As early as the 1940s investigators sought an explanation for some of the behavioral manifestations of pregnancy in the realm of the woman's psychologic makeup. Robertson, 16 in a study of 100 pregnancies found that there was frequently undesired sexual intercourse and an absence of orgasm associated with the nausea and vomiting of pregnancy. In 100% of the women with severe, nausea, sexual function was disturbed, as opposed to 9% in the control group. It is not clear whether there is a cause-and-effect relationship, or which direction it takes.

The myth that sexuality is nonexistent for infants and children was shattered by Freud's works nearly half a century ago. Unfortunately, unfounded beliefs about a nonsexual existence at the other end of the life continuum have persisted. In reality, there appears to be no single point in man's existence at which sexual functioning ceases.

To examine the gradual changes in sexual function and behavior in context, one must view the biologic, psychologic, and social changes seen in the young adult, the middlescent, and the aging individual. A helpful framework for viewing the crucial psychologic tasks at various points throughout the life cycle is Erikson's schema. Duval offers an explanation of the social tasks throughout life and examines them in the context of the family life cycle. Finally, some investigators, most notably Masters and Johnson, have documented the physiologic parameters of sexuality throughout varying points of life.

During the middle years, approximately the period of time between the age of 50 years (or when the children leave home) to the age of retirement, people are faced with major changes in life-styles. According to Duvall, there are a number of demands placed on persons during the middle years, including emancipating adolescent children, making a comfortable home, achieving a peak in one's career, maintaining relationships with aging parents, and developing satisfaction from use of leisure time, social responsibility, and friendship. In addition to the above rather monumental tasks, men and women are faced with accepting and adjusting to the physiologic aspects of middle age and developing new satisfactions in the relationship with the spouse.

The critical task for this portion of the life cycle is resolving feelings of self-esteem versus feelings of despair. The issue is acceptance of one's own life cycle, rather than feeling despairing, disappointed, and abandoned. Social pressures and expectations, feedback from significant others, and finally one's own perception all influence how one evaluates the success of his life.

Some of the psychosexual disorders discussed in the previous and following chapters are strongly linked to the crises of developing intimacy and sex-role identity. Depression or problems in school may herald budding sexual difficulties. However, the problems most likely to be brought to the clinician are sexual inadequacy and conflicts about one's sexual response. The sexual inadequacies frequently seen in this age group are male impotence and orgasmic dysfunction in the female. Men who feel overcome by or fearful of women subsequently develop anxieties about their sexual performance or prowess. As their levels of anxiety rise, attempts are made to consciously create an erection, which usually results in impotence. Until the initial fear-anxiety-impotence cycle is disrupted, the man may become progressively more dysfunctional.

As the man ages, certain social and psychologic factors influence his sexual responsiveness. Masters and Johnson noted several recurrent themes in interviews about waning sexual responsiveness. Monotony in the sexual relationship or the feeling of being taken for granted was a common factor in loss of interest in sexual performance. Concerns with economic or career pursuits, mental or physical fatigue, physical and mental illness of the individual or his spouse, and overindulgence in food or drink also interfered with sexual activity. Finally, fear of failure caused many men to retreat from coital activity rather than risk repeated embarrassment.