Flat A-4, Shrinivas Apartments
584 Narayan Peth,
Near ‘Kanyashala’ and Ramanbag School
Above Arihant Tradelink.
Email : firstname.lastname@example.org
Today in the twenty-first century, almost all doctors and sexologists opine that masturbation is a natural harmless activity. Organizations like SIECUS (Sex Information and Education Council of the United States) endorse the view that masturbation is normal and it is almost impossible overdo this activity. Parents are told to accept masturbatory practices of children as a growing up phenomenon. Therfore, all of us now agree that masturbation and sexual intercourse are enjoyable methods of solo and partnered sexual gratification.
The following paper, which I presented at the World Association of Sexology (WAS) conference at Sydney, Australia in April 2007, needs a debate if hedonistic sexual gratification could be responsible in causing any sexual problems under special set of conditions in certain select individuals.
My paper proposes a new diagnostic classification within the sexual dysfunction group and terms it as ‘Sexual Burnout Syndrome’ (SBS)
The word BURNOUT is proposed because:
What is Burnout?
“A state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that failed to produce the expected reward.”
Freudenberger H. J. and Richelson G. - Burnout: The High Cost of High Achievement. Garden City, New York: Doubleday & Company. 1980.
“Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals.” Maslach, C. - Burnout -The Cost of Caring. Englewood Cliffs, New Jersey: Prentice-Hall. 1982.
Burnout is a problem that ends up depleting the person’s energy and makes him lose touch with himself and others. The onset is usually slow. The early symptoms include a feeling of emotional and physical exhaustion; a sense of alienation, cynicism, impatience, negativism and feelings of detachment to the point that the individual begins to resent work involved and the people who are a part of that work. In extreme cases, the individual who once cared very deeply about some activity suddenly cuts it off from his life to the point that he no longer cares about it at all. The irony of burnout is that it happens to the same person who previously was extremely enthusiastic and brimming over with energy and new ideas when first involved in that endeavor.
Dr. Hans Selye is one of the founding fathers of stress research and has conducted numerous experiments and observed how organisms handle long-term stress. He reports that after an initial period of adaptation, they endure well for a fairly long period of time until, all of a sudden, they collapse without any obvious direct cause. To illustrate this he gives an example of bomber pilots in the Second World War who would fly effectively for many missions, but then show “neurotic manifestations” as pilot fatigue set in.
A number of you may have experienced short-term burnout wherein after hard mental work at a specific task for an extended period, simple things become difficult and concentration begins to falter. You feel exhausted and performance suffers. Taking a break helps things to improve and you can handle the situation with a new vigor. However it’s the long-term stress contributes to chronic exhaustion that leads to a full-blown burnout.
Although stressful, many of you can derive pleasure from work as it gives a sense of identity and more significantly - a monetary reward. Early in your career, ideals and ambitions are high and you to tread this path with zest and passion. The problem begins when things become too much and get out of hand. If supportive mentors leave or move on and an unappreciative and non-encouraging boss takes charge, trouble is brewing. Soon your ideas may not be appreciated and there is no one to sympathize when you err. It’s still worse if team members plot and plan against you and those around become ungrateful and difficult.If you are proactive, energetic, committed and are able to adapt to these circumstances, it is likely that you respond to obstacles like these by increasing commitment and hard work. A majority of you are able to find some solutions to problems mentioned above however some initially bend, then buckle and finally break under pressure. When and how this happens depends totally on the person concerned. Burnout begins to set in at this stage and unless something is not done fast, life can become a disaster.
Sooner or later you experience complete job dissatisfaction and going to work itself becomes a cause of stress. You get more tired and less energetic. If in addition to the boss and colleagues your friends and family fail to extend support, you become increasingly disenchanted and disillusioned. In extreme cases, you completely lose faith in the system to become cynical, embittered and life itself starts becoming totally meaningless. Severe depression and recurrent suicidal thoughts then continue to haunt your mind.
This is full-scale burnout.
What are the warning signs that you are heading to such a burnout? When anything you liked tremendously doesn't feel ‘fun’ anymore, that’s the danger signal. If you're so beset with commitments you made you are heading for a burnout. Burnout is the result of a cumulative process leading to emotional exhaustion and withdrawal. Experiencing loss of energy, lack of motivation, or need for a tonic suggests that there’s danger ahead. The symptoms of burnout are as varied as the sufferers. In addition to the above mentioned indicators, some persons become angry, some resort to blaming others, some become quiet, introverted or depressed. Others manifest burnout by under or over-eating or abusing alcohol or using mood-altering substances. Still others may experience a range of physical symptoms, including chronic illness, high blood pressure and frequent headaches.
Burnouts are quite common in the computer software and call center industry in India. Many youngsters have odd and extended working hours in companies that outsource their work from the West and they finally suffer the consequences. It is interesting to note that even pursuing interesting and entertaining hobbies repeatedly for a prolonged period of time makes them less pleasurable. Enjoyable and delightful activities like playing your favorite game, eating a much-loved food or entertaining pastimes can cause a burnout for that particular activity.
In sports the word ‘burnout’ is used if a sports-person undergoes extensive training and plays a game ‘excessively’ at very young age and then peaks off early to rapidly and completely lose interest in the sport. Such a person is also prone to become a victim of physical injuries and sometimes has to abandon the sport altogether. Two classic examples of a burnout are tennis players Tracy Austin and Andrea Jaeger who turned professional very early in their careers and suffered the consequences.
If a pizza lover is offered pizza for breakfast, lunch, dinner and for an in-between snack, initially he would love to eat it to his heart’s content. However if he is offered nothing else but pizza for for a prolonged period, he is bound to develop nausea even by the sight and smell of one. He may even fall sick if he is forced to eat nothing else but a pizza. What would happen if a movie buff is given a home theater with ample stock of DVD's? To begin with he would be most happy but soon a time would come when his interest and desire to watch movies will diminish. He will emerge bleary eyed and tired and may not want to watch a movie for a considerable period of time. This is a ‘pizza burnout’ or ‘movie burnout’ and something similar happens in a sexual burnout!
Brief Case Histories of two patients
Given here are two cases of multi-orgasmic men who initiated sexual activity (masturbation or partnered sex) at an early age at an ‘excess’ frequency.
In their mid-twenties, they reported classic ‘burnout’ symptoms like physical exhaustion, mental fatigue, emotional detachment and depersonalization in addition to loss of libido, erectile dysfunction & reduced orgasmic pleasure .. i.e. Sexual Burnout Syndrome.
Case # 1
Mr. X is man in his mid-twenties * Just completed his studies and has a new job * Family members are pressurizing him to marry * He is unwilling because sex has 'no meaning' in life as desire for sex is gone * Reports of erectile dysfunction * After age 25, he noticed a decrease in his urge to masturbate and this led to a reduced frequency of masturbation * In about a year his erections had become weaker * Now at 26, his morning erections are almost non-existent * Desire to masturbate is much less * If he attempts to masturbate, the penis does not erect fully and ejaculations are weak and devoid of pleasure * This has made him feel depressed & stressed * Now listless & frustrated as drive, commitment & passion for masturbation is gone * Has emotional & physical exhaustion; a sense of estrangement, pessimism, & feelings of detachment * Remains fatigued and tired *
Case # 2
27 year old man, Mr. Y came for therapy with a partner * Both were concerned about his lack of libido and erectile dysfunction * ‘Enjoyed sex' since early age * Masturbation at age 8 years * First sexual experience at age 11 with 22 year old woman * Soon sexually involved with another 18-year-old woman & a little later another 19yr old woman * Continued to see them on an 'almost daily' basis * Being multi-orgasmic, he was able to 'happily satisfy' his lovers * They enjoyed his company as sex was wonderful & enjoyable * At age 21, fell in love with a 20 old girl & was sexually active with her within a few months * Continued to see the other women …… albeit with a less frequency * In the following years, he noticed sex was less interesting, erections less strong * Had intercourse without emotional involvement * Orgasms were less enjoyable * At age 25, he experienced erectile dysfunction for the first time * Sex with three other women had stopped * Soon, failure during sex became a 'regular' feature * Praised his girlfriend for being supportive & coaxing him to seek treatment for these problems * His partner said that she was charmed & fell madly in love when they first met 6 years ago * However, in the last 2 - 3 years, he became despondent, felt emotionally overextended & drained out * She was surprised to see this change in his personality & loss of interest in sex in 16-18 months *
Studying the above cases reveals that the two men stimulated themselves to experience multiple orgasms on a daily basis for a prolonged period during their youth. Therefore, at each orgasm/ejaculation they were releasing endorphins to experience its euphoric bliss followed by post orgasmic fulfillment. Was this the cause of them having Sexual Burnout Syndrome?
CONTROVERSY ABOUT MASTURBATION
At one end are people who say that masturbation is wrong to practice at any time in life as it is immoral, abnormal and injurious for everyone. Whereas, sexologists and doctors of modern medicine declare that masturbation at any age is natural, absolutely harmless & that it cannot be overdone.
DSM-IV (Textbook of Psychiatry) is mute on masturbation, yet some believe that compulsive sex / masturbation is a clinically useful concept & is associated with a multitude of problems. Besides, excess or overindulgence of masturbation or sex is difficult to quantify.
Yet, we need to know more about Sexual Burnout Syndrome: Why it could happen?
The nervous system (brain and nerves) enables us to connect with our surroundings via our senses (vision, hearing, touch, taste and smell). Nerves provide a link between the brain and organs to control all body functions including sexual behavior.Nerve cells (neurons) communicate with other cells by means of a complex ways that involves an electro-bio-chemical messaging system.
Neurotransmitters are biological chemical messengers that transmit signals between a nerve cell (neuron) and any another cell in our body at specialized junctions called synapses. Neurotransmitters are believed to be stored in ultra small bubble like sacs (vesicles) at the terminals of nerve cells and they are responsible in transmitting signals from one neuron to another.
Dopamine, serotonin, adrenaline, noradrenaline, phenylethylamine, oxytocin, endorphins, nitric oxide, estrogen, testosterone, vasopressin, prolactin, etc. are some of the numerous neurotransmitters/neurochemicals that have an important role in sexual function.
The characteristic specialized contact zone that has been presumptively identified for the communication between the terminal of a nerve cell and another cell is called a synapse and the ultramicroscopic space between them is called the inter-synaptic cleft. On the receiving neuron/cell, there are a large but limited number ‘receptors’ to receive different neurotransmitters that ‘jump’ across the synaptic cleft. It is believed that the all the receptors and neurotransmitters are dedicated to each other, which means that a single receptor can accept only that neurotransmitter it has been assigned to receive and once they bind, the receptor cannot accept the same neurotransmitter for a certain fixed period of time that is uniquely preprogrammed in our body.
Receptors are classified as adrenergic, dopaminergic, serotonergic, opiate, etc. based on the type of neurotransmitter, hormone or drug they bind with. The concept that receptors being sensitive to not only the body’s own neurotransmitters, hormones, etc. but also to externally administered drugs and other chemicals was proposed by Langley in 1905. This was based on his observation that some chemical substances mimicked positive biological response (agonists) while other chemical substances prevented it (antagonists).
When the receptors of a receiving cell are stimulated with the same neurotransmitter (receptor agonist) for a certain prolonged length of time, the receiving cell then starts to reduce the number of receptors on the synapse of its receiving terminal. Conversely, prolonged exposure to a receptor antagonist increases receptor density on its receiving terminal. Suppose a neuron has a hundred receptor sites where the neurotransmitter attaches itself to ‘pass on’ the message, then repeated stimulation by that particular agonist results in reduction in number of these receptor sites to say - sixty. This condition is called ‘down regulation’ of the receptors of a neuron. This modulation of neurons at the receiving end causes a ‘blunting’ of the response to that particular stimulus resulting in a necessity of larger dose of that drug to produce similar result.
‘Rewarding’ proactive behaviors such as eating (food), drinking (alcohol), and sexual activity are controlled by neurotransmitters called Endogenous Opioids (Endorphins).Therefore, some individuals have a propensity to drink or eat in excess and thereby endure its short / long-term consequences like intoxication or obesity, which could advance to liver cirrhosis, coronary artery disease, hypertension, etc.
Similarly some individuals tend to masturbate or indulge in sex much too often, because each orgasm releases large amounts of endorphins and they repeatedly experience its thrill and euphoria.
Considering Sathe’s Orgasm hypothesis, one could further deduce that repeated orgasms/ejaculations over a prolonged period could reduce the density of opiate receptors on neurons a condition that is called ‘down regulation’ due to a process called ‘post-synaptic modulation of neurons.’
This could result in reduced response to endorphins which probably in turn makes a person experience less intense orgasms. As a result he remains unsatisfied and starts stimulating himself to orgasm over and over again. This further leads to a ‘chronic high’ of endorphins in the inter-synaptic cleft of neurons reducing the opiate receptor density still more.The final outcome of this is a possible loss of desire for sex together with impotence (erectile dysfunction) and reduction or complete loss of euphoria of orgasm (anesthetic orgasm). It’s interesting to note that similar complaints are reported by individuals who are addicted to morphine, opium or heroin!
More research is needed to verify this hypothesis because this natural and physiological process (not drug induced) is not been investigated and reported so far.If the medical fraternity can accept that a major cause of obesity is over-eating, then it ought to approve that over-masturbating or indulging in ‘excess’ sex from a very young age has the potential to cause Sexual Burnout Syndrome.
Just as liver cirrhosis & lung cancer affect only some certain chronic alcoholics & smokers respectively, does ‘early age initiation’ along with ‘repeated multi-orgasmic sexual activity’ for an extended period predispose certain susceptible persons to Sexual Burnout Syndrome?
Sexual Burnout Syndrome possibly strikes Susceptible young men who become sexually active very early in life who …