2.2. Second Clinical Report
A 40-year old African American enlisted serviceman with 17 years of continuous active duty presented with difficulty achieving erections for the previous three months. He reported that when he attempted to have sexual intercourse with his wife, he had difficulty achieving an erection and difficulty maintaining it long enough to orgasm. Ever since their youngest child left for college, six months earlier, he had found himself masturbating more often due to increased privacy. He formerly masturbated every other week on average, but that increased to two to three times per week. He had always used Internet pornography, but the more often he used it, the longer it took to orgasm with his usual material. This led to him using more graphic material. Soon thereafter, sex with his wife was “not as stimulating” as before and at times he found his wife “not as attractive”. He denied ever having these issues earlier in the seven years of their marriage. He was having marital issues because his wife suspected he was having an affair, which he adamantly denied.
His medical history was only significant for hypertension, which was diagnosed more than two years earlier and had been well controlled with a diuretic: 25mg of chlorthalidone daily. He took no other medications or supplements. His only surgery was an appendectomy performed three years prior. He endorsed smoking three packs of cigarettes per week for over ten years and drinking one to two drinks per week. Physical exam revealed vital signs within normal ranges, normal cardiovascular exam, and normal appearing genitals without lesions or masses.
At the end of the exam, his issues were attributed to heightened sexual stimulation threshold from exposure to hardcore Internet pornography and frequent masturbation.
To phrase it differently, the partnership grew towards some thing we both appreciated while the program criteria turned into supplementary
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