Dr. Abraham Morgentaler, MD, FACS, is an Associate Clinical Professor of Urology at Harvard Medical School and the founder of Men’s Health Boston, a treatment center for male sexual and reproductive disorders. He is the author of three previous books and his work has appeared in the New England Journal of Medicine, The New Yorker and the WSJ among others. He researches, lectures internationally, and sees a limited number of patients via his new program, Personalized MensHealth.
Do Men Really Fake It?
After almost twenty-five years of medical practice specializing in the treatment of men with sexual and reproductive problems, I thought I had heard and seen pretty much everything. But when David, a twenty-five-year-old man, walked into my office and told me that he faked orgasms with the new love of his life, Sarah, I had to make sure I’d heard him correctly. What a fantastic twist! Once I got past the immediate, practical question of how David faked it, what really interested me was why a man would do this. David’s answer was simple and touching. He was in love with Sarah and was simply trying to do what he believed was the right thing by her. That is a refrain I hear regularly from men in one form or another, yet this admirable, loving aspect of male sexuality is hidden among the detritus that passes as wisdom for what men are all about.
This book is about the fascinating, rich, nuanced, and surprising world of men and sexuality. In these pages I share the stories of David and so many other men who have come through my offices at Men’s Health Boston, seeking help for one type of “guy problem” or another. Behind those closed doors, men from all walks of life—laborers and celebrities, professors and new immigrants—have shared with me the most intimate details of their lives. Often I have been the first and only person brought into their confidence. I share these stories and my perspectives here because I have come to believe that what we think we know about men, sex, and relationships is totally incorrect. The truth is, we know next to nothing.
It’s obvious that some men behave badly, but as a culture we have focused far too much on the bad behavior of the few. Usually, the men we ridicule are public figures with lives so different from most of ours that a man would be well within his rights to say, “What does Tiger’s behavior have to do with me?”
For every man who behaves badly, I can give you ten who are dedicated and thoughtful, doing the best they know how to be a man and a solid partner. When men share their most intimate stories about sex and relationships, what I hear repeatedly is a determined effort to be for their partners what they believe their partners want them to be—responsible, reliable, strong. It is confusing to know how to be a man these days. Sexual roles may have become muddled, yet the desire among men to be “good” to one’s partner remains.
The comedian Robin Williams jokes, “Why did God give men two brains but only enough blood to run one of them at a time?” In family-friendly newspapers we find comic strips depicting men with eyes bulging out of their heads as a pretty woman walks by. These jokes about men could have been lifted unchanged from the late 1960s and 1970s when I was a teenager, even though the world of gender and sexuality is so different today, thanks to major cultural events such as women’s liberation, the advent of the birth control pill, the high prevalence of women in the workforce, and the introduction of Viagra, to name just a few. Our concepts regarding men are stuck in a time warp. How did we get to this point when women lament, “Why can’t I find a good man?” and “Men just don’t ‘get’ it”? Men, having bought into the zeitgeist, fall all over themselves trying to prove to a potential or current partner that they are different from the insensitive, overly aggressive Neanderthals that make up the rest of the male gender. A friend who lives in a house filled with women—his wife, three daughters, and two stepdaughters—has a framed poster hanging in his kitchen that always makes me chuckle: “If a man speaks in the forest and no woman hears him, is he still wrong?”
We live at a moment of history when we have more information about sex at our fingertips than any time before, yet we know so little about male sexuality. If we are so ignorant of basic information, how well can we hope to have a true and meaningful understanding of something as complex as the male psyche when it comes to sex?
A recent front-page story from the New York Times reported on a study in which young fathers in the Philippines were found to have lower testosterone levels than similarly aged men without children. A professor of anthropology at Emory University concluded that the lower testosterone in young fathers was Nature’s way of making the father behave better in a relationship: “I’m here, I’m not looking around, I’m really toning things down so I can have good relationships.” As another professor, from the University of Nevada, put it “A dad with lower testosterone is maybe a little more sensitive to cues from his child, and maybe he’s a little less sensitive to cues from a woman he meets at a restaurant.”
The conclusions drawn by these highly educated professors perpetuate the myth that a man and his behavior are directly influenced by his moment-to-moment blood concentration of testosterone. In this standard narrative, men with high testosterone are so highly sex-charged that they are likely to cheat on their partners and make poor fathers, whereas lower testosterone allows a man to become more domesticated. We see some version of this familiar story in magazines and newspapers every week. However, it is false. As a physician who has raised and lowered testosterone levels in several thousand men, I can assure you that the relatively small changes noted in this study do not impact a man’s behavior or his “nurturing capacity.” In fact, testosterone levels decline by as much as 50 percent in young men every single day from morning to evening, without causing a change in mood or behavior. Indeed, the most likely explanation for the drop in testosterone in the young fathers is sleep deprivation. Any kind of disordered sleep lowers testosterone, which explains why in this study the lowest levels of testosterone were found in fathers of newborns.
This is a perfect example of how quick we are to believe that a man’s true nature must be altered, for example, by lowering his testosterone, to become a faithful partner and nurturing father. What an insult to all the great husbands and dads out there!
It’s not easy being a man these days, and certainly not a sexual man. Seismic changes in our social landscape have fractured the era of male dominance. As the father of two capable young women, I applaud the leveling of the gender playing field. Yet it is naive to assume there has not been a cost to this relatively sudden cultural change. There are now far fewer opportunities for men to feel powerful and, well, manly.
Recently, Mara and George—both thirty-two, with two young sons—came to see me in my office. George was a building contractor, Greek, a little stocky, with a round face, a solid-looking man. George told me, “Mara doesn’t think we have sex often enough. I start my days at five am, I want to play with the kids when I get home, and then most days I collapse after dinner. Mara thinks it’s strange that I’m too tired to have sex more than once or twice a week.”
I looked toward Mara, pretty, slender, with long, dark hair. She looked very fit. “Doctor, I thought guys were supposed to always want sex. And before I had the kids, George was always ready. Now I want it, and he doesn’t. Is it me? I worked hard to get rid of the baby fat from my last pregnancy, but it doesn’t seem to matter to him. I’ve asked him whether he’s found someone else, and he says ‘No,’ but I just don’t get it.”
Alone with me during his examination, George took the opportunity to tell me more. “Doc, it’s worse than you can imagine. Mara is sure that I’m cheating. She’s been snooping through all my stuff. I feel like I constantly have to reassure her that we’re okay, that I still find her sexy, that I still love her. It’s a bad time for my business, and I’m stressed. Truthfully, some of the time we have sex, I’m doing it just to keep Mara happy.” The idea that a man would have sex with a woman for her benefit rather than his own runs counter to the traditional story line about the selfish, egotistic sexual male seeking only his own gratification. Yet there is nothing unusual about George’s story. Women have always had expectations from their men; now this expectation has shifted in new ways to the bedroom.
A young man in his midthirties, without any erection problems, asked me for a prescription for Viagra. When I asked why he wanted it, he replied, “It’s tough out there, Doc. The last woman I dated told me when she wanted sex, how she wanted it, and how many times she needed it. I’m just trying to keep up!”
It is tough out there for men. The world is changing rapidly, and the misinformation that passes as conventional wisdom about male sexuality leads many men to have anxiety, low self-esteem, and conflict within relationships.
Let’s get something straight: sex is how animals reproduce, from the smallest single-cell organism to insects, fish, reptiles, birds, and mammals. We tend to forget about the reproductive part of sex because humans have been clever enough to find ways to separate sex from reproduction via various forms of contraception. What is important to understand is that the drive for sex is not a choice, a luxury, a human invention. It is one of the most powerful drivers for all species on this planet. If tuna didn’t have a powerful sex drive, there would be no tuna. If dogs didn’t have a powerful sex drive, there would be no dogs. And if humans (male and female) didn’t have a powerful sex drive, there would be no humans. This is a biological fact.
My perspectives on sexuality were influenced greatly by my initial choice of biology as a career. In my very first class as an undergraduate at Harvard College, the Nobel Prize laureate George Wald presented the big bang theory and described the subsequent primordial soup that eventually led to organic molecules and the beginnings of life. I was hooked. For three years as an undergraduate I worked in the reptile laboratory of the brilliant biologist David Crews (now at the University of Texas at Austin), studying the effects of testosterone on the sexual behavior of male lizards. Reptiles are extremely important in evolution because they represent the common ancestor of the “higher” animals, namely birds and mammals. It is the primitive reptilian portion of our brain that drives our sexual behavior, with input from higher centers in the cortex.
It makes perfect sense that the sexual centers in human brains are deep, old in evolutionary terms, and anatomically distinct from the “thinking” part of our brain, namely the cerebral cortex, because sex has very little to do with thinking. Indeed, lust, libido, sex drive—whatever one wishes to call it—seems to be almost a form of madness. It is irrational, primal. In the throes of lust, women and men behave differently than in every other sphere of their lives. Individuals who are germ-phobic and who wouldn’t dare to touch a doorknob without first wiping it down with a cloth will, when sexually excited, throw themselves into skin-on-skin, sweat-on-sweat, full-body contact with another person, even exchanging body fluids along the way. Powerful men and women who experience rage at any perceived disrespect at work engage happily in sex play in which they are subdued, dominated, demeaned. Sex is a break in the normal fabric of our lives. One can no more reasonably separate sexual desire from normal men and women than one can separate wetness from water.
Despite our sexual nature it is unacceptable to be sexual whenever the urge arises. All human societies have found ways to bind our sexuality by rules, norms, culture. It is endlessly fascinating to me how we manage to incorporate the “madness” of our sexuality within the framework of a rational life in which we aspire to be honorable and productive. One of the consequences of the inevitable tension between primitive urges and civilized behavior has been to make sexuality into a big secret, something not practiced in public, and not spoken about.
I would argue that a key component of the women’s movement and the rise of feminism was the way that women educated themselves about their bodies and their sexuality. A landmark event in the 1970s was the publication of Our Bodies, Ourselves, a book with graphic illustrations that could be found on almost every woman’s college bookshelf; the book encouraged women to take a mirror and examine their genitalia, find their clitoris, and to experiment with masturbation so that they could experience orgasms more easily. It explained anatomy, menstruation, birth control, the whole works.
There has never been a similar book for men, at least none that gained any national attention. A book that explained, discussed, and normalized male sexual behavior. Perhaps this book can start the conversation. Certainly there is a need for such a dialogue, for the benefit of women as well as men.
What will emerge from the stories in this book is that men are complex, thoughtful, and eager to be a valued and respected partner. It will be surprising to many to learn that a man’s sense of his own masculinity is intimately related to his ability to regard himself as a successful sexual provider.
There are other challenges to overcome in the realm of male sexuality besides ignorance, particularly physical ones. The medical world was stunned when the Massachusetts Male Aging Study in 1994 revealed that 52 percent of relatively healthy men between the ages of forty and seventy reported some degree of impotence. So many men! We never knew.
Premature ejaculation affects as many as 20 percent of young men and nearly an equal number of older men. It is difficult to feel great about oneself as a lover when sex ends almost as soon as it begins. And new data show that one-third of men over the age of forty-five have abnormally low levels of testosterone, which can cause poor erections, low sex drive, and difficulty achieving an orgasm.
This book is about real men in real situations. By providing a behind-the-closed-door perspective on men, sex, and relationships, I hope that we will move out of the darkness and toward a more realistic, and kinder, view of what men are all about and how their minds work. Female readers may be happy to learn that there are good men out there. And male readers may take comfort from realizing that they are not alone. The truth is that men are so much more interesting and complex than we would ever have believed.
Copyright © 2013 by Abraham Morgentaler