The Sexual Male, Problems And Solutions. By Milsten, R.
& Slowinski, J. (1999) Norton. 331 Pages, USA $25.95, CAN $36.99
Reviewed by Annette Fuglsang Owens, MD PhD; firstname.lastname@example.org
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The Sexual Male arrives at a time when an overwhelming response to the drug Viagra suggests that the general public is eager to receive a book detailing male and female sexual concerns. Another recent book, Sexual Medicine in Primary Care, by William L. Maurice, directed towards medical health professionals, should be equally welcome. There is a lamentable absence of current material addressing the understanding and knowledge required to approach and deal with sexual problems.
Dr. Richard Milsten is the former chief of urology at Underwood-Memorial Hospital and medical director of the Center for Sexual Health in Woodbury, New Jersey. Dr. Julian Slowinski is a senior clinical psychologist at Pennsylvania Hospital, Philadelphia, a certified sex therapist, and clinical assistant professor in the department of psychiatry at the University of Pennsylvania School of Medicine. The two authors approach male sexual problems from different angles and integrate their views and substantial experiences in this book. Together they have created a tremendously rich and useful source of information and advice. The Sexual Male is well written and not without a good sense of humor. Relatively short chapters with high-lighted key points can be read either separately or consecutively.
Who will benefit from reading The Sexual Male? Everyone. The man with erection difficulties who is trying to understand his problem and address its remedy; the woman who has lost interest in sex or who is suffering from another female sexual dysfunction; and their sexual partners. Perhaps the young reader who is curious about the recipe for lifelong sexual health, or the older individual who wants to understand sexual changes related to aging, or anyone considering Viagra. This book will appeal to a broad, diverse audience.
We are taken on a journey through history, beginning with the cultural evolution of how erectile dysfunction (ED) was conceived and treated. In Egypt, the crocodile's penis was considered a symbol of virility and sometimes consumed in order to increase potency. Only four decades ago, besides passing heated or cooled metal rods into the penis as an attempt to treat inflammation, ED was treated with the delivery of electric shocks to the testicles. Have you ever wondered about how ED was viewed in the Middle Ages, or what Hippocrates had to say about this subject?
Both the anatomy and physiology of the erection mechanism are well illustrated and explained. Recent discoveries are reviewed, such as the effects of nitric oxide and cyclic guanosine monophosphate as neurotransmitters in the erectile tissue of the penis (which led to the production of Viagra).
I was perplexed at finding the word "impotence," considering it's negative connotation, used throughout the book. This term, meaning "without power," seems a relic as we leave the 20th century. However, the authors have chosen to use "impotence" interchangeably with "erectile insufficiency" and "erectile dysfunction." Other terms defined and explained, often using case examples, are "ejaculation," "orgasm," and "premature ejaculation." Perhaps "retrograde ejaculation" should have been included in this section as well. This phenomenon is only anonymously mentioned in passing in a later chapter, "Removal of the Prostate Gland for Cancer," and requires, I find, a more detailed explanation.
The powerful statement that "impotence may be the most untreated illness in the United States for which treatment exists" is followed up by a detailed analysis of its possible causes (psychological and/or physical), diagnostic tests, and treatment options. Besides information about how health professionals will approach the problem, the reader receives valuable instructions on how to self-evaluate the problem. Simple exercises are suggested for treating ED oneself. The motivated reader could make considerable progress towards recovering sexual health and will be well prepared to meet and interact with health professionals about sexual problems. Two of the final sections, "Preventing Problems: What You Need to Know" and "Moving Towards Sexual Health," clearly state that ED is not only treatable - it is preventable as well. "Do you wish to enjoy nicotine or sex?" may become an effective slogan for the prevention of tobacco use.
Topics of special interest include: When to resume sexual activity after a heart attack; death during intercourse; the single man and sex; sexuality and religion. Since some men with erectile difficulties are diagnosed with diabetes, this fact could have been included in the chapter, "Impotence as a Predictor of Heart Attack and Stroke." Diabetes is only briefly mentioned in a separate chapter, "Physical Causes of Impotence," and later the book recognized diabetes as being one of the most important factors (besides smoking, high fat levels in the blood, and high blood pressure) for the development and prevention of ED. In my opinion, an individual chapter on diabetes listing all the key facts in one place and not scattered throughout the book would have been desirable.
What makes The Sexual Male valuable not only to men is the section, "Women's Issues: Both Sexes Need to Understand." By answering 15 questions, the sexual partner of a man with ED will be able to assess how the problem affects their relationship. Suggestions on how to approach the problem lead the couple towards recovering a sexually healthy relationship. The book explores reasons why restoration of erections may not solve relationship problems. Specific female sexual problems and their impact on ED, and vice versa, are also described. It takes two for a relationship. Keeping it healthy requires a fine balancing act between partners. The information applies to heterosexual as well as homosexual couples.
The final sentence of this book concludes with the positive announcement, "Sexual Health Is Yours!" which really projects the fundamental attitude of this entire book. Motivated readers will find an abundance of help in:
1) defining, assessing, and approaching sexual problems
2) initiating treatment processes through simple exercises
3) understanding how relationships are affected
4) burying old myths about sexual performance and function
5) taking charge of creating their own path towards sexual health.
I highly recommend reading The Sexual Male to anyone wishing to expand their general knowledge about human sexuality or seeking answers to specific sexual questions or concerns.
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