Selective cases of postoperative retention of urine, premature ejaculation, impotency in the male, dysuria, ureteral spasm, and chronic bladder irritation respond to hypnotherapy. Pseudo-orientation in time can help emotional repercussions that might be expected with male or female sterilization. Hypnorelaxation indirectly may have an important bearing on female infertility, as the fertilizing capacity of the sperm is possibly affected by stress factors.
POSTOPERATIVE URINARY RETENTION
Treatment
Postoperative urinary retention, after pelvic or perineal surgery, often is completely relieved by posthypnotic suggestions.3,5,8,21,25,27 An authoritarian hypnotic approach, such as, “You will void in exactly 20 minutes,” is seldom successful. Permissive technics together with sensory-imagery conditioning are more successful. Under hypnosis it is suggested, “Perhaps you may be able to remember in detail what it felt like the last time you urinated. Try to imagine the sensations you experienced the last time you emptied your bladder.” When able to do this, the patient is asked to describe the subjective sensations associated with the act of micturition. These are fed back immediately or during subsequent sessions. No time limit for carrying out the act is mentioned.
After the patient is trained in autohypnosis, he is told, “If you imagine yourself urinating again and again, then you will have no trouble starting the stream. Try not to urinate until you have reexperienced urinating in your mind first.” Asking the patient to carry or not to carry out the act places him in a position in which he cannot refuse or resist the operator's suggestions. Whether or not he urinates, he is being controlled without realizing it. Since the patient does not set the terms, there is no way for him to mobilize further fears that he will not urinate. As the result of the repeated rehearsals of “urinating” under autohypnosis, confidence replaces his irrational fears. Invariably these patients will urinate within several hours, especially if deeply hypnotized and taught autohypnosis during the initial sessions.
These technics are indicated where repeated catheterizations are required. Several publications fail to mention psychogenic factors in urine retention.12,21 This is surprising, as the contraction of the bladder muscle and the maintenance of urinary continence are cortically controlled. The concepts of “voluntary” and “involuntary” control of micturition need to be modified.
The author has seen a number of patients in consultation, many of whom were used for teaching purposes in a hospital setting. In those with highly resistant symptoms, hypnosis was successful in over 80 per cent of the cases. Direct symptom removal by command is seldom effective, as the fearful subject thinks his inability to urinate is “involuntary.” The author recently saw a 60-year-old female who had not voided for 10 days after a hemorrhoidectomy. Utilizing the technics described above, urination occurred within 4 hours after her initial hypnotic induction.
HEMODIALYSIS
There is a growing body of literature on the psychological responses of hemodialysis patients. Of particular interest is the common occurrence of anxiety and apprehension, both before and during dialysis. Hypnosis effectively reduces the anxiety and enables patients to become more tractable to the procedure.9
CHRONIC BLADDER IRRITABILITY
Chronic and recurrent irritability of the vesical neck of the bladder, secondary to psychogenic factors, often is noted in women.28 The predominant symptoms are discomfort, frequency, and dysuria; these respond to hypnotherapy. Many female patients use frequent micturition as a masturbatory equivalent, especially if frigid. One patient's dysuria cleared up only after correction of her husband's impotency. For another, a severe cardiac who was unable to have sexual intercourse, glove anesthesia under autohypnosis was used to relieve her bladder discomfort.
“PEE-SHY” PROBLEMS
Crasilneck and Hall describe a much-neglected syndrome—the “pee-shy” problem.4 Persons so afflicted are unable to urinate in public toilets or when others are watching. These writers recommend that hypnosis be employed in a reassuring, calming way, with suggestions for ease and relaxation in the usually anxiety-filled situation. Patients also can respond to systematic desensitization wherein a hierarchy is set up, and then each step of the situation producing anxiety is treated by successive approximation or stepwise progression. Hypnosis would greatly facilitate this approach.
PREMATURE EJACULATION AND IMPOTENCE
Premature ejaculation and impotency are so widespread in our culture that they might well be called the “emotional plague.” Impotency accounts for many gynecologic symptoms, such as the congestion-fibrosis-hyperemia syndrome. The vascular stasis is secondary to orgasmic dysfunction.
Organic or primary impotency can be established or ruled out by the history. Absence of erection, or premature ejaculation, is always noted, whether the situation is copulatory or masturbatory. No nocturnal emissions or morning erections occur. Heredity, physical factors, and age are predisposing factors to psychogenic or secondary impotency. Ejaculation occurs before or soon after penetration; the erection cannot be maintained.
The psychological causes may be due to anxieties produced by faulty attitudes toward sex as guilt, fear of failure brought on by intense mental activity, preoccupation, fatigue or repeated episodes of failure, hostility toward the spouse, and lack of affection. Abstinence also leads to impotency. The idea is common that sex is wicked, sinful, and not to be used to demean the mate, whom the patient may equate with his mother; moreover, he may be potent with other women (facultative impotency). Another common factor is a deep-seated need to fail in order to reject the mate for various reasons, which are usually unrecognized. Other factors, such as an overly aggressive or highly experienced sex partner, may intimidate the passive male, particularly if latent or overt homosexuality is present. Alcoholism and diabetes are entities often resulting in impotency. Traumatic experiences during childhood, unresolved oedipal conflicts, and feelings of organ inferiority contribute to secondary impotence. Often secondary impotence can be a conversion reaction to threatening life situations. The female who shows her revulsion for the sex act or has the desire to “get it over in a hurry” can render the male impotent. The psychophysiology of erection and ejaculation has been described.15,26
Treatment
Such drugs as testosterone to increase the libido, anesthetic ointments to abolish sensitivity of the glans penis, and prostatic massage have only a placebo effect. Premature ejaculation is often refractory to all types of psychotherapy. Misconceptions and faulty attitudes toward sexual matters must be corrected by reeducation. The male who is sometimes impotent requires only superficial psychotherapy. Most need better communication, particularly if boredom and monotony set in. Many men are totally incapable of love in a mature sense.
Strong reassurance under hypnosis often establishes confidence for the prematurist. Von Schrenck-Notzing reported many forms of impotence that were treated by suggestion and directive hypnotherapy. The first step is to demonstrate that the patient is capable of an erection. Recovery is initiated once self-confidence is strengthened and reinforced. The constant preoccupation with the symptom can be reduced if an indifferent attitude over failure is suggested. Forcing the sex act is harmful. The nondemand performance approach is often helpful.20 Favorable results have been obtained by hypnobehavioral therapy.11,18
Hypnotic treatment of impotence has been reported by several writers.2,6,14,19,23 Anesthesia of the penis has been cured by hypnosis.7 Others have utilized hypnosis for the homosexual component of the impotence.1,14 Four hundred cases of impotence treated by hypnosis and psychotherapy have been reported.4
Technics have been developed utilizing revivification of previous satisfactory sexual contacts under autohypnosis. This effectively conditions the prematurist to perform adequately. In other cases, especially in those who have never had a satisfactory sex act, the premature ejaculation can be treated by reversing the fear of too rapid ejaculation. The following posthypnotic suggestion is illustrative: “You might consider the possibility of being very concerned over not being able to ejaculate, regardless of how hard you try. The more you try, the more difficult it will be to lose your erection.”
Time distortion can be employed to prevent premature ejaculation in a good subject by making him think that he has maintained an erection for a relatively long time. During deep hypnosis it is suggested, “Thirty seconds of subjective or experiential time will seem like 2 minutes of clock time.” Thus, if the prematurist maintains an erection for only 30 seconds, he will think that he had it for 2 minutes. This positive hallucination by which time is “expanded” can be reinforced through further posthypnotic suggestions; it rapidly helps to restore confidence in the patient's staying ability. The wife should be apprised of the situation and told to praise her husband's ability. Naturally, the husband is not made aware of this.
The above hypnotic technics are incorporated with supportive psychotherapy. If the patient feels accepted, he will wittingly or unwittingly reveal the basis for his fears and anxieties that are associated with his sexual inadequacy. Guidance directed toward breaking up the harmful reflex patterns enables the individual to react to his problem in a healthier manner. Extensive probing and attempting to exhume the past is fruitless, especially for the impotent male, who has never been erectively and ejaculatively potent. What should be emphasized is that the spiritual relationship between the partners influences the performance of the sex act.
Sensory-imagery conditioning under autohypnosis combined with behavior therapy are especially effective for refractory cases.
The most disheartening cases are those unfortunate individuals who contend that they are unable to develop an erection during the sex act. The author sees many of them. The majority of these feelings, too, are psychogenic in origin. It has been demonstrated recently that the midline and the anterior thalamic nuclei via the limbic system cortically control sexual functioning. A modification of autogenic training and desensitization therapy is helpful.
Over 60 per cent of individuals can be helped by behavior modification and reconditioning under autohypnosis. The results are relatively permanent, but the work is tedious and often heartbreaking for therapist and patient.
CYSTOSCOPY AND SURGICAL PROCEDURES
There are several reports on the use of hypnoanesthesia for cystoscopy,3 with or without pyelography and other urologic procedures such as urethral dilation and catheterization. Posthypnotic suggestions of relaxation can prevent postinstrumental spasms.
Many different types of minor surgical procedures have been performed under hypnoanesthesia, such as amputation of the penis, circumcision, meatotomy, vas ligation, and fulguration of venereal warts. Many huge scrotal tumors, weighing up to 80 pounds, were removed by Esdaile under hypnosis per se.10 He also performed circumcisions, removed testes, injected hydroceles, and did other similar surgery—all without anesthesia and all before 1850! Today there is no need to eliminate anesthesia, but hypnosis can reduce preoperative anxiety and tension, as well as neurogenic shock in seriously ill patients.
VASECTOMY
Pseudo-orientation in time or hallucinated age progression can be employed to ascertain possible contraindications for vasectomy.16
Since posthypnotic amnesia is always necessary, this procedure can be used only in good hypnotic subjects. Pseudo-orientation in time and abreaction under hypnosis do not necessarily prove that a vasectomy may produce serious psychological repercussions. However, it is better to err on the side of safety when highly charged material evoked without the subject's knowledge points toward a personality difficulty which might be aggravated years after the sterilization. Therefore, the motivation for vasectomy must always be evaluated carefully in terms of its psychological significance.
MALE INFERTILITY
The male is responsible for over 50 per cent of all barren marriages. Little is known about the relationship of disturbed emotions to semen quality and motility. These, rather than the total sperm count, are often important factors in the ease of conception. There is a growing awareness that emotional conflicts can alter the sperm's fertilizing capacity. It is well known that fatigue, shock, worry, and tension often produce infertility in both animals and humans.16 This is due to overproduction of endogenous norepinephrine, secondary to specific or nonspecific stress. Hypnosis has not been able to increase the sperm count or influence sperm motility. However, adverse enzymatic changes can be produced in the sperm, secondary to autonomic imbalance, and thus inactivate the sperm's ability to penetrate the ovum, even though the sperm appears morphologically normal and adequate in quantity.
FEMALE INFERTILITY
Posthypnotic suggestions directed toward relaxation, tranquility, and freedom from anxiety may be helpful for certain cases of infertility in the female that defy all types of therapy. Though the author has no adequately controlled data to present in this important and neglected entity, it offers a fruitful area for further research.
REFERENCES
1. Alexander, L.: Treatment of impotency and anorgasmia by psychotherapy. J. Am. Inst. Hypn., 12:165, 1971.
2. Biegel, H.G.: Therapeutic approaches of impotence in the male. II. The hypnotherapeutic approach to male impotence. J. Sex. Res., 7:168, 1971.
3. Brown, T.B.: Hypnosis in genitourinary diseases. Am. J. Clin. Hypn., 1:165, 1959.
4. Crasilneck, H.B., and Hall, J.A.: Clinical Hypnosis: Principles and Applications. New York, Grune & Stratton, 1975.
5. Cucinotta, S.: Acute urinary retention successfully treated with hypnosis. Am. J. Clin. Hypn., 3:201, 1961.
6. Dittborn, J.: Hypnotherapy of sexual impotency. J. Clin. Exp. Hypn., 4:181, 1957.
7. Doane, W.L.: Report of a case of anesthesia of the penis cured by hypnotherapy. J. Am. Inst. Hypn., 12:165, 1971.
8. Doberneck, R.C., and McFee, A.S.: The prevention of postoperative urinary retention by hypnosis. Am. J. Clin. Hypn., 3:235, 1961.
9. Dy, A.J., and Fabbri, R.: The use of hypnosis with the hemodialysis patient. Am. J. Clin. Hypn., 14:173, 1972.
10. Esdaile, J.: Hypnosis in Medicine and Surgery. New York, Julian Press, 1957.
11. Fabri, R.: Hypnosis and behavior therapy: a coordinated approach to the treatment of sexual disorders. Am. J. Clin. Hypn., 19:4, 1976.
12. Fleming, A.R.: The use of urecholine in the prevention of postpartum urinary retention. Am. J. Obstet. Gynecol., 74:569, 1959.
13. Gonzaga, J.G.: Sophorological treatment of psychic impotence. Am. J. Clin. Hypn., 14:206, 1972.
14. _________: Treatment of male homosexuality by means of hypnosis. Am. J. Clin. Hypn., 14:206, 1972.
15. Kroger, W.S.: Psychosomatic aspects of frigidity and impotency. Int. Rec. Med., 171:469, 1958.
16. _________: Hypnotic pseudo-orientation in time for determining psychologic effects of vasectomy and sterilization in the female. Fertil. Steril., 14:535, 1963.
17. _________: Help the impotent male help himself. Consultant, 10:37, 1972.
18. Kroger, W.S., and Fezler, W.D.: Hypnosis and Behavior Modification: Imagery Conditioning. Philadelphia, J.B. Lippincott, 1976.
19. Levit, H.I.: Marital crisis intervention: hypnosis in impotence/frigidity cases. Am. J. Clin. Hypn., 14:56, 1971.
20. Masters, W.H., and Johnson, V.E.: Human Sexual Inadequacy. Boston, Little, Brown, 1970.
21. Nourse, M.H.: Management of the patient who fails to void after operation. J.A.M.A., 171:84, 1959.
22. Owen-Flood, A.: Hypnosis in anesthesiology. In J.M. Schneck (Ed.): Hypnosis in Modern Medicine. Springfield, Ill., Charles C Thomas, 1959. Pp. 88-100.
23. Schneck, J.M.: Psychogenic impotence with a hypnotherapy illustration. Psychosomatics, 11:352, 1970.
24. Solovey, G., and Milechnin, A.: Concerning the treatment of enuresis. Am. J. Clin. Hypn., 2:22, 1959.
25. Van Dyke, P.B.: The case of the recalcitrant bladder. Am. J. Clin. Hypn., 14:256, 1972.
26. von Schrenck-Notzing, A.: The Use of Hypnosis in Psychopathia Sexualis. New York, Julian Press, 1956.
27. Werner, W.E.F.: Hypnosis in the prevention, control and therapy of urinary retention. Am. J. Clin. Hypn., 5:64, 1962.
28. Williams, G.E., and Johnson, A.M.: Recurrent urinary retention due to emotional factors. Psychosom. Med., 18:77, 1956.