The woman is bright, beautiful, and obviously interested.

Getting It On with Sexual Dysfunction

Today, sexual dysfunction is attacking even the mightiest of men, like axes at oak trees.

Over lunch, between the coffee and the Benedictine, the woman asks my handsome male friend to go to bed with her. His eyes light up and his eyebrows jiggle, but his smile hides the terror in his heart. They go to his apartment, he touches her, kisses her, undresses her, is aroused — and ejaculates before coitus can begin. Disappointed, she never asks for a repeat performance. My friend said it happened every time.

An epidemic of male sexual dysfunction seems to be creeping across the land, attacking even the mightiest of men like axes at oak trees. Thus far, talk of the phenomenon is based on personal experiences and, as the doctors say, clinical impressions. It also seems to be largely limited in scope to heterosexual experiences among the white urban middle class, and usually within marriage relationships. But the unmarried also seem heavily affected. One single woman I know, who has no trouble reaching orgasm with the successful, dominant men she is attracted to, says that out of her last six sex partners two could not get an erection and one ejaculated prematurely. Is her experience unique or even unusual? The statistics are vague, uncertain whispers in the wind: Dr. William Masters and Virginia Johnson of the Reproductive Biology Research Foundation in St. Louis, say that two-thirds of all American men now suffer from sexual dysfunction at some time during their lives. This is astonishing, considering that twenty-five years ago less than 1 percent of the men interviewed by the Kinsey Institute of Sex Research said they had at some time suffered from sexual dysfunction. The truth may lie somewhere in between. But the dozen reputable sex therapy clinics in the United States are backlogged for months, and their therapists are working twelve hours a day, six days a week. They treat more men than women, and most of the men come in because their wives or lovers are sexually dissatisfied.

Luckily, 80 to 90 percent of men with the most common sexual dysfunctions — premature ejaculation, impotence, and retarded ejaculation — can be successfully cured in a few weeks by new sex therapy techniques.

My harassed friend, for example, has been saddled from adolescence with premature ejaculation and a reputation as a lousy lay. He tried everything to prolong his erection: during intercourse he thought of the stock market, pinched his thighs and arms, pulled his mustache. Nothing worked. Finally, on his recent thirtieth birthday, he bought himself an $1,800 present: two weeks’ worth of sex therapy in Berkeley, California. He has returned home a cured man.

Are greater numbers of men indeed suffering from sexual traumas in this era of alleged sexual liberation? Or are more men just coming out of the closet to face up to long-standing inadequacies? Certainly the statistical potential for sexual failure is greater today than ever before, simply because women are more open to sexual experimentation with men. A recent survey shows that three-fourths of the single women today have sex before the age of twenty-five, compared with one-third when Kinsey was collecting sexual data a quarter-century ago. Men and women are also living longer, aging slower. Researchers have found that, contrary to cultural myth, men do not reach a physical “sexual peak” between the ages of eighteen and twenty-five and then spend the rest of their lives in decline. Physiologically there is no reason why most men can’t enjoy a healthy sex life up into their eighties, as long as they keep in shape with regular intercourse or masturbation (at least twice a week) during the earlier part of their lives.

The definition of what constitutes a good heterosexual relationship has changed. In the past, a man was likely to feel he had sex problems only if he were clearly impotent. But the Kinsey studies showed that most married men spent only two minutes or less on each act of intercourse; today the average is ten minutes, and men have more chance to feel uneasy about the subtle dynamics of foreplay and the selection and variety of sexual positions — what one therapist calls the “smorgasbord of sex.” Men are also more concerned about satisfying their sex partners and leading them to orgasm. And women, demanding sexual equality, are more likely to openly criticize men who can’t satisfy them. These little extras can add pressures that in some men lead to sexual dysfunction.

Such problems do not begin and end in the bedroom. Therapists are finding that sexual dysfunction problems below the belt affect a man’s entire mental outlook. They now believe that sexual inadequacies can be the cause of mental problems, not just a reflection of them.

Men most susceptible to sexual break-down are those who have had strict religious training in which sex was equated with sin; those who received no sex education as children; men who were ridiculed or disgusted by early sexual experiences; men who have low self-esteem or tremendous business pressures; men who are overconscientious and overcontrolled. Some doctors feel that the feminist movement aggravates sexual problems in already insecure men and increases their anxiety about performance. Add to all this a good dose of sexual ignorance — pervasive even among today’s teenagers and college students — and a breakdown in communication between sex partners, and a man can find himself sliding into an abyss of frustration and fear.

These signposts all point to a great sexual malaise in the country. But even if this era of liberation may have generated a sexual crisis of deep and unknown proportions, it has also promoted fresh and unexpected solutions. Until recently, not much could be done about sexual deficiencies. Traditional psychotherapy dragged on for years, usually to an unsuccessful conclusion. However, there are now a dozen reputable therapists who are reversing the past approach to the problem. They treat the body first; then, as the physical relationship improves, they work on changes in attitude. They do not believe, as Freud did, that sex problems are a sign of deep-seated pathology. “Our patients are unhealthy only because they have lost the ability to make love,” one therapist in New York says. “We work on changing their sexual behavior; we teach people how to communicate, not how to fuck.” With this approach, almost every man can be helped back to sexual health in a few weeks’ time, usually at a cost of from $1,200 to $2,500 — though a few clinics do charge on a sliding scale. Some doctors in private practice also treat sex problems at a cost of $50 to $100 a session. Treatment averages from five to six sessions, and it can run up to twelve or more. Patients who also need traditional psychotherapy usually arrange regular sessions outside sex therapy.

“Masters and Johnson estimate that two-thirds of all American men now suffer from sexual dysfunction at some time during their lives.”

Most sex therapy is based on the sexual research done by Masters and Johnson in St. Louis. A male-female team, preferably one physician and one psychologist, first tries to teach a couple how to enjoy each other’s body without sex. The doctors become new authority figures, in essence new parents, who break down the old associations of sex with guilt, shame, and fear. The couple are always treated together, regardless of which partner has the sexual problem, because Masters and Johnson believe that in sex “there is no such thing as an uninvolved partner.” Some clinics require that the couple check into a hotel during treatment, to create a honeymoon atmosphere. Others allow them to remain at home, and see the patients several times a week at the office.

Treatment begins with a physical examination and a lengthy discussion of the causes behind the sexual problem. The couple is then instructed to strip naked, in private, and to take turns touching and stroking each other’s body, except for the genitals and breasts. Intercourse during these first sessions of “sensate focusing” is forbidden, for the purpose is to learn how to be sensual without being sexual. Most people have never learned to be comfortable with physical closeness — touching, embracing, or kissing — unless it ends in sex. These sessions try to break that pattern, and train people to enjoy and explore each other’s body freely, without any demand to perform sexually. A few clinics also use nude group encounter sessions, with the rule that there be “no fucking on the premises.” After a few days of such luxury, the patient begins treatment for the specific problem.

For men, the most common problem is premature ejaculation. This can have its origin in early sexual experiences with prostitutes or with “nice” girls in the back seats of cars, where speed is of the essence. Some therapists find that the premature ejaculator is often aggressive, driven, and dominant, and uses his dysfunction to maintain control of a bad sexual relationship. “It is his weapon, his way of saying to a woman: ‘You’ve overwhelmed me, or castrated me. But I won’t get mad; I’ll just get even,’” explains Dr. Donald Sloan, director of the sexual therapy and education center at New York Medical College. “Doctors are notorious premature ejaculators, along with stockbrokers, executives, and people who are used to being in control,” he says. The premature ejaculator is also considered by some to be more selfish than most men, less considerate in his lovemaking, and more likely to blame his sexual problems on the wife rather than himself, which is why the woman usually talks her man into therapy.

In fact, it is not uncommon for a woman to come in feeling guilty because she can’t have an orgasm, and then learn that nothing is wrong with her. She can’t experience orgasm because her husband ejaculates after a few thrusts in her vagina. Some therapists, however, refuse to attach labels of aggression and dominance to premature ejaculators. “I have treated captains of industry and Caspar Milquetoasts. Premature ejaculation is just a failure of reflex, like a child not toilet-trained,” says Dr. Clifford Sager, clinical professor of psychiatry at Mount Sinai School of Medicine and psychiatric director of Jewish Family Services.

Experts also disagree on the definition of premature ejaculation. Some define it as an inability to keep the erect penis in the vagina for up to two minutes before ejaculation. Others feel if a man comes quickly, but still satisfies his partner 50 percent of the time, he is not premature. “We’ve seen men accused of premature ejaculation just because they can’t last an hour and a half,” says Dr. Sloan. He believes any ejaculation is premature if it takes place “prior to a man’s wishing it, and we assume the wishing includes giving maximum pleasure to his partner.” The main criterion for enjoyable sex is the sexual satisfaction of both partners, and in that sense, everyone agrees that their treatment is almost 100 percent successful.

Sexual Dysfunction Solutions

The “cure” is a purely physiological one, in which the sex partner is taught how to caress the penis just to the point of orgasm, then repress it, usually with a squeezing technique, described in Understanding Human Sexual Inadequacy, edited by Fred Belliveau and Lin Richter and published by Little, Brown & Co.

In this “squeeze” technique, the woman sits on the bed while the man lies on his back with his head away from her, his legs draped over her thighs. The woman places her thumb on the underside of the penis, where the shaft ends, and her first two fingers on the upper side, on each side of the ridge which separates the glans from the shaft. When he feels he is about to come, she squeezes the penis and ejaculation is delayed. Although this is not supposed to hurt, some men say it does and some therapists use a “start-stop” technique. Dr. Sager insists he gets equally good results by teaching the man to become aware of when he is ready to come, and then stopping all movement for fifteen to twenty seconds until the feeling passes and he can continue. But advocates of the squeeze method find it such a quick and sure cure that they routinely teach it to men who come in for any sexual problem — simply as a preventative measure.

After the man gets used to maintaining an erection for fifteen to twenty minutes at a time, he makes his first attempts at intercourse. He lies quietly on his back, and his partner straddles him in a sitting position and inserts the penis in her vagina. Both sit quietly until he feels ready to ejaculate. Then she removes the penis, applies the squeeze to retard ejaculation, and reinserts it. Within a few weeks he is back to a “normal” sex life, although it may take as much as a year before he can control ejaculation without that special squeeze. Masters and Johnson believe premature ejaculation could be eliminated by 1980 if everyone knew and used the technique.

Sexual Dysfunction Expands

The treatment of impotence, a sexual dysfunction problem almost as common as premature ejaculation, is not nearly as simple or successful. Impotence is either the inability to get the penis hard enough to enter the vagina or, even if it enters, to remain hard long enough for ejaculation. A man who can ejaculate but cannot get or keep an erection is still considered impotent. As in cases of premature ejaculation, certain types of men seem susceptible to impotence. One psychiatrist describes the impotent patients he sees as “push-around-able,” men who feel inadequate in most areas of life and have a great fear of inadequate performance. “Often the impotent man has been put down by parents or peers as undeserving. If his wife screams at him, he retreats. Where premature ejaculation is a weapon, impotence is a defense,” he says.

Men over forty who have lost a wife through divorce or death, heavy drinkers, and those who suffer constantly from career or money problems are all likely victims. Young boys frequently have spells of impotence, says William Simon, co-author with Patricia Miller, both of the Institute for Juvenile Research in Chicago, of a study of 3,000 youngsters from the ages of fourteen to eighteen. “When you’ve been jacking off all the time and are at last faced with the big moment — a real woman — the expectation and pressure are enormous, and quite often nothing happens,” says Simon.

“Experts disagree on the definition of sexual dysfunction. ‘We’ve seen men accused of premature ejaculation,’ says one doctor, ‘simply because they can’t last an hour and a half.’”

In addition, a growing number of men in their twenties are complaining of impotence, a phenomenon that Dr. William Frosch, a professor of psychiatry at New York University School of Medicine, has termed the “new impotence.” Frosch and several colleagues attribute impotence in these men to the changing and more aggressive sexual roles of women. Frosch says that they are already likely to be hostile toward women, have castration fears, or be latent homosexuals. “The fantasy is that freedom to perform sexually leads to fewer problems,” he says, “but in fact it leads to different kinds of problems.”

Occasionally, a man may become impotent in response to signals from his lover. A wife having an affair with another man, for example, may let her husband know in subtle ways that she no longer enjoys sex with him. He senses the rejection and becomes impotent. In such cases, the therapists first handle the woman’s needs and conflicts before dealing with the man.

One couple I know descended slowly into a sexual hell after the husband became impotent in response to his wife’s changing attitudes. She wanted to put their two children in a daycare center and pursue her own career as a writer. She felt that her husband was trying to keep her tied to domestic duties and vented her frustration by constantly picking at him. He responded with an icy withdrawal that extended to the bedroom. Then after three years, he suggested going to a sex therapy clinic. At first the treatment depressed her, until the therapy made her realize that she really wanted her husband to remain impotent, for by keeping him weak she could gain the strength to free herself from him. The therapist pointed out that in the long run she would only destroy herself by building her strength on the weaknesses of her husband. Once the couple understood the game, they stopped playing. He is potent once more and she is writing; they are deciding, hopefully on a healthier basis than before, whether to continue the marriage.

Men with occasional impotence are easier to treat than those who have never had an erection — a condition called primary impotence. These men have often suffered during childhood from strict religious training, seductive mothers, or humiliating first experiences with prostitutes. Many have had early homosexual experiences and consider themselves basically homosexual. Yet even in these most difficult cases, six out of ten respond to treatment.

Occasionally, premature ejaculation can lead to impotence, because a man often withdraws emotionally from his lover and deliberately ignores sexual signals during intercourse in a desperate attempt to delay orgasm for even a few seconds. Eventually, if he manages to block out enough sexual signals, it can lead to a total inability to have an erection. Here, of course, the therapist treats impotence first, then the premature ejaculation.

Impotence can also be caused by thyroid deficiencies, spinal injuries, and surgery affecting the pudendal nerve that stimulates the penis. For reasons unknown, more than one million diabetics are also impotent.

More Sexual Dysfunction Solutions

Treatment for impotency begins with instructions not to participate in any sexual activity until told to do so, discussions on the causes of the impotence, and several days of mutual stroking of all parts of the body except the genitals. After several days, the couple are allowed to masturbate each other. Each guides the hand of the partner and tells the other which stimulation is most pleasant. Therapists use this technique to break down the “spectator” syndrome, in which people afraid of sexual failure end up by mentally “watching” rather than enjoying their sexual activities. “Until a man realizes he has control over his sexual act, the woman must be there only as an instrument of his pleasure. The same holds true for the man when the woman has sexual problems,” says New York therapist Stephanie Cwok. “The relationship must be nondemanding, an exchange of emotional commodities,” she says. Even if a man has an erection during these pleasurable sessions, he is not allowed to have intercourse. “He must learn,” says another therapist, “that erections come and go — they’re no big deal.” Therapists also use the mounting sexual tension to their advantage in the treatment.

Every day for a week, the wife teases the man to stiffness; they then lie in each other’s arms until the penis is again flaccid. Next the woman sits on top of the man, plays with his penis until it is erect, and then eases it into her vagina. In the beginning of most sex therapy for men, the woman mounts the man during intercourse, because it has been found that the traditional man-on-top missionary position is the most difficult one for controlling ejaculation. She rocks slowly back and forth a few times, stops, and lets her husband thrust a few times. Neither partner is expected to climax, and if the man loses the erection, the couple tries again later.

While therapists work on other problems in the marriage, the couple does this exercise each day. The man is never told to reach orgasm but, within a few weeks, eight out of ten men who have climaxed at least once before during their lives will do so again. Studies show that they then continue to remain potent for years. Some therapists claim even higher success rates by having the man introduce the penis gradually — by fractions of an inch — into the vagina during each day of treatment.

Men with primary impotence — men who have never had an erection — also present special treatment problems, because most of them are sing le. Since treatment is unfeasible without a sex partner, therapists request that these men bring a girl friend. If there is no girl friend, some clinics — the Group for Social Development in Berkeley, California, for example — use sexual surrogates. (The Berkeley clinic is where my friend went; his premature ejaculation problem, he found out, was caused largely by his hasty backseat sex habits in adolescence.) The Berkeley clinic uses three full-time sex surrogates, called “sex therapists.” Each man who has no lady of his own and goes through the two-week treatment program spends four hours a day with these surrogates — three hours alone in her private studio, then one hour reviewing the session with her and a psychologist. Many women who work as surrogates have had sex problems that were treated successfully. All surrogates must be intelligent and open to self-criticism, says a clinic spokesman, because the job is “so much more difficult and more demanding than that of an ordinary therapist.”

Surrogate sex partners, exotic as they sound, may actually exacerbate problems, for the sexually dysfunctional man, since he feels under greater pressure to perform with an attractive, confident, and unfamiliar woman. “It’s a much heavier trip and the therapy takes longer,” says Dr. Bernard Apfelbaum, a psychologist at the clinic. But the clinic, which has treated 150 single men with surrogates, finds its success rate is as high as that for married men. “Of course, treatment is easier in a marriage relationship, because communication is already established,” Apfelbaum says. “With a new partner, a man must first open up to her, and learn to trust and share, before he can deal with his sex problems. Basically, this is training in communication, in giving and receiving pleasure.”

“‘We teach people how to communicate,’ says one sexual dysfunction therapist, ‘not how to fuck.’”

Sexual Dysfunction Niche

Men who suffer from retarded ejaculation, the least common of the major sexual dysfunctions, often use sex to communicate, but what they communicate is a sense of self destruction laced with fears of dominance and death. They are described by many therapists as desperate and sometimes suicidal. They have a paranoid belief that all other men are their rivals. Retarded ejaculators achieve erection easily, but then it takes them hours to ejaculate — if at all — and they often give up from exhaustion. With these men, women often achieve multiple orgasms during intercourse; but, although a man may briefly enjoy his status as super-stud, his sexual fears eventually overwhelm him. “They associate ejaculation with danger, with death and castration,” says Dr. Lionel Ovesey, a professor of psychiatry at Columbia University.

Many retarded ejaculators associate sperm with strength; they feel that each time they ejaculate they lose some of their power. For them the vagina becomes a mouth that sucks their life-sustenance. Masters and Johnson found many such men were severely punished as boys for masturbating or having wet dreams, so that the commandment “Thou shalt not ejaculate” was imprinted on their minds. And some men simply dislike their wives so much that they hold back just to frustrate them.

The physical cure for retarded ejaculation is fairly simple. The wife is instructed to masturbate her husband in the ways he finds most exciting until he at last ejaculates in her presence. Once he associates her with pleasure rather than threat, they go on to the next step. The wife straddles her husband, manipulates him almost to orgasm, puts his penis inside her, and he thrusts until he ejaculates. The object is to break the pattern by getting even a drop of semen into the vagina. Once this is accomplished, and the husband finds he is not harmed or weakened, the couple are taught to prolong coitus until both can reach orgasm.

Masters and Johnson report success rates as high as 80 percent for treatment for retarded ejaculation, but other therapists are more skeptical about the ultimate success of treating the symptom without lengthy psychoanalysis. Dr. Ovesey cites as a typical patient a thirty-eight-year-old businessman who was severely depressed, anxious and suicidal. As a child, he had been intimidated by both parents: his father often threatened to cut off his penis, and his mother once beat him so hard with a baseball bat she broke his arm. Later, he sought financial success as an outlet for his aggressions — yet when he achieved it after a bitter power struggle with a business partner, he was overcome with guilt. At first he was unable to ejaculate with his wife unless he was on the bottom and she on top, and eventually he was unable to ejaculate at all. When he came for therapy, he was having dreams in which he was the victim of castration and homosexual rape. He felt that his partner had been like a father to him, and that he had symbolically castrated him. He was afraid of violent retaliation. After four weeks of psychotherapy, he gradually began to ejaculate again. “Treatment [of retarded ejaculation] must be aimed at the underlying conflicts, and not at the symptoms, regardless of the patient’s reason for seeking help,” Dr. Ovesey says. Others agree that treatment should be approached through psychotherapy. “Often the criminally insane are retarded ejaculators,” says Dr. Sloan. “It’s a more severe psychopathology; the psychosis should be treated first.”

Despite progress in sexual therapy, full knowledge of the causes and effects of sexual habits remain as inaccessible, yet alluring, as buried treasure. The most daring explorers thus far have been William Masters, a balding fifty-nine-year-old gynecologist, and dark-haired Virginia Johnson, forty-nine, a psychology major and now Masters’s wife, who first began to observe and record the effects of intercourse on sexually healthy men and women in their St. Louis laboratory in 1959.

They learned, among many other things, that penis size is unrelated to sexual performance. Small penises generally enlarge much more impressively than do large penises, so that when stimulated there is little variation in size. The size of the penis has little effect on a woman’s sexual pleasure, for the vagina adjusts itself to the size of the organ. They found, too, that the elderly can and do enjoy sex. When a man passes his sixties, the force of ejaculation may decline, and achieving erection may take longer, but he probably has the capacity for continuing enjoyable intercourse — some men report sex is even better in their mellow age than in their hurried youth. Women are also capable of having orgasms in old age, and many report that their sexual enjoyment increases after menopause — perhaps because they no longer have to worry about pregnancy.

Masters and Johnson also found that most women are capable of having up to six orgasms before being satiated and that there is no physiological difference between clitoral and vaginal orgasm. Both of these facts, of course, affect a man’s concept of his own sexuality and how best to please a woman. Interestingly enough, the sex researchers have noted that under laboratory conditions supposedly healthy men failed to achieve orgasm six times more often than their women partners, a phenomenon they attribute to a greater culturally induced anxiety about sexual performance. It is still considered more humiliating for a man to fail sexually than for a woman. Masters and Johnson’s early research is described in the book An Analysis of Human Sexual Response edited by Ruth and Edward Brecher (Signet, 1966).

All of this indicates that sexual dysfunction is an illness unto itself, more often caused by cultural taboos and sexual ignorance than by mental or physical illness. In fact, it is often the case that sexual problems cause mental problems. Lack of touching, stroking, and sexual contact can bring on mental illness — and treating the physical hangup is the first step toward a cure. Dr. Harry F. Harlow of the University of Wisconsin, found in experiments with monkeys that subjects reared with wire-frame substitute mothers and isolated from physical contact with al I other monkeys, became sexually neurotic as adults unable to have intercourse. When fake cloth-mothers were substituted, so the monkeys could cuddle, their neuroses were less marked. Many men who seek sex therapy were isolated physically or emotionally from their parents and peers and thus missed out on the most important part of sex education, which begins at birth with touching, body smells, voices, and warmth and affection between parents and children.

Sexual Dysfunction Solutions Continue

“Masturbation,” says Dr. Leon Zussman, a New York gynecologist-sex therapist, “is the first natural sexual activity humans undergo. Babies touch their eyes, nose, ears, and genitals — that is, they try. But even today mothers usually push their hands away because touching is a no-no. One of the common signs among impotent men is that they’ve never masturbated.” Big-city doctors still see patients who, for example, believe that if they ejaculate in the presence of a woman they will become paralyzed from the waist down. Zussman and his wife, Dr. Shirley Zussman, co-directors of the human sexuality program at Long Island Jewish Hospital, recently successfully treated fifteen couples who were still virgins after eight years of marriage.

‘“The great American myth,’ says one psychiatrist, ‘is that you have to have a mutual orgasm.’”

These couples sometimes had sexual hangups so severe that the Masters and Johnson treatment alone was not enough. For example, in one young couple who had been married three years, the wife would not let a gynecologist approach her even for a Pap smear (a routine test for uterine cancer), and her husband had never had an orgasm. Over a period of three weeks, the wife was taught to insert vaginal dilators into her vagina, beginning with one the size of a ballpoint pen. It took her one hour to insert a tiny portion of the first dilator. Each succeeding week she was given a slightly larger dilator, until in the tenth week she was able to insert one the size of a large penis and would permit her husband to put his hand on hers as she guided it in.

Meanwhile the Zussmans worked with the husband, who conceded after several weeks that as a child he had once awakened “by accident” to find he had a partial erection. “I was, in his eyes, the father, ready to pounce on him if he ever admitted it,” says Leon Zussman. “When he finally got over that fear, I told him the next time he woke with a partial erection to masturbate himself to orgasm. Eventually, he did.” The Zussmans taught the husband and wife to masturbate separately, and then to masturbate while sitting across from one another in the same room. Finally, they were allowed to try intercourse, first guiding the dilator in, then substituting the penis. Within three months they were having intercourse regularly, and a year later their first baby was born.

The Zussmans believe strongly that all couples who come in for therapy should first be given a thorough examination in the presence of the spouse and the two doctors, who explain each part of the genitals and its role in sexual response and pleasure. Most men, it turns out, have never even been permitted to look at their wives’ genitals — indeed, most women have never seen their own genitals, which they could easily do with the aid of a mirror. “Before the exam,” Leon Zussman says, “women often tell us we can examine them in front of the entire hospital — but not in front of their husbands. Afterward they feel differently. The men invariably find the exam a revelation, and the most common remarks I hear are ‘incredible,’ ‘fantastic,’ and ‘why haven’t I seen this before?’ Those who feel the vaginal area is a dirty, secret place have their heads turned around by the beauty of it. We teach them that it is all right as part of sex and loving to touch, taste, smell, and enjoy.” And yet the efforts of these clinics and doctors are only oases in a desert of sexual ignorance. The proliferation of sex magazines, porno films, “how to do it” books (some of which, like Dr. David Reuben’s Everything You Always Wanted to Know About Sex, contain misleading information), and commercial partner-swapping parties, are an indication of people’s thirst for information in this area.

Unfortunately, even as premarital sex increases on the college level, sexual misconceptions still abound in all age groups. “The knowledge that college kids have of their own sexual functioning is not much different from what their mothers or fathers knew,” says a psychologist who teaches and counsels at a private college on the East coast. “I am constantly amazed at how little information the students have — and yet where would they get it? Most parents of this generation still don’t tell them, good sex education programs are just now getting under way, and even most medical people still lack exposure to new attitudes.” In fact, doctors are often surprisingly unknowledgeable about sexual problems. People who become doctors tend to be hard-workers, diligent, conscientious, and not particularly likely to have active social lives. They often repress their own sexual desires in favor of their work and show embarrassment when talking to patients about sexual problems. Only now are medical schools beginning to incorporate courses on human sexuality.

This combination of old sexual myths and new sexual behavior has created a different set of problems for young men today. “The opportunity for hit-and-run sex is disappearing,” says William Simon, a former Kinsey collaborator now with the Institute for Juvenile Research in Chicago. “No longer do young boys have their first experiences with the community peg board down the block. Instead they have intercourse with girls they know, and have to learn to handle a whole range of social and sexual roles at the same time. Before, when young sex was in a shadowy world, they didn’t have to worry about word of failure getting out. But now they run the risk of their partner telling her friends about it.” When Simon and a colleague, Patricia Miller, recently completed their study of young people, they found that while coitus rates for girls were increasing, the coitus rate for boys in their teens had actually declined from Kinsey’s era. This indicates, they feel, a hesitation among young men to expose themselves to sexual failure with girls they know.

Exactly how serious early sexual failure can be is a matter of debate. Simon believes that all sexual experiences in youth are traumatic. “It’s par for the course that a young man will have sexual problems on his first sexual contact,” he says. “It’s just part of the agony of coming into adult sexual behavior, a problem of mixing the complexity and richness of masturbatory lives with the pragmatic social-sexual relations with a real girl. After all, in the fantasy world of masturbation, no woman ever said or did anything he didn’t want her to.” Simon believes men, like women, must learn about sex, and only practice makes perfect: “The old idea was that only women needed sex education, and men just had to listen to nature. Now we know that damned little is programmed, even in men, and that almost everything must be learned.”

But the yoke of failure rests heavier on men than on women, and many, including Masters and Johnson, believe that early sexual debacles can establish a lifetime pattern of sexual inadequacy, as it did with my friend who finally sought help with a sexual surrogate. Not only are men under more pressure to perform, but they are more concerned than ever before that their women reach orgasm. Dr. William Frosch, among others, believes that women’s new sexual attitudes are responsible for much of this new pressure, that women’s liberation is creating sexual havoc among some men: “Before, women were willing to suffer silently in the Victorian fashion if they weren’t sexually fulfilled. But now they are more demanding about their sexual rights. They feel entitled to sexual satisfaction, and they make their expectations known — sometimes early in the relationship before trust between the couple is really established. If a man is expecting to go through the courtship ritual, and is suddenly expected to perform in three seconds flat, it can have a devastating effect,” he says. Again, there are no hard data to back him up. “You can’t win,” says Dr. Shirley Zussman, who disagrees with Frosch. “When women were less responsive they were blamed for male sexual problems. Now that they are more aggressive, they also get blamed. It’s a vicious circle.”

Perhaps as women accept their own sexuality they will relieve men of some of the burden. “Women’s liberation is the best thing that can happen to men,” says one therapist. “Previously, it was unromantic, iconoclastic, for a woman to discuss how she liked her clitoris touched. Or if she had a ‘thing’ about her sensual elbows, she expected the man to know it instinctively. When he didn’t realize that she liked her elbows stroked, she secretly blamed him for not being sensitive to her needs. For many who come for help, it’s the first time they’ve experienced a semblance of equality and accepted their individual responsibility for sexual failure and pleasure.”

A Future with Limited Sexual Dysfunction

The biggest challenge to sex therapists is teaching both men and women to express their sexual needs in specific terms, such as “please touch my penis like this,” followed by a demonstration, rather than use the old “does that feel good?” followed inevitably by a vague “yes.” “Too many married couples play a guessing game and never verbalize anything,” says Dr. John O’Connor, associate clinical professor of psychiatry at Columbia University. “You want to please your sex partner, but you fear making yourself vulnerable by taking the risk of saying what you would really like for yourself.”

“Some doctors feel that the feminist movement aggravates sexual problems in already insecure men and increases their anxiety about performance.”

In one case, a restrained Princeton graduate came in for therapy with his wife, complaining that he just didn’t enjoy sex. During treatment, the therapist asked him if he and his wife ever spoke to one another while making love, ever used four-letter words to turn each other on. When the man said no, the therapist asked him if he might respond favorably to such language in bed. “Well, I might a little,” he said. “Why didn’t you tell me that!” exclaimed his wife, who was sitting next to him. “You always told me not to say those things in bed!” “Yes,” replied her husband, “I told you not to say them, but you never asked me if they turned me on.” From then on, she fi lied their sex with four-letter words, and the more he told her to stop, the more she talked. Both said their sex life improved tremendously.

“Hopefully, the man will one day feel free to be on the receiving end — not just the performance end — and both will understand it’s all right for a man to be passive and a woman active in sex,” says Dagmar Graham, who was trained by Masters and Johnson in St. Louis and is now director of training at the New York Medical College’s sexual therapy and education center.

Mrs. Graham believes that, bad as things are here in the United States, they are worse everywhere else, even in Sweden where she was reared. “In Sweden they are totally performance-oriented. Sex is a gymnastic exercise,” she says. “Sex is based on the man being able to perform as many times as possible in one night. There is no sex therapy there of the type available in this country, and I doubt whether it would be accepted, because sexual problems are even more threatening to Swedish men. I find the same attitudes in Sweden that I find in Latin America — a macho syndrome.”

By treating the sexually ill, the therapists are at least learning how to keep the rest of us sexually well. To cure sexual boredom (which could lead to a breakdown in communication), tension, and a dysfunction, they suggest the alternate orgasm. “The great American myth,” says Dr. Clifford Sager, “is that you have to have a mutual orgasm. But it’s impossible to give and to receive at the same time. There is something delightful about the joy and pleasure of giving someone an orgasm. You can feel the emotion of it in your head and guts, and can share in it.” Therapists also recommend a variety of new coital positions. The man on the bottom with the woman lying or sitting on top, for example, permits more freedom of movement. This is the position often recommended when men have sex problems, because it puts the woman in a position of control and psychologically removes some of the performance pressure from the man. Then many couples prefer various other positions. As for sex aids, most commercial aphrodisiacs work only if you believe they work; you are paying for a state of mind. Dr. Wardell Pomeroy, a former Kinsey collaborator who is now in private practice in New York, says good health, exercise, lots of sleep, minimal drinking, and the right foods are still the best aphrodisiac. Coconut oil, powders, dildos for women, and group sex are also sometimes useful. All else failing, the sex therapists suggest you try a new partner.

But just how bad are things here? Some say very bad. Masters and Johnson believe that half of all married couples have sexual problems that should be treated. “Of course, more men are sexually inadequate than ever before believed,” says Dr. Lonny Myers. “There is a tremendous amount of sexual hypocrisy in all societies, ours included.” But how many men have sexual dysfunctions? And are the numbers growing? There seem to be no statistics. The therapists just shrug their shoulders and return to the patients lined up in their waiting rooms.

As a general matter, it seems like sexual dysfunction would be an atypically difficult area to poll. Sex has to be at the center of most of the lying we do to ourselves. Consequently, even when you find people who will be honest with the researchers themselves, how can we be sure they are being honest with themselves? … On the upside, around here we need not always bother ourselves with such lofty ruminations. Have you seen our Pets? … For the record, we have no idea if any sexual dysfunction exits in that group, but then that question does not appear on the standard questionnaire either. That seems good.

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