Jason, a 60-year-old, first noticed a problem with erections when he was in his teens. When he was with a woman, he could not maintain an erection, although he felt very aroused. And even when he masturbated, his erection would disappear before he could ejaculate.

Jason went to numerous doctors, seeking help. Although his testosterone level was normal, Jason was given shots of the hormone—but there was no improvement in his erections. Jason got married after a doctor said it would solve his problem, but that didn’t help either. Only very rarely could he maintain an erection for enough time to allow him to have intercourse. His wife was frustrated, depressed and hurt by the situation, and so was Jason.

The couple went to more doctors, seeking help. One psychiatrist tried to persuade Jason that he could live without sex, saying that companionship was all that really mattered. But the suggestion didn’t go over very well with Jason and his wife. They wanted to enjoy sex.

Other doctors, unable to identify a physical cause for Jason’s problem, told him he had a psychological problem. “Everyone told me it was psychosomatic,” says this soft-spoken, well-dressed man, who looks younger than he is. But although no one could find a physical cause, Jason was reluctant to believe that his problem was indeed “all in my mind.” Over many years, Jason paid a high price for his leaky veins—and the lack of medical knowledge about erections that existed during most of his life. He felt his self-esteem and confidence slipping away, and believes this contributed to problems at work. He was often depressed and withdrew from social activities to spend more and more time alone. After several years, Jason and his wife stopped having any type of sexual relationship. They were too frustrated.

But recently, new tests found that leaky veins were the source of Jason’s impotence. He had surgery to correct his malfunctioning veins, and for the first time in many, many years, Jason reports that he wakes up in the morning with an erection. (More about the surgical treatments for vein problems is found in chapter 8.) After some adjustment to their new physical relationship, Jason and his wife are able to enjoy intercourse.

*65\184\8*

What is the magic behind the mystery? While erections seem to just “happen,” erection is really a very complicated process that involves hidden nerves, arteries, veins, hormones and, of course, some more visible parts of a man’s body like the penis and testicles. Although a lot is known about the intricacies of erection, it is still veiled in mystery.

Lifting the veil is important, because understanding how erections happen can help explain why they sometimes don’t. And this knowledge will also help you and your partner understand why it’s normal for a man’s erections to vary somewhat in size, firmness and duration—or even, on occasion, fail to appear.

Since the subject is anatomy, you may find it helpful to examine yourself or your partner while reading this chapter. In fact, couples might benefit from reviewing the material together to see for themselves just what we are describing.

*22\184\8*

While we know that men are easily aroused and reach orgasm more quickly and easily than women, not all are quite as sexually straightforward as many women believe.

Meeting Men’s Needs-I have no doubt that men also require the excitement and gratification derived from an emotional involvement in lovemaking. There is hardly a man who does not need to feel loved, admired and physically cherished if he is to experience the true depths of sexual pleasure with his partner. Yet far too many women tend to place the entire responsibility of initiating and orchestrating sex on their men. Traditionally, the man suggests sex and the woman either accepts or rejects him, and in this way the man usually determines how much sex a couple has. This amounts to a great deal of pressure, and many sensitive men do not really relish having such a burden. Better sex and happier couples ensue when partners feel equally free to suggest or refuse sex, and do so equally often.

Taking responsibility for suggesting sex also means that lovemaking will result more from inclination rather than obligation. Women can easily say “yes” to sex but are uninvolved. For a man, a compliant but unresponsive woman will never be as exciting or as satisfying as a woman who is involved and skilful.

*107\79\2*

For most women, masturbation is the introduction to sex. Few women have a clear idea of their own sexual anatomy, and so wouldn’t know where they like stimulation unless they’d masturbated. Masturbation helps a girl to know how she functions sexually, and it helps her to form preferences. It almost certainly gives her the first orgasm.

Women can often find it harder than men to achieve orgasm, and the ability to discover what feels good and exciting, what arouses them and what makes them less inhibited, less fearful and more willing to let go is most often discovered through masturbation. Once a woman has achieved orgasm by this means, it becomes easier to repeat.

Masturbation is important for older women too. It increases lubrication and reduces vaginal pain due to dryness. Whether it has been continual, or taken up again on the loss of a partner, it is an ideal sexual activity — an easy way of achieving orgasm — and one guaranteed to prolong your sexually active life.

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• You use sexual terms in your conversation and speak intimately to your partner.

• You take your partner’s body and hold it or rub it against yours.

• You offer him a variety of kisses.

• You engage in open-mouthed kissing, with your tongues inside each other’s mouths.

• While he is clothed, you fondle your partner’s body.

• You take off your partner’s clothes and look at his naked body.

• On your partner’s naked body, you bestow a variety of caresses.

• You lick or gently suck your partner’s nipples.

• Using your hands, you explore and stroke your partner’s penis and testicles.

• You lick and kiss your partner’s penis and testicles.

• While stimulating his penis with your hands, you enable your partner to reach orgasm.

• Using your mouth on his penis, you bring your partner to orgasm.

• You reach orgasm by intercourse in the following positions: your partner on top; lying side-by-

side; with you on top; with your partner approaching from behind; sitting; kneeling; standing.

• You caress or kiss your partner’s buttocks and anus.

*57\79\2*

Highly personal patterns, like our individual smell associations, make it extremely difficult to generalize about attraction. Men and women, in general, are attracted to the sexual characteristics that separate them – for example, women’s larger breasts, men’s broader shoulders. Cultural expectations, too, have a large role to play; a man to whom an English woman would be attracted is probably very different from a Chinese woman’s ideal partner. Age, social class, personality and the qualities we are looking for in a particular partner also very much determine whether or not we find a person attractive.

Many myths exist as to what men and women find attractive in each other. There is no proof, for example, that gentlemen prefer blondes as studies have shown that dark-haired men prefer brunettes, and fair-haired men like brunettes and blondes equally. And, while men think women like men with hairy chests and large penises, most women mention attributes such as tenderness, affection, respect, sensuality and kindness as a man’s most attractive qualities. If pressed, women will admit generally to preferring dark-haired men of average build, with small buttocks, and a tall, slim physique; penis size is rarely mentioned.

*31\79\2*

There’s no doubt that an awareness of and familiarity with sexual anatomy can make you a better lover. Knowing where your partner’s most sensitive areas are, how they are likely to respond to stimulation and touch – and what happens when they do – means that you will be able to give him or her maximum pleasure. And, if you realize that your partner is an individual who certainly will respond to particular caresses, perhaps in a very individual way, your lovemaking will become much more effective and mutually satisfying.

Men find it somewhat easier to understand their own sexual anatomy since their sexual organs hang outside the body and are clearly and constantly visible. But both women and men are less familiar with female anatomy, and this is because so many of the important parts lie hidden within a woman’s body.

Just as in other areas of anatomy, the genitals of men and women are individual; they come in a range of shapes and sizes. Normal variation means that a few women have exceptionally large or small vaginas, just as the occasional man has an exceptionally large or small penis. Women rarely express dissatisfaction with the size and shape of their external genitals — maybe because comparison with those of other women is not usual, so ignorance is bliss. However, the vast majority of men are dissatisfied with the quality of their sex organs, and many feel that a small or average penis is a drawback to their sexual value.

Fortunately, there are many women who couldn’t care less or who hardly notice the size of their partner’s penis. Indeed, some women are physically uncomfortable with a big penis; a smaller penis is easier for a woman to take when it comes to oral sex, for instance. Furthermore, many of a woman’s sensations from intercourse come from the clitoris and from the nerve endings that are mainly in the first couple of inches of the vagina, so the length of the penis really is irrelevant. It is a man’s skill and patience as a lover, not the size of his penis, that is responsible for giving his partner sexual satisfaction.

On the other hand, many women are dissatisfied with their breasts and it may be that some of the dissatisfaction that both sexes have regarding their visible anatomy is the result of foreshortened viewing; both penises and breasts are normally viewed by their owners from the top down. What really matters, though, is taking pride and delight in your own individuality, and not worrying about what your genitals look like compared with others, and that everything functions normally.

*6\79\2*

My re-reading of the sex manuals, some in newer editions, confirms what Lewis and Brissett wrote over ten years ago, and also suggests that men are still believed to be the sexual experts, who should be able to guide, instruct, and educate their women into better sex, provided the woman is complaisant, relatively receptive, and ready to be instructed.

They also imply that although sex can be seen as work it is also pleasurable, which most work often is not. This creates a dilemma in the mind of some men who place a high value on work and a lower value on pleasure. It seems morally wrong to them to devote much time to a pleasurable activity, when so much ‘real’ work needs to be done. The files brought home from the office have to be read; the boat has to be painted; the car has to be washed; the lawn has to be cut; the rubbish has to be put out; exercise – golf, tennis, squash, or jogging – has to be taken; the children have to be watched playing organized sport; and sex is relegated to something done when all these important matters have been completed. The result may be that the man only reaches sex when he is tired, or has other things on his mind. He does not want sex for mutual enjoyment but only to get rid of his sexual tension and if necessary to satisfy his partner as quickly as possible.

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The third and shortest phase of the sexual cycle is the orgasmic phase. Once a man has reached this phase there is no way of stopping. Come what may, he is going to ejaculate. Although the higher brain centres are involved in orgasm, no voluntary control can prevent a man from ejaculating once he has reached this stage, so that orgasm resembles a reflex.

The first part of the orgasmic phase is one which lasts less than 3 seconds, during which the man knows that he is going to ejaculate. Inside his genital tract, his prostate gland, and perhaps his seminal vesicles, have begun to contract, forcing seminal fluid into the deepest part of his urethra, which stretches to accommodate the 2 to 5 ml of seminal fluid and the added secretions from his prostate gland. At the same time the entrance from the urethra to the bladder has been closed, so that the seminal fluid cannot escape backwards into it.

The erection nerves end in the walls of the arteries which supply lood to the penis, and the impulses cause the arteries to become wider, so that an increased amount of blood flows into the penis. Normally, blood flows in and out of the penis at a steady rate, but if the penis is sexually stimulated, the blood flows in faster than it flows out, and an erection results. You can appreciate this better if you can imagine a hollow plastic cylinder shaped like a penis, closed at one end and filled with sponge. If you dip the open end of the model in water it will rapidly become heavier and stiffer. This state will continue as long as the liquid remains in the cylinder.

This is what happens when the arteries supplying blood to the penis dilate. Blood flows in, and the sponge-like cylinders of the penis become engorged with blood so that it becomes firm, stiff, and erect.

In some diseases, such as diabetes, the blood-vessels which supply the penile cylinders may become narrowed (or atherosclerotic). These damaged blood-vessels are unable to dilate in spite of parasympathetic nerve stimulation and the man is unable to achieve an erection – in other words he has erectile impotence.

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