From Rudy Giulianis prostate to Tom Greens testicle, mens private parts have been on public parade of late. In the opening pages of his new book, "Sexual Health for Men: The Complete Guide," Harvard endocrinologist Richard Spark ties the new willingness of men to publicly discuss the fallibility of their love tackle directly to the 42nd American president and a little blue pill.
Using the randy commander in chief and Viagra as a jumping-off point, Spark delivers an encyclopedic guide to all things male, from discolored semen to the viability of alternative erectile treatments. "Sexual Health for Men" is instructive, calming and frequently entertaining.
During a recent interview, Spark discussed his version of the Clinton legacy, shifting attitudes about male sexual health and alternatives to Viagra. Oh, and then theres the one about Dr. Brindley and his performing penis ...
The first paragraph of your book mentions President Clinton. The second paragraph mentions Viagra. Can you talk a little bit about the pivotal part the president and Viagra played in opening up the discussion of male sexuality?
We really didnt talk much about male sexuality in polite company until the episode with Clinton and Monica [Lewinsky]. That sort of opened the floodgates. Fortuitously, almost two months to the day when the article regarding Clinton and Monica appeared in the papers, the New York Times had their first Column 1 story about the fact that Viagra was being approved. Everybody was chatting about Viagra, from Maureen Dowd to Jay Leno. After that, the whole issue of mens sexuality became open game.
You write that Viagra legitimized male sexuality not only as conversation material but as a valid health-care issue.
Absolutely, because men who had problems with sexual health didnt discuss it. But now, when doctors [ask about sexual function], theyre being surprised to hear men say, "Im glad you brought it up, doctor, because now that you mention it ..."
Are there specific at-risk populations in the field of mens sexual health?
The major at-risk group are the smokers. [Then there are] the people who have certain other problems like diabetes mellitus, certain individuals who abuse recreational drugs -- cocaine, for example, is a stimulant initially, but eventually has a negative effect on a mans sexual function. There are other men who take medications designed to treat problems like high blood pressure or depression who can experience side effects that interrupt their sexual function. All of this is gone over in the book; we try to cover every area.
Even down to the effects of bike riding.
Well, bike riding is one thing that has been a source of great interest to the cyclists of America. There have been some studies reported on cycling and its impact on a males potency, and we review those in some detail in the book. The difference is that the studies have been done on the real champion bike racers. The people who are cyclists in my practice tell me that the average cyclist who is out for the weekend jaunt or something of that nature does not place himself at the same degree of risk as the individual who is doing these marathon bike races, where he is constantly putting pressure on his genital area and perineum and compressing the nerves that are important to use to allow erections to occur.
I imagine that for some segments of the male population, cultural taboos -- stoicism, for example -- put them at risk as much as anything.
When men experience sexual difficulties, its the same sort of symptom as a headache. Theres a reason for it, and we can usually work it out. The vast majority of headaches that people have are related to the fact that theyre under tension, or extreme stress -- a couple of aspirin or Tylenol and the headaches will go away. Every now and then the headaches are indicative of something more lurking. Most patients, if theyre troubled by headaches, have no hesitation whatsoever in talking to their physician, saying, "Look, this is bothering me." The trouble is, people dont recognize sexual dysfunction as a symptom. They recognize it primarily as a failure of being a man, and that really is devastating, because it puts a block between them and the help they need.
Much of the progress made in the recognition and treatment of womens health issues -- most notably breast cancer -- has come about as a result of highly publicized campaigns, events and celebrity involvement. Do you see a need for a corollary movement for mens health? There have been some recent examples, including Bob Dole speaking about erectile dysfunction.
I thinkBob Dole was very courageous to speak about that. There is one thing that distinguishes Bob Doles courage from other mens courage: His problems occurred after he had surgery, so his problems were the result of something that was done to him and not his fault. [Professional cyclist] Lance Armstrong was courageous also. But again, [his testicular cancer] was nothing that he did; its something that happened to him. And thats really a distinction that has to be made. The concept that sexual dysfunction is a mans fault is something that has to be rooted out and eliminated.
In Chapter 3, you write "paradoxically, in an age smug with a sense of heightened sexual enlightenment, the only ones left 'in the closet' are men -- impotent men." The phrase "in the closet" reminds me that when we think of the problems of male sexual health, many of us tend to think in terms of heterosexuality. Does the gay male population tend to its sexual health in more open terms, and indeed, in some ways, have recent historical events involving the gay community helped men in general address issues of sexual health?
The gay man is more aware of his sexuality, and when his sexuality is disrupted, he tends to seek help more promptly. He may go through his friends in the gay community to see what can be done; he may be more comfortable with certain physicians who are primarily dealing with the gay population. But they recognize its a major disruption in their health because its a disruption in the way they derive pleasure from life, and they will go immediately and try to achieve some sort of resolution of their problems. So they are a little bit more tuned in to their own body -- at least thats my experience. They are more willing to discuss this promptly. If they dont discuss it or recognize it as a problem, their partner will point it out to them.
Early in the book you hold an interesting conversation about the sea change in the understanding of impotence -- the great shift from psychogenic impotence. While advances in recognition and treatment of the physical forces of impotence have been welcome, is there a danger that men may fall into the classic American trap of thinking a pill will fix everything? In some cases, I guess a pill does fix everything.
There are a variety of different problems for which we would like to have a single-pill solution, and in the case of erectile dysfunction, with the availability of Viagra, and soon Uprima, and all the buzz about getting the new testosterone gels available, there is a hope that the single treatment will change everything around. I think we all have this sort of fantasy that were going to be able to recapture life as it was 20, 30, 40 years ago, and while I dont want to dash anybodys fantasies, the reality is that we will be able to function and function very, very well, but we will never be 21 again. While thats unfortunate, there are probably some blessings associated with that also!
Theres a lot in the book about Viagra, but you also branch out into everything from fakery to yohimbine that may actually have some potential.
Yohimbine has a very interesting history. It was introduced years ago, and it was said to be the pill that would resolve all mens sexual problems -- a perfect segue from what we were just discussing. It came on the market with this exotic lineage; it came from this tree in Africa, and it was marketed under the name of Afrodex. The initial report said it was phenomenally successful, and there was a brief flurry of interest when it was put on the market, and then it almost immediately disappeared. Subsequently, other pharmacy firms have resurrected it, and its now available in several forms. And it turns out to be useful for certain types of sexual dysfunction, particularly those that occur in men who take antidepressant medications and lose their ability to have sex.
Speaking of erectile treatments and their development, I have to mention the tale of Dr. Brindley.
Are you talking about the section of the book called "Dr. Brindley Goes to Las Vegas?"
Yes. Its a stunning anecdote.
Well, it is a stunning anecdote, but in point of fact, everybody who was at that meeting tells me about it, and it really was a dramatic event. In 1985, Brindley went to an American Urologic Association convention in Las Vegas. He presented rather erudite data on the nature of relaxation of muscles in the part of the penis that must dilate for an erection to occur, and then pointed out the fact that you could probably create an erection by giving yourself an injection directly into the penis and allowing blood flow to occur. And in point of fact, he said, he had just injected himself in the bathroom. He then dropped his pants and showed everybody his rather prodigious erection. He even marched around the room to have people inspect it. This was a very bold and daring thing to do. It started the whole technique of intrapenile injection, which still remains a viable treatment for men with sexual dysfunction.
So the upshot is that he made a valid point and quite an arresting impression.
Well, it was quite a dramatic impression. I cant imagine anybody I know doing anything like that in any medical meeting that we have. Most of the people we have are nervous enough just getting up to give their regular lecture and show their slides.
In the historical section of the book you write of times in which impotence was blamed on spirits and witches. In some ways, are we still hung up on the karma and voodoo of male sexual health?
[Historically,] the whole recipe for dealing with sexual dysfunction was very imaginative and very, very clever. It related to the fact that sometimes people believed that witches were responsible for the loss of their sexual function and that when they were responsible for this, there were ways to rid themselves of these spells. One of the things was placing the testicles of a cock under the bed, or sprinkling the walls of the house with dogs blood, or carrying bile of fish. All of these things are folklore, obviously, but they were passed on from person to person because they didnt know where to turn. This is part of the legacy that persists today. You can look into any of the mens magazines and find advertised products guaranteeing to improve your sexual function.
Is there any sort of general statement you want to make regarding mens sexual health?
One of the things that we are well aware of is that the population of men that I see in my practice is older and older. Fifteen to 20 years ago, if I saw a 75-year-old man who came into my practice and wanted to have his sexual function improved, we would have found it unreasonable. You know the joke about that?
No, go ahead.
The 80-year-old man comes in and says, "Doctor, I want you to lower my sexual function." The doctor says, "Look, youre 80 years old -- any sexual function you have only exists in your head." He says, "Thats what I mean -- I want you should lower it!" But in point of fact, I have 80-year-old men now who are doing quite well on small doses of Viagra and theyre very happy with that. We have the capacity to do that, to do it carefully and not put them at risk.
And thats what the exciting thing about this is today. Weve got the capacity to deal with men and their problems and say to them, "Look, we can chat about almost anything, and theres no person who at any age has to feel embarrassed about talking about this." The important thing is, we have some solutions, we have some answers and the sense of being all alone and isolated is no longer valid. You just have to come forward and speak to the doc about the problem, and we can have a solution for you.