In the most recent Sex Talk, Dr. Hilda and Dr. Pat turned the focus to men. Here, they get down to specifics about testosterone levels, erections, and who might want what, and when.

Dr. Pat: Well, I think we do have to give the man’s point of view.

Dr. Hilda: We have to talk a little bit about what men go through, because otherwise we seem selfish. What I say to my patients is that as men get older, they do tend to have some difficulties related to hormones and the testosterone hormone—

Dr. Pat: It’s not just hormones.

Dr. Hilda: Yes, there are a lot of things. But certainly we know that testosterone is higher in the morning, so men will continue to have good erections—or better erections—in the morning rather than at night.

Dr. Pat: Don’t you always tell your patients that if there is some difficulty, they should initiate sex in the morning?

Dr. Hilda: Yes, I do tell them that. But you know what they say to me? Most women think, “I’m not attractive in the morning. I haven’t brushed my teeth. I don’t smell good. My hair’s a mess.”

Dr. Pat: After they’ve been married for 20 years?

Dr. Hilda: Yes. They still worry about their appearance in the morning. So they’re more reluctant to do the whole morning sex thing.

Dr. Pat: As if he cares.

Dr. Hilda: As if he cares, exactly. Exactly.

But in addition to that—the fact that the erections are better, or tend to be better in the morning than at night—men are able to maintain erections for a longer period of time in the morning. Women find this very difficult to understand, but some men, once they get that erection, they’re afraid of losing it, and that’s why they don’t engage in much foreplay. It’s like, “Okay, it’s ready. Let’s go. Because if I don’t do it right now, I may not have it in 15 minutes while I’m massaging your back and giving you a foot rub, et cetera, to warm you up.”

Dr. Pat: But that would be really good information for the couple to share on that walk.

Dr. Hilda: Yes, communication is key to a great sex life.

Dr. Pat: Right. A woman might tell her partner,I would be more interested in having sex if you whispered a few sweet nothings in my ear and maybe nibbled my neck.” And he might say, “Well, the reason that I’m so focused on having intercourse is that I can’t always predict how long the erection will last.” But how do we get a couple to be so comfortable that a man can have this kind of conversation? It’s a lot easier for a woman to say, “You have to nibble my neck” than for a man to say, “I could lose it.” It’s easier for us, because as long as we keep the vagina moist and elastic, we don’t have to worry about much.

Dr. Hilda: Exactly. We can have sex any time, anywhere.

Dr. Pat: Right. And with anyone, and the guys know it. [Laughter]

Dr. Hilda: Well, I think that I would be more receptive to 3 a.m. sex if he remembered that there are other things to do besides intercourse, and if sometimes, when I’m ready to have sex, he gives me those pleasures. You know what I’m saying? I think that for many women, oral pleasure is more pleasurable than intercourse.

Dr. Pat: More predictably pleasurable.

Dr. Hilda: Exactly. I would agree with that. And for some women, just the act of oral sex is satisfying enough without the intercourse. So it would be more reasonable for some women, myself included, if you mixed up the 3 a.m. intercourse with the oral pleasures at the time when I like sex most, which is about 10 or 11 o’clock at night before I fall asleep.

Dr. Pat: I understand.

Dr. Hilda: Once I’m asleep, it’s not that easy to wake me up.

Dr. Pat: Well, one of the interesting things about oral sex—I’m so glad we brought it up—is the issue of HPV and throat cancer. There’s an increasing amount of information about this troubling issue. We were one of the first non-medical sites to write about it.

Dr. Hilda: It was in the New York Times yesterday.

Dr. Pat: It was in the New York Times recently—

Dr. Hilda: And I received a thousand phone calls.

Dr. Pat:   —that men are getting throat cancer because they’re having oral sex with women who have HPV. I knew it was coming. I wrote about it. I spoke to three or four head and neck cancer surgeons, and they all said the same thing: “Pat, there’s nothing we can do about this. Do not open this can of worms, and no, I’m not giving you a comment.” Well, I did open a can of worms, and I think we should run it again soon with a little connection to that New York Times piece.

Dr. Hilda: So what’s the answer? Are you going to tell women across America that they should give up oral sex?

Dr. Pat: Listen, Hilda, we’ve got a problem. Nobody wants throat cancer. I do think it’s not unreasonable for a woman to have an HPV test and show the guy the results. If I were HPV-positive, I wouldn’t ask somebody to give me oral sex and risk getting throat cancer. Just like I wouldn’t ask him to smoke three cigars a day. I mean, I might like the fragrance and it might be an aphrodisiac for me, but it causes head and neck cancer. We have to be realistic. We’ve got something new at play here that’s going to have an impact on sexual behavior in the 60s-and-beyond group. The sexual-revolution women were free to experiment, and certainly oral sex was something that most of the members of our mothers’ generation knew nothing about—

Dr. Hilda: Poor things!

Dr. Pat: —and would have found the idea appalling because society hadn’t prepared them for it. And then our pot-smoking, slightly addled group in the 1960s and 1970s changed the way women thought about themselves as sexual persons. How one approached different sexual activities became freer: free love, free sex, free to do other things. But we have to take this new information into consideration. And for women, the problem is that men are not being tested. And women have to really think about whether they’re going to have oral sex with men, especially if they don’t know their sexual history.


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