In this episode of Sex Talk, Dr. Pat and Dr. Hilda turn to the male libido, performance anxiety, and ways of maintaining intimacy and sexual satisfaction—for both of you.

Dr. Pat: I think this is the time to segue into the male libido.

Dr. Hilda: Yes! I think that is one of the things that I’ve seen really bring a woman to tears. When the man is older—

Dr. Pat: In his 50s.

Dr. Hilda: No, it starts earlier.

Dr. Pat: Really!

Dr. Hilda: Mm-hm. It’ll start in their 40s, because men’s testosterone levels start going down significantly in the 40s. They may start to have some difficulties with erections, either getting an erection or maintaining an erection.

Dr. Pat: Often associated with depression and fatigue and loss of muscle mass and just sort of a general malaise.

Dr. Hilda: So many different things. In this economy, they can have stress-related difficulty as well.  But when men start to have problems with their… masculinity, they will often withdraw from sex because they don’t feel comfortable. They have a fear that they’re not going to be able to perform, and they start to withdraw.  So what I see—

Dr. Pat: Well-described performance anxiety.

Dr. Hilda: Very much so. And what I see are women who come in absolutely terrified, crying, depressed.

Dr. Pat: They’re always certain that it’s them.  He’s having an affair—

Dr. Hilda: Yes, it’s always about them.

Dr. Pat: —or he doesn’t find me attractive.

Dr. Hilda: They’re always certain that it’s them. And they fear two things: either he’s seeing somebody else, or he doesn’t find me attractive anymore. When a man doesn’t want to have sex with you, it can be a very painful experience. I hear this all the time in my practice.

Because as women, we almost always assume that it is our fault, our problem, rather than that he has an issue. You know, we rarely think that maybe he has a physical or emotional problem that’s causing him to have difficulty becoming aroused and erect and maintaining an erection. It can cause huge psychological trauma for women. And so I think it’s important for women to have that conversation with their gynecologists, but also with their partners. Once I have that conversation with them about the fact that men do go through—I guess we can’t call it menopause…

Dr. Pat: It’s called andropause.

Dr. Hilda: Andropause. But they do have changes in their libido, in their hormones, in their performance as they get older. And it has nothing to do with whether he finds you attractive or not. This is what happens with age. Pat, have you found that your patients are very upset and blame themselves when their partners have a decrease in their libido?

Dr. Pat: Erectile dysfunction, which is part of low testosterone, is a subject that I hear a lot about. I do know a terrific erectile dysfunction specialist whose name I often give to patients. I tell them that they can go for a consultation to the erectile dysfunction doctor, to see if they think their husbands would be comfortable with him, and also to get information from him about how to talk to the husband about the kinds of options that are available. And I always encourage them to ask the husband to have just some blood tests done and to have a total and free testosterone test done by the general doctor. Because who wouldn’t like to feel better?  I mean, low testosterone causes so many unpleasant symptoms for these men. It is not just loss of predictable sexual function but the range of symptoms has a significant impact on many men.

Dr. Hilda: Many women, I think, accommodate to their partner’s sexual appetite and sexual needs. It is part of a woman’s way of accepting what is. And many women have been prepared by their mother’s stories and their aunts’ stories, and the stories of women of a generation before us, telling us that sex goes away. But it’s so often a mindset that sex means intercourse. Even when there are erectile issues, it doesn’t mean that one can’t have pleasurable sexual intimacy.

Dr. Hilda: Oh, absolutely. There are a lot of things you can do with a soft penis.

[Laughter and crosstalk]

Dr. Pat: Well, now, there’s a recipe for conversation: Ten things to do with a soft penis.

Dr. Hilda: First of all, just because a penis is soft doesn’t mean that it’s not sensitive. So I tell women to have that conversation with their partners—that you don’t have to have a firm erection. You can still have pleasure. I can give you pleasure with a soft penis, and you can certainly give me pleasure with a soft penis. One of the ways of doing it is to have your partner lie flat, you get on top, and you simply rub your vulva and clitoris on his soft penis. Sometimes that by itself makes that soft penis remarkably hard—even if he thinks it’s not going to work, that it’s not going to do anything. But he can have pleasure just from the stimulation, either orally or with the hands. In fact, men can ejaculate without having an erection. It has happened. But they can get pleasure from just the attention that you give to a soft penis, and you can please yourself by rubbing yourself on a soft penis. And of course there are fingers, tongue, lips, oral stimulation that he can provide for you. So you can have a really great sex life without having an erection.

Dr. Pat: So much of this, though, involves the capacity for the couple to be able to have a conversation about—

Dr. Hilda: To communicate.

Dr. Pat: —about issues that are really at the core of one’s understanding of what it means to be a successful man or a successful woman in the bedroom. And one sets that up years in advance. If a woman is smart, she’s going to begin to put emotional capital into her partner’s bank account and hope that he in turn will put some emotional capital in hers. So that when one of them has a problem with vaginal dryness and needs to bring up the subject of lubrication, or the other one has a problem with an erection that doesn’t last as long, and there has to be a conversation about, “Well, you know, instead of taking 30 minutes to have, you know, luxurious, long love-making, we should use this thing while we’ve got it, and let’s focus,” the emotional basis for that is already in place.

Dr. Hilda: You just brought something to mind that I wanted to add to the conversation about lubricants. Women sometimes have difficulty bringing the lubricant out and using it. Some worry that he might be turned off by it.

Dr. Pat: I tell them to use it in foreplay. Put it on the penis first.

Dr. Hilda: Exactly, use it in foreplay.

Dr. Pat: They get very excited.

Dr. Hilda: And it’s just part of your sexual act.

Dr. Pat: I do suggest that women start in their mid-40s, before it’s an issue, so that it becomes part of the repertoire.

Dr. Hilda: Exactly. You rub it on him, and then you give him some, and he rubs it on you. Therefore it’s not, “Oh, I’m defective because I don’t lubricate,” or he’s not thinking, “She’s not aroused. I don’t turn her on anymore because she’s not lubricated.”  It’s just part of the sex act—you’re bringing out the lubricant and you’re having fun. And it increases that foreplay, which goes away when you’ve been with someone for a while. Many couples just don’t spend enough time on foreplay. So bringing this lubricant out and rubbing it on each other increases the foreplay that tends to disappear after a while.

In the next Sex Talk: Increasing desire in a longstanding sexual relationship.

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  • Stacy Brown January 16, 2018 at 10:26 pm

    Dr. Pat
    On sex talk # 6 regarding male sexuality and female satisfaction, I want to thank you for the 10 steps which is dealing with a male ‘s soft penis. I had to have have prostate surgery and that result left me with a soft penis.
    But your steps gives me encouragement and hope to deal with this situation. i have looking for ways to change , i am a healthy vibrant male, and excepting for this area, i am in excellent health. thank you for any and all other information, as I am looking to please my partner….
    I appreciate you writing this article. Thanks !

    Reply