He's Just Not Up for It Anymore (15 page)

I believe that his natural shyness and performance anxiety was exacerbated by repeated incidences of sexual dysfunction and eventually he just gave up on himself and stopped trying. (Female, 50s)

Men are supposed to be ready to go at the drop of a bra. Therefore, a lot of guys believe that the easy erections they had when they were 16 should keep on rising effortlessly at 60. You’ve probably all heard the one about a woman needing to build desire slowly, simmering like a Crock-Pot, while a man gets aroused in an instant, similar to nuking leftovers in a microwave. Although we never much liked the analogy, the Crock-Pot/microwave compari-son has some truth to it. Women, as a rule,
do
take longer to reach a level of peaked desire and achieve orgasm. Men
are
often ready much sooner.

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HE’S JUST NOT UP FOR IT ANYMORE

Only about 20 percent of men with ED seek professional help.

However, some women are ready to go at the speed of light, some men need a lot of stimulation, and sex, like life, is often surprising. But it should be no surprise if a man needs more stimulation as he ages, because many do. Multiple studies have indicated a decline in male sexual functioning after age 40. In spite of this, when Lenore Tiefer interviewed hundreds of men at Montifiore Medical Center in the Bronx, she found that most of them expected to get an erection just by looking at nude pictures in
Playboy,
and this included men in their 50s.

The expectation that erections will come as easily at 60 as 16 is irrational. Nearly four out of ten baby boomers report that they or their partners have experienced erectile dysfunction, something likely to be underreported. Statistics vary, solutions vary, but the websites of the big three erectile dysfunction drugs—Viagra, Cialis, and Levitra—all agree on one thing: ED affects over 30 million men in the United States. Validating studies, including the 1992 National Health and Social Life Survey, report the same figure. This is a serious problem, and not to be overlooked or dismissed, although many men choose to do so.

Frequently it can be easily and effectively cured, if the man is willing to admit there’s a problem. Bob Dole and famous athletes endorse ED

drugs, and the back walls of baseball stadiums scream VIAGRA. Nevertheless, only about 20 percent of men with ED seek professional help.

HOW ERECTION OCCURS

When physical or mental stimulation results in the brain sending a message of arousal via the nervous system to the penis, here’s what (ideally) happens: The artery to the penis dilates to twice its diameter, blood flow is increased, and the veins that carry blood away from the erectile dysfunction: the silent passion killer 127

penis are blocked. The two spongy, cylinder-shaped structures in the shaft of the penis called corpora cavernosa relax, allowing the increased flow of blood to cause expansion. A membrane surrounds the corpora cavernosa, which helps to trap the blood and sustain erection. Thus, an erection takes place when there is increased inflow and decreased outflow of blood to the penis. (This can also happen on an involuntary basis due to friction, or upon awakening, or during sleep.) There are seemingly endless erectile variations other than the ideal.

A man may be unable to achieve erection on a temporary or more permanent basis, or get a partial one, or get one and lose it several times while making love, or get one but not maintain it for intercourse, or initially maintain it for intercourse but not sustain it. The experience may be elusive, with numerous permutations, or always pretty much the same. But unless there is increased inflow and decreased outflow of blood to the penis, no erection takes place.

WHAT PREVENTS AN ERECTION?

Blood has to flow easily into the penis, and remain trapped there for a period of time, to enable it to become erect. Therefore, vascular diseases, such as arteriosclerosis (hardening of the arteries) or high cholesterol (excess cholesterol adheres to artery walls, making it difficult for blood to pass through) can impede an erection. Heart disease and stroke may also have a negative effect. Other physical causes include diabetes, and the aftermath of colon, rectal, or prostate surgery. In addition, many medications have ED as a possible side effect, including some for depression, anxiety, diabetes, and hypertension.

Any of the above, in relation to optimal sexual health, should be discussed with a physician as soon as possible.

Lifestyle factors can also diminish a man’s ability to get or maintain an erection. As almost everyone has experienced at least once, too much alcohol rarely leads to a great night of passion. A heavy drinker 128

HE’S JUST NOT UP FOR IT ANYMORE

may experience erectile dysfunction on a more permanent basis. Drug abuse also can discourage an erection (and a partner). So can obesity.

Healthier men have an easier time getting and maintaining erections, and eating less and exercising more can result not only in weight loss, but in better sex. Clearly, poor lifestyle choices are often indicators of other psychosocial factors, and the cause of physiological ones. And anything as serious as alcoholism, drug abuse, or obesity should be dealt with immediately, ED or not. But potency can be an additional benefit of improved habits.

THAT MAGIC WAND: HOW CAN

A MAN COMPETE?

When Hitachi developed a microphone-shaped vibrating “massage therapy” product that became the bestselling vibrator of all time, they called it a Magic Wand. It was a supernatural pleasure tool—

only a blackout could impede performance. Men are conditioned to believe that they should perform, for better or for worse, in sickness and in health, just like that appliance. They should turn on as soon as the switch is pushed, and keep on going, even if 30 million of them don’t.

Men are conditioned to believe that they should perform,
for better or for worse, in sickness and in health.

Why is there so much denial of a problem that affects so many?

Urologist Abraham Morgentaler states that shame is the primary reason men do not seek help: “They are ashamed they cannot perform sexually the way they once did or think they should.” To compound the problem, many think the cause is psychological, even though it more often isn’t. “Persistent failure then becomes a sign (in erectile dysfunction: the silent passion killer 129

their own minds) of failed willpower in addition to a failed erection—another sign of diminished masculinity.” Journalist David M.

Friedman argues that there aren’t too many ways left for a man to prove that he is protective and strong, as technology has robbed him of most easy displays of male prowess. “A man is no longer measured by his physical strength, his ability to build shelter for his family, fight in hand-to-hand combat, or draw water from a well. Machines do that for him. Muscles are more symbolic than useful. So the erect penis has become the most powerfully symbolic muscle of them all.”

Sociologists suggest that the past thirty years challenged men’s tradi-tional areas of supremacy tremendously—they were no longer necessarily the most powerful sex at home, work, or in politics. Erectile dysfunction may be the last, limp straw—the ultimate threat to an already shaky masculinity.

Of course, a loss of the ability to get or maintain an erection can be sliced and diced into a million sociological, physiological, and psychological pieces—but when it happens to a man it is devastating. There used to be little reason
not
to suffer in silence; what’s the point of discussing this with your physician if you don’t think there’s any cure?

Then, in March of 1998, just weeks after Monicagate broke and the president of the United States’s penis and semen began to be discussed regularly on the nightly news, Viagra was approved by the FDA and became a household word. The “little blue pill” wasn’t just a boon to the millions of men who needed some help, but to late-night talk-show hosts, too. (We can’t blame them for making jokes, it’s what they get paid for, but can you imagine anyone laughing about a new pill that cured diabetes or heart disease?)

If you suffer from ED, it’s hardly a joke, and finally there was a solution other than embarrassingly awkward penile pumps, surgery, questionable herbs, unappealing suppositories, and even less appealing injections. And miraculously, the little blue pill worked for most men. That is, if they were among the 20 percent courageous and secure enough to give it a try.

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ANOTHER UNFORTUNATE MALE EQUATION:

NO ERECTION = NO SENSE OF SELF

He doesn’t get much of an erection and feels like he is a failure as a husband. (Female, 66, married to her 66-year-old husband for five years)

J. Francois Eid is a New York City urologist specializing in erectile dysfunction. He believes that if a man loses his potency, he loses a part of his identity. Essayist Phillip Lopate agrees—he quips that just saying the word out loud makes him nervous. Sociologist Warren Farrell once mentioned that it is a rare disease that
becomes
the identifying characteristic of the inflicted, as in “I
am
impotent,” in contrast to, for example, “I
have
cancer.” This seems to be the case in sexual issues, regardless of gender. A woman is likely to say that she is nonorgasmic, and it wasn’t too long ago that nonorgasmic women were called “frigid.” Similarly, the extreme negativity of
not
being potent resulted in a new, politically correct way of stating the case; around 1992, it became known as erectile dysfunction, or ED for short, allowing Tom Wolfe to wittily call impotence “the disease that dares not speak its name.”

An ego-threatening disease by any other name is still a marital landmine.

Many men shut down completely, afraid that kissing and other displays of affection might be misconstrued and lead to embarrassment. It is easier to pretend fatigue, or (not necessarily duplicitously) claim anxiety and stress and far less threatening to masturbate and get a release of tension—no erection necessary. Some men shut down so completely that erectile dysfunction inhibits their ability to feel any desire at all. A 1990 study found that 20 percent of men who experienced ED also had a difficult time having an orgasm.

To compound the problem, it is usually extremely difficult if not impossible for a woman to understand how devastating this is. Even erectile dysfunction: the silent passion killer 131

the most sophisticated woman, in terms of male sexual function, may irrationally blame herself, believing she is no longer attractive, desirable, or loved. When conventional solutions like new lingerie and candlelit bubble baths fail miserably, she may become angry, depressed, or both. It is understandable for a woman to be frustrated, confused, or even enraged when she feels less than desirable; it is also not surprising that some suspect their partners of infidelity. However, so many men suffer from this problem that it is important to realize that although no one wants to talk about it, maybe least of all your spouse, you are not alone. You are part of a silent crowd.

VIAGRA, CIALIS, AND LEVITRA ARE NOT,

WE REPEAT
NOT,
APHRODISIACS

We must mention here that those blue, yellow, and orange pills, respectively, do not cause a man to become excited. They only work if he is aroused, and the arousal part will only happen if he is “turned on” by his partner or some other stimulation. We cannot state this too strongly. It is easy for us to understand why some women feel disappointed that their partners need a pill to get an erection, but it is not a rational disappointment. In fact, these pills can be an easy solution to a problem that was once extremely difficult to solve.

Pills won’t give men an erection unless they are stimulated.

They have zero effect on low libido.

So, one more time, pills won’t give men an erection unless they are stimulated. They have zero effect on low libido. A guy who is willing to ask for help from his doctor is taking a big, difficult step and is really trying to solve the problem. If the problem is physical, and it 132

HE’S JUST NOT UP FOR IT ANYMORE

usually is, PDE5 drugs (short for phosphodiesterase type 5) work 65

percent of the time.

Pfizer’s Viagra (sildenafil), Lilly’s Cialis (tadalafil) and Bayer’s Levitra (vardenafil) all work in more or less the same way, by allowing blood vessels to relax enough to increase the flow of blood to the penis and stay there. Although all are similar compounds, they have small molecular differences, which mean that if one proves unsuccessful, another might work just fine.

Viagra takes about one hour to work and lasts about four. It should be taken on an empty stomach; doctors suggest three hours after eating.

Cialis takes about thirty minutes to work and lasts about thirty-six hours, which is why the pill is called “Le Weekend” in France. It can be taken with or without food. (Full disclosure: Bob has been a spokesperson for Cialis.)

Levitra takes about forty-five to sixty minutes to become effective, lasts about four hours, and can be taken with or without food.

They all may interact with other medications, so the physician will need a complete list of any being used. He will probably recommend alternatives to the PDE5s if the patient suffered a heart attack or stroke in the past six months, has very high or low blood pressure, liver or kidney disease, or certain other, less common physical conditions.

The physician will help decide the most appropriate pill. For example, diabetics, with a slower rate of gastric emptying, might be advised to use Cialis or Levitra because they can be taken with food.

He might also recommend you consult a urologist.

Confidence Resurrection

We mentioned that these pills aren’t love potion number nine. However, if a man stops being sexual with his partner because of ED and ED only, and takes a pill that alleviates the problem, he may be able erectile dysfunction: the silent passion killer 133

to make love again eagerly and fearlessly. He still has to get aroused, but a renewed belief in himself and his sexual abilities may enable passion to come back along with his erection.