impotence

The No-Sex Class and Patriarchy's Otherwise Paradoxical Indifference to Male Impotence and Low Libido

Posted by figleaf on Mon, 2011-01-10 01:47

While introducing the interesting-sounding film Orgasm Inc, which is about the potential medicalization of women's orgasms, Gwen of Sociological Images raises the issue of men's orgasms. Or, more specifically, of men's erections.

In the article “In Pursuit of the Perfect Penis: The Medicalization of Male Sexuality” (available for free if you search for the title and Tiefer’s name), Leonore Tiefer discusses the way that the increasing attention paid by the medical community to conditions defined as “impotence,” and the way it has become medicalized, requiring any number of surgical, psychological, and/or pharmacological interventions. While some men have undoubtedly benefited, the largest beneficiary is the medical community itself. The broadened definition of what counts as “erectile dysfunction,” for instance, has created a larger market for drugs such as Viagra and Cialis.

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Women's sexual dysfunction is complicated enough, as evidenced in the post's comments thread. Discussion of men's dysfunction is if anything even less, um, sophisticated.

One commenter, a possibly otherwise-well-intentioned young man, chirped

 

Best solution for impotence: try with someone you love and respect.

I replied... not exactly incivilly but perhaps a bit brittly that the people I know who seem to be most aggrieved by male impotence are their partners... particularly the partners of survivors of prostate cancer surgery. I added that I didn't think it would be particularly productive to tell them to become more lovable or respectable.

I have a feeling, though, that the reflex is to balk at the assumption that men's partners would be more aggrieved by impotence than the men themselves.  After all, as Leonore Tiefer says in "In Pursuit of the Perfect Penis," our contemporary image of men is tied extraordinarily to male sexual performance (which is what I mean when I suggest it's more accurate to label men rather than women "the sex class.")  With that understanding it would seem like madness for me to suggest that impotence, particularly low-libido-related impotence, would be less cause for concern for the man than his partner(s.)

Here's the thing, though: what's assumed to be the measure of sexuality in contemporary society?  (Hint: See the previous paragraph.)  If you recall that one of the big feminist indictments of modern sexuality, and the politics of sex and gender in general, is that men are the baseline reference for sexuality.  'Member that whole Hegelian thing about how people with privilege can go around oblivious to their privilege because those subordinate to them adjust themselves to meet the needs of the privileged?

Well, if a man imagines himself the baseline of sexuality, as we actually tend to do quite a lot, then we're going to do what?  Initiate sex when we're horny, right?  Right!  And when our partners aren't in the mood we're going to do what?  Either act to seduce them or else complain that they're never interested.  With me so far?

We're used to this notion that men are always "ready" for sex, right?  Used to?  Heck, we're practically indoctrinated with it!  Heck, one of the major premises of Orgasm Inc is that women's sexuality is being medicalized in order to help them "keep up" with men's high, high, go-go libidos.

Ok, so... if you've got this guy who only thinks about sex at all when he's horny, right?

And he's only horny maybe a couple of times a day, right?

He's happy and thinks everything's copacetic, right?

From his perspective he gets horny, he initiates sex, and if his partner's interested they have sex, and if not then he complains about it.

And now let's say this same guy, still only thinking about sex at all when he's horny, right?

Only now he's only horny maybe a couple of times a year, right?

From his perspective, once again, as the assumed/default baseline he gets horny, he initiates sex, what, exactly is different from his perspective?  Nothing, right?

And if his partner complains?  Well, bogus Rule of Desire #1 to the rescue: it's both inconceivable and intolerable for a woman to have sexual desire. So off to the shrink for her... if she doesn't seek counseling on her own to find out what's "wrong with her" now.

Is this starting to make sense? If a man is the measure of "sex" then his degree or frequency of interest is by default the "normal" to which all others are expected to adjust.

That's not to say that his partner won't bring it up, or even that he won't respond. Or feel bad for not "keeping up."

Can I twist the gee-isn't-gender-construction-fucked-up knife just a little bit further?

Because men's sexuality and libido are considered the baseline, to the extent most men respond to impotence it's in relation to who? Their partners? Oh, I don't think so! It's to either a) their former selves, b) their expectations of themselves, or c) concern for being compared to, or by, their peers.

Is it any wonder, then, that the people I've heard complain most bitterly about male impotence have been partners rather than the men themselves?

Do we want to leave it there?

And meanwhile we've got no-doubt well-meaning people like the commenters at Sociological Images who are saying stuff like blah blah Viagra blah blah Patriarchy blah blah male expectations blah blah blah. When in fact Patriarchy, with a nice assist from its Two Rules of Desire, is surprisingly fine with impotence and low male libido. It's certainly never concerned itself with possibility that female partners might have sexual desires of their own... let alone unfulfilled ones!

Final clue: In most relationships involving male sexual dysfunction which partner is most likely to initiate contact seeking medical or sexual advice, the man or the woman? Right in one! More often than not it's the woman who tries to get the ball, as it were, rolling.

Our social expectations and stereotypes about sexual dysfunction, male and female, aren't helping. At all!

I conluded my less-than-generous comment at Sociological Images with the following thought: is there an issue with medicalization of sex? Oh yeah. There’s plenty of that. And I think it’s a very, very good idea to be wary of the industrial tendency to take a drug or procedure originally developed for people with genuine need and turn it into a mass-market product. But one shouldn’t discount legitimate uses. Which, when it comes to sex, is enormously common. Turns out, though, there’s more than one form of prudery influencing some of the radically bad ideas in the field. Those who think there should be no intervention because sex is bad, and those who think there should be no intervention because what could possibly go wrong?

Neither kind could be less helpful than the other.

The way to be part of the solution is not avoid being part of the problem.


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The Kinsey Institute on What Condom Reluctance Might Really Indicate... And What to Do About It

Posted by figleaf on Wed, 2010-12-29 00:43

Echidne of the Snakes says

As the Kinsey Institute noted in a study this year, men who can't sustain an erection while wearing a condom are less likely to wear a condom while having sex. (Duh.)

Men who reported having sex with three or more partners in the past three months were almost twice as likely to report erection loss compared with men having fewer partners. These findings underline the importance of encouraging men to discuss condom use with new lovers.

Men who lost their erections were much more likely to remove condoms prematurely, or to report that the condoms broke. Earlier research showed that men who didn't know how to use a condom properly were more likely to report breakage.

Source: Echidne of the Snakes

That sounds about right. Sometimes I've had erection problems with condoms too. Although when that's happened it turns out there are roughly 10,000 other mutually orgasmic heterosexual activities that don't require them. No real reason to obsess about the one or two where they are. And, not to put too fine a point on it, sometimes when you do those things first it turns out you can get a condom on without erection loss.

Who ever said only women need to receive foreplay?

More to the point, who ever said only women enjoy receiving forplay?

Mmmm, foreplay.


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A (Possibly Stealth) Objection to Condom Use: Loss of Erection

Posted by figleaf on Wed, 2009-07-29 17:40

This week’s question for Em & Lo’s Wise Guys feature is “Is sex with a condom really all that bad?”

As usual the answers vary but the consensus tends to be… not all that bad, no, but not so great either. Reasons given by this week’s Wise Guys (disclaimer, I’m an occasional Wise Guy for Em & Lo) vary, as do those by men and women in comments. I was glad to see that some men are starting to be willing to talk about one that’s probably really important but not often discussed.

One downside of condoms I keep hearing about privately but not so much in open discussion is loss of erection. I’ve had a vasectomy, and been pretty much in long-term “fluid bonded” relationships, since just before concerns about HIV emerged so I don’t actually have a lot of experience with condoms. But even when I was an… um… perpetually upstanding young man it took a lot of gear-shifting to unwrap and properly put on a condom, and between the mental distractions, the time spent, and the fact that putting one on necessarily means you’re thinking about myriad consequences if something went wrong I’d often shrink to a point where penetration became difficult.

And since, as I discovered decades later, it’s actually not just me it would be very nice if there was more, and more open, discussion of the effect.

I’m guessing it’s an even bigger problem for men who already have other problems getting and keeping erections.

This isn’t to say I’m complaining about condoms, just that I’m guessing that at least part of male discomfort with the things comes not from the (ahem) straight-up loss of sensation but surprise or dismay about flagging, however briefly, when standard narratives about masculinity says it’s least supposed to happen. So, I guess, instead of complaining about condoms (which is pretty common) I’m complaining about the standard myths, narratives, and procedures involved in getting it on, and keeping it on, while putting it on. :-)

Again, obviously it’s not a problem for every man but it’s evidently a problem for quite a few of us. A little help with that would be handy.

For the record, for me anyway, if and when (usually when) my erection returned intercourse with a condom isn’t so less pleasant than intercourse without that I’d rather do without.


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The "No-Sex" Class and "Whoopie Pills"

Posted by figleaf on Tue, 2008-08-19 20:19

Anthony McCarthy of Echidne of the Snakes perhaps inadvertently shines a light on a classic “no-sex” class assumption.

You get used to filtering out commercials during the evening news but once in a while one breaks through your defenses. At the tail end of a Levitra commercial Sunday they included sudden deafness as a reported side effect. Sudden deafness now joins the list of announced effects of taking whoopie pills…

...the most interesting question is how far geezers, themselves, are willing to go to achieve rock hard erections into their late senescence. Would they accept having their head fall off, one wonders? Would they miss it? I’ve got to listen more closely tonight to hear if death is a reported side effect of aphro-geeziacs, by name or not. The answer may have already been reported.

Read the quote in context here.

A bit of desk clearing though. “Geezers?” “Late senescence?” “Aphro-geeziacs?” Sheesh, ageism much? Also, you don’t have to be geriatric to have problems with erections. Prostate cancer survivors, diabetics, men with heart disease, and men with untreated (and sometimes treated) depression experience it long before they’re “senescent,” and sometimes even before their hair thins or grays. But I digress…

So! I’ve mentioned elsewhere that I think it’s unfortunate that medication like Viagra is assumed to exclusively benefit men, or that contraceptive pills exclusively benefit women. McCarthy’s post reminded me of those strongly-gendered assumptions about the two medications and then, with his “whoopie pills” characterization, gave it a nice nudge forward. Check it out!

- Language of erection pills: frivolously facilitate (men’s) sexual enjoyment, i.e. “whoopie.” Because, you know, inside the “no-sex” class paradigm only heterosexual men enjoy sex. Their heterosexual partners merely endure it.

- Language of contraceptive pills: virtuously prevent (women’s) pregnancies. Because, you know, inside the “no-sex” class paradigm women’s interest in sex begins and ends at pregnancy.

But are women always and only interested in contraception only so they won’t get pregnant while passively lying back and thinking of England? And are men really always and only interested in erections for own pleasure? Sure, sometimes (and for those sometimes thank goodness for modern sensibilities about divorce.) But always? Only? The dominant paradigm says so. Why support it?

As I said in that previous post, for most heterosexuals both contraception (especially earlier in life) and erection medication (especially later in life) are as much for couples as for individuals.

—-

Quick question about Viagra and similar drugs: It looks like there really are a lot of unpleasant side effects and it sounds like they’re not all that rare either. So are they really consumed as recreationally as pop culture seems to think they are?


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One Pill / Makes You Larger / And The Other / Makes You Small...

Posted by figleaf on Tue, 2008-07-29 00:05

Petra Boynton takes a look at the recent story about Viagra possibly working for women on anti-depressants. I actually thought the press handled the press release relatively well compared to earlier stories that semen alleviates depression or this not-even-meant-as-a-prank fellatio/breast-cancer-prevention story from last year. That’s actually not a vote of confidence though. While most of the articles have been surprisingly clear that the viagra thing worked for only a very small subset of women with sexual side-effects from anti-depressants Boynton has other concerns.

The media coverage has been predictably uncritical. It has tended to suggest that Viagra is a wonder drug that will save depressed women, and as a subtext suggested it could also help the sex lives who weren’t depressed too.

If you are a woman or the partner of a woman with depression there are several things you need to know about this research before you go asking your doctor for a Viagra script.

The study does rightly state that some anti depressants can lead to sexual problems (usually the inability to have an orgasm through intercourse or masturbation, taking longer than usual to reach orgasm, and/or a lack of lubrication). In order to be an issue, however, women can’t just have these symptoms – they have to be bothered by them too. Meaning if a woman finds it difficult to reach orgasm but isn’t distressed by this then it is not an issue requiring clinical intervention. It’s worth noting that depression can lead to women finding it difficult to reach orgasm or have any desire for sex. It can be worrying for a depressive patient who recieves pharmacological treatment and expects to feel better to discover their sex life hasn’t returned in the way they wanted.

Read Boynton’s full analysis here.

While research subjects were chosen from women who didn’t have orgasmic difficulty until they began taking anti-depressants Boynton points out that care givers nor patients (nor, perhaps, patient’s partners) might not be so discriminating.

[T]his is not always just down to the side-effects of medication – the underlying causes of the depression may not have gone away and could easily still be contributing to a woman’s sexual problems. For example problems within a relationship, family difficulties, work problems, economic or housing difficulties, issues with childcare, isolation or a lack of support could all be contributing to a woman’s sexual difficulties.

And that gets to a point I think about a lot when I think about men and Viagra. And depression. And consent.

I don’t have erectile dysfunction, or at least not yet — I’m only in my 50s — but I do have mild bouts of… I’ll call it “physical” depression because while I still feel optimistic, cheerful, even playful mood-wise I get loss of energy, shyness or withdrawal, sleeping a lot more than usual, oh, and two other symptoms that I think of a sure-fire indicators: resumption of nicotine cravings (even though I quit years ago) and diminished libido. I’m in the middle of one of those slumps this summer, which partly explains my slow posting rate, my horrible personal-correspondence rate. (This doesn’t count as the apology to everyone who’s map I’ve seemingly dropped myself off of.) As in Boynton’s last paragraph external factors such as having children and partner home for the summer, a busy travel season, various elderly but fairly distant relatives passing away, a ton of projects around the house, and an extended allergy season are seriously contributing factors.

I actually think I’m starting to come out of the slump a bit — as is often the case we only notice these things when things start to improve, and I’m pretty sure I wouldn’t have posted about it in the first place if I wasn’t perking up a bit. But I digress… if only slightly.

Anyway, I was already sort of thinking about in my earlier pink-is-for-girls/blue-is-for-boys pill post but it seems like some of the consequences of the Viagra for Women story illuminates similar problems for men.

For instance while my partner and I are pretty compatible when it comes to conflict resolution in the past I’ve been involved with people who loved both to argue and to then have make-up sex. I’m not sure if I’m just sensitive (I once slept, literally slept slept, on a mattress made entirely of sacks of dried peas so I can’t be too sensitive) but after an argument all I want is a lot of time, alone, to process. The last think I want is physical contact, let alone sexual contact! Which with one partner in particular was cause for further acrimony as she was pretty insistent that make-up sex was important in relationships.

Had Viagra been available at the time I might have felt it was a good solution to “my problem” with sexual interest after arguments. Instead the solution I eventually found was to end our relationship — which was probably for the best for both of us considering our, well, other considerable incompatibilities.

Anyway, just to be clear this isn’t a “what about the menz, we getz pressher too” post. Instead it’s just an observation that some of the concerns anticipated in the event a “female libido” pill is developed might be examined among depressed or alienated Viagra users.

Because (as I mentioned in that pink/blue post) while Viagra has certainly been trumpeted as a “get back the feeling” drug for men it’s also been an “it’s about time” drug for their partners. Who, after all, are often healthy and generally younger humans and therefore as likely to desire sex and intimacy as… men in similar situations who despair of their partner’s libido.

So… I’m a little rattled today (believe me that didn’t help although a lot of unbidden tears throughout the day hasn’t hurt either!) Anyway, I’m not sure any of this makes sense.

I’m just saying that from my own situational, post-argument disinterest in sex, and my experience of pressure to meet a partner’s expectations in those situations, I’m just saying that an enterprising young student of psychology or relationship therapy might get a nice paper out of studying some of the perhaps less obvious reasons men might take Viagra… with it’s possible insights into potential consequences of “Viagra for women.”


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Deconstructing Reconstruction

Posted by figleaf on Thu, 2008-06-19 21:18

Sungold of Kittywampus has an interesting post up about reconstructive surgery after breast cancer vs. prostate cancer. I’d like to excerpt the whole thing but I’ll pull out the relevant bits as best I can.

According to Nate Jenkins at the AP, the state of Nebraska has decided that there’s no need to help men who are struggling with erectile dysfunction. It already stopped Medicaid payments for Viagra and related drugs when the federal government did the same in 2006. Now it’s excluding penile implants from Medicaid coverage as well.

From patient accounts that I’ve read, the erection resulting from the implant feels natural and pleasurable to both partners. Most of the men who have an implant wonder why they didn’t get the surgery sooner.

...

[A]part from the cringe factor, this is what they’re up against:

State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs.

The federal government will still help pay for penile implants in states that choose to continue covering the procedure under their Medicaid plans.

Medicaid is meant to pay for the medical necessities of needy people and “sex is not medically necessary,” she said.

Do I even need to enumerate what’s wrong with this? ...

The ruling is also blatantly sexist. The state Medicaid program covers breast reconstruction, as most private insurers are required to do in accordance with federal law. Where’s the difference? Again, from the AP:

Chaumont, who moved to Nebraska about a year ago to take her current position, said she didn’t know why the decision was made to cover breast reconstruction under Nebraska Medicaid but added that it didn’t strike her as unreasonable.

“I don’t think breast cancer has anything to do with sexual dysfunction or sexual impotence,” she said.

I’m always uncomfortable when breast cancer and prostate cancer get pitted against each other. Both deserve adequate – no, generous – funding. It should never be a zero-sum game. And in this case, there’s no conceivable reason to cover one but not the other. Breast cancer has effective advocates. Prostate cancer remains largely in the shadows. That’s the only real difference.
...

At bottom, Chaumont is enforcing the idea that sex is optional and probably downright icky or evil. That sex is not for people who are aging or ill (even if an increasing number of prostate cancer patients are in their 40s and 50s). That sex is not a part of mental health. She doesn’t give a shit that their partners suffer nearly as much from the loss of marital “delight.” But what gave her the right to impose her own anti-sex views on Nebraskans who’ve had the double bad luck to be both poor and seriously ill?

What’s next? Will the state of Nebraska refuse to subsidize walkers or canes on the theory that walking is not a medical necessity? You can stay alive without walking, chewing, seeing, or fucking. And you can survive for decades without using your higher brain functions, including logic and empathy, as Chaumont’s decision proves. It seems that even thinking is not a medical necessity.

Read the quote in context here.

I’ve been interested in medical side effects that inhibit libido or sexual function, especially in men, for quite a while. Our narratives of men as the “sex class” are so pronounced that, as Sungold says, men who suffer such calamities often vanish from sight. (By some accounts the Bible forbids them going to church!) There’s even a pretty strong tradition, thoroughly embedded in the “no-sex” class by the way, that Viagra and penile implants are of interest only to men and that their partners have no, zero, none investment in their partner’s sexual functionality. And as I’ve mentioned elsewhere several times recently the issues is further complicated by sexist/ageist bias: menopausal women who are still interested in sex have been standing objects of derisive humor for generations.

Anyway, great post by Sungold about a topic we really should be having a lot more conversations about.


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Sex education for cancer survivors and other medical patients

Posted by figleaf on Mon, 2007-07-30 11:41

When I was in 10th grade my English teacher went into the hospital with some kind of abdominal complain and came back out with a full hysterectomy. Which didn’t sit very well with her, her being newly married, still childless, and still only in her mid 20s. She’d let it pop up in conversation every now and then and each time she’d cut it off with a remark along the lines of “well, I guess I’m supposed to feel lucky I’m alive.”

Hmm. Another interesting article from ScienceDaily.com, this time about sexual problems for long-term cancer survivors from the University of Chicago Medical Center. (I used to read ScienceDaily for work, well, daily. I’ll probably start dialing it back into my regular rotation again.)

“Discussions with a physician about sexual consequences of cancer and cancer treatment matter a great deal to many of these patients,” Lindau said. “But survivors report that such conversations infrequently occurred. If such discussions are not happening in this context,” she said, “we suspect that they are even less likely to occur when the connections between disease or treatment and sexual function are less apparent.”

“It seems unbelievable to me,” added one cancer survivor who responded to the survey, “that a surgeon would remove one’s sexual organs and never talk about sex.”

Read the whole article here.

Two points worth mentioning about the study. First, it focused on 20 year survivors and a lot (a lot!) has changed since then when it comes not only to quality of sex but general quality of life issues in medicine. The attitude back then was much more “you’re lucky to be alive, quit complaining.” Or at least a lot less than there used to be.

Second point being that only women survivors were studied but I’m pretty sure the findings and recommendations would benefit all survivors.

The first study to look at sexual function in very long-term female survivors of genital-tract cancer found that these women were pleased with the quality of their cancer care but less satisfied with the emotional support and information they received about dealing with the effects of the disease and treatment on sexuality.

While 74 percent of the women in this study believed that physicians should initiate a discussion about sex, 62 percent of women who had undergone “severe compromise to their reproductive and sexual organs” said their physicians had never brought up the effects of their treatment on sexuality.

Women who had not had such a discussion were three times as likely to suffer from multiple sexual problems at the time of the survey, the researchers report in the August 2007 issue of Gynecologic Oncology.

And of course a disconnect between treatment of non-sexual vs. sexual side effects isn’t limited to cancer survivors. Any number of other medical procedures, and all kinds of prescription drugs also affect sexuality in all kinds of ways from instant menopause after hysterectomy to instant impotence from major nerves severed during prostate surgery to a simple inability to reach orgasm on some antidepressants or loss of interest on others. Oh yeah, and some people wind up with frequent, spontaneous, uncontrollable-and-therefore-unwelcome orgasms.

I know some of my readers are in school to become sex therapists. If I was looking into careers in sexology, medicine, and/or sex and relationship counseling I think I might do worse than specialize in the study and treatment of medically-induced problems with sex. Unless I’m terribly behind the times I think it would be a wonderful area to go into where I think you could help a lot of people.

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