Penis Power: Interview with Dudley Danoff
Urologist Dudley S. Danoff, MD, FACS, is the author of Penis Power: The Ultimate Guide to Male Sexual Health (Del Monaco Press, 2011). It’s an upbeat and even entertaining guide to the complexities, myths, facts, and vagaries of owning a penis (or, in my case, liking penises and being endlessly fascinated by them). Dr. Danoff covers how they work and what’s going on when they don’t work—psychologically as well as physiologically.
My male readers often write me with age-related questions about their penises: what’s a “normal” change with age vs. what’s a medical problem, how they can deal with erection difficulties, how to negotiate new needs and issues with a partner. “We are tragically ill-informed about the penis,” says Dr. Danoff, and he aims to change that.
Although this book is not specifically aimed at our age group, all of it applies to us, and I guarantee you’ll say, “I didn’t know that” several times as you read, even if you’ve owned a penis for 50, 60, or 70 years.
I invited Dr. Danoff to answer questions that specifically address men age 60+ and the women in their lives. I welcome your comments.
Q: What is your big message to our older men?
A: Sex is good for you. It maintains overall physical strength and cardiovascular health, and most of all, it keeps you invigorated. A man’s penis is there to serve him from puberty to old age.
Q: What are the most common misunderstandings that men age 60+ have about their penises or about their sexuality in general? What do you wish all men knew as they aged?
A: By far, the most frequent complaint I hear from men is that they do not have the same level of sexual desire they used to have. It takes longer to get an erection, it takes longer to ejaculate, it takes longer to get aroused again after they make love, and their erections are not as firm. These conditions are all predictable changes that occur as men get older.
Attitude is the key to penis longevity. My super-potent patients tell me that sex gives them as much joy at 70 as it did at 20. Some say the sex is even better! Equal pleasure can be obtained from occasional, prolonged intercourse with one orgasm as with frequent, rapid intercourse with multiple orgasms.
All men, as they age, deserve active, healthy sex lives as long as they remain physically fit. Do not expect to do at 60 what you did at 40. Adjust your sexual activities as your body changes, just as you adjust other activities. Look upon the adjustment as both a new challenge and a new opportunity.
As you age, learn to use your mind and imagination to make up in creativity what you may lack in physical strength. As long as you are able to breathe, move your extremities, maintain relative control over your bodily functions, remain alert enough to identify the date and day of the week, and sustain a positive mental outlook, you can continue to exercise your penis power indefinitely.
Q: What would you say to many men age 60+ who tell me that they don’t get good information or direction from their urologists when they report undependable or nonexistent erections? They are commonly told, “Well, you’re older now,” or “It’s ED,” without a medical workup to see whether some underlying condition is causing the ED.
A: Find another urologist who is knowledgeable about erectile dysfunction and is willing and able to thoroughly evaluate you. A comprehensive evaluation, including a full cardiovascular evaluation, by a qualified urologist is essential. Endocrine issues, such as low testosterone or unrecognized diabetes, can then be treated, and erectile dysfunction will improve. Knowledge is power. There are many treatments on the urologic menu for erectile dysfunction, but first you need a proper diagnosis to identify the underlying cause. Treatment is both available and effective in almost all cases and will result in satisfactory erections.
Q: Many men would rather sever their own leg than admit to a doctor that they are experiencing erectile difficulties. Why is it important to see a doctor before self-treating with drugs or other assists?
A: Many serious medical conditions that are first manifested by erectile difficulties go unrecognized. It is absolutely essential to get a full evaluation by a qualified urologist in all cases of erectile dysfunction in order to determine the presence or absence of some serious (or not so serious) medical problem and treat it accordingly. For example, if low serum testosterone is found, testosterone replacement therapy can give spectacular results. Under no circumstances should a man self-treat his erectile dysfunction with over-the-counter preparations without first determining the presence or absence of an underlying medical condition that is correctable.
Q: How can women enhance their partner’s and their own sexual pleasure when erections and intercourse are not the main events?
A: Most importantly, do not think old! Sexual pleasure is all about attitude. If your mind is strong and your partner’s mind is strong, intimacy and sex without vaginal penetration can be enormously pleasurable. The key is not to lament what you have lost. Be grateful for what you still have and make the most of it. Age is not a deterrent to great sex. Rather, it is a challenge and an opportunity.
If you keep your enthusiasm, you can compensate for or even delay the effects of aging. You do not stop having sex because you are old—you get old because you stop having sex! Talking candidly with your partner about aging is the best way to find a solution for maintaining a healthy sex life.
Q: What else do you want women to understand about their male partners?
A: Older men are just as penocentric as younger men are, even though capacity may be diminished. I would encourage older women to become more “penis oriented.” Older women who are penis oriented have more fun and also have better marriages, more faithful partners, and greater personal fulfillment in all aspects of their lives. If you believe that each partner has the mutual responsibility to satisfy the other’s needs, then it follows that you will hold up your end of the bargain as a woman by making your partner’s penis one of your top priorities.
Being penis oriented does not imply a belittlement of female sexuality. It simply means learning to understand and accommodate an older man’s penis needs by approaching that task with all of the pride and skill that you would bring to any other endeavor. I assure the older woman that if you take the steps to become informed, you and your man will reap rewards you have only dreamed about.
Images are from Penis Power: The Ultimate Guide to Male Sexual Health by Dudley Seth Danoff, MD. ©2011 Dudley Seth Danoff. Reprinted by permission of Dudley Seth Danoff. Copies of the book are available at your local bookstore or may be ordered through Amazon.com.
Healing Painful Sex: Interview with Deborah Coady, MD
I was happy to receive a review copy of Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain by Deborah Coady, MD and Nancy Fish, MSW, MPH. This book is entirely devoted to sexual pain in women: the myriad possible causes, how to figure out which one or combination is yours, and what to do about it.
The authors are a power team: Deborah Coady is a gynecologist and a pelvic/vulvar pain specialist. Nancy Fish is a therapist with degrees in social work and public health, and she personally experienced chronic pelvic pain until Dr. Coady helped her resolve it. I asked Dr. Coady if she would answer some questions that women our age often ask me:
Q. Many older women are reluctant to ask their gynecologists about sexual pain because a) they’re embarrassed, b) they think this is part of aging, and c) they fear their doctors will be dismissive. What would you say to these women?
A: These feelings and fears are completely understandable. Unfortunately, the medical profession has until now given too little attention to the sexual concerns of women as we get older. Women often are dismissed or rushed when they bring up their problems. And this is not the fault of the patients: A recent survey of gynecologists by Stacey Lindau, MD of the University of Chicago hints to their discomfort, as well as their lack of experience and formal training in this area of medicine. While 60% responded that they did ask about sexual problems at the first visit, only 14% asked about pleasure with sexual activity. It is often up to women themselves to be pro-active, ask the hard questions, and remember that they are entitled to medical therapy for this medical problem, or referral to an MD who can help.
Q. My readers sometimes report that after a long time without sex (due to lack of a partner or disinterest from a partner), they try to have sex again — and they can’t: It’s too painful. What should a woman do about this?
A: On average, about 5-6 years after their last menses, most women develop thinning of their vulvar and vaginal tissues, often causing pain with sexual touching or intercourse, or with urination after sexual activity, or itching, burning and even surface bleeding after sex. This can occur even in women taking systemic estrogen therapy. As estrogen levels decline both the surface skin and underlying connective tissues thin, shrink, and lose elasticity. Most pain is actually located at the vaginal opening itself, rather than deep inside the vagina as previously thought. The good news is that since these tissues are exquisitely hormonally sensitive, even small doses of estrogen, with or without testosterone or DHEA, applied to the vaginal opening (the vestibule), can reverse these changes within 2-4 weeks, and then even lower doses can be used to maintain the improvement. Some women with severe loss of elasticity will also be helped by a course of pelvic floor manual physical therapy, to help
normalize the connective tissue, and relieve the reflexive muscle spasms that some women develop due to their pain.
Q. I like your questionnaire (107-111) because women often don’t know how to pin down just where and what the pain is that they’re experiencing. I recommend that women scan or photocopy that questionnaire to show their medical professionals. Would it be a good idea to
carry a copy of Healing Painful Sex to the appointment, too, in case the doc hasn’t heard of your book?
A: One of our missions in writing the book is that women would have it as a resource to get their gynecologists informed and up to speed on treating sexual pain. Many patients have done just this, and their MDs have actually been grateful for the introduction to the book.
Q. If a gynecologist says, “You just need lubricant” or – worse! – “Well, at your age, you can expect that,” what should an older woman say to get diagnosis and treatment? I tell women to say, “If you don’t know how to help me, please refer me to someone who does,” but that might
seem more confrontational than you would recommend! What would you advise her to say?
A: I would advise her to say exactly that. We have to advocate for ourselves and we deserve up-to-date treatment for sexual pain. A healthy
sexual life is a basic human right, even defined as so by the World Health Organization!
Q. How can a post-menopausal woman weigh the benefits of HRT vs. the health risks if she’s experiencing vaginal thinning and tearing?
A: There is absolutely no evidence that the small amount of estradiol or estriol available for use at the vaginal opening is absorbed to any degree that would induce breast cancer. The doses are tiny compared to HRT doses that are meant to be systemic, that is, to go to all parts of the body. To help hot flashes the doses need to reach the brain in quantities much much higher than the topical estrogen will ever give. And with the evidence now showing that estrogen alone does not increase the risk of breast cancer anyway, women can be assured that topical therapy, especially if mostly applied to the vaginal opening, is safe. It is also now known that the thicker and more estrogenized the vulvar and vaginal tissues are, the less absorption into the body. So a stable constant regimen is better than going on and off the topicals, with the tissues thinning again in between.
Q. How do we educate our medical professionals to stop being dismissive and take our sexuality seriously, whether we’re 60, 70, or 80?
A: This is a work in progress, but educational outreach through professional societies like NAMS, the International Pelvic Pain Society (IPPS), and the International Society for the Study Of Vulvovaginal Disorders (ISSVD), as well as patient advocacy organizations, especially the National Vulvodynia Association (NVA) is helping. The websites of these societies all list health professionals by area to help patients find a knowledgeable MD. We also need to devote more time to formal education on sexuality and pain in medical schools and residency programs.
As always, I welcome your comments. If you’re experiencing pain with sex, I hope you’ll read both Naked at Our Age and Healing Painful Sex. Then please carry both books with you to show your doctor!
Things You’ll Never Hear Him Say When He Sees You Naked
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| Photo by Ruth Lefkowitz |
I discover it’s not just single women: I had a conversation with a man about my age who is no longer having sex with his wife because she’s too embarrassed about her weight gain to be naked with him.
Other men tell me similar stories — that their wives hide their bodies, and the men miss the sex and the intimacy, but don’t know how to ease their wives past their distaste for their bodies.
I’d like to talk to both genders here:
Finally, after meeting so many frogs (and not even tempted to kiss any of them), you’ve met a man who makes your heart flutter big time. You’ve flirted, you’ve gone on a few dates, you’ve talked half the night, you’ve laughed at his jokes and he at yours. On your last date, you kissed… and kissed. His hands went exploring, so did yours, and you know that on the next date, more than your lipstick will come off. You’ve even had the Condom Conversation.
But, your inner worrier keeps asking you, what if he sees your body and heads for the hills?
You’ve got to trust me on this, he’s not going to say or even think any of the following:
- “Oh, gee, you have so many wrinkles!”
- “You’d be so pretty if you lost weight.”
- “Huh—I thought you looked younger with clothes on.”
- “I like firmer butts and perkier breasts.”
- “Uh, I gotta go now.”
No, whether or not he voices it out loud or conveys it with a smile or melting eyes, here’s what he’s thinking:
Partnered women: Does your husband have the same body as when you first dated? I doubt it. Realize that your man wants you, wants the bonding with you, wants the sexual pleasure with you. Instead of asking him, “Do I look fat?” try asking, “What do you find the sexiest part of my body?” His answer might surprise you, and I’ll bet he’ll be delighted that you asked.
Men: You may not realize how insecure we women are about our bodies. We need to hear from you that you find us sexy, alluring, beautiful. If you think our breasts are gorgeous, or our rear view turns you on, please tell us. Even an “I could gaze into your eyes forever” will make our hearts flutter. We need you to help us affirm our bodies. A hefty dose of romance does wonders for us, too!
We women are our own worst critics, always have been. Remember those teenage pimples? Those worries about our shape and smell? Let’s decide, once and for all, that our bodies are just right, capably of visually delighting a partner and of bringing us both great pleasure.
If we can’t do that at this time of life, when can we? Even if we don’t fully believe it, acting “as if” we’re proud of our bodies will help make it so.
So when it’s time for that get-naked date, prepare with some gorgeous lingerie, dim the lights if you feel the need, but don’t black out the view (candles are sexy and flattering), have lubricant handy, and enjoy.
I’d love to hear from both women and men about this topic! Please comment.
This post was originally published in a slightly different form 11/8/11. I expanded and updated it 11/20/2012.
When the man no longer wants sex: guest post by Jason Kae-Smith
He’s Just Not That Into It
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| Jason Kae-Smith |
After months of his wife’s pleading and an eventual ultimatum, “Ted” (not his real name) found himself sitting somewhere he’d never imagined—the office of a sex therapist. The three-year journey leading up to this day was painful; a strained effort along a cumbersome path littered with resentments, accusations, and much confusion.
As Ted told his therapist, “I just don’t get it. I love my wife. She’s intelligent, she’s compassionate. She’s a wonderful mother to our children. She’s my best friend and I love hanging out with her. I just don’t want to have sex with her anymore.”
It turns out Ted isn’t alone. In the United States, there are an estimated 10 million men in sexless, heterosexual marriages. And while many would assume that women’s lack of desire is the main culprit, recent trends indicate that it is just as likely the men who have lost that loving feeling. Many sex therapists are seeing an increase in heterosexual men coming to them for problems with desire, some noting that the percentage of men with low desire now outweighs the percentage of women.
Calgary sex therapist David Hersh, EdD, observes, “When I first started and I would see couples with discordant desire, it was mostly the woman who wasn’t interested. Now about 55% of these couples are seeing me because the man has lost interest.” Several therapists queried confirmed a similar trend in their practices.
It’s not clear if there are actually more men experiencing low desire or if it’s just that more men are now seeking help. Hersh says he believes the latter is the case. “Now, men are more informed about the condition. Traditionally there was a double standard where ‘real men’ always wanted to have sex. But you’re not so strange anymore if you don’t want it.”
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| Ricky Siegel |
Sex therapist Ricky Siegel agrees, stating, “I think there’s little doubt that the most obvious factor to the issue of low desire in men is that ‘Real men are not supposed to have low desire!’ So where it has become an acceptable script for women, it’s one of the things that men suffered about in quiet shame.”
In 2008, Bob Berkowitz and Susan Yager-Berkowitz published the results of their survey of over 1300 men who identified as no longer having sex with their spouses. The respondents listed several reasons for their loss of interest in sex, some of which included emotional struggles with things like depression and anger. Others reported they began avoiding sex because of problems with sexual functioning and eventually lost interest in sex altogether. And while many men initially suspect their loss of libido might be a result of low testosterone, research findings, such as those reported by Sari van Anders in the May, 2012 issue of Archives of Sexual Behavior, continue to suggest this is more often not the case.
Despite his assertion that everything was okay, “Derek” told his therapist that he reluctantly agreed to a session because, “I love my wife and I will do this if she feels it is important.” Derek’s wife “Cindy” was concerned because recently Derek had stopped initiating sex with her, something that she said was “unusual” for him.
Derek said was likely due to stress or perhaps “getting a little older” but when Cindy was invited to talk about experiencing her own sexuality, a different kind of narrative began to emerge. Cindy stated that in the beginning of her relationship with Derek, “Sex was okay but I was never all that into it.” But she added, “Lately, something happened. And now it’s like I can’t wait to jump on this man.”
It turns out that “something” was her reading the best-selling 50 Shades trilogy. Cindy’s sister had turned her onto the books and to Cindy’s surprise the books turned her on, prompting her to embrace and embody her sexuality like never before. After some contemplation, Derek finally conceded that Cindy’s sudden interest in sex had a surprising blanketing effect on his desire for her. “I don’t get it,” he said. “I mean, this is what I always wanted. But when it happened, and all of a sudden she’s wanting to go to the sex store and buy toys and try new things—I don’t know, I guess it kind of turned me off.”
When it comes to treatment, experts often recommend a physical examination (just to be sure) and then consultation with a sex therapist. But what can therapists do to help men get their mojo back? Fortunately, those who practice and write about clinical sexology are continually developing ways for therapists to think about and respond to requests for help. The traditional model is to look at problems in the relationship first. One of the current trends in therapy is to go right to the sex.
As for Ted, the specific course of his future sessions will be guided by the choices he and his therapist make as their therapy conversations unfold. Today’s session marks a turning point in his journey, a change of direction toward the possibility of getting out from underneath the weight of low desire.
“This was good,” he told his therapist at the conclusion of their meeting. “It feels good to get this off my chest.” He added, “I guess I feel a lot more hopeful, like this isn’t just the way it has to be when you get married and are with someone for a long time.”
Jason Kae-Smith is a certified sex therapist with a practice in Grand Rapids, MI. Among other things, he is interested in ways people are able to give value to sexual pleasure throughout their lifetimes. The article from which this is excerpted first appeared in Contemporary Sexuality, the journal of American Association of Sexuality Educators
Counselors & Therapists (AASECT).