Men Just Want To Talk About Sex

He was in his fifties and he wanted the same medications he had, except for one thing. He just could not manage to have sex with his live-in girlfriend.  He never had.  I was filling in at a clinic where I knew this was the only time I would see him.

There are a couple of strategies with prescription medications that sometimes work.  A partial agonish to reverse a receptor; adding another antidepressant.  I reluctantly told him about them, since a complex mental illness was being otherwise quite well managed. I mean, this man’s diagnosis was “schizo- affective disorder.”  He had been really psychotic, hearing bad things and thinking they were real and running naked in the streets.  As much as I think an interest in sex is healthy and part of normal living, I certainly did not want to risk having all of these horrible things happen to him again. Luckily, he told me the last thing in the world he wanted to think about was another drug.  Even a little bit of another drug.

There are herbal solutions that actually work.  I was thinking about some oriental herbs, which I certainly did not think were that expensive.  But he assured me he had no disposable income at all. Maybe true, maybe not, but I always wonder at least a little bit when people tell me that they want something very badly, but then do not seem to find any money for it.  I mean, he was a heavy smoker (over a pack a day) and I was certain insurance did not pay for that.  I tried to approach this subject, and he became so angry at me I would have dived under the desk for protection if it had been physically possible.

Money is the new taboo.  I have no lack of male patients who want to talk to me about sex.  I never have. One told me once that he envied me and my job, as he figured psychiatrists got paid to talk to people about sex…something I would often like to avoid doing in these settings.  I cannot think of one person who has voluntarily discussed with me what money they get and how they spend it.  I often have people on staff who have at least some expertise in these matters, but nobody seems to want to talk to them, either.

I told him he was thinking of the problem in the wrong way.  Since we had ruled out anything that could help physically, he could probably do more with what he had.  No, I would not tell him graphically, although my mind went back to a brilliant lecture on this I had listened to and absorbed excitedly in my French medical school.  I was told that every Frenchman (and I believe men of other origins are built exactly the same, although clinical trials are limited) had, in addition to the usual genital equipment, a nose, a mouth with tongue, two hands and two feet.  Thus, any failure to please a woman was either a lack of communication or a lack of imagination.  Seven (yes, count them seven) parts of the body that could please a woman.

He thought, as many people do, that the quality of physical sexual intimacy was what made a relationship.  I told him that the quality of the relationship made the quality of the sexual intimacy.  He made me repeat it. I tried to explain, resisting his desire to make me talk dirty quite completely.

I told him to ask his woman how she had pleasured herself in the past, or thought she would like to be pleasured in the present, and do the best he could with whatever part of his body he could.  Period.  Talk about it and do it, if he really cared.  In other words, ask her, not me.

He started shaking his head and said he had tried everything, although he finally admitted one thing he had not tried was talking. He shrugged his shoulders, but at least I got half a smile.

I believe the major barrier to joy and fulfillment is not anything anatomical, but rather the belief that all is known and the desire to stop trying.  I do not want to be sexist here, but in many physiological ways, heterosexual sex is a man’s game.  A man who thinks he already knows the game will stop playing, and ceasing to play may be the greatest sin of all. I had little more to say, so I renewed his medications, and reminded him how fortunate he was to have a willing woman in a world full of lonely people, and telling him to maximize this amazing resource.

He was at least old enough to remember the world’s greatest song about lonely people.

The reference was sincere and it got a smile.  It was not contrived, for many people with his diagnosis did not have any kind of a woman companion. I shook hands and wished him well. He said I had at least made him think. I told him I was glad I had been able to do that.