SEXUALLY SPEAKING

MENS SEXUAL HEALTH

YOUR MAN IS NOT A LIGHTSWITCH: MEN’S SEXUAL HEALTH

There is nothing as socially constructed as our expectations of sexual experience. Culturally, we have this idea that men’s sexuality is like an on/off switch, easy to access and operate, and women’s sexuality is a deeply intricate and complex switchboard requiring an engineer’s precision management. Well, in actuality, male sexual function is simple when it is simple and complex when it is not so simple.

When addressing the sexual concerns of men (defined here as those who selfdefine as male) we must consider sexual response (desire, arousal, orgasm) as well as the domain of sexual satisfaction and psychological harmony with sexual expression.

In the domain of sexual response, the last 25 years of sexual science indicate that despite anatomic differences sexual response is actually not so different among biological sexes (while it may be vastly different among individuals). Many cisgender males, about a third, encounter challenges in their pursuit of sexual function. While erectile function concerns are well known to the general public, male sexual problems also include concerns about orgasm with a quarter of men concerned about early orgasm/ ejaculation, and approximately a fifth concerned about delayed orgasm . About one in five men are struggling with distressing desire concerns. Four million American men have low testosterone which can affect sexual functioning in a

BY JENNAFER KELLY

variety of ways. There are less frequently reported entities such as post-orgasmic illness syndrome (flu-like symptoms for days after each orgasm) as well as pelvic floor dysfunction (tightness or weakness of the muscles in the pelvic floor) affecting men as well as women.

Almost every penis can be treated to produce an erection. Some lifelong early ejaculation remits with oral or topical treatments. Desire can be enhanced with testosterone therapy or with medication adjustments. Treatments directed toward improvement of sexual function, such as erectile dysfunction medications, sometimes lead to satisfaction (aka when it’s “simple”) and sometimes, despite restored sexual function, sexual satisfaction may be elusive.

Sexual satisfaction and wellbeing are influenced by factors beyond the biological-- psychological, cultural, and relational aspects-- and sexual concerns may need treatments on several or all of these levels (aka “not so simple”). Sexual satisfaction and pleasure are important for overall health and wellbeing as well as for relational wellbeing. Relational wellbeing, especially for men, is correlated with improved overall health and longevity. In a 2021 study, sexual satisfaction was identified as one of the five most influential positive factors contributing to relational satisfaction.

So, what are some of the “not so simple” barriers to sexual satisfaction for men? Performance pressure can cause serious problems. Societal expectations about performance and masculinity may be directly responsible for a variety of sexual function concerns. A performance orientation makes it hard to focus on what is arousing -- leading to problems with erection and orgasm (both early and delayed). Some men fear losing an erection and this physiologic anxiety (anxiety as it is experienced in the body) leads them to orgasm quickly. Other men can’t keep an erection until orgasm because they can’t stay focused on the sensations and feelings of physical arousal.

Mood disorders may be consequences of living with this pressure and consistently failing to achieve sexual goals. Subsequently, in a vicious cycle, both mood disorders and their treatments can worsen sexual functioning. Additionally, there is almost a total lack of information about pleasure in sexual education, for both male and female bodies—and this may leave many men feeling broken, alone, and hopeless about contributing to pleasure in their partner as well as their own. Another hidden reality: the prevalence of sexual violence against men and boys is in the vicinity of 3% of the population and this may be an underrepresentation. We need to take care regarding assumptions that men are comfortable with touch and sex, that they have not been abused, and that they wanted all the sex they have experienced. Past sexual traumas can influence a variety of sexual and relationship concerns, including difficulty with sexual satisfaction.

Pleasure is an integral aspect of male sexual functioning.

Men often find themselves performing with partners rather than enjoying. One

“Often, when sexual concerns are addressed sooner rather than later, it is easier to resolve them.”

way to help men direct their attention toward pleasure is to let them know how destructive this performance focus can be. Encouragement from a partner that presence and enjoyment is desired rather than performance can be healing—however, this message is hard for many men to take in fully given how powerful the social messages about sexual performance can be. In the words of sex researcher, Peggy Kleinplatz, PhD “Great lovers are made, not born.” In order for people of all genders to have satisfying sex, it is important we unlearn the many harmful social messages about how sex is “supposed” to be. Another critical tool is being able to speak frankly and without shame about needs for emotional intimacy and sexual satisfaction. This can have some unexpected impact, for example, men who seem to have very high desire for sexual contact or use of sexually explicit media (i.e., pornography) may have little ability to communicate their needs for intimacy or what turns them on. Individual or relational sex therapy may be useful when satisfaction and pleasure continue to be elusive.

Often, when sexual concerns are addressed sooner rather than later, it is easier to resolve them. When people wait ten (or more!) years, it may take longer to ‘fix’ the problem than facing it head-on. So sometimes it’s not so simple, helping men get better at having the sex they want to have. And sometimes when a man feels compassion for himself (and his partners) he will take the courageous step and take his shame and feeling of inadequacy out of the closet, open the door, and say hello to a better, bolder sex life for everyone involved.

Pebble Kranz, MD FECSM and Daniel Rosen LCSW-R, CST are the co-founders of the The Rochester Center for Sexual Wellness. The center is comprised of certified sex therapists and a Fellow of the European Committee on Sexual Medicine (FECSM) and serves patients of all genders with a multidisciplinary, systemic approach. Delivering expert sex and relationship therapy and sexual medicine evaluation and treatment, RCSW aims to use the best available medical and social science evidence with a focus on interventions with proven efficacy and safety. In addition to direct care for patients, the center provides training for medical and mental health providers on the path to becoming certified in sex therapy and sexual medicine.

FINDING YOUR SUPERPOWER

As I sit here waiting at the drive-in to watch Black Widow, I am thinking about how these superhero movies showcase what it is we all secretly hope to be but believe we can’t ever be something so larger than life in its presentation or affect. That couldn’t be farther from the truth. Granted, we aren’t going to be running around in a skin-tight costume and looking flawless as we save the world. But our gifts are equally as powerful as theirs and actually do heal the world. You just have to be willing to use them and do it unapologetically.

As children, we all have huge dreams about who it is we think we will be when we grow up. I was sure I would be either a famous artist, a supermodel or Tina Turner’s backup singer. I told everyone who would listen with complete confidence I could do it all. That they would all one day be telling their friends “they knew me when…” It’s pretty incredible how limitless a child’s mind is. Then society comes along and tells us to limit our beliefs and our hopes we had carved for our future lives. They imprint their own insecurities on our growing minds and make us question ourselves and our dreams. The joy then begins to fade when we think about what adulthood will look like for us. Were we just being silly? Were my parents and teacher right when they said I was just a daydreamer that couldn’t concentrate? That it would hamper my dreams because it affected my schoolwork? I began to believe I wouldn’t be any of what I had dreamed a few years earlier and suddenly became withdrawn, sad and afraid of what I had wanted for my life. Their own fears had seeped into my pores like

BY LISA WAGNER

a deadening poison. I believed I had no superpower after all.

But then I read a story about how a man came about a tribe living in the mountains. The tribe’s shaman showed him around and introduced him to their leaders. The last tribe’s person they came across sat alone on a hill, gently moving his arms to one side as he looked up at the sky. The visitor asked what this person’s job was. The shaman replied, “He creates our weather.” The visitor was taken aback and replied that “this was not a possible thing. The weather was a scientific phenomenon. Why does this man believe he creates the weather?!” The shaman simply said, “Because no one ever told him he couldn’t.” It hit me like a ton of bricks. Why does anyone tell us we “can’t” do anything we dream of? It felt like a release of the decades of fear I had harbored and that my soul had reached the surface and taken a gulp of glorious air.

Our own limiting beliefs that society, family members or friends help to shape are what cause us to have shame around what it is we know down deep we are capable of creating. How many of us keep quiet that we love to sing, write, paint, act…anything that can go under the heading, “Creator”? I used to hate it when people asked me, “So, what do you do?” I envied my husband, who owned a business. His answer came easily. I felt apologetic when I said I was an artist. It was always followed up with being a mom and helping my husband run the business and doing his bookwork. It felt more legitimate an answer than having people look at you sadly as the wife whose husband supports her hobby. It took me decades to take ownership of who I truly am and paving my own way in the art world. It’s like we think they’ll ask us to break out all our work for their judgement and approval. No one’s done that to-date, by the way. If anything, it inspires them to step into their own creative vision with less trepidation.

So, what happens when we get really brave and suit up into our superhero dreams and try them out for size? We not only give ourselves permission to be who we were out on this earth to be. We also pass on that courage to someone who may never have used their gifts without your taking that leap of faith in you and your abilities. Therefore, they’re meant to be shared! When we do that healing work, we begin to not only build our resilience; we help someone else do the same.

Women especially tend to put themselves on a timeline and the back burner. If we don’t know what we wish to be before we hit 30 (or maybe 40), we tend to get in a rut that’s hard to pull ourselves out of. Life gets in the way, as do financial and familial obligations, but also our own negative self-talk. The older we get, the more engrained our beliefs squash out our soul and all its dreams. Thinking we are too far along in life to shift into our light is erroneous and detrimental to our mental well-being. What would happen if today you decided to just try what it is you’ve been called to do for as long as you can remember? What would it hurt? Nothing. We only hurt ourselves and those we love most when

“What would happen if today you decided to just try what it is you’ve been called to do for as long as you can remember? What would it hurt? Nothing.”

we decide to bury our heart’s desires. Shouldn’t we shine brightly for them, too? Becoming a beacon is the greatest gift one can give others. It’s that beautiful ripple that’s steeped in love.

As the movie just finished (don’t worry-I wrote the above before it started), I saw these women stand up and be their own superheroes. We live in a time where our messages are changing. We truly are limitless. Your potential to create a life of your truth and power is what will bring out the best in everyone and everything. This is what will truly save the world. Now go put your creative thinking cap on and become who you’re meant to be. We need your expression of love that aren’t your kryptonite any longer. They are what makes you magnificent and worth celebrating by just showing up and honoring your gifts.