was sure his wife was already asleep, then woke up early and left before his wife woke up.

Because he slept only a few hours every night, Samuel was fatigued and too stressed to perform well at work. His boss was not pleased and threatened to sack him. Samuel felt cornered from all ends. My assessment was that his self-esteem was at its lowest. I diagnosed him with sexual performance anxiety.

Sexual performance anxiety is based on the false belief that sex is like football or rugby; that a man or woman must show their prowess. For a man, ‘winning the game’ equates to true manhood, which is characterised by a huge penis, firm erection, and long hours of penetrative sex. Failure to achieve this superhuman performance makes one persecute themselves, believing that they are failures. These thoughts can overwhelm the person making them lose self-confidence. Their egos crash and this begins to affect all aspects of life including work performance.

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“That analysis is very much what I am going through,” Samuel interjected. Affected men also develop weird self-image and may feel unattractive and even stop grooming. They may feel that one part of their bodies, including sex organs, are abnormal. This is part of the psychological distortion brought by performance anxiety.

Treating performance anxiety starts with the understanding that sex is not a game to be won; it is an act of giving and receiving pleasure. This goes beyond penetrative sex. There are many ways to pleasure your spouse without necessarily engaging in penetrative sex.

“But doctor, that does not work for Africans,” Samuel said. Samuel’s belief is what couples must change to evade performance anxiety. The myth that penetrative sex must be movie-like leads to severe anxiety if things do not go as per the expectations. This anxiety is counterproductive because it knocks off any remaining sexual abilities.

While refocusing the mind is key, investigating and treating any sexual failures which could have led to the problem in the first place is important. I therefore examined Samuel to rule out any underlying medical problems. Test results showed no obvious disease. I concluded that Samuel’s problems were psychogenic. The treatment for this was sex therapy which Samuel had to undergo with his wife. It took three months to resolve the problem.

“This treatment has not just saved my marriage, I have quit alcohol and my performance at work has also improved,” Samuel said on his last therapy session. I nodded.

I shook his hand to bid him farewell. “Seeking care in good time saves families, communities and the whole country,” I said as he left the clinic.



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