The New Male Sexuality (81 page)

Chapter 16

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On the role of the clitoris in women’s sexual pleasure, see S. Hite,
The Hite Report
(Macmillan, 1976), and W. Masters & V. Johnson,
Human Sexual Response
(Little, Brown, 1966), Chapter 5.

This page
On women who can orgasm solely via fantasy, see B. Whipple, et al., “Physiological Correlates of Imagery-Induced Orgasm in Women,”
Archives of Sexual Behavior
, 1992,
21
, 121–133.

“Three researchers …”
A. Ladis, B. Whipple, & J. Perry,
The G-spot and Other Recent Discoveries About Human Sexuality
(Holt, 1982). “the evidence for an anatomical structure is shaky …” W. Schultz et al., “Vaginal Sensitivity to Electric Stimuli,”
Archives of Sexual Behavior
, 1989,
18
, 87–95.

This page
On the physical similarities between male and female orgasm, see Masters & Johnson,
Human Sexual Response
. Regarding emotional similarities, the classic study is by E. Vance and N. Wagner: “Written Descriptions of Orgasm,”
Archives of Sexual Behavior
, 1976,
5
, 87–98.

This page
Masters & Johnson,
Human Sexual Response
, 1966, 76–78.
On the basis of her interviews and research, Susan Bakos concludes that “physiologically, all women are capable of having multiple orgasms, though probably less than 50 percent do.”
Sexational Secrets
(St. Martin’s Press, 1996), 192.

This page
My sources for how women like to be sexually stimulated are, aside from my personal experiences, the following: conversations over the years with Linda Banner, Lonnie Barbach, Mary Buxton, Sandy Caron, Carol Ellison, Susan Hennings, Joyce Polish, Vivian Resnick, and Anne Weiwel; interviews I did with women in 1977, 1991, and 1998; and various books, including all of Lonnie Barbach’s; S. Bakos,
Sexational Secrets;
and S. Kitzinger,
A Woman’s Experience of Sex
(Penguin, 1988).

Chapter 17

“Surveys show that many men …”
“Sex Partners Can’t Be Trusted for AIDS Protection, Study Says,”
San Francisco Chronicle
, Aug. 12, 1989, A-5; S. Cochran & V. Mays, “Sex, Lies and HIV,”
New England Journal of Medicine
, 1990,
322
, 774–775.

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The tragic story of Magic Johnson shows why using condoms is necessary for sexually active singles. The woman he got the HIV virus from didn’t tell him she had the disease either because she feared the consequences of sharing this information or because she didn’t know she was infected. And he in turn didn’t tell subsequent partners because he didn’t know he was infected.

“A recent survey …”
S. Cochran & V. Mays, “Sex, Lies and HIV.”

Chapter 18

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J. LoPiccolo’s discussion of “good prognostic indicators” for sex therapy is similar in several ways to my list of ideal partner characteristics. He places particular emphasis on both partners holding realistic views of sexual functioning, on the woman being able to accept nonintercourse sex during treatment, and on the man believing that he can fully satisfy her without an erection. “Post-Modern Sex Therapy for Erectile Failure,” in R. Rosen & S. Leiblum (eds.),
Erectile Failure: Assessment and Treatment
(Guilford, 1992).

Chapter 19

This page
A. Ellis has published so many works it’s difficult to know which to cite. Two of the most important are
How to Stubbornly Refuse to Make Yourself Miserable About Anything—Yes, Anything!
(Lyle Stuart, 1988) and
A New Guide to Rational Living
(Wilshire, 1975), coauthored by R. Harper.

This page
On getting your mind on your side, there are a number of useful books. Among those I like are D. Burns,
Feeling Good
and
The Feeling Good Handbook
(Morrow, 1989); almost anything by A. Ellis; M. Seligman,
Learned Optimism
(Knopf, 1991); and one I wrote with A. Lazarus,
Mind Power
(Ballantine, 1988).

This page
My summary of Greg LeMond’s victory in the Tour de France is taken from two articles in
Sports Illustrated:
F. Lidz, “Vive LeMond!,” July 31, 1989, 13–17; and E. Swift, “Le Grand LeMond,” Jan. 1, 1990, 55–72.

Chapter 20

“It has been estimated …”
I. Spector & M. Carey,
Archives of Sexual Behavior
, 1990,
19
, 389–408.

“According to a number of studies …”
A few years ago P. Kilmann and I estimated that 75 to 85 percent of men develop better ejaculatory control in therapy: “The Scope and Effectiveness of Sex Therapy,”
Psychotherapy
, 1984,
21
, 319–326. My current estimate—based on my own results, on reading the therapy literature, and on discussions with colleagues—is a bit higher, but it applies only to men who stay in therapy for at least eight sessions and who are willing and able to do the homework exercises, including exercises with a partner.

“rapid ejaculation is almost always due to …”
In fairness, I should say that there may be a physical component for a small number of men. Some clients seem to be extremely sensitive to penile stimulation—that is, the same amount of stimulation that another man might describe as simply nice takes them very close to orgasm. One man like this who had the problem for many years and had given much thought to it said, “It’s as if my arousal system is always in hyperdrive.” My experience with such men is that although they need to spend more time than other men on the beginning exercises, they often do develop very good control. Regarding the issue of how women have orgasms, S. Hite,
The Hite Report on Male Sexuality
(Macmillan 1976), and L. Wolfe,
The Cosmo Report
(Arbor, 1981), come up with almost identical figures: Only about a third of women reliably orgasm in intercourse and the rest, the large majority, require direct clitoral stimulation.

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For information on antidepressants used to treat quick ejaculation, I have relied on the comprehensive review by Ray Rosen et al., “The Effects of SSRI’s on Sexual Function,”
Journal of Clinical Psychopharmacology
, in press.

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J. Semans, “Premature Ejaculation,”
Southern Medical Journal
, 1956,
49
, 353–358.

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M. Perelman, personal communication.

Chapter 21

I could not have put this chapter together without the generous assistance of two psychologist/sex therapists, Joe LoPiccolo and Ray Rosen, and three of the most knowledgeable urologists in the country: Ken Goldberg, Irwin Goldstein, and Ira Sharlip. Aside from the specific references given below, I have also relied on R. Rosen, “Erectile Dysfunction: The Medicalization of Male Sexuality,”
Clinical Psychology Review
, 1996,
16
, 497–519; R. Rosen et al.,
A Process of Care Model: Evaluation and Treatment of Erectile Dysfunction
(The University of Medicine and Dentistry of New Jersey, 1998); and the proceedings of two conferences on the pharmacologic treatment of male sexual dysfunction, the first given in September, 1997, in Universal City, CA, the second at the American Urological Association, June, 1998, in San Diego.

“It is estimated …”
The estimate is formed by extrapolating from the results of the study that found that 52 percent of men between 40 and 70 have erection problems. H. Feldman et al., “Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging
Study
,”
Journal of Urology
, 1994,
151
, 54–61.

This page
L. Sonda et al., “The Role of Yohimbine for the Treatment of Erectile Impotence,”
Journal of Sex and Marital Therapy
, 1990,
16
, 15–21.

This page
On vacuum devices, there are three important articles in
Journal of Sex and Marital Therapy
, 1991,
17
: R. Witherington, “Vacuum Devices for the Impotent,” 69–80; L. Turner et al., “External Vacuum Devices in the Treatment of Erectile Dysfunction,” 81–93; R. Villeneuve et al., “Assisted Erection Follow-up with Couples,” 94–100.

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S. Althof et al., “Sexual, Psychological, and Marital Impact of Self-Injection of Papaverine and Phentolamine,”
Journal of Sex and Marital Therapy
, 1991,
17
, 101–112; S. Althof et al., “Why Do So Many People Drop Out from Auto-Injection Therapy for Impotence?”
Journal of Sex and Marital Therapy
, 1989,
15
, 121–129; B. Fallon, “Intracavernous Injection Therapy for Male Erectile Dysfunction,”
Urologic Clinics of North America
, 1995,
22
, 833–845.

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J. McCarthy & S. McMillan, “Patient/Partner Satisfaction with Penile Implant Surgery,”
Journal of Sex Education and Therapy
, 1990,
16
, 25–37; R. Lewis, “Long-term Results of Penile Prosthetic Implants,”
Urologic Clinics of North America
, 1995,
22
, 847–855.

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I. Goldstein et al., “Oral Sildenafil in the Treatment of Erectile Dysfunction,”
New England Journal of Medicine
, 1998,
338
, 1397–1404. A. Morales et al., “Clinical Safety of Oral Sildenafil Citrate (Viagra) in the Treatment of Erectile Dysfunction,”
International Journal of Impotence Research
, 1998,
10
, 69–74.

“But a more serious problem …”
M.D. Cheitlin
et al.
“ACC/AHA Expert Consensus Document: Use of Sildenafil (Viagra) in Patients with Cardiovascular Disease,”
Journal of the American College of Cardiology
, 1999,
33
, 273–82. “Dying for Sex,”
US. News & World Report
, January 11, 1999, 62–66.

Chapter 22

This page
W. Masters & V. Johnson,
Human Sexual Response
(Little, Brown, 1966),
7
, 252.

Chapter 23

This page
W. Masters & V. Johnson describe their work with surrogates in
Human Sexual Inadequacy
(Little, Brown, 1970), 146–154.

“Other therapists I know …”
One report of a very large number of cases seen by a therapist-surrogate team is B. Apfelbaum, “The Ego-Analytic Approach to Individual Body-Work Sex Therapy,”
Journal of Sex Research
, 1984,
20
, 44–70. Apfelbaum estimates that 90 percent of the cases were successful.

“this kind of therapy is not widely available …”
One indication is that in a survey of the kinds of methods used by almost three hundred sex therapists, surrogate therapy was employed in less than 2 percent of the cases treated and was therefore the
least
used method. P. Kilmann et al., “Perspectives of Sex Therapy Outcome,”
Journal of Sex and Marital Therapy
, 1986,
12
, 116–138. My impression is that this is simply because the vast majority of sex therapists don’t work with surrogates.

Chapter 24

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In 1977, Helen Kaplan criticized Masters and Johnson’s sexual response cycle for not including a desire phase (“Hypoactive Sexual Desire,”
Journal of Sex and Marital Therapy, 3
, 3–9), and Harold Lief reported that desire problems had become the most common presenting complaint in sex therapy clinics (“Inhibited Sexual Desire,”
Medical Aspects of Human Sexuality, 7
, 94–95).