ANDROPAUSE, sometimes called MALE MENOPAUSE

 Though the potency crisis that hits many men in middle age has some obvious causes – age, alcohol, stress – the decline is hormonal and psychological as well. Men often won’t discuss it with their doctors, their wives, or their lovers.

Dr. Stephanie Buehler (www.LearnSexTherapy.com), heading up The Buehler Institute, joined the program once again. When men and women face the same passages with different needs and directions, how does the partnership survive? Dr. Stephanie and Dr. Diana talked about it all!  Women go through the process of menopause in different ways, but it’s almost a universal experience. Men are all different.

Often there are existential issues. For example: Does my life have meaning? What parts of myself have been neglected that I am now free to live out? Do I matter? The denial of aging can show up in a man’s embracing symbols of success and vitality. It may also contribute to men avoiding seeking help when they experience sexual issues as they age.

Women are often concerned about their partners. One of Dr. Diana’s clients said, “I have some menopausal symptoms – but the main problem is that my husband has more! He’s 52, withdrawn, moody, and angry that he’s aging and losing his hair. Also, he just doesn’t get aroused anymore. And I got tired of things not happening when I tried to get sex started. I always thought it was me. I stopped trying because I thought it was embarrassing to him.” These are not uncommon complaints from female partners.

The two sex therapists discussed typical psychological problems such as lethargy, depression, increased irritability, mood swings, and an overall lessening of a sense of well-being. As men move into their 50s and 60s, they may have intermittent problems in gaining and sustaining erections. They may also feel some slackening of sexual desire. And unless a man is in a good relationship with a supportive partner, the shock of all these changes can bring on a powerful psychological crisis, which can actually frighten a man into erectile dysfunction (E.D.). Still, they don’t talk about it. Men may have integrated this idea: “Your job as a male is to be strong.”

It’s important to underscore that there is a robust population of older men who survive this potential crisis with their egos and erectile abilities intact. In one large study, forty percent of these healthy males remained completely potent at age 70. A man’s general physical health picture is significant. Organic factors contribute to E.D. in up to 80 percent of men.

Of all the causes for erectile dysfunction, the most common is impairment of the blood supply to the penis. This results in many males who won’t even try to have sex!

Dr. Stephanie points out that some female partners are not helpful, heaving insults like, “What’s wrong with you?”

Once again, USE IT or LOSE IT comes into play. And it requires a trusted partner, and some self-discipline around drinking, eating, exercise, and preventive health measures.

Many men have emotional connection problems. They didn’t get training in this; rather, they got performance training. Dr. Stephanie recalls Dr. Steve Braverman asking, “Does a man have to have a hard penis in order for sex to take place?”  As a man gets older, and feels less secure sexually, intimacy and trust with his partner become critical.

The two sex therapists also talked about alcohol, diet, and stress. The chronic use of alcohol can murder potency. Urologists report that when looking at the tissue from patients with chronic alcoholism, the nerve is killed inside the penis. Tom Lue, an internationally known expert on the treatment of male sexual dysfunction, notes “It’s almost impossible to revive. Usually, it takes 10 or 15 years of chronic heavy alcohol use to kill the nerve.”

In 1995 Dr. Diana spoke about aging and sexuality at a Washington, D.C. conference. The keynote speaker, Dr. William Masters (of Masters and Johnson), was asked his best advice for an older man who is worried he’s losing his potency. Dr. Masters was nearly 80 then, and his voice filled with tenderness: “Talk to your partner. Tell her you have these concerns. She’s probably concerned and afraid to tell you. Then talk to a competent sexologist about how to reactivate your bedroom scene.” Dr. Masters treated sexual dysfunction for nearly 50 years. He had a humble definition of good communication in a relationship: “It’s the privilege of exchanging vulnerabilities.”

Click below to listent to the interview (approx. one hour):

Sexual Communication Improves As We Get Older

Dr. Stephanie Buehler joins Dr. Diana in a conversation about sexual communication; later, the sex docs speak about menopause. Dr. Buehler (www.LearnSexTherapy.com), founder of the Buehler Institute, is a licensed psychologist and AASECT Certified Sex Therapist and Supervisor. She is the author of several books on sexuality and relationships. Dr. Stephanie notes how important it is for the aging person to acknowledge and cope with changes. What doesn’t change is the solution: Couples need to figure out their sexual needs and wants and communicate them (and perhaps put down their phones for a while!). Conversation, it seems, is the most powerful type of foreplay. Talk to each other about sex. What do you want to feel? Desired, young, and alive?  Or?  Then you have to decide if you’re willing to put in the work. Practice, practice! Gourmet sex is like gourmet cooking. They don’t happen without focus.

Dr. Buehler points out that before having a hard conversation with a loved one, it’s important to identify what you want to say. Perhaps it is, “I am sad and what I need from you is extra affection.” Have empathy for your partner. On the other side is contempt, a dangerous feeling.

We have to adapt to changes as we age. Good sex needs re-imaging, expansion! Outercourse is wonderful because there’s no goal … you can just enjoy the feelings. The man doesn’t have to worry about his erection because there is no penetration. Partners can get out of their brains and into their bodies!

Connection rules. In the heat of an argument, many people have trouble reaching out. Remember, hurt underlies anger. Couples have to decide that the relationship is more important than all those things they do that annoy each other. Positive reinforcement instead of criticizing always wins!

Dr. Stephanie observes that in some Asian cultures where aging is revered, women don’t have as negative an experience with menopause. Older women are seen as wise and are protectors. Many menopausal women say emphatically “This is my time!” She was a good girl, a good wife and a good parent. She’s done for everyone, and now she is going to take care of herself. Bioidentical Hormone Replacement Therapy, BHRT, can provide the missing hormones resulting from menopause. Please listen to the podcast for all the details!

Click below to listen to the program (approx. one hour):

Alternative Relationship Arrangements

David Steinberg is a writer of consummate intelligence and compassion! Whether he is writing books or taking photographs, it comes across that sex is who we are, how we live, and how we experience pleasure and life. I’ve known David since 1988 when his first book Erotic by Nature was published. We’ve been friends for 35 years!

David and I discuss Open Relationships (one aspect of ethical nonmonogamy) and Living Apart Together. David and Kim, his partner of 17 years, practice both. David talks about how they give each other freedom, they get to be who they authentically are. He says they keep it fresh!  Every year and a day Kim and David meet to review and further define their relationship. Do they want to continue for another year and a day? It appears they have the real thing going on, a true love story!

Ethical Nonmonogamy (ENM) describes the situation where members of a couple consent to having additional sexual and/or romantic partners, and it’s gaining in popularity. More than a fifth of single American adults have engaged in ENM according to recent studies. ENM requires self-reflection, radically open communication, and compassion. Boundaries and rules are discussed; they may need to be re-negotiated over time. The trust is built on the fact that there’s nothing to hide.

Living Apart Together (LAT) refers to committed couples who each keep separate homes, often because they cherish private space and financial independence. Often these couples begin their relationship later in life. Both David and Dr. Diana have their respective LAT situations. The thrill in your relationship tends to endure because you are not living with each other all the time, thus helping to avert the slippery slope into a gray, monotonous relationship. Dopamine, the hormone of arousal, flows when there’s anticipation of wonderful sex to come! Yes, let there be spaces in your togetherness.

David Steinberg is also the author of This Thing We Call Sex. His fine art sexual photography will be assembled into a book Loving Couples, now in production. When it is published, he’ll be back to talk about it, I promise!

Click below to listen to the interview (approx. one hour):

Dr. Mark Schoen

Dr. Mark Schoen is a sex educator and a filmmaker whose website www.SexSmartFilms.com has been called the “Netflix of sex education.” Fifteen years ago, Dr. Mark started with 46 films and now his site has over 600 films divided into three categories – Education, Research, and Therapy.

Many universities use Sex Smart Films knowing that it is a sex educator’s dream come true! Parents need to familiarize themselves with the Education section of the site. Research shows that mothers and fathers who talk about sex with their kids are more likely to end up with adult children who share their values.

Dr. Diana suggests that her client couples use the Therapy section for Sensate Focus Exercises. For her female clients with anorgasmia, using the “Becoming Orgasmic” steps can help with just that! Dr. Mark says many people use these two sections for self-help – when sex therapy is not an option.

Watching any of the films of Mark’s site can be a great way to improve a couple’s communication. Pause after a scene and talk about it. This may help articulate wants and sexual needs. Plus, we learn so much visually.

Dr. Mark and Dr. Diana discussed possible consequences of little or no sex education.

Many folks need to be educated about what it means to be transgender. The transgender community is perhaps the most misunderstood and mistreated minority in America and around the world.

Mark Schoen’s documentary “TRANS” shares the stories of several transgender people in various stages of their lives and their transition, ranging from a 7-year-old to those in middle age. Family and friends viewing this film will better understand what their loved one is going through. At a Univ. of Michigan discussion, a male-to-female trans person was asked if they chose this. The reply: “Who the fuck would choose this?!” They are born this way.

Dr. Mark Schoen gave birth to Sex Smart Films. What a valuable resource!  Check it out.

Click below to listen to the interview (approx. one hour):

Cannabis + Sex = More Pleasure

Dr. Jordan Tishler, MD, is a cannabis specialist with a practice in Boston. Dr. Tishler graduated from both Harvard College and Harvard Medical School. Now he helps patients around the world. All of his appointments are virtual.

His website has lots of helpful information. Soon Dr. Tishler will publish his randomized, controlled study with one thousand females, looking at situational orgasmic disorders. Most women can bring themselves to orgasm by masturbating, especially using a vibrating toy. Orgasms with a partner are more difficult for many women. Cannabis helps with orgasms!

“Evidence Mounts: Cannabis Enhances Lovemaking for Most” is the title of Michael Castleman’s Psychology Today Blog post (Oct. 15, 2022). Dr. Diana and Dr. Tishler spoke about the key points:

• As cannabis becomes increasingly legal, many studies show that most users report better sex.
• A 2020 report from Stanford researchers revealed that cannabis increases desire and arousal for most women and improves orgasm and satisfaction, and for most men, cannabis improves their erections and increases orgasms and satisfaction.
• Cannabis doesn’t improve sex for everyone, but the research shows that two-thirds of users report sexual benefits.

Cannabis helps with pain and healing. Dr. Diana shared about her abdominal surgery in February. Cannabis helped with the pain … much better than the opioids! Two weeks after the surgery, she felt ready to resume sex with her husband. Smoking pot made a difference! More healing ensued! (Dr. Tishler also commented on the problem with opioids is that they can cause constipation; in some cases, addiction.)

Another cannabis benefit is that with lowered inhibitions, laughter and play may be more accessible! A good laugh—like a good cry or good sex—is a natural tranquilizer. Turns out, laughter is a natural stress-buster! Plus, remember that couples who laugh together, last together!

On the topic of cannabis vs alcohol, Dr. Tishler observed that alcohol is essentially yeast poop … it’s been through fermentation. It is waste.  The phytocannabinoids in cannabis come from a plant and work on the human body’s own endocannabinoid system. Dr. T. points out that alcohol is toxic to neurons, to the liver, heart and even bone marrow.

Dr. Tishler is a superb guest because he’s so articulate and dispenses excellent information! Spend some time on his website.

Dr. Diana also has more details available in her bonus chapter, “Cannabis for Couples.” Download it free from DearDrDiana.com.

Click below to listen to the interview (approx. one hour):