Richard G. Wendel MD. MBA.
Just like all living organisms, mammals must be able to grow and reproduce. And in most species the reproductive function is a fairly strait forward core competency complicated only by male or female competitive behaviors. But humans are quite different from other mammals and to conform to our cultural norms, human sexual fulfillment is a capricious maze of competing biologic, sociologic and psychologic forces. Humans talk more about sex than almost any other topic aside from maybe sports and the weather and yet they are quite clumsy and often confused when it comes to the implementation of the mating ritual. Each society introduces unique standards and morality to mold this purely basic instinct and sex is saddled with infinite inhibitions relevant to political, religious, tribal and social restraints.
One explanation for the paucity of rigorous studies about human sexuality is that it is very difficult to define what is normal and what is abnormal. It is difficult to apply objectivity and rational thought to sexual expression and if you try to launch a double-blind scientific study of sexuality, the controls are often just as variable and screwed up as the group being studied. To put a statistical frame around sex is like trying to produce a formula for a forced drill of goldfish.
The somatic or voluntary nervous system in humans provides precise control over physical movements, and the involuntary nervous system efficiently maintains a steady state or homeostasis without much coaching. The frontal cortex of the brain which is conveniently called the ‘executive center’ contains the control center for rational behavior. It obviously maintains some control over sexual behavior, but the nuclei within the brain where reproductive instincts reside and sexual performance is initiated and sustained are located further down in the lower centers of the brain and brain stem. It is easy to see how these two control centers might have different goals and objectives or at least a different slant in how to go about it.
The neural network and pathways that conduct the electrical impulses for the physical performance of sexual intercourse reside in the involuntary parasympathetic and sympathetic nervous systems. Unlike the motor cortex of the brain that enables one to move a skeletal muscle at will, the involuntary nervous systems, although in a constant state of readiness, doesn’t usually follow voluntary sexual commands unless they are in sync with one’s emotional milieu and readiness. And emotions, libido and sexual programming are thought to each emanate from differing locations within the brain. Add to this the fact that sex is a highly conditioned and reinforced type behavior and you soon realize that sex does not simply have a start and stop button. Put crudely, from a male and female perspective “Peter rarely lies” and “Fake orgasms are rarely convincing”.
In the human species, there are many erogenous zones that have a plethora of nerve endings. The foremost of these is the entire perineum that includes the external genitalia and perianal areas. Young children quickly come to recognize these sensitive areas; stimulation of which is pleasurable. Perhaps, a parent will tell a child not to play with themselves ‘down there’ or explore the orifices, but with these innate erogenous zones the child learns more through exploration as opposed to parental guidance. Immature males experience penile erections with or without touching of these sensitive areas. And stimulation from contact with parents or relatives can be arousing even if it falls in the realm of routine toilet training and changing clothing. The taking of a rectal temperature, an enema, medical examinations or stroking of the genitalia can cause sensations that produce sexual fantasies that later may influence adult behavior.
A number of studies suggest that sexual orientation is determined during intrauterine life and occurs early during the development of the fetus. One commonly held theory is that it relates to poorly defined hormonal factors that embryological influence the genital ridge during intrauterine life. Homosexual orientations seem to occur randomly without linkage to any familial factors. And many scientific studies fail to show any consistent relationship to the genome, epigenome and anatomic changes in the brain. In the DSM 5 classification of mental disorders homosexuality is not listed as a medical disease and anthropological studies show that homosexuality has been recognized in all cultures regardless of any cultural proscription.
My conversations with several gay young men revealed that all were aware of their attraction to the same sex very early in their lives. With heterosexual orientation the same holds true. Play behaviors emerge early in childhood consistent with male or female sexual orientation. Speaking for myself, I avidly looked at the nude pictures of women in my father’s medical textbooks and when I first danced with a girl in the fifth grade, I knew there was something very special about girls.
I believe that many adults do not appreciate the extent to which our young children are sexual beings. This is certainly not a subject that is easily discussed with a child that basically lives in a sensory world with no frame of reference other than dependency. Thus, infantile sexual ‘make-believe’ or even ‘playing doctor’ evolves unrestrained by moral considerations and parental impute. Even as childhood fantasies may be irrational like dreams; nevertheless their effect can carry over into normal and even unusual sexual preferences in adult life. Reproduction is a primal instinct where desire and fantasy may partially live in the subconscious world and yet highly influence conscious behavior. And for parents this dream world is locked out of sight and control.
In young adult life, there are many inhibitory social factors that impact the natural feel of sexuality. Starting in middle school and high school a girl’s reputation could be hurt if she ‘acted out’ sexually even if it involved just kissing and petting. In my high school years, no girl wanted to be labelled a ‘make-out’ especially since boys of similar age rarely could keep a secret and often bragged. Recently, the dire effect of social media sexting has made headlines and this has been linked to some teen suicides especially in young girls.
Religious proscriptions about premarital sex remain to some degree as do parental wishes that their daughters remain inviolate until marriage. Plus most all parents wish for their sons to associate with a ‘good crowd’ and date nice girls from good families that can be brought home to meet the family. For teenagers, privacy and fear of discovery causes sexual relationships to be more impulsive than well-reasoned due to these barriers. Indeed, male hormonal surges and persistence often short circuit the usual intimacy and courtship that typically precedes a healthy consensual coupling. Regret and even blame are added to the fear of pregnancy and venereal disease. Moreover inexperience and ineptitude often makes the encounter unsatisfactory and may have lifelong psychological consequences. And unsatisfactory sex may contribute to performance anxiety and avoidance of sex even as sexual expression is an instinctual drive that comes fully equipped.
The Adult Condition
Even as sex is instinctual and hard-wired, the mating ritual is highly susceptible to positive and negative reinforcements. Privacy, safety, mood, transferences, beliefs, expectations, cleanliness, odors and health often complicate this very natural activity and, moreover, can directly impact performance. Indeed, the male and female ego is highly intertwined with sex and self-esteem, and one or more bad experiences can have a long term dampening effect on sexual expression. Additionally, speaking as a Urologist, few individuals are completely satisfied with the size or configuration of their sexual anatomy. Moreover, when they read beauty and muscle building magazines their body contours and perceived beauty often fall short as well. This causes a heightened self-consciousness and sensitivity to any critical or derisive comment during love making. Just one insult or any expression of dissatisfaction can severely damage a relationship and instill self-doubt.
Many other factors may influence sex. Each partner has a unique set of fantasies, idiosyncrasies and turn-ons/turn-offs. Women especially want a romantic setting as a prelude to love making and some desire lengthy foreplay and teasing. More men are inclined to want to swiftly get down to business. Some couples act passively, while others are more emotive with passion, body movements, throaty sounds and verbal exchanges. There are some men and to a lesser extent woman that wish to bypass the emotional underpinnings and think that sexual pleasure begins and ends with ejaculation or climax.
One statistic that causes disbelief (and denial among men) is found in Master and Johnson’s studies on Human Sexuality. Their data showed that male ejaculation on average occurred 55 seconds after penetration. Obviously, this short time frame is designed for procreation, but is not very reassuring for those that consider their mating ritual a form of physical endurance and intimacy plus a type of contemporary artistry. It does explain why couples rarely experience ejaculation and orgasm simultaneously.
Today, the ubiquitous exposure to pornographic videos have influenced sexual expectations and commoditized sexual expression. It has added new twists to love making that may be contrary to Victorian ways of thinking. It certainly has made a market for vibrators, dildos and sex toys, and explicitly exposed couples to sexual practices such as oral and anal sex that at one time were considered to be aberrant and kinky sexual practices.
If you manage to successfully navigate these sexual concerns and have a gratifying sexual relationship; sexual activity tends to gain a special momentum. The repetitive reinforcement gets imprinted into a ‘sexual map’ we create in our brains that is very similar to the common pathway followed by addiction to other pleasurable experiences. The early ‘sexual maps’ leave a trail to follow for both permanent and less permanent sexual relationships. In my experience as a urologist, libido may fade with age but some old folks are still quite motivated with hard-wired sexual maps.
A satisfactory sex life is an important ingredient in enduring relationships. There is an old adage about marriage that ‘if sex is good it is responsible for 20 percent of marital bliss, but if it is poor, it is 80 percent of marital dissatisfaction.’ Over time the frequency of sexual intercourse in a long term relationship declines and a humorous take on this is that ‘if you put a jelly bean in a jar for each time you had sex during the first six months of marriage, you could take one out each time from that time forward and still have some left over.’ I doubt that this holds true today as premarital sex and cohabitation before wedlock are quite common and increasingly acceptable arrangements.
Recently the #MeToo woman’s movement has surfaced to encourage women victims of sexual abuse and misconduct to speak out and come forward to tell their stories. The response to this initiative has finally gained traction and seems to be influencing corporate cultures. Certainly the casualties from sexual misconduct that include elected politicians, actors and executives attest to the effectiveness of new guidelines for engagement with subordinates and the opposite sex.
For many years, the EEOC, a Federal agency, has had the authority to investigate hostile work environment claims about 45 percent of which are relate to sexual misconduct. Often sexual improprieties went unnoticed. But due to the #MeToo movement many more businesses are adding clauses to their HR manuals that include anti-harassment training, anonymous reporting and protection for the sexual whistle blowers. The recent women’s march in all of the major cities across America suggests that this issue will not fade in the conscience of the nation. I have often wondered why with so many consensual opportunities would a business executive try to inappropriately steal a kiss, fondle a butt or bodice, demand sexual favors through threats, make unwanted physical contact and expose themselves?
Prostitution is alleged to be the oldest profession in the world. In many countries it is legal and regulated. In others it is illegal, unregulated and part of the criminal underworld. In Japan there are sex tours to visit places like Thailand to partake of their brothels. Paid sex separates sex from relationships and I often wonder how many men are impotent or have premature ejaculation when faced with paid ‘sex on demand’ with no emotional underpinnings. I would think masturbation would be a more cost effective mature alternative that does not bring with it the threat of blackmail, STD and possibly remorse.
If a man or woman wishes to have an affair, it is a fairly straight forward process. Consensually, men and women don’t just fall into bed together and even under the influence of alcohol or just being ‘horny,’ there is conscious intent. The devil made me do it is not a legitimate excuse. Moreover, smutty jokes and crude ‘locker talk’ and a ‘hostile work environment’ are rarely the initial stimulus for an illicit affair. The serial philanderer always has their ‘mating antennae up’ looking for provocative or receptive body language and eye contact from an attractive partner. By virtue of proximity and opportunity these suggestive signals often emanate from coworkers or friends. The affair often begins with an excuse to meet for a cup of coffee or maybe lunch or a drink after work. Office parties, especially during the winter Christmas season are a breeding ground for casual encounters. These meetings permit the private assessment of the risks, convenience, motivations and ability to conceal the affair. If the opportunity costs are not too great, the pair exchange contact information and the affair begins. In this type of relationship in which both parties are heavily invested right at the start sexual intercourse occurs at the first meeting. Outcomes from philandering are unpredictable. Here are some scenarios.
- Over time one or both parties back pedal because of guilt or conflict
- One or a few intimate encounters take place and the pair evolve into being just friends
- A single encounter with sexual intercourse followed by regret, anger and avoidance
- A satisfactory relationship that leads to a typical affair lasting about one year after which the curiosity wears off, circumstances change or one partner’s expectations become greater than the other’s
- On again and off again casual affair with no permanence or commitment (may span many years)
- A lengthy arrangement with varying degrees of intimacy, commitment, sex and financial subsidy
- An affair that turns serious and explodes the status quo and reshuffles relationships. This scenario occurs with some regularity and is a serious generator of divorce and family breakup
Without exception, having any type of affair carries risks with the threat of wide ripple effects and often unanticipated consequences. In general, the ego gratification and adventurism of an affair does not exceed the heartache, recriminations and guilt that it causes at its termination. Men and women that are philanderers cheat because they enjoy it regardless of how they rationalize the dalliance and justify it on the basis of unmet wants and needs.
The motivating factors for entering into illicit relationships between single or married individuals are quite varied. Psychoanalysists often attribute it to the male’s search for a surrogate mother and narcissism. The expression Men are from Mars (the Roman god of war) and women are from Venus (the goddess of love and beauty)” or “men are hunters and women gathers” probably captures some of the instinctual and aggressive elements. Certainly, sexual gratification, libido and attraction may be the fuel that kindles the flame, but there are most always some additional motivations such as conquest, revenge, depression, loneliness, dependency needs, promotion and so on.
In traditional courting, men have always been more fixated on physical attractiveness and sexual attributes than women who certainly like handsome men but are also attracted to men with position, affluence and warmth. In marriage today in which both women and men are bread winners other factors also play a more prominent role than heretofore. For instance, women executives tend to marry men executives, and male physicians tend to marry female physicians rather than their office personnel and nurses. This, of course, has augmented the economic and social gap between rich and poor in our society. Philandering, however, does not adhere to this differential.
The propelling reasons for affairs between married and single individuals are extremely variable. Some single women naively date married men and only later question their involvement realizing that the relationship is going nowhere. Some married women and men feel cheated by an unhappy marriage and more susceptible to acting out. Many men and women have emotional problems that are palliated by the aphrodisiac of intimate relationships. Some fall into relationships due to inexperience or because they misinterpret the advance (the innocent virgin) while others want to have an adventure. Many are on the rebound from a failed relationship or marriage or in a transition period in life when they move to a new city or job. And there are some that have personality disorders and are very gifted as sexual partners, an asset that they use to manipulate the world around them. And there are some men and women that have few options to land a mate and are looking for some form of social life, perhaps financial support and feeling of self-worth even with the slim hope of stealing a mate.
Plus, there are some women that love to sleep around with many partners. And a few even have fantasies about being raped, abducted or going to bed with someone of a different race. In fact, one study on sexual behavior found that the rape fantasy is fairly common and that these women had better sex lives. Promiscuous women generally have more sexual partners than roaming men (professional athletes and entertainers with entourages excluded).
At the end of the day, there are a myriad of reasons to cheat and break the customary rules. The overriding truth is that most philanderers both men and women enjoy the intimacy, sex and the adventure of these trysts. Many talk about a midlife crisis or seven year itch in marriage in which the individual feels short-changed in the competition and acts out. I am not convinced that this is a common precipitating factor.
Male Erectile Dysfunction
About 40 percent of my urologic practice was treating male erectile dysfunction (ED). Most of these men had multifactorial performance anxiety rather than any underlying medical reason such as advanced vascular disease or anatomical problems. Indeed, the male anatomic and physiologic mating mechanism is very durable and one of the last to go with aging. Reassurance was the primary therapy for performance anxiety. To alleviate the pressure these men felt, I often gave this a medical explanation for their problem and gave them supplements such as Vitamin E or testosterone shots. We also used vacuum erectile devices with limited success because they were cumbersome to use. Penile implants were an option but again with limited success. Today we have Viagra and Cialis that are quite effective in producing erections and successful if the couple is motivated.
In general, I found male sexual dysfunction to be mainly psychological and related to a host of feelings such as anger, rejection, inadequacy, resistance, availability and lack of a suitable partner. A few just had low libido with lack of interest. Many were encouraged by their female partners to seek urologic consultation. A psychological test, the Millon, that I administered was not found to differentiate or be predictive of organic versus a psychological basis for ED. A satisfactory sex life highly reinforces itself. And when sex is good, it gains momentum, but when there are complicating factors it can also quickly lead to a dampening of the passion and thrill that makes it a ho-hum experience that is increased by fear of failure.
Marriage versus cohabitation and affairs are different animals. With living together or cohabitation for an extended period of time the relationship is put under the magnifying glass and the relationship probed for the entire range of issues such as finance, social networks, skills, knowledge and abilities. And this occurs without the bonds of a formalized commitment. Thus cohabitation takes away the discovery process of marriage and may replace some of the excitement that goes with marriage with greater realism and objectivity. This can be either good or bad but can result in uncovering frictions and uneven ‘power relationships’ that would probably be glossed over or mediated by the bonds of a marriage certificate and would not result in dissolution.
Marriage that is not attended by a lengthy courtship is quite different from living together. In reality, sexual needs and wants can, in most instances, be met with multiple partners better outside of a marriage. And marriage is carried out with the expectation of permanence, fidelity, financial sharing, children, blending of lives and maintaining a residence. And with this range of new responsibilities come a need for greater tolerance of your spouse and in-laws plus more respect and sensitivity to their needs and personal space. Marriage invariably brings some good and not so good surprises. Few newlywed couples are totally prepared for the transition and mature enough to cope without a major dose of forbearance, perspective and tenacity. Truthfully, why would an independent, autonomous man or woman that enjoys freedom ever want to get married? After all, the all-consuming infatuation and romance of marriage are generally fleeting and child rearing is not a barrel of laughs either.
Having been married 59 years, I understand why folks get married and I vote for marriage. For starters, there are obvious cultural reasons. Marriage puts a frame around financial and family matters. It is the ideal mode for child rearing and supporting your parents as they grow old. Most importantly marriage provides the warmth and security of having someone there for you through thick and through thin that meets your inherent dependency needs. Plus, from a medical standpoint, marriage is therapeutic and increases longevity. The survival advantages of marriage, children and grandchildren are huge. Few do well with being alone with no one that truly cares or has an obligation to care. Most all marriages have some degree of dysfunction but as the years pass it generally lessens and having a mate in the autumn of your life, especially for men, is a strategic imperative for happiness. That is why men remarry at a higher rate than women when they are widowers.
The Changing State of Marriage Today
When I was growing up one of Frank Sinatra’s most popular songs had the following lyrics; Love and Marriage, Love and Marriage; They go together like a horse and carriage; this I tell you, brother; You can’t have one without the other. In the 1940s and 50s this resonated as the cultural norm, and then came the 1960s with the hippie counter-culture and Flower Power. In the late 1950s Playboy magazine made the scene with a nude Marylyn Monroe featured in the centerfold. Many smutty tabloids followed and in 1972, the sexually graphic XXX movie Deep Throat hit the cinemas. This opened the door to a growing range of pornographic material that populated print and visual media. Today internet porn is viewed by the majority of our youngsters long before they have even entered, much less gone through puberty. This permissiveness has caused a cultural dichotomy in which sex and marriage are no longer viewed as culturally inseparable and exclusive. The Ward Cleaver-esque idealized American family model with the dutiful stay at home mom, a bunch of well-behaved children and meals together is still a part of the solid marriage, but few unions consistently achieve this high standard today.
Statistics confirm that the desire to get married and the attendant commitment to be married is not as compelling and universal as it once was. In fact, a 2010 survey of Americans between the ages of 18 and 29 found that half thought that marriage was becoming obsolete. Their views are supported by the fact that 50% percent of first marriages, 67% of second marriages, and 73% of third marriages end in divorce.
In my lifetime the greatest cultural change in America has been the ascent of women into the workplace. In 1961, in my graduating medical school class there were only three female graduates out of 83 students and the surgical residency programs nationwide had virtually no women residents. Today there are more women graduates from our medical colleges than men and this type of shift has occurred in law and many other professions as well. Thus, the stay at home dad to care for the kids may reshuffle the roles that men and women play in the family. Moreover, the younger generations are more focused on ‘lifestyle balance’ where social life, leisure time, parenting and hobbies are given equal importance when compared to work than in the past. Role reversal and income parity can create a competition that stresses the identities of the couple in a broad range of activities including sex.
Many societal trends have undercut or at least complicated the traditional heterosexual marriage that was/is punctuated as a legal and moral covenant that was permanent “until death do us part”.
- Increasing numbers of young and, most notably, older couples are cohabitating without any formal arrangement
- Same sex marriage is legalized and greater numbers of gay individuals are ‘coming out’.
- Increasing numbers of multi-racial and multi-ethnic unions are occurring
- Marriage and child bearing is increasingly taking the back seat to postgraduate education and aspiring career pathways (older marital and child bearing ages)
- Gender identification (LGBT) has become a political issue
- Fewer high-paying jobs have been created to support a family on one or even two incomes leading to increasing age at the time of marriage
- An increasing number of ‘boomerang’ children live with their parents
- Increasing numbers, mainly women, enjoy the independence and freedom of living free from the constraints of marriage
- Rising earning power of women that make them less dependent on a male bread winner
- A more liberal and tolerant attitude toward multiple sexual partners
- Decreasing numbers of extended families and multigenerational family businesses
- High educational costs and a creeping apocalypse mentality about the future of the human race
- Job mobility
Perhaps not all of these trends are destructive of marriage. For some couples a cohabitated trial period might be predictive of marital compatibility. And ‘sleeping around’ with a number of partners might mold expectations and avoid nuptial surprises. But sociologically, the best predictor of marital success remains the determination of the two partners to make it work. A quote that is pertinent to marital bliss is “marriage is the epitome of tolerance.” Of course, children, financial obligations, inheritance, social networks, medical problems and outside opportunities impact marriage and form the glue that may or may not motivate a couple to stay together. Certainly, the pressures and social stigma to remain in a bad marriage are less today than in earlier times. But despite the claims of divorce lawyers that divorce can be an amicable and a simple mediation process, most all divorces are ugly affairs and this is especially true if the very same divorce lawyers get involved.
The Good Old Days of Courtship
I have no idea if humans are genetically monogamous or polygamous. Is variety the spice of life or is a strong relationship with one intimate partner the optimal epigenetic trait? I am certain of one thing; with all of the uncertainties of aging and the future; it is very reassuring to have someone there for you through thick and through thin. Unquestionably, this need steadily increases as your grow old. The wonder and joy in having grandchildren, family reunions and compatible companionship far outweighs the independent luxury of living it up alone. Often being single becomes permanent as you find yourself alone with no one that cares. If there is a good sexual accord in a marriage, it is a bonus.
The new sexual freedom does detract from the compelling experience of the traditional courting ritual. There was a time before online match-ups, pervasive pornography, multiple sexual partners and new sexual practices and expectations when kids primarily dated those in their social group, school classmates and family circle of acquaintances. They fell in with the social norms and it was unusual to kiss on the first date. Multiple dates resulted in a relationship based upon familiarity and social intimacy, before sexual intimacy. During this routine there was time to nurture and magnify infatuation and dreams about your girlfriend or boyfriend. This lead to a framework of fantasies, desire and respect for the partner. It was not uncommon for a boy to place his girlfriend on a pedestal on par with his mother or for a girl to view the boyfriend as a comparison figure to their fathers. Stated differently, in the good old days generally you did not put the sexual cart before the horse of personal and psychological harmony. These measured steps, however, were exhilarating and thrilling as they enveloped your partner in a shroud of mystery, expectations and idealization. Today this may seem outdated, but I think the new approach to mating has lost something quite special.
I am sure that this characterization does not capture the journey for the majority of young couples. There is great variation. Furthermore, there are both pluses and minuses to the new sexual roadmap. Maybe multiple sexual partners make marital expectations more realistic and avoid some mismatches that could deteriorate into unhappy marriages and divorce.
The Main Message
I am certain of one thing; with all of the uncertainties of aging and the future; it is very reassuring to have someone there for you through thick and through thin. Unquestionably, this need steadily increases as your grow old. The wonder and joy in having grandchildren, family reunions and compatible companionship far outweighs the independent luxury of living it up alone. Often being single becomes permanent as you find yourself alone with no one that cares. If there is a good sexual accord in a marriage, it is a bonus.