He's Just Not Up for It Anymore (17 page)

tercourse. The American Psychiatric Association defines rapid ejaculation as follows:

A. Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

B. The disturbance causes marked distress or interpersonal difficulty.

C. This is not due exclusively to the direct effect of a substance (e.g., withdrawal from opioids [narcotic pain managers]).

Rapid ejaculation has more recently been defined as when ejaculation happens in less than one minute and occurs before, or soon after, penetration into the vagina. The defining characteristic, however, is that the male has no control, and generally has deep feelings of inadequacy and shame after it occurs. Clearly, a man suffering from PE

may have reason to prefer solitary to partnered sex. It is considered to perhaps be the most common male sexual complaint. Twenty-five percent of American men suffer from rapid (or premature) ejaculation.

25 percent of American men suffer from rapid
(or premature) ejaculation.

Perhaps due to an older demographic, this did not seem to be an issue of primary importance to our respondents. Although, like ED, possibly underreported, only 16 percent of the men said premature ejaculation was a factor in their not having sex with their wives, although 20 percent of the woman believed it was. This 46-year-old woman expresses remorse over the way she treated her 45-year-old partner: 142

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I’m sorry I let myself get so angry when he started to have a problem with premature ejaculation. I was so mad because he was pretending it wasn’t a problem. I was so frustrated I used to yell at him after he had an orgasm.

Clearly, this woman’s insensitivity to an issue her spouse considered extremely embarrassing compounded his anxiety, which, in turn, likely exacerbated the problem.

PE is one of the easiest sexual problems to solve, using behavioral therapy. A man can train his body to be aware of when he is getting close to the point of inevitability, and then either slow down or change what he’s doing. Many men self-trained to be rapid ejaculators in those furtive and fast early days of adolescent masturbation and continue this behavior into adulthood. Then they try, unsuccessfully, to

“retrain” by focusing on anything other than their partner and the sensations of lovemaking. They rationalize that if they think about baseball scores or interoffice memos, the problem will go away. The fallacy with this approach is that they are also “retraining” to be unin-volved, uncommitted partners, while doing nothing to decrease the performance anxiety that is the psychological foundation for rapid ejaculation. For example, a fear of intimacy or discomfort with his own sexuality can lead to PE; further separation from his sexuality might only aggravate the real issues. In addition, he may become so expert at this waiting game that erectile dysfunction replaces premature ejaculation as a different road to the same ultimate, sexless destination. He is doing nothing to reduce his stress and anxiety.

There has been some recent research, and preliminary success, in treating PE with low doses of antidepressants. The caveat, of course, is that it may treat the condition, but lower the libido. The erectile dysfunction drugs also have shown promise, and if premature ejaculation has been a problem, it is certainly worthwhile discussing both with your physician.

erectile dysfunction: the silent passion killer 143

RETARDED EJACULATION

The inability to be orgasmic or just taking too long—these are usually seen as exclusively women’s issues. Men having a problem ejaculating is rarely discussed. And yet 27 percent of our female respondents felt this was a reason their husbands stopped being sexual. Fifteen percent of the males agreed.

Numerous medications can cause a man to have this problem.

These include some (but by no means all) drugs that treat cardiovas-cular issues. Many drugs for depression and anxiety that lower libido prevent or inhibit ejaculation as well. If necessary, discuss this with your physician. It may be possible to switch to a different medication, or reduce dosage. Substance abuse, especially cocaine and marijuana, can also result in inhibiting orgasm. One of our male respondents reported that although he no longer has his heroin addiction, he still has difficulty maintaining an erection or having an orgasm.

Male retarded ejaculation is rarely a psychological issue. However, it has been theorized that certain men are so anxious to please their partners that they are unable to relax enough to please themselves, similar to some nonorgasmic females. Others can orgasm only with prolonged friction generally not possible during intercourse. These men can ejaculate when alone, or sometimes with manual partnered stimulation.

BETTER SEX THROUGH CHEMISTRY?

The pharmaceutical companies are researching new and improved drugs for male sexual issues, for example, the next generation of PDE5 inhibitors. A low-dosage “once-a-day” version of Cialis (2.5 mg as compared with current 5 mg, 10 mg, and 20 mg dosages now available) was approved for the European market. U.S. application 144

HE’S JUST NOT UP FOR IT ANYMORE

has been submitted. This will be marketed as a pill for men who want to be able to function sexually at any time. They can, theoretically, take a pill every morning with their baby aspirin and vitamin, and love will truly mean never having to say they’re sorry. If it works, the guy will once again be his old, pre-ED self.

SSRIs (selective serotonin reuptake inhibitors) have been prescribed off-label by physicians for years in the treatment of rapid ejaculation. Dapoxetine, an SSRI specifically developed to be marketed for this purpose, was recently rejected approval by the FDA but was granted it in Europe. In one study, although Dapoxetine was perhaps not as efficacious as one might hope (the participants were able to have intercourse for an additional minute), those taking it did report more enjoyment and control over their performance. As we have previously mentioned, SSRIs, marketed as antidepressants, can result in lower libido, erectile dysfunction, and inhibited orgasm (hence the off-label usage for rapid ejaculation). A new generation of SSRIs is being researched to treat depression without deleterious sexual side effects.

Hormonal birth control for men appears to be in the not too distant future. A progestin-releasing implant will be effective for up to a year when combined with quarterly injections of androgen and is re-versible. For the first time, men who fear impregnating their partners, perhaps to the point of not being able to optimally function, will be in complete control, without having to disrupt the sex act in any way.

Lifestyle drugs can be extremely effective and can, in fact, have a significantly positive effect on one’s life and style. But, if men don’t use them, all the new innovative research won’t make any difference.

What angered so many of our female respondents was their husband’s refusal to get any help for his problem of erectile dysfunction, when it seemed so readily available. According to them, seven out of ten men suffering from impotence refused to see a physician.

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CAUGHT IN THE NET

When we bought our computer over six years ago, our sex life started to go downhill. He would spend all night watching porn. I would lie in bed alone and wonder if he even loved me anymore. (Female, 20s)

We had some surprises while doing our research, but it was no shock that a woman takes it personally when her partner secretly masturbates to a virtual lover. It is both mysterious and hurtful that a beloved would prefer a solitary experience with a one-dimensional online fantasy to an intimate and real one with his wife.

Masturbation seems to play a different role in the sex lives of men and women. When Shere Hite compiled her two classic statistical volumes of male and female sexuality in the late 1970s, she noted that “most women felt that the main importance of masturbation was to substitute for sex (or orgasm) with a partner,” but “almost all men, whether married or single, with or without an otherwise active sex life, said they made masturbation a regular part of their lives.”

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HE’S JUST NOT UP FOR IT ANYMORE

He once told me that he likes to masturbate because he can focus on himself and he doesn’t have to worry about pleasing another person. He knows what he likes and he gets it done quickly. (Female, 20s)

Psychiatrist and sex therapist Avodah K. Offit, in her beautifully written
Night Thoughts: Reflections of a Sex Therapist,
says this about masturbation: “Whether we share our sexuality becomes a matter of choice, not obligation. Most men take this freedom for granted, but many women need to be taught,” and then adds that, from a woman’s perspective, “For most of us, the ultimate message of masturbation is still a longing for someone else.”

This seems to be an irreconcilable difference. In spite of all the childhood taboos or because of them—the subterfuge, fear of being caught, parental warnings and recriminations—most men seem to make time for masturbation whether they’re in a relationship or not.

It’s simply a question of how much time and energy they have left for partnered sex.

If most men consider masturbation a birthright, it seems clear that a daily groaning board of sexual fantasies to help them along, virtually endless in variety, private, and cheap, would have appeal. The audi-ence laughs loudly and knowingly in the musical
Avenue Q
when a female puppet sings the praises of the Internet for easy access to information and online shopping, but a cynical male puppet retorts:

“Why do you think the Internet was born? Porn, porn, porn!”

There is plenty of porn to go around, with or without the Internet.

America is the world’s largest producer of “adult entertainment”—an estimated $10 billion industry. Dr. Joy Browne, psychologist and radio personality, says that although the Internet has changed accessibility,

“Porn is as old as the cave painting. The only thing to change is the technology, not the phenomenon.”

Nevertheless, easy access has possibly increased time spent with pornography for those guys once limited to line drawings and erotic caught in the net

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stories. Fifty-eight percent of the men who responded to our survey said they watched porn online regularly. Of that group, 72 percent watched one to five hours per week, 19 percent six to ten hours per week, and 9

percent amazingly watched more than eleven hours a week, which would translate to a minimum of twenty-three days a year. They did not say, however, that pornography was necessarily the primary reason they stopped being sexual with their wives, and it might have been the result of marital problems rather than the cause.

A lot of “women of the night” have been replaced by

“women of the Web.”

Thirty-nine percent of the women reported that their husbands watched pornography online regularly. Of that group, 67 percent reported one to five hours weekly, 19 percent six to ten hours, and 13

percent said more than eleven hours a week.

Of course, the women could only approximate, and their anger and frustration may have inflated those estimates. Conversely, the men may not be aware of how much time they are really spending with their private harem of gorgeous smiling women who will never reject them or ask for anything that can’t be delivered. What a place!

To paraphrase Garrison Keillor—all the women are beautiful, all the men are hard, and all the sex is above average.

HOW CAN A WOMAN COMPETE

WITH A DREAM?

Before pornography was readily available and “proper” women saved themselves for marriage (or at least a commitment), sex often appeared at the top of young men’s shopping lists. Nineteenth-century men 148

HE’S JUST NOT UP FOR IT ANYMORE

learned about how to please a woman by visiting prostitutes, and they were taught a wildly inaccurate view of female sexuality in the process. Swiss psychiatrist Auguste Henri-Forel warned about this when he said: “The company of prostitutes often renders men incapable of understanding feminine psychology, for prostitutes are hardly more than automata trained for the use of male sensuality. When men look among these for the sexual psychology of women they find only their own mirror.”

Although a lot of “women of the night” have been replaced by

“women of the Web,” this remains a terrific depiction of what twenty-first-century DVDs and online pornography delivers, and if a man confuses it with real life, it can create serious problems. In
Mismatch:
The Growing Gulf Between Women and Men,
political scientist Andrew Hacker, crunching the numbers in search of answers to the question of why “marriages are briefer than at any time since this nation began” suggests that, as example, the large market for pornography “conveys a lot about what men want—and apparently aren’t getting—from their marriages.”

I’d just like to reiterate that this is one of the worst problems that a relationship can go through. Now that I have left my por-nographically obsessed ex-husband I have realized how emotionally abusive it is to withhold sex and still demand that your partner be monogamous. I think a lot of people assume that this type of situation only occurs when women have had a bunch of kids or are not as physically attractive as they once were. At the time I was 23 years old, in very good shape, and described as very attractive. My ex-husband, for whatever reason—I think laziness—was still more interested in looking at pictures online than interacting with a real live woman who he claimed he loved. (Female, 20s)

caught in the net

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It is selfish to deny sex and expect fidelity in return,
especially without conversation.

It is understandably difficult for this young woman to comprehend what could possibly have gone wrong. She writes that after the first year of her marriage, sex dwindled to once every few months. Her spouse may have just been lazy, as she suggests, but it is more likely that something else made him prefer solitary to partnered sex—perhaps depression, fear of abandonment, or performance anxiety. But whatever the reason, she makes an excellent and often overlooked point—it is selfish to deny sex and expect fidelity in return, especially without conversation. It is even worse when the withholding partner openly prefers pornography to the woman he married.