• Magnesium deficiency has been studied in France in this connection-as long ago as 1930 a French specialist found that it was a valuable food supplement in men with prostatic problems. In one study twelve men with prostatic problems were given magnesium tablets. Ten of them were cured. Another French doctor found that magnesium reduced the swelling of benign enlarged prostates. Often, the reduction in size was small but the improvement in the man great. The specialist concluded that magnesium contributed to the battle against senility. Food sources of magnesium are Dolomite tablets, wheat-germ, honey, nuts, brown rice, seeds of various kinds and kohlrabi.
• Zinc is now the most researched of all the trace elements, with more than a thousand learned papers a year appearing on the subject in the western world alone. Zinc is especially plentiful in the prostate gland for reasons that are as yet unknown. There is a well-established link between a lack of zinc and prostate problems. A prostate gland that is abnormal due to infection contains less zinc than a healthy one. In benign enlargement zinc levels are the same as normal but in cancer of the gland zinc levels are low. Semen too is very rich in zinc but it is still not known why all this zinc is necessary in the male reproductive tract. Zinc appears to be related to spermatic physiology so perhaps prostatic fluid (which contributes substantially to the amount of fluid a man ejaculates) is rich in zinc to sustain sperms and to help them mature.
In a Canadian study, a 35 per cent fall in prostatic zinc levels resulted in mild enlargement of the gland. When the drop in zinc approached 40 per cent the men suffered from chronic infection of the gland. When it dropped by 66 per cent the men developed cancer. Foods rich in zinc are seafood, brewer’s yeast, onions, bran, eggs, nuts, rabbit, peas, beans, lentils, wheat-germ, gelatin and beef liver.
• Coffee and sugar have provable effects on the prostate gland. Every year thousands of men in the UK and US die from prostatic cancer or from the more severe effects of benign enlargement. In Japan cancer of the prostate is almost unknown and even benign enlargement is uncommon. Japanese researchers examined the differences between the diet of men with prostatic troubles in Japan and in the West. There were, of course, many differences but the most compelling was that the Japanese male drinks almost no coffee. The Japanese researchers then went to World Health Organization statistics and found that in Sweden, where the death rate for prostatic cancer is the highest in the world, coffee consumption is also the highest in the world (8 kg per person per year). They then went through a list of twenty countries and found that for nearly all of them the correlation applied.
They next checked for research into cancer-causing agents in coffee. A US study had indeed found that benzo-pyrene and other cancer-producing hydrocarbons are present in lightly roasted coffees such as are drunk in the US and Europe. Very long roasting does not produce a coffee rich in these substances-such coffee is drunk in Italy where cancer of the prostate is half that of Sweden. So could it be that over thirty years of coffee drinking these tiny amounts of carcinogens can produce prostatic cancer? Sugar consumption is also statistically linked to prostatic cancer and whilst no correlation can be found between coffee consumption and other types of cancer in the body, this is not so with sugar. There is a higher incidence of cancer of the breast, ovary, intestine and rectum the more sugar a person consumes. This raises the question as to whether it could be the sugar in the coffee that could be causing the prostatic cancer and not the coffee itself. More research is needed.
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The therapy process consists of erotic tasks performed at home, plus weekly or semiweekly meetings with the therapist. At each therapy session, the therapist and patients explore together the feelings and emotions experienced during the erotic exercises, which often are deep and profound. The therapist must be sensitive to the verbal and nonverbal cues that reveal the anxiety beneath the overt and covert responses of the patients and takes great pains to uncover their real reactions to the therapy, if progress is impeded. In this way not only does the therapist help the couple to obtain a clearer picture of their individual functioning and dyadic transactions, but also the partners learn to be frank and open about their emotions in general and their erotic preferences in particular.
Typically, the patients are instructed to perform the exercises more than once during the week. It is common for couples to experience difficulties during the first attempt, and to resolve these difficulties by the last attempt. With these patients, it is necessary only to present the next set of tasks. It is also common for patients to experience initial difficulties that are only partially resolved during the week; with these patients, some exploration of the resistances encountered, with insights and/or interpretations offered by the therapist, is often enough for a complete resolution. These couples also would probably be instructed to go on to the next set of erotic tasks.
These outcomes used to be the most common. However, the population seeking help for their sexual problems seems to be changing. More and more couples are coming with more profound problems that have remote causes. This results in increased difficulties in performing the sexual prescriptions. These resistances and obstacles can occur even before the exercises take place, for example, in deciding which partner “should” initiate the exercises and whether the other partner “must” agree. Other couples can “misconstrue” the instructions or interfere with his or her partner by “sabotaging” the process. Such maneuvers will compound the difficulties normally encountered in performing the actual tasks. Some couples can perform exercises properly and ruin the results – by having intercourse, for example, when intercourse has been proscribed. When these patterns persist or appear deeply entrenched, more intense psychotherapeutic confrontations and explorations are required.
Such psychotherapeutic, as opposed to behavioral interventions are performed strictly in the service of the experiential aspects – the sexual therapy prescriptions. Resolution is attempted only to the depth necessary to allow the tasks to continue; the resolution of intrapsychic or interpersonal conflicts for their own sake is avoided. Similarly, the therapist will tend to avoid offering insights to the couple that may apply to other realms but not to the psychosexual, if they pose a resistance to treatment.
If the resistance seems slight or manageable, it is bypassed, and the couple is instructed to proceed to the next exercises. Bypassing may also be indicated in certain unusual cases, for example, a man with erectile problems may have difficulty assuming the passive role in non-genital sensate focus, but may be much less resistant to genital stimulation. (The former is “womanly,” the latter is “manly.”) Although the inability to accept affectionate “pleasuring” may imply a severe disturbance, it should not be explored in this case. Instead, the man’s resistance to non-genital pleasuring would probably be bypassed, and the couple would be instructed to perform the next exercise, genital stimulation.
If the problems experienced during the sexual exercises appear too severe to be bypassed and are obstructing the sex therapy process, they must be explored jointly by the therapist and the patients. The probable prescription will be a repetition of the same exercise for the next week, which is often enough to solve the problem. When bypassing and repetition techniques are both ineffective or when the resistances seem formidable, they must be confronted directly.
The erotic exercises themselves include those described by Masters and Johnson, in addition to many others which have been developed in the last five years, such as in the treatment of premature ejaculation. In the Masters’ and Johnson’s technique, the female is instructed in the “squeeze” technique, applying pressure to the coronal ridge area of the penis to inhibit the ejaculatory reflex. Kaplan uses a modification of the Semans technique (Semans), in which the female aids the male in what is essentially a desensitizing procedure. It is felt that the Semans’ technique gives the responsibility for ejaculatory control to the male, to whom it is most appropriate.
The Kaplan method prescribes a unique series of exercises for each couple. Other methods prescribe the same exercises to all patients, with specific exercises for the particular complaint. In Kaplan’s technique, the dysfunction, as well as the motivation and assets of each couple, determines the course of the treatment. Using this approach, relief of the symptom will usually take place between six and sixteen sessions, although some patients have reported cures in as few as three sessions.
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The earliest of the psychosexual stages Freud described was the oral stage. At this earliest phase of infantile development, the infant’s needs, perceptions and behaviors are centered primarily on the mouth, lips, tongue, and other organs related to the oral zone. Pleasurable excitations and affects arise from stimulation of the mucosal surface of these organs. The primary model of oral stimulation and satisfaction is breast feeding, in which hunger pangs give rise to oral sucking movements which are then satisfied by active sucking on the mother’s nipple and the consequent feeding.
The oral zone maintains its dominance in the libidinal organization for approximately the first eighteen months of life. Oral sensations would include thirst, hunger, sensations related to swallowing, satiation of hunger, and the pleasurable tactile stimulation evoked by sucking on the nipple or nipple substitute. Libidinal satisfaction at this stage of development, how-
ever, may not be restricted solely to the oral zone but may also arise in connection with the multiple forms of tactile stimulation that are connected with mother-child contact, not only in the feeding situation but in the multiple contexts of infant mothering. There is some evidence, particularly from animal studies, that such maternal contact and tactile stimulation has an important influence on the infant’s affective development.
The oral drives are generally regarded as consisting of separate components, the libidinal oral drives and the aggressive oral drives. States of oral deprivation or tension tend to stimulate a seeking for oral gratification which is typified by the state of satiation the infant reaches at the end of a nursing period. Lewin has suggested that there is an oral triad which consists of the wish to eat, the wish to sleep, and the wish to attain that quiescence and relaxation which occurs at the end of sucking just before the onset of sleep. It is generally thought that the libidinal needs of oral erotism predominate in the early phases of the oral stage, but that they become compounded with more aggressive components later on in the stage of oral sadism. The development of oral sadism can express itself in biting, chewing, spitting, or crying. For many analysts, particularly those of the Kleinian persuasion, such oral aggression is associated with primitive wishes and fantasies of biting, devouring, and destroying. Such fantasies, for example, may be directed against the mother’s breast as an expression of primitive incorporative wishes. Although such fantasies can often be recovered in primitive regressive states (in psychotic or border line patients) and may even be elicited in the more regressive associations of even healthier patients, there is no good evidence to substantiate the operation of such fantasies at early infantile stages of development.
In developmental terms, the objectives to be attained in the oral period are among the most important for establishing a well functioning personality and for establishing the rudiments of a significant capacity for an accepted relationship with objects. If the oral period can be carried through successfully, the child should be able to establish a trusting dependence on the nursing and sustaining object and to establish a comfortable expression of oral libidinal needs and to find their gratification without significant conflict or ambivalence from the oral-sadistic wishes to attack, devour, or destroy the object.
The failure to achieve these objectives in one degree or another can lay the foundation for the development of pathological traits. Excessive oral gratification or deprivation can result in significant libidinal fixations. The traits deriving from such infantile fixations can include excessive optimism, narcissism, pessimism, and demandingness. Oral characters are often excessively dependent and require others to give to them and to look after them. Such persons want to be fed and supported and nurtured, and may be selfishly demanding in their attempts to have these wishes gratified; but they may be also exceptionally giving to others as a way of eliciting a return of being given to in kind. Oral characters are thus often extremely dependent on their objects and on a return of support and narcissistic supplies in order to maintain a fragile and often faltering self-esteem. Characteristics of envy and jealousy may often be associated as pathological manifestations of such basically oral traits. Such oral traits are often associated with fairly primitive degrees of narcissism, but these dimensions should be considered separately.
Nonetheless, the oral phase may find a successful resolution and thus provide the basis for character traits positively contributing to personality functioning. Such individuals may develop capacities for giving, for giving to and supporting others, and for receiving from others without a sense of excessive dependence or envy. They may develop a capacity to rely on and trust others and to be capable of relying on themselves and of trusting themselves in their complex dealings with others and in facing the difficulties and challenges of life. The continuing capacity for trust and reliance, either as an enduring possession of one’s own inner life or in one’s relationship with the significant others in his environment, rests ultimately on the development of the basic sense of trust during this earliest oral phase of psychosexual development.
Erikson has characterized these complex aspects of character development deriving from pregenital phases of psychosexual development as phases of psychosocial development. He envisions the phases of psychosocial development arising out of the psychosexual phases as being characterized by certain definitive crises in the development of the individual personality, leading finally to a phase of identity formation. The specific psychosocial crisis associated with the oral phase is the resolution of basic trust versus basic mistrust. The capacity for enduring trust in oneself or in others represents a successful resolution of the early object related crisis in the oral phase, while the failure to resolve that crisis results in a basic and perduring mistrust which provides the basis for a lasting impairment in the capacity to relate to others and to rely on one’s own inner resources.
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There is a commonly held notion that women are tougher on other women than men are. The evidence supporting this assertion is only fragmentary. In general, women and men have been shown to share the identical sex stereotypes, to have the same differential standards for men and women, and to be equally sex-biased in their behavior. However, there is a style among professional women that gives rise to and perpetuates such ideas.
The “queen bee” syndrome (Staines, Tavris, Jayarante) is that in which successful women who could assist the careers of other women prefer not to do so. Queen bees choose not to be mentors and to teach new women “the ropes” and, despite the power to help women advance, they do not support them. There are a number of reasons for this behavior.
First, being a member of a minority often causes people to identify with those in power and to dissociate themselves from those in their own social category. In this way, there is the possibility of being hailed as an exception and being accepted into the ranks of those with power. Second, these women may enjoy their uniqueness. They may relish their positions in male-dominated fields and be unwilling to open the door to additional women who not only will lessen their unique status but also might make them compete for it. Third, these women often have made their ways up the career ladder with great hardship and sacrifice, and they may resent what they perceive to be the “special treatment” and “premature advancement” of younger women who are seen as capitalizing not only on their own talents but on the pressures of the women’s movement.
There might well be resistance by established women to the advancement of new young women. But there is no evidence that similar prejudices are harbored by the younger or less established women who usually are the participants in research studies. On the contrary, the overall degree of sex bias evidenced by men and women, whether in the experimental laboratory or in the field, has not been shown to differ dramatically or consistently.
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Because of anthropology’s emphasis on marriage and social control, there has been a general de-emphasis on the study of extramarital sexuality. Also lost in the shuffle is the view of sexuality as a component of culture, since it has been assumed to be a component of marriage. Despite this obvious and continuing orientation to sexuality only as it prevails in marriage, some anthropologists have recently begun to report on extramarital relations, mostly in Africa, native South America, Polynesia, and New Guinea.
Wagley, for one, had no choice but to recognize sexual activity outside of marriage, for Tapirap? Indian men take six- or seven-year-old girls as wives, a custom they refer to as “raising your own wife”. These men have to find sexual satisfaction surreptitiously; their marriages are, at least initially, asexual. After doing field work among the Fulani, a pastoral people of Upper Volta, Riesman offered this important critique of the standard anthropological understanding of marriage and sexual control:
It is a commonplace in anthropology to say that marriage, as an institution, channels man’s sexual impulses so that they contribute to the maintenance of social structures rather than their subversion. But in reality, in the case of the Fulani at least, the effect of marriage is much more complicated than that. On the one hand, instead of channeling sexual impulses, so that they flower within limits defined as legitimate, marriage, in its beginnings, makes this flowering very difficult. Instead of being a honeymoon, in which the young people can satisfy their passion and begin to become a unit which will present a common front to others, this period in Fulani marriage prevents the couple from being together and, especially, prevents them from becoming a unit. On the other hand, the ease of divorce and the possibility of polygamy are a positive encouragement to men to be interested in other women. In the same way, this interest on the part of men is an encouragement to women to remain in a way available, whatever their matrimonial situation at the present.
Riesman criticizes the “sexual channeling” function of marriage identified and emphasized by Malinowski. Malinowski assumed a universal function in marriage, based on his Trobriand data, which in effect focuses emotional and sexual feelings and behavior in one direction, on one person (in monogamous unions). Riesman also cites a statement made by Bohannan, that “marriage and the resultant family is, everywhere, one of the main modes by which sexual activity within the society is controlled”. Bohannan is aware, however, of periods of relative sexual freedom in various societies and of the non-familial institutionalization of sex, prostitution being the obvious example in our own society.
Work such as Riesman’s indicates the mistake of studying sexuality exclusively within the context of marriage and the family for the Fulani case and it warns against similar assumptions and oversights in work on other societies. Riesman may be aware, however, that Malinowski’s focusing effect in marriage may still operate for Fulani women, if not the men. “Being available” and being free to have additional and various sexual partners are different.
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In summarizing age-related changes in sexual capacity, Masters and Johnson state that “there is no question of the fact that the human male’s sexual responsiveness wanes as he ages.” The variables affecting this change are both physiological and psychosocial. This is also true for females, who Masters and Johnson contend, have no time limit with regard to sexuality. With the obvious exception of reproduction per se, age-related changes in sexual capacity are not as severe for females as for males. The components of female sexual behavior are not as “obvious,” and female sexuality has traditionally not been as “performance-oriented” as has male sexuality. For example, the inability of a male to achieve a rapid erection is an obvious sign of waning sexual function; the female analogue of this, the inability to lubricate readily, is not as obvious and can be alleviated more easily, either endogenously or exogenously. The male’s signal of sexual responsiveness is external and evident. The female’s is much less overt. Sexual capability is a principle part of most males’ roles and self-concepts; capability per se is not the stereotyped badge of femininity. Previous experience and availability of appropriate sexual partners are important influences on sexuality for both men and women. Within the constraints set by physical changes, experience and attitudes towards self and sexuality are probably the most important determinants of sexual functioning and satisfaction in later years—but this is probably as true in young and middle adulthood.
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Surgery to install an inflatable implant is usually done under a general or spinal anesthetic, and not a local, because the operation is more extensive. And with this type of implant, a two to four day hospital stay is the norm.
The surgeon gets access to the body through the scrotum, or through an incision in the lower abdomen, above the penis. He then cuts into the corpora cavernosa. All the components are usually inserted through one incision and placed in their proper locales. Before the patient is sewn up, the reservoir is filled with fluid—usually a solution of water and contrast material so the fluid will show up on an X-ray. Then the tubing which connects each part is hooked up. And all the components are tested to make sure they work.
Some surgeons prefer to leave the prosthesis partially inflated, others leave it completely flaccid. If s typical for a catheter to be inserted into the bladder for a day or so. And while the patient is still under the anesthetic, the doctor will pump the implant up and down several times to make sure everything is in working order.
In general, it takes a little longer to recover from inflatable implant surgery than from an operation to put in a semirigid prosthesis, because the surgery takes longer and is more complicated. If s typical to have a bruised and swollen penis and scrotum following surgery (ice bags on the area can help), and if s common to feel a burning sensation the first few times that you urinate. You’ll want to take a week or two off from work, and to take it easy while recovering.
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The concept is very simple: eating fish at least once a week will lower your cholesterol, enhance overall vascularity, and improve erectile health in the process. New studies on the effects of fish eating support the idea that polyunsaturated fatty acids are responsible for this. The omega-3 fatty acids, found primarily in the oils of the fish, lower blood triglyceride levels. The omega-3s seem to make blood less likely to coagulate, which, in turn, makes it less likely to clot. They accomplish this by raising the levels of prostacyclin in the blood, thereby making the arterial walls relax. At the same time, they lower the levels of thromboxane, another chemical messenger which is responsible for the constriction of blood vessels.
One study of 1,300 men showed that those who consumed at least eight to nine ounces of fish weekly (and that was mostly canned tuna) had an incredible 40 percent lower risk of a fatal heart attack than those men who ate little or no fish.
To get the fullest benefits of all fish has to offer, I suggest that you eat it two or three times a week. Fatty species, such as herring, cod, mackerel, salmon, and sardines, contain greater quantities of omega-3s than do leaner varieties. But if the idea of eating that extra piece of fish each week is just not appealing to you, there are other ways to get the omega-3s you need. Flaxseed may be the source that will work for you.
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ED is not only one of the most troubling side effects of many psychiatric drugs, it is also the least discussed. “I thought it was just me,” a patient said after learning that an antidepressant that he had been taking daily for two years caused his ED. “I was embarrassed to talk to you about it. And I didn’t know if there was anything you could do for it, anyway.”
If ED is going to become a problem for men undergoing pharmacotherapy with tranquilizers or antidepressants, the trouble usually begins during the first month of treatment. For many men who experience this initial side effect, and then stay on the program long enough to benefit from diminished anxiety and/or reduced depression, there will eventually be a reawakening of sexual interest and, consequently, improved sexual performance.
Over time, however, the sexual picture may change, again because of the drugs. Many of the treatments for psychiatric-related disorders negatively affect sexual response by impacting the autonomic nervous system, which controls the genitals. Other psychiatric drugs can block nerve function, making it difficult, or even impossible, to achieve an erection or ejaculation. High doses of tranquilizers prescribed for anxiety and depression not only cause ED, they can also be responsible for the lessening of libido (sexual desire), an inability to ejaculate, and gynecomastia (breast enlargement in men).
The popular new class of depression-fighting drugs, SSRIs, such as fluoxetine and sertraline, also inhibit sexual function. SSRIs are selective serotonin-reuptake inhibitors, a group of drugs which affect the neurotransmitter, or brain chemical, serotonin, which affects mood. These medicines often contribute to ED, diminish sex drive, and block orgasm. This latter problem is so widespread with Prozac, Paxil, and Zoloft, three of the most widely used SSRIs, that I often prescribe low dosages of them to men complaining of premature ejaculation. Current estimates of men taking SSRIs who have erectile problems range from 9 percent to 24 percent.
While it sometimes happens that sexual problems diminish after a man has adjusted to the drug he is taking, it is usually the exception to the rule. Taking a drug “holiday,” or having sex when the drug is at its lowest concentration in the body, are alternatives that work for some men (see pages 165 and 166-68). For others, yohimbe (the pulverized bark of an African tree, available in health food stores or by prescription) or red ginseng can alleviate ED when taken in combination with their SSRI medications. Many of my patients have responded very well to changing from Prozac to either Wellbutrin or Serzone.
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Any relationship is bound to have its physical ups and downs. However, a realistic appraisal of personal satisfaction is something that must be faced if a couple is to reach an enlightened connection. In the case of Rachel and Joshua, their sexual problem was, interestingly enough, related to the society in which they lived. A couple in their early twenties, they had been married for a year when they came to see me. Participants in an arranged marriage dictated by their culture, they were expected to have children as soon as possible. They told their respective families that they were seeing doctors to address their fertility problem.
Sadly, whether fertility was an obstacle was a moot question. The fact was they had only achieved intercourse a couple of times. At his young age, Joshua was experiencing erectile dysfunction.
“Our parents brought us together, we got married, and now we’re expected to have children,” Joshua told me with frustration rising in his voice. “We want to—of course. It’s just that I can’t perform regularly.
I don’t understand it!”
His physical exam revealed abnormally high cholesterol, which, I hastened to explain, very often contributes to ED as a man ages. I suspected that in Joshua’s case, the ongoing pressure to immediately build a family might be the major culprit and I suggested a consultation be with a sex therapist.
After numerous sessions, the therapist reluctantly agreed that no progress had been made. It was at this time that Joshua and Rachel enrolled in the Vasomax study.
My only concern in their case was that they had little frame of reference to compare before-and-after personal sexual experiences. “We’ve been together for a while now,” Rachel ventured, “and, despite the problems we’ve been having, we’ve been able to get to know each other in a very positive way. What I see this pill giving us is the opportunity to build on what we’ve already established. If we can get over this hurdle, I’m convinced that the love and affection we have for one another will move us forward to where we want to go.”
Joshua nodded in agreement. “Rachel is right. We want to get past this dark period and move on—even if it takes us a while to do it.”
Happily, the pill did for them what they hoped it would, and their joint feelings made the outcome the satisfying one they were hoping for. The personal satisfaction issues in this case were:
• mutual frustration at the lack of a sex life
• shared comfort in the basic relationship, based on compatibility
• anticipation of exciting and fulfilling sexual experiences—as well as becoming first-time parents
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