The first sexologists were still heavily influenced by Victorian thinking. Havelock Ellis, an English doctor, was the first Victorian with a modern view of sexuality. He believed that a person’s attitude to sexuality was individually and culturally determined. This was something totally new, since in the preceding centuries, it had been assumed that sex was the same for everyone.

The contribution of Sigmund Freud will be familiar to many readers. He gave a name to the unconscious and classified the sexual components of our personality. Freud was one of the first doctors to listen to his patients, and was the first to point out how important it is for the patient to gain an insight into his or her own problems. Theodoor Hendrik van de Velde (1873-1937), a Dutch gynaecologist, made an important contribution to sexology. His international best­seller The Perfect Marriage (1926) is one of the most famous modern sex manuals, selling over a million copies. Van de Velde stressed the importance of sexual relations and an attitude of giving and taking. Unfortunately he limited his readers’ sexual experience by advocating that they should strive where possible for simultaneous orgasm – an over-romantic presentation of the facts. In that respect manuals some­times do more harm than good. For a long time Van de Velde remained a classic example of a prophet without honour in his own country, and it is not difficult to guess why. He wrote frankly about desire and sex, which, in those days at least, was not done. What’s more he ran off with one of his patients, a married woman eight years his junior – another no-no.

In America it was Robert Latou Dickinson who did ground­breaking work, also with women. For example, he examined the vagina with the aid of a glass tube in the shape of a penis, through which a lamp could be shone. This allowed him to observe the interior of the vagina directly, and this aid was refined by later researchers.

Alfred Kinsey, who had trained as a zoologist, did mainly large- scale quantitative research into human sexuality. Though many ‘case histories’ had been written, especially by Freudians, no one had ever used large samples. Certain sexual practices today regarded as perfectly normal were considered ‘deviant’ by the Freudians. Kinsey demon­strated that much ‘abnormal’ sexual behaviour, for example homo­sexuality, is in fact quite normal.

William Masters (1915-2001) and Virginia Johnson (1925-) were the founders of modern sexology, a typical interdisciplinary science. They had the courage to observe and measure sexual responses in the same way that physiologists had studied respiration or digestion. Masters determined at the outset of his scientific work that he would collaborate with a woman since he as a man would never be able to understand how a woman experiences sexuality. This was a brilliant idea. In the treatment of men with erection problems, the reverse may be true: only men can fully understand what a man feels in such a case. Masters and Johnson achieved overnight fame when they published their first book, Human Sexual Inadequacy (1966). ‘Older couples can enjoy a healthy, normal sex life, at least well into their eighties,’ wrote Time, and there was a general chorus of approval from the media.

Masters and Johnson’s idea was that a couple where the man had erection problems, should spend more time together, say on two evenings a week. On one evening it was the man’s responsibility to create the right mood, and on the other the woman’s, preferably with background music and tasty nibbles and dips. And then the couple, naked on the sofa, were supposed to stroke each other a little, though the man had to stay above the belt! The intention was to take sexual­ity out of the sphere of emotional rejection, the urge to perform and the fear of failure. In a number of cases the therapy proved effective. Prob­ably it was connected with what we used to call ‘tag-free’ in games of hide and seek: if you stood on a certain spot, you couldn’t be tagged. Some women felt ‘tag-free’ in this therapy since the rules of the exercise did not allow them to be touched below the belt. A bit of back rubbing, that was all – very primitive, in fact, but sometimes it worked.

If that didn’t help, one could do a course of therapy at the Masters and Johnson clinic. For the treatment of impotent bachelors they had secured the assistance of female volunteers, who were carefully chosen. The therapy had three main aims: the man must rid himself of his fear of failure, and of the habit of playing the observer and the woman must regain confidence in her man. These aims were to be achieved by means of emotional concentration exercises. Just as at home, the couples were not initially allowed to have intercourse, only stroking and caressing, so they had no need to fear failure. The man usually achieved an erec­tion after one or two of these sessions. At this stage the couple were still not allowed to have intercourse, but had to continue the pleasurable stroking until erections occurred regularly. Then the couples had to practise making the erection disappear and come back again. The idea was that the man should overcome his fear that if the erection disappeared during intercourse, it would not return at all. When the experts felt that the moment had come to tell the man to attempt to penetrate the vagina, the woman was instructed to kneel over her partner. She had to insert the penis into the vagina and make sure that at that stage she made no demands. If the erection disappeared she was to make the penis erect again with her hand. This treatment by Masters and Johnson proved successful with over 6o per cent of men.

Their treatment methods came in for their fair share of criticism. One of the objections was that the human aspects of sexual intercourse were neglected. In the view of the critics Masters and Johnson saw coitus too much as a kind of mechanical process of stimulation and responses. They were accused of paying insufficient attention to the spiritual element in human sexual experience. Yet for all the criticism these two sexologists retain their reputation as pioneers in their field.

As regards scientific research into erection problems, Erick Janssen made a significant contribution in 1995, distinguishing between the reflex erection and the arbitrary psychogenic erection. The first type operates through the spinal column and results from touching or stimu­lation of the penis. The psychogenic erection originates in the brain and in response to visual impulses, erotic fantasies, etc. Scarcely any research had been done on how the two sorts of erection combine and interact. Janssen provided a research structure with which the inter­play could be studied. Men with ed were exposed to physical and visual erotic stimuli, separately or in combination. For physical stimulation he used a ring-shaped vibrator that could be slid over the penis. The visual stimuli consisted of erotic film clips. It was found that with test subjects whose ed had been diagnosed in the old way as probably psychological in nature, the purely physical stimulus of the vibrator scarcely resulted in an erection. If the men simultaneously watched an erotic film, an erection was achieved much more easily – as if concerns about one’s own sexual functioning affected mainly the reflex erection. When the erotic film was added, these concerns could obviously be suppressed and the physical experience – the vibration of the penis – could be placed more in a sexual context.

The fact that negative experiences or sexual worries can impede the achieving of an erection was shown by the following. If the impotent men were asked while watching the erotic film to do mental arithmetic or to watch a Tom and Jerry cartoon, the erection achieved turned out to be stronger. Mental arithmetic and cartoon mice can obviously reduce erection problems!

In addition Janssen believes that, in contrast to what is claimed, fear of failure is not a cause of impotence. Research shows that this claim by no means always holds good. For example, a number of test subjects were asked to achieve an erection within two minutes, or they would be given an electric shock. ‘The shocks were never given,’ said Janssen, ‘but the threat did increase sexual arousal. And when you go to bed with someone for the first time, in theory it ought not to succeed. But at a time like that you think of only one thing, and in most cases it works out ok.’

Years ago, in an interview entitled ‘Good conversation and a sex film deal with erection problems’, a now retired professor of sexology, Koos Slob (1940), gave his urology-unfriendly view: ‘Modern diag­nostic techniques are so sensitive that if you or I go to the urologist some abnormality or other will always be found. But whether it will actually cause any problems is highly doubtful.’ After which the inter­viewer remarks that Slob never gives his car a ‘major service’, but only has essentials like tyres and brakes checked. . .

Not only in this interview but also in his inaugural lecture Slob em­phasized his view that in most men with erection problems the cause is psychological. All in the mind, as it were! His nuanced view, however, made him sometimes see virtue in a ‘minor’ urological service. It has long since ceased to be the case that urologists are wary of directly associating the genitalia with sex and eroticism. There is increasing interest in the influence of the psyche – call it the brain – on individual organs. Typical examples of this are the development of neurocardio­logy and neurourology.

Slob’s inaugural lecture opens in elegantly epigrammatic fashion:

The softness of our penis escapes our attention. Yet it’s just as well that most men have a limp penis for most of the time. We undervalue our genital softness not only because in a patriarchy so many phallic values are acquired, but also because all of us identify masculine energy and real masculinity with the vital­ity of a youthful male image. As we grow older the degree of hardness of our penis declines. Frightened as we are of our own mortality, we do not want to see our own genital softness and project it onto women, whom we find weak, and soft and vul­nerable – all signs of mortality, all qualities to be looked down on and denied. . . The undervaluation of genital softness and overvaluing of the phallus have made the world a dangerous place for men. The price of that undervaluation is the loss of an essential spiritual energy and strength. It is the energy and strength associated with the ‘Via Negativa’.

Of course these epigrams, with their echo of Lord Nelson’s blind eye to the telescope, have a seductive ring, but such airy notions cut no ice in daily urological practice, and Slob realizes that only too well. The fact remains that urologists and psychologists tend to think rather differ­ently about things. In his heyday a well-known sexologically orientated professor of psychology characterized urological involvement with erection problems as ‘plumbing work’. He was forgetting – and one can hardly hold it against him as a non-doctor – that urologists have the reputation of being the most intelligent of all surgical specialists (in other words: they are very bright plumbers). They earn well too – so is that perhaps the problem?

Almost a hundred years ago behaviourists helped prevent funda­mental research into the physical causes of ed from getting off the ground. After all, the problem was virtually always psychologically based. This view led to therapeutic nihilism and gave doctors little encouragement for further research. (‘You’re not twenty any more’.) Consequently, at the point where the first man walked on the moon, knowledge about erections did not extend beyond the fact that ‘cush­ions’ in the erectile tissue compartments in the penis might be able to retain blood.

In the past few decades much ground has been made up, especially since the introduction of Viagra. Scientists from different disciplines seized on the erection, and the same thing happened with male fertility problems. Yet modesty is still in order. Scientific findings reflect only a very small part of everyday reality, which is often so bitter. Writers and poets, major and minor, male and female, undoubtedly give a broader, more human view of reality. Ample evidence proves the truth of that statement. Erection problems and fertility disorders hurt less when writers, poets and philosophers reflect on them. In that way reading comes to resemble a form of mental surgery, in which one’s ‘suffering’ is placed in a broader perspective.