Posts Tagged ‘“best of” Joan’s blog’
Erectile Dysfunction: Michael Castleman Talks to Men
8/18/11 update: I’m bringing this older post to the top because it answers so many of the questions about erectile dysfunction that my readers are asking. Michael Castleman is also one of the experts in Naked at Our Age and I respect his knowledge and ability to convey important information simply and compassionately.
So many readers–both male and female–have been asking for information about erectile dysfunction that I asked Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions. His interview starts here and continues here.
Q: Explain erectile dysfunction (ED) and why it happens.
MC: Only a small fraction of men from age 45-60 have true ED. A larger but still modest fraction of men over 60 have true ED. True ED is the inability to raise an erection despite vigorous extended hand massage of the penis. True ED is usually the result of a medical problem, either a problem with the nerves that control erection, or more likely, narrowing of the arteries that carry blood into the penis. Like the arteries of the heart, the arteries into the penis can become narrowed by atherosclerotic plaques. Causes of plaque formation: heart disease, diabetes, smoking, high blood pressure, high cholesterol, high-fat diet, sedentary lifestyle. In other words, all risk factors for heart disease are also risk factors for ED. In addition, ED can be caused or aggravated by stress and anxiety, which constrict the arteries and limit blood flow into the penis.
Q: What about men who are capable of erections, but they’re less reliable than they used to be and require more stimulation?
MC: While only a fraction of men over 45 experience true ED, just about every man experiences what sex therapists call “erection dissatisfaction” (EDis). After 45 or 50 or so, men with EDis can still raises erections, but they don’t rise as quickly as they used to. They no longer rise from fantasy alone–seeing an attractive woman or some erotic scene. Men begin to need direct penis stimulation by hand or mouth. When erections rise, they may not look/feel as firm as they were in the man’s 20s. They may also droop from minor distractions, anything from donning a condom to hearing a motorcycle roar up the street.
The good news is that EDis is a normal and natural part of aging. If older erections wilt a bit, hand massage and/or oral stimulation bring them back up again–IF the man remains relaxed and patient with himself. If the man gets stressed and anxious, this reduces the likelihood of a return to fullish erection.
Many (most?) older men are unclear on the distinction between true ED and EDis. Many mistakenly think they have ED when they experience the normal age-related erection changes of EDis. Now EDis can be disconcerting. I’ve been a sex educator for 30 years. I knew all about what happens to erections after 50. But when those changes started happening to ME, I found them unnerving. P.S. Erection medication (Viagra etc) helps treat EDis. In fact, most men who take erection drugs don’t have true ED. They have EDis.
Q: Many men fear that they can’t please a woman without an erection, or they give up on sex altogether. Is an erection necessary for sex?
MC: Of course not. As you know, women’s pleasure organ is the clitoris. Many women prefer cunnilingus to intercourse. Surveys show that only 25% of women are reliably orgasmic from intercourse, no matter how vigorous or how long it lasts. So women know that an erection and vaginal insertion are not necessary or sufficient for sexual pleasure and orgasm. But many men DON’T know this.
Q: How did men’s sexual education skip that important concept that women’s orgasms are based on clitoral stimulation, and that most women don’t need penis-in-vagina penetration for their pleasure?
Most men get most of their sex ed from pornography. Porn is totally penis-centered. Porn actors have monster cocks, which makes normally endowed men feel they’re “too small.” Mainstream porn includes a bit of massage and cunnilingus, but it’s mostly about sucking and fucking, so that’s what men come to believe sex is all about.
I’ve spent my life as a sex educator and counselor trying to persuade men that they’ll have better sex and get better reviews from women if they ditch their preoccupation with their penis and focus instead on leisurely, playful, whole-body, massage-based sensuality. But compared with porn, which is viewed overwhelmingly by men and is by far men’s #1 source of sex ed, the combined voices of every sex expert on earth amount to a little whisper in the hurricane of porn porn porn.
Here’s where I plug my book, Great Sex. Its message to men: If you want great sex, if you want women to sing your praises as a lover, stop trying to imitate porn. In fact, do the opposite of what you see in porn. Not only will she be happier, you will be, too. You’ll enjoy sex more and have fewer sex problems–more cooperative erection and better ejaculatory control.
Michael Castleman, M.A., is the author of twelve books, including Great Sex
: The Man’s Guide to the Secrets of Whole-Body Sensuality and Sexual Solutions: For Men and the Women Who Love Them. From 1991-95, he answered the sex questions submitted to the Playboy Advisor. Visit his website about sex after midlife, http://www.greatsexafter40.com//.
“I’m Going to Make You Coffee….”
If you ask me if I still miss Robert, two years after his death, I answer, “Only when I breathe in or out.”
I still start each morning recapturing a memory. Today it was the way he opened his ocean-blue eyes in the morning and smiled, his face melting with love. “Let’s snuggle,” he would say. Then one of us would decide, “I’ll snuggle you,” and we would shift to our sides, the snuggler wrapped around the back of the snuglee.
I loved when Robert snuggled me, enveloping me, so close that we couldn’t tell where he ended and I began, if indeed there was a distinction. I would take his hand in both of mine, push my nose into his palm, and inhale deeply. His palm smelled of sleep, a warm, enticing smell that was totally Robert. I can still smell his hand, still taste his skin as I kissed him everywhere my mouth would reach.
Other mornings he woke ready to meet the day, his garden or art studio beckoning, no time for snuggling. He announced, “I’m going to make you coffee,” and I always responded, “I love it when you make me coffee.” He padded out to the kitchen to grind beans, boil water, and arrange the filter cone over a metal coffee pot that had journeyed with him for decades. 
The “make you coffee” ritual started early in our seven-year love affair, and persisted wherever we were, home or hotel, and whatever else was happening in our lives. Towards the end, when his body started succumbing to cancer, he told me, “As long as I can make you coffee in the morning, I know I’ll be all right.”
Then one morning, he tried to get up, and he couldn’t. He stumbled, his legs trembling, his back stabbing with pain, his brain unable to emerge from sleep. He sat back on the bed. “I can’t do it,” he told me, and we both cried, as I’m crying now, remembering the day that everything changed.
…Now I make my own coffee in his special coffee pot and carry it to the living room where I’m surrounded by Robert’s paintings. I write memories in my journal—snippets of sweet conversation, playful games we invented, afternoons that turned into evening as we made love as if life depended on it. Maybe it did.
Even though I write for a living, using a computer and all the tech tools available to me, I write my memory journal in longhand. Somehow writing longhand comes from the heart more than the brain, and I rediscover memories I had forgotten. 
My hand lingers over the page, and I picture Robert’s hand –the artist’s hand making love to the canvas, the gardener’s hand making love to the dirt, the dancer’s hand making love to the music, and my lover’s hand–making love to me. What does matter, at this point in my life, is that I’m taking with me the best of what Robert and I shared. That’s what he’d want for me, and what I want for myself. I find joy in my writing, in dance, in close friends, in physical and mental exercise, in learning, and yes, in my memories of Robert.
I hold my coffee cup to my cheek. It’s just the right temperature.
How to Talk about Sex with Your Partner
“How do you talk about sex to a partner who shuts down conversation?” A reader asked. I’m republishing this 2008 post because Yvonne Fulbright’s information is vitally important for couples who need help breaking through the communications barrier.
I often hear from people having sexual problems with their partner. They may want more, less, or a different kind of quality of sex. Although sexual difficulties won’t magically go away by talking about them, effective communication is a big first step.
I asked certified sex educator Yvonne K. Fulbright for communications strategies she recommends to her clients who are having difficulty resolving sexual problems. “Unless you make your wishes known, your partner is not going to change or even attempt to fill your needs,” she says. “Humans can’t read minds, so you have to try to communicate your desires in order to get what you want out of a relationship.” Here are her suggestions for bridging the communications gap:
1. Let your partner know how you feel, e.g., “I am really hurt and confused that you haven’t wanted to make love for years.” It’s important not to attack your lover and to use “I statements” such as, “I miss having sex with you.” You cannot be faulted for how you feel, and expressing yourself this way is likely to get a more positive reaction than something like, “What’s wrong with you? You never want to have sex.”
2. Don’t make assumptions, which close off an open discussion and can cause your partner to clam up. Avoid questions that only invite a yes/no response. For example, say, “I was hoping we could talk about why we’re not having sex anymore,” instead of, “Are you not interested in sex because I no longer attract you?”
3. Pick a time when you can focus on just the two of you. Don’t have the conversation when you’re doing another task. Plan a time when you can create a private space to talk, and make it a communal experience, e.g., over a cup of tea. The more natural you can make the conversation, the less threatening it will be.
4. Do not accuse or blame your partner for the problem. Instead, communicate that you want to work on your problems as a team effort.
5. Pay attention to your own and your partner’s body language. A great deal of what you’re saying isn’t coming from your mouth, but from your stance, how you’re holding your arms, and your facial expressions. Do you appear defensive? Uncomfortable? Does your partner? Attention to body language will help you to gauge how the conversation is going.
6. Ask for suggestions on how to make things better, rather than telling your partner how it should be done. People are much more likely to act on what they see being possible vs. what someone dictates to them, especially in an intimate relationship. You, too, should also give suggestions, but they should come across as just that – suggestions.
–Certified sex educator Yvonne K. Fulbright, PhD, MSEd is the author of several books, including Sultry Sex Talk to Seduce Any Lover
Erectile Dysfunction: Michael Castleman Talks to Women
Update note: I first posted this interview in June 2007. I have so many new readers now that I wanted to bring it to the forefront, because it’s such an important issue for both men and women. Often men feel they can’t talk about ED with their partners. Women tell me their men seem to emotionally disappear and avoid sexual activity and discussion. Michael Castleman helps all of us understand what’s going on. — Joan
In a previous post, I interviewed Michael Castleman, a sex educator, counselor and journalist specializing in men’s sexuality to answer some questions for men about erectile dysfunction. In this part of the interview, Castleman talks directly to women:
Q: What don’t women understand about erectile dysfunction (ED)?
MC: Like men, few women understand the difference between true ED and erection dissatisfaction. [See Erectile Dysfunction: Michael Castleman Talks to Men for explanation of the difference.] Women also don’t really appreciate how men FEEL when EDis or ED develop. It’s sort of like how women feel when they lose a breast to cancer. You’re still alive, but you feel diminished. A part of your body you took for granted isn’t there anymore, or in the case of men, doesn’t work like it used to. And this isn’t just any part of the body. It’s a body part that in a profound way DEFINES you as a man or woman. For women, loss of a breast raises issues like: Am I still attractive? Am I still sexual? Can I still please a man sexually? Men with ED and EDis wrestle with similar issues.
Beyond this, men have lived their whole lives pretty much taking their penises for granted: See a sexy woman, get hard. See porn, get hard. Think a sexual thought, get hard. Then all of a sudden–and in many men this happens pretty suddenly–they’re in a situation where they expect to have to rearrange their underwear to accommodate some swelling down there, and then….nothing. Nothing happens.
Many don’t understand what’s happening to them or why. But even those who do, me for example, feel surprised, upset, disappointed, depressed. Change is stressful. But when the changes concern the penis, well, men get seriously freaked out.
Now women often (and rightly) believe that men are too focused on the penis. That’s often true. It takes most young men years (sometimes decades) to leave penis-centric sex behind and understand the erotic value and pleasure of whole-body sensuality, a lovestyle more based on whole-body massage than on just sticking it in somewhere. Men who never get there, men who continue to view sex as penis-centered, when their penis stops behaving as they expect, they often think it’s the end of sex, that they’re over the sexual hill, that it’s all over. In my experience as a sex counselor and writer, few women appreciate how diminished men feel as they get used to EDis… if they ever adjust.
Q: Why can’t men express these concerns?
MC: Many reasons. In general, men tend to be less emotionally articulate than women. Men are socialized to be the “strong silent type,” to keep a “stiff upper lip,” to “grin and bear it.” In other words, to deny what they’re feeling and just go on. As a result, men get less practice than women discussing their emotions, and when they do, they’re less skilled than women. Now some women believe that men don’t HAVE emotions because they don’t discuss them. Wrong. Men feel things just as deeply as women. They just are less likely to discuss them, and if they do, they’re less likely to be able to really articulate how they feel.
The two genders have different natural histories of sex problems. With the exception of vaginal dryness, which is easily mitigated with lubricants, most women have most of their sex problems/issues when they’re young. Young women wrestle with the mixed messages that they should be sexy but not trampy, that they should want love/sex, but not want sex “too” much, not be “too” easy. But how easy is too easy? Young women also have issues with orgasm. Many don’t have them and have to learn how to release orgasms.
Meanwhile, few young men have sex problems–other than coaxing women in to bed. The young penis works just fine, thank you very much. Maybe the guy comes too soon (this is the #1 sex problem of young men), but only rarely do young men have problems with erection. Then they hit 45 or 50 and suddenly, the erections they took for granted their entire lives start to fail them. They freak. It’s almost unthinkable. Many Americans found themselves speechless after Sept. 11. It was so horrible, unimaginable. Men don’t discuss their ED or EDis in part because it’s unimaginable–then it happens and they’re speechless.
To many men, having reliable erections is a significant part of what defines them as men. If they have problems in the erection department, some fear that the women in their lives will view them as less than real men. So why talk about it? Why invite her to rub his nose in the fact that he’s less of a man?
Q: When should a couple seek counseling?
There’s no hard-and-fast rule on this. But when a problem festers, when you find yourselves having the same conflict over and over again, when there seems to be no way out, no resolution, basically, when you feel stuck, that’s when to consider counseling.
Now every sex problem is also a relationship problem and visa versa. If the main issue is power/control/decision making or conflict resolution, then a couples counselor is probably the place to start. But if they main problem is sexual–a desire difference, orgasm issues for the woman, erection issues for the man–then I’d start with a sex therapist.
Personally, I’m a fan of sex therapy. This is not self-serving because I am not a sex therapist. But studies show that two-thirds of couples who consult sex therapists report significant benefit within 6 months. That’s pretty good. Men with ED or EDis need to reframe their thinking about sex. They need to get away from porn-inspired sex and explore whole-body sensuality. This is often unfamiliar to men. They often fight it. So going back to a therapist week after week can help keep them on the path to self-discovery.
To find a sex therapist, visit the American Association of Sex Educators, Counselors, and Therapists (AASECT). Click the map of the U.S. and Canada, and get a list of all the AASECT-certified sex therapists in your state or province.
Q: What if the man won’t go?
The woman should go by herself. This is not as good as the couple going. But going solo gives the woman a place to vent. It may equip her with new coping skills that can help deal with the couple’s issues. And she may be referred to some written material, e.g. my book and others like it, that she can litter around the house and hope he picks up and checks out.
Michael Castleman, M.A., is the author of twelve books, including Great Sex