1) The Sexual Male. Problems and Solutions (9-September-1999)
2) Sexual Medicine in Primary Care (8-October-1999)
3) Sexuality, Society, and Feminism (16-February-2000)
4) Eros and Pornography in Russian Culture (27-March-2000)
5) Brief and Extended Interventions in Sexual Abuse (22-May-2000)
6) Erectile Dysfunction. Integrating Couple Therapy, Sex Therapy, and Medical Treatment (30-June-2000)
7) Women's Sexualities. Generations of Women Share Intimate Secrets of Sexual Self-Acceptance (25-July-2000)
8) Sexual Health For Men. The Complete Guide (25-August-2000)
9) The Male Body. A New Look At Men In Public And In Private (20-September-2000)
10) The Penguin Atlas of Human Sexual Behavior. Sexuality and Sexual Practices Around the World (23-October-2000)
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 2.
9-September-1999
By Milsten, R. & Slowinski, J. (1999) Norton. 331 Pages, USA $25.95, CAN $36.99
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:
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defining, assessing, and approaching sexual problems |
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initiating treatment processes through simple exercises |
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understanding how relationships are affected |
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burying old myths about sexual performance and function |
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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.
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 2.
8-October-1999
By William L. Maurice (1999) Mosby; 366 Pages, USA $ 39.95
Sexual Medicine in Primary Care was written by Dr. William L. Maurice, MD, FRCP(C); Associate Professor at the Division of Sexual Medicine, Department of Psychiatry, University of British Columbia, Canada, in consultation with Dr. Majorie A. Bowman, MD, MPA; Chair at the Department of Family Practice and Community Medicine, University of Pennsylvania, USA.
Dr. Maurice brings nearly 30 years of experience to the field of treating patients with sexual problems. As a psychiatric resident he had the outstanding opportunity to be introduced to the field of human sexuality during a clinical elective in Masters and Johnson’s clinic. Three decades later he now passes on his vast knowledge about assessing, interviewing, diagnosing, and treating people with sexual problems or concerns.
Dr. Bowman has served as a consultant for the book. With a background in family practice, she adds an important dimension to Sexual Medicine in Primary Care, emphasizing issues relevant to primary care health professionals.
Dr. Maurice teaches at the University of British Columbia, Canada, where medical students have the privilege of undergoing a thorough training in Sexual Medicine. Not unlike other medical schools worldwide, the fundamentals of human sexuality are introduced during the initial years: the sexual response cycle, the endocrinology of reproduction, sociology of sexuality and often some psychology. The University of Columbia Medical School, however, distinguishes itself from other facilities by offering students the possibility to gain clinical experience in addition to their fundamental understanding of human sexuality. Students are guided through the art of sexual interviewing skills, and ultimately have the opportunity to practice their skills in a sex-specialty clinic. Sexual Medicine in Primary Care was in part written in order to provide students with written materials and guidelines for this part of their clinical training.
From personal experience, I know how crucial it is to receive this medical training before entering the real world and it’s real problems. I studied at the University of Copenhagen Medical School, Denmark, and a course in human sexuality offered during our clinical training period was essential in allowing us to graduate as physicians capable of addressing sexual concerns with our patients. We also learned how to treat some of the less complicated sexual problems, and felt comfortable in doing so after the course.
Sexual Medicine in Primary Care will provide many clinicians with basic skills required for dealing with patients concerned about sexual problems. The information presented applies to a wide field within the health sector, and not only medical students, but nurses, social workers, psychologists and other health professionals may benefit from reading this book.
The book can be read from cover to cover, or it may be used as a quick reference guide. A detailed list of contents quickly guides the reader to relevant chapters and paragraphs. Sexual Medicine in Primary Care furthermore provides a rich source and an excellent basis for a course or a lecture series in human sexuality.
Part One of the book deals with sexual history-taking, interviewing skills, and assessment of sexual concerns. Part Two focuses on diagnosis, treatment, and referral criteria for patients with the following sexual dysfunctions: low sexual desire (chapter 9), ejaculation/orgasm disorders (chapter 10), erectile disorders (chapter 11), orgasmic difficulties in women (chapter 12), and intercourse difficulties in women; pain, discomfort and fear (chapter 13).
The book is organized sensibly and thoroughly. Exhaustive and up-to-date reference lists follow each chapter. A large number of case stories provide examples of what type of cases a clinician may encounter and serve as welcome breaks in the information-rich text. Periodically, essential phrases are highlighted and visually emphasized in small boxes. This feature, together with the very detailed list of contents, may aid the hurried reader in quickly extracting pertinent information from the book.
I found many of the illustrations extremely informative and well suited for instruction. The assessments of various sexual dysfunctions are illustrated in diagrams that provide important visual aids to comprehending the wealth of information presented in the text.
Each chapter ends with a final summary, repeating and emphasizing the most essential messages from the chapter.
Appendix I (p.299): "First Assessment Interview With A Heterosexual Couple", and Appendix II (p.313): "First Assessment Interview With A Solo Patient" provide examples of dialogue between Dr. Maurice and clients. His comments on why and how to ask particular questions make these appendices valuable reading, especially for less experienced health care professionals.
Appendix IV (p.335): "Sex-Related Web Sites For Patients/ Clients/ Consumers And Health Professionals" lists a large number of relevant Internet resources.
Appendix V (p.341): "Medication & Sexual Function," summarizes sexual side effects of commonly used drugs.
In my opinion, the following features of the book are highly valuable:
1) Dr. Maurice has provided a detailed list of examples of questions to ask at an initial visit. Even more important, he has included questions not to ask.
2) There are also many good examples of dialogue and suggestions for responding to certain questions.
3) The book offers guidelines for:
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a) ordering labs, |
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b) determining whether a patient can be dealt with in the primary care setting, |
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c) when to transfer someone to a sex-specialist. |
4) The following sections provide highly essential information for students and clinicians. If you do not have time to read anything else in this book, these pages are highly recommended:
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a) Box 9-1 (p.171): "Common Medical Conditions That May Decrease Sexual Desire," |
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b) Box 9-2 (p.174): "Commonly Used Pharmacological Agents That May Decrease Sexual Desire," |
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c) Box 11-2 (p.238): "Causes Of Generalized Erectile Dysfunction," |
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d) Appendix V (p.341): "Medication & Sexual Function" |
Some comments are inclined to be too specific, limiting their more general application. Consider two questions on page 177:
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".....Suggested Question when Talking with a Heterosexual Man/Woman: "About how often are you and she/he sexually involved with each other?"....." , or |
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".....Additional Suggested Question when Talking with a Heterosexual Man/Woman: "What kind of thoughts do you have before or during your sexual experiences?"....." |
By leaving out the specification "Heterosexual Man/Woman" the questions would have been more general, since they may be addressed to anyone, regardless of their sexual orientation.
As a practitioner in the field of sexuality and chronic disease, as well as medical and physical disabilities, I found chapter 8: "Talking About Sexual Issues: Medical, Psychiatric, and Sexual Disorders (apart from dysfunctions)" very useful. However, so much information is compressed into this particular chapter I sometimes lost my orientation.
Chapter 8 may have benefited from being broken into three separate chapters (I - III), such as:
I) Sexual Issues In The Context Of Medical Disorders
II) Sexual Issues In The Context Of Psychiatric Disorders
Here I would in particular have liked to find more details on separate disorders which may be encountered in a primary care setting, such as depression, schizophrenia, manic/depressive episodes, and personality disorders. However, this may have exceeded the scope of the book.
III) Sexual Issues In The Context Of Sexual Disorders
On page 145 in the section "Sexual Disorders (Apart From Sexual Dysfunctions) Sexual Sequelae of Child Sexual Abuse in Adults: Sexual Issues and Questions," Dr. Maurice mentions the breach of confidentiality if sexual abuse of children is suspected. Perhaps this information should have been highlighted in a separate box, or even been presented earlier in the more general section (Part One) of the book. During discussions of sexual concerns with a patient/client, a situation may develop where confidentiality may have to be breached. I find it important to warn both the health professional who is conducting the interview and the patient about this possibility.
Female sexual problems and concerns are well covered in chapter 9 (Low Sexual Desire in Women and Men), chapter 12 (Orgasmic Difficulties in Women), and chapter 13 (Intercourse Difficulties in Women; Pain, Discomfort, and Fear).
In chapter 10 (Ejaculation/Orgasm Disorders) pharmacological treatment of premature ejaculation (PE) is discussed. The fact that some antidepressant drugs, such as paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil), have the sexual side effects of inhibiting ejaculation is considered an advantage when treating PE. I do not have any reservations about this statement, but I believe that it would have been appropriate to point out that the same drugs all may have yet another sexual side effect: decreased sexual desire (T.L. Crenshaw & J.P. Goldberg, "Sexual Pharmacology; Drugs That Affect Sexual Function", Norton, 1996). It is important to know that when treating PE with these drugs, sexual desire may be negatively affected. Part of this information is found later in the book, and clomipramine is listed in Appendix V (p.341): "Medications & Sexual Function" under "Decreased Sexual Desire." However, neither paroxetine nor sertraline are included here, and perhaps should have been.
Chapter 11 (Erectile Disorders) provides an outstanding source of information. This topic clearly has been the focus of much recent research. Thoroughly reviewed topics include: anatomy and physiology of erections, epidemiology, etiology, history taking, physical examination, laboratory investigations, treatment options and referral criteria. Every primary care health professional should be familiar with the information outlined in this chapter.
My only minor criticism of chapter 11 involves a comment made on page 233: ".....Rather than the communication exercise it is, sensate focus is sometimes mistakenly thought of as a way of allowing one to discover previously unappreciated physical feelings in particular body areas....." True, sensate focus may primarily be an exercise for improving communication skills. However, when someone becomes more aware and appreciative of different sensations during the process, I find this an important part of the exercise, and it should not be de-emphasized. Perhaps this never was Dr. Maurice’s intention, but nevertheless I found the wording unfortunate.
The list of Internet resources (mainly web sites) in appendix IV (p.335) includes many good references that may serve as starting points for doing more in-depth research of various topics on the Internet. Due to the constantly changing nature of the World Wide Web, it is impossible to provide a complete list of web sites. However, I was surprised to find the web sites for AASECT (American Association of Sex Educators, Counselors and Therapists; http://www.aasect.org) and ABS (The American Board of Sexology; http://www.sexologist.org) missing from the list. On the other hand, I was introduced to several excellent and useful web sites.
At least two facts place primary care health professionals in extremely important positions, encouraging them to be able to deal with sexual concerns:
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1) They are in the unique position to prevent HIV/AIDS by talking to their patients about sexual practices, by providing information about safe-sex measures, by giving advice, and by reaching some patients before infection may occur. |
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2) ".....Sildenafil (Viagra)........will likely result in a substantial shift in the treatment of men with erectile difficulties away from specialists and towards physicians in primary care....." (p.247/248) |
I highly recommend this book to anyone in the health sector. Needless to say, I hope that teaching facilities will incorporate it in their suggested or required reading materials.
As we move into a fresh millennium, the fact that sexual problems often constitute a part of life should no longer be ignored. Primary care health professionals must be able to address sexual concerns with their patients. This book will teach them how.
More information about this book (including detailed Table of Contents) can be found at the following web site that was created for this purpose: http://www.interchange.ubc.ca/maurice/
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
16-February-2000
Editors: Cheryl Brown Travis & Jacquelyn W. White (2000) American Psychological Association. 432 Pages, USA $49.95 (hardcover);
ISBN: 1-55798-617-7
Table of Contents:
I. EPISTEMOLOGY, THEORY, AND METHODS
Chapter 1 Social Construction of Sexuality: Unpacking Hidden Meanings
Jacquelyn W. White, Barrie Bondurant, and Cheryl Brown Travis
Chapter 2 Biological Models and Sexual Politics
Danny S. More and Cheryl Brown Travis
Chapter 3 Gender Differences in Sexuality: Results from Meta-Analysis
Janet Shibley Hyde and Mary Beth Oliver
Chapter 4 The Social Construction and Social Effects of Sex Research: The Sexological Model of Sexuality
Leonore Tiefer
II. LIFE COURSE DEVELOPMENT
Chapter 5 A Normative Perspective of Adolescent Girl’s Developing Sexuality
Deborah P. Welsh, Sharon S. Rostosky, and Myra Christen Kawaguchi
Chapter 6 Sexual Roles of Girls and Women: An Ethnocultural Lifespan Perspective
Pamela Trotman Reid and Vanessa M. Bing
Chapter 7 Sexuality During Pregnancy and the Year Postpartum
Janet Shibley Hyde and John DeLamater
Chapter 8 Menopause and Sexuality: Ageism and Sexism Unite
Sharon S. Rostosky and Cheryl Brown Travis
III. MEANING AND FUNCTION
Chapter 9 Only Joking: Humor and Sexuality
Mary Crawford
Chapter 10 Beauty, Sexuality, and Identity: The Social Control of Women
Cheryl Brown Travis, Kayce L. Meginnis, and Kristin M. Bardari
Chapter 11 Dangerousness, Impotence, Silence, and Invisibility: Heterosexism in the Construction of Women’s Sexuality
Laura S. Brown
Chapter 12 A Cultural Context for Sexual Assertiveness in Women
Patricia J. Morokoff
IV. SEXUALITY AND THE SOCIAL ORDER
Chapter 13 Consent, Power, and Sexual Scripts: Deconstructing Sexual Harassment
Suzanne B. Kurth, Bethany B. Spiller, and Cheryl Brown Travis
Chapter 14 Re-Examining the Issue of Nonconsent in Acquaintance Rape
Patricia L. N. Donat and Jacquelyn W. White
Chapter 15 Understanding the Unacknowledged Rape Victim
Arnold S. Kahn and Virginia Andreoli Mathie
Editors and Contributors:
Editors are Cheryl Brown Travis, PhD, professor of psychology at the University of Tennessee, Knoxville, and Jacquelyn W. White, PhD, professor of psychology and director of women’s studies at the University of North Carolina at Greensboro. Dr. Travis’ extensive background in female health and psychology is complemented by Dr. White’s knowledge on gender issues and aggression. A number of outstanding contributors has been gathered, producing a rich source of information regarding current women’s issues.
The Books Audience:
Sexuality, Society, and Feminism appeals to a broad audience ranging from readers interested in sociology, cultural diversity, social work, and women’s studies to those focusing on psychology, medicine, and other health sciences. A quick look at the table of contents demonstrates the broad area of topics discussed. Even an intriguing chapter on humor and sexuality is included.
General Comments:
This compilation of essays will serve as an important tool in current debates and it may evolve as a historic document describing the status quo of female issues at the beginning of the 21st century. Sexuality is viewed from a feminist perspective. I was impressed with the depth and expertise revealed in the various chapters. A wealth of information is presented and up-to-date reference lists provide rich sources for further reading. Results of past and current studies are critically reviewed while directions for future research are pointed out. Cultural diversity with respect to myths, morals and practices are described throughout the book and are the focus of Chapter 12. A wide spectrum of feminist issues is covered making it impossible for me to comment on each separate chapter in the context of this book review. Instead, I will highlight below some of the issues which I found particularly stimulating.
Female Development Through the Life Cycle: From Adolescence to Menopause
Section II. Life Course Developments paints a detailed picture of women’s development from adolescence until post-menopause, including pregnancy and the first post-natal year. At several stages during this development the female is not only affected by physiological hormone changes from within, but she simultaneously experiences a variety of external social and cultural influences and expectations. In our Western culture some of these phases in a woman’s life cycle are frequently pathologized in research and in our social views. Instead of accepting a changing and developing hormone status as normal and healthy, different phases in a woman’s life are turned into medical problems which in turn demand remedies.
Adolescence is often viewed as problematic since the young woman’s developing sexuality is automatically thought to herald sexual intercourse and thus a risk of pregnancy and sexually transmitted diseases. At the other end of the developmental spectrum, menopause is equally or even more pathologized. Our Western culture focuses on deficiencies and diseases such as pelvic atrophy, ovarian dysfunction, estrogen deprivation, etc. Many women are seeking medical help in order to restore their hormones. This stands in sharp contrast to men, who’s hormonal changes known to take place in mid-life are not pathologized to the same degree.
This pathology oriented perspective of adolescence and menopause prevents an understanding of a woman’s different life stages as being normal and healthy. In this context it is notable how different menopause is perceived in other cultures. Recent studies on Japanese, Mayan, African, and Indian women are reviewed, and it becomes clear that biology and culture strongly interact creating diverse experiences of menopause. "Women in non-Western, non-industrialized cultures, in which the mother-in-law role is associated with increased power and status, associate menopause with increased freedom, sexual satisfaction, and frank relief that childbearing is over.....Some cultures even lack the supposed universal symptom of menopause - the hot flash."
Originating from Denmark, I have often been asked why the teen-pregnancy rates in Europe are so much lower than in the Unites States. One of my arguments has always been that teenagers in the Scandinavian culture are raised with an emphasis on learning to take responsibility for their own lives. Adolescence is viewed not so much as a problem but rather as a fact which has to be accepted by everyone and dealt with by the individual. This applies to both young men and women who learn to be responsible adults. The decision to either practice abstinence and to postpone sexual activity or to include safe-sex measures then comes from the adolescent himself or herself and not as a ruling from above.
Sexual Harassment and Rape
Section IV. Sexuality and the Social Order raises the issues of sexual harassment and rape. Cultural differences and even time-related differences within our own culture are reviewed. During Colonial times rape was considered a crime against the man who "owned" the woman, whether her father or her husband. In the 19th century, a woman who was raped was considered impure. During the following 20th century it was assumed that a woman who had been raped had contributed to her own victimization. Not until the 1970’s was rape reconceptualized as a means of intimidating and controlling women. Rape no longer was defined only as a physical and emotional violation of a woman by a stranger, but other men known to the victim might also use rape as a means of control. From this redefinition of the term "rape" emerged the new phrases of "date rape," "acquaintance rape," and "marital rape."
Chapter 15 examines why some women have had experiences that would legally be classified as rape, yet do not consider themselves rape victims (unacknowledged rape victims). When a person thinks about the events that make up the experience of rape, usually one of two distinct rape scripts emerge: 1) The acquaintance rape script in which the assault takes place in-doors, involves a known assailant, and includes little force. 2) The stranger rape script which entails a violent attack out-doors by an unknown man possibly using a weapon. Unacknowledged rape victims distinguish themselves from acknowledged rape victims in a number of ways, including the nature of their rape script (stranger rape script versus acquaintance rape script), the amount of force experienced, the amount of negative affect and feelings of victimization experienced during and after the rape, whether she used alcohol or drugs prior to the rape, and the influence of peers following the rape. It becomes clear that two women who have had nearly identical rape situations may each perceive the events in completely different ways depending on their own values and beliefs and on the reactions of their peers.
Chapter 15 concludes with a vision for future research: "From a qualitative perspective, we need to expand our knowledge of the dominant discourses in our society, particularly of those dealing with relationships between women and men. Analyses of men’s dominant discourses and how their shared beliefs and values compare with those of women would be useful. This research could shed light on the reasons men engage in sexual intercourse after a woman has indicated she does not want to participate. Perhaps through research of this sort, women and men can come to share common dominant discourses about love, sex, and relationships such that all nonconsensual sex is acknowledged as rape."
Conclusion:
Whether used as a reference book or read cover to cover, Sexuality, Society, and Feminism will attract wide audiences. Besides providing a detailed analysis of past and current feminist issues, this book may play an important role in setting new trends for future research in the new millennium. It may encourage society as a whole to adopt more feminist views which in turn will influence current morals, ethics, and myths. As Patricia J. Morokoff concludes in Chapter 12: "We have something to look forward to."
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
27-March-2000
Edited by Marcus C. Levitt and Andrei L. Toporkov. In the Series “Russkaia potaennaia literatura.” Ladomir Publishers, Moscow, 1999.
700 pages; 39 color illustrations, 165 b/w illustrations. ISBN 5-86218-177-6. $25 (plus $3 postage and handling and taxes if applicable). Hard cover.
Available from
Prof. Marcus C. Levitt
Department of Slavic Languages
University of Southern California
Los Angeles, CA 90089-4353
Thirty-one authors contributed to this volume, which compiles papers originally presented at the “Conference on Russian Pornography”, held at the University of Southern California, Los Angeles in 1998. Editors are Dr. Marcus C. Levitt and Dr. Andrei L. Toporkov. Dr. Levitt is professor of Russian Literature at the University of Southern California, and the author and editor of several books related to Russian literature. He has written many articles on 18th and 19th century Russian literature and is currently working on a book about the visual arts under Catherine the Great. Dr. Andrei L. Toporkov, doctor [PhD] of philology, is a leading researcher at the Institute of World Literature of the Russian Academy of Sciences, and professor at the Russian State Humanities University. He specializes in Slavic folklore, ethnography, and the history of Russian literature. He is the author of the books: "The Origins of Etiquette: Ethnographic Essays” (1990, with A. K. Baiburin), "The Theory of Myth in Russian Literary Scholarship of the 19th Century" (1997), and he has edited a whole series of books.
The other contributors include professors in Russian and Slavic languages,
literature, history, and political science, and librarians from Russia, Europe,
and the United States. The wide field of expertise represented by these
contributors is reflected in the book, which covers topics from early Russian
literature to political and social developments in the former Soviet Union.
Since glasnost and the political changes in Russia over the past few years, strict censorship has been replaced with free speech, allowing pornographic literature to appear in public. Not only has contemporary pornography become a new freedom, past Russian erotic literature, hidden away for decades, has been revealed. This volume is part of the series “Russian Forbidden Literature,” shedding light on previously inaccessible literature.
Several chapters in “Eros and Pornography in Russian Culture” describe the recent pornography boom in Russia and some unsettling developments that may or may not be related. Post-communist society has been afflicted with violence, crime and rape, and incidents of syphilis, gonorrhea, and HIV/AIDS are on the rise. Communists and nationalists blame demoralizing influences from Europe and America. Russian and Western feminists associate the explosion of Russian pornography with domestic violence, trafficking of women, and the sexual exploitation of Russian women in the workplace.
I have personally witnessed parts of the fall of communism as reflected by the length of the line in front of the Lenin mausoleum at Red Square. In the summer of 1988 the line was endless. Many Russians and a few tourists waited for hours to view the mausoleum. I had come to run the Moscow Peace Marathon, and Western influences were already visible at the time. A Tina Turner sound track greeted us as we ran through Gorky Park, and after the race Westerners passed sneakers on to thankful Russians who had completed the 26 miles bare-footed. Others traded their shoes, jeans, and other parts of their Western wardrobe in for Rubles. The black currency market was vibrant.
On a visit five years later, I found the city of Moscow transformed. The line in front of the mausoleum was gone, and I managed a view of Lenin. Russians trading Rubles for Western goods were no longer visible. I exchanged my money legitimately in a Moscow bank now offering exchange rates equal to those available on the street. The classic Russian department store Gum near Red Square had been transformed into a Western style shopping mall with Elizabeth Arden on sale and a well-equipped business center, and a few blocks away the world’s largest MacDonald attracted locals as well as tourists.
This time I had arrived in Moscow by Trans-Siberian Railroad from Beijing, an eventful trip that clearly demonstrated new trends in Russia. Our main excitement was not, as I had initially thought, being stuck in the Mongolian Gobi Dessert in a 24-hour sand storm. The highest excitement began when we finally crossed the Russian border. A spirit of “free trade” befell our train, which was suddenly transformed into a busy marketplace. At every stop Chinese passengers sold women’s silk underwear, leather jackets, and other products to cheerful Russians. In turn, locals came on board with champagne and caviar, and Russian prostitutes offered their services to Chinese men. Some of the changes in Russian society over the past decade are now evidenced by the fact that this book exists and by its contents.
The orientation of the layout would be enhanced by positioning the bi-lingual table of contents at the beginning of the book instead of at the end. English chapters are followed by brief summaries in Russian and vice versa, and all illustrations have captions in Russian with English translations in the back. Unfamiliarity with the Cyrillic alphabet is not a handicap.
The volume contains numerous never-before published illustrations from Russian archives and private collections. Some of the fine black and white illustrations with sexual contents date back to the late 17th Century. Some of the 39 color illustrations by I.S. Efimov (1878 – 1959) are outstanding. These are not hard-core literal pornographic images, but imaginative, striking illustrations.
The contents of this volume span a wide range of topics, including 1) early erotic and pornographic Russian literature, 2) the history of Russian pornography laws, and 3) contemporary social, political, and literary developments with a focus on sexuality and pornography.
1) Early erotic and pornographic Russian literature: Like other Western European countries at the time, the Russian state developed a governmental system in the late 18th Century to regulate the distribution of sexually explicit material. By the 19th Century, strict censorship was imposed in Russia, forbidding the publication of a variety of materials deemed to be corrupting to public morals. Even though the circulation of printed sexually explicit material was forbidden, this did not prevent oral transmission of folk tales and incantations.
The first few chapters of “Eros and Pornography in Russian Culture” describe early Russian Eros, followed by a number of chapters devoted to Catherine the Great who was Empress of Russia from 1762 until 1796, and who’s erotic reputation has become a legend. “…all the Empresses of Russia had had lovers, but none raised the number of them so high as Catherine the Second. She changed them every twenty-four hours, or oftener. The position of a lover was a public office: the highest, most lucrative, and withal the most entertaining – at least so long as Catherine retained her beauty – which existed in Russia. The qualifications for the office were a handsome face, a fine figure, and above all great physical vigor…” (Stern, B. 1896 – The Private Life of the Romanoffs, trans. Seth Traill. Washington, DC: National Publishing Company).
Several chapters highlight erotic components in Russian and Western European literature by Tolstoy, Marquis de Sade, Casanova, and Rudolph Erich Raspe (Baron Munchhausen) amongst others. Catherine the Great inspired several of these literary works and was in direct communication with some of the authors.
2) The history of Russian pornography laws: The chapter “Pornography and the Law” by Paul W. Goldschmidt provides a detailed analysis of Russian legislation with respect to pornography from early tsarian legislation until recent changes in pornography laws over the past decade. This section of the book also deals with political developments with respect to sexual health. Whether the facts that divorce was legalized in 1918 and that the “First All-Union Congress for the Struggle Against Venereal Disease” was held in 1923 are related or not remains questionable. Nevertheless, this was the first time that sex education with lectures on hygiene was implemented on an official and programmatic level. Somewhere along the way sex education got lost, and today apparently only a minority of Russians use contraceptives, probably contributing to the explosion of the rate of sexually transmitted diseases and HIV/AIDS in Russia.
3) Pornography in Russia today: The final section of the book, “Pornography in Russia Today,” provides an analysis of various Russian men’s magazines and Russian gay porn and several pornographic literary texts from the past two decades. One common denominator throughout these texts is that rape is often described in terms of the woman enjoying being raped. This is also reflected in contemporary Russian humor, to which a whole chapter is devoted. Rape in these texts appears to be an assertion of male sex-rights, and primarily a sexual act, which the assaulted woman encourages. This unsettling presentation clearly has repercussions on many aspects of Russian life.
Readers interested in previously censored Russian literature, or in learning more about the past and present situation in Russia with regard to pornography, may find this book extremely interesting. I certainly enjoyed reading it, and I consider the illustrations of exceptional quality.
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
22-May-2000
By
Robert H. Rencken, 2000; American Counseling Association (ACA). ISBN:
1-55620-178-8; 232 Pages
Available
from ACA for $24.95 (ACA member price)/ $33.95 (non-member price). Order number:
72691 at 1-800-422-2648
The Author:
Robert Rencken, CCMHC, has been a mental health counselor, school psychologist and clinical sexologist in private practice in Tucson, Arizona, for over 25 years. He has given nationwide workshops and seminars on the issues of sexual abuse, incest, and childhood sexuality.
The
Audience:
A wide range of professionals gets into contact with the issue of sexual abuse: The schoolteacher or school counselor who wants to understand how a victim should be treated at school. The medical or mental health professional whose client has a past history of sexual abuse. The law enforcement professional who works with families experiencing sexual abuse. The Child Protective Services agent. And many more. All these professionals work with individual segments of the entire picture. “…The intent of this book is to provide a clear and basic framework for understanding the dimensions (scope, taxonomy, philosophy) and dynamics (individual, familial, societal) of pedosexual behavior, particularly child sexual abuse. The major focus is on the implementation of integrated intervention strategies for any professional who faces only one ‘piece of the puzzle’…”
Brief
Interventions:
Mainly due to budgetary constraints, today’s mental health professionals are generally challenged to apply brief interventions instead of long-term treatments. Rencken introduces several brief interventions, which may prove effective under these constrained circumstances.
Contents:
Since his original version of this book, Intervention Strategies for Sexual Abuse (1989) the area of sexual abuse has received much public attention. New insights gained over the past decade, such as the issues of false accusations; “planted,” repressed and recovered memories; ritual and satanic abuse; and increased attention to female offenders have been included in this new edition.
The book is concise and brief without appearing superficial. Much information has been compressed into an easily accessible and readable format. In his initial chapter “Overview of the Problem,” Rencken provides clear definitions of terms such as regressed, pedophile, rapist, and ritualistic. He further introduces his pedosexual taxonomy, which enhances clinical communication by establishing clear description of the abuse along four axes:
1) The setting
2) Possible age combinations between victim and perpetrator
3) Level of coercion
4) Offender dynamics
Chapter 2 describes intervention strategies with victims of abuse in children less than age 7, between the ages of 7 and puberty, and treating the adolescent victim. Even though brief, this chapter provides much detailed information. Following are chapters on intervention strategies in the treatment of offenders, and of family and adult survivors. Finally, eleven case stories present examples for how these intervention strategies are applied in real life situations, and Chapter 6 “The Road Ahead,” concludes the book with an outlook on education and prevention of sexual abuse. An extensive glossary and a reference list are attached.
Brief and Extended Interventions in Sexual Abuse presents a very complex and multi-dimensional topic in an accessible and comprehensive format. Besides offering clear definitions and a logical taxonomy enhancing communication between different professionals involved, the book provides a number of treatment strategies, which will benefit anyone working in the field of sexual abuse.
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
30-June-2000
By Gerald R. Weeks & Nancy Gambescia (2000) Norton
ISBN: 0-393-70330-4; 201 pages, USA $30, CAN $42
The Authors:
Gerald Weeks, Ph.D. is a professor at the University of Las Vegas and is the author of numerous books on sex and marital therapy. Nancy Gambescia, Ph.D., teaches the treatment of sexual dysfunctions to therapists and has a private practice focusing on marital and sex therapy in Bryn Mawr, Pennsylvania.
The Audience:
The book is mainly targeted towards health professionals who come into contact with clients affected by erectile difficulties. General readers may find some valuable information on erectile dysfunction, its assessment, and various treatment options.
Contents:
The book begins with an overview of issues and concerns surrounding erectile dysfunction (ED), including a very good list of misconceptions about erections and a discussion of why someone with ED may be reluctant to seek professional help. Emphasis is on ED being a couples’ problem, and that couple/marital therapy should go hand in hand with sex therapy and sometimes medical treatment.
The authors present sex therapy and couple/marital therapy as two separate and non-inclusive fields. True, the two areas may have developed independently from each other and still be “…professionally, academically, and organizationally separate (p.3)…” However, I believe that the two fields have already merged to a greater extent than Weeks & Gambescia recognize. Many professionals have been trained and certified in both areas. It is obvious that most sexual difficulties present themselves in the context of a relationship, and someone’s sex-life, including its strength and weaknesses, simply cannot be properly dealt with out of this context.
Following is a chapter on the medical aspects of ED. The information presented in this chapter may in particular be useful for mental health professionals who wish to familiarize themselves with the most recent advances in the medical treatment of ED. This chapter may also prove useful for a person affected by ED, as it provides information regarding different treatment options. The chapter offers a good discussion, but there are a few minor errors:
1) “…Erections are often present during rapid eye movement (REM) sleep and also when a man awakens from sleep with a full bladder (p. 16)…” Authorities generally agree that the latter statement is a myth, and only REM sleep is associated with erections.
2) In the paragraph on Sildenafil (Viagra) it is stated that: “…Sildenafil promotes the release of nitric oxide and inhibits the breakdown of cyclic GNP… (p. 36).” GNP is repeated several times in this paragraph and should be GMP, short for cyclic guanosine monophosphate. To the eye of anyone familiar with the correct term, this minor error corresponds to saying UPA instead of USA. Also, Viagra does not promote the release of nitric oxide, the substance responsible for increased blood flow to the penis during erections; it simply enhances its effects by inhibiting the enzyme responsible for its breakdown.
For the remainder of the book, which deals with the psychological aspects of ED, I have nothing but praise. The authors clearly demonstrate their experience and expertise in providing sex therapy for couples affected by ED. Psychological and interactional or dyadic risk factors for ED and their assessment are reviewed. Basic principles, strategies and techniques for sex therapy with couples are discussed. Clinical examples of therapeutic questions and excerpts of dialog between therapist and client add further understanding to the theoretical aspects presented in this outstanding section of the book.
The chapter “Integrating Psychological and Medical Treatments” guides health professionals on how to combine various treatment options in order to optimize the effect for the client. A typical example is to prescribe Viagra in order to break through performance anxiety. The male may become more sexually confident and competent, and as a result be more receptive towards some techniques used in sex therapy. Also, other possibly co-existing difficulties such as premature ejaculation, lack of desire, and orgasmic difficulties can sometimes be dealt with more effectively if the man’s erectile difficulties have been by-passed with Viagra.
One of the final chapters deals with common pitfalls therapists encounter and how to avoid them. A number of suggestions, such as “Don’t take sides,” “Don’t intervene too quickly,” and “Don’t answer questions until you are ready,” serve as excellent reminders for the health care provider and can be applied in more general terms when dealing with issues other than ED.
Last, valuable guidelines and tools for dealing with communication difficulties and anger between partners are presented.
Conclusion:
The fields of marital therapy, sex therapy, and medicine will merge further as a result of this book. I can highly recommend it to health care providers with different training backgrounds dealing with clients affected by ED. They will find valuable information, guidelines and instructions on how to integrate various treatment options for ED, thereby optimizing their clients’ treatment.
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
25-July-2000
By Carol Rinkleib Ellison, Ph.D. (2000)
New Harbinger Publications, Inc.; ISBN: 1-57224-196-9 paperback; 350 pages,
US$ 15.95
Carol Rinkleib Ellison, Ph.D., is a psychologist in private practice, an assistant clinical professor with the Department of Psychiatry at the University of California San Francisco, and an adjunct faculty member at the Institute of Imaginal Studies in Petaluma, California. A fellow with the Society for the Scientific Study of Sexuality, Dr. Ellison is an esteemed researcher and regular instructor of human sexuality courses for mental health professionals. She is the co-author of Understanding Sexual Interaction and Understanding Human Sexuality.
Who would have been better suited to provide the foreword
to this extensive study of female sexuality than Beverly Whipple, Ph.D., R.N.?
Dr. Whipple herself has conducted much research on female sexuality, and over
the past two decades she has contributed to the field with over eighty research
articles, many interviews and presentations, and several books, including the
world-wide best seller The G Spot.
Few large-scale surveys on women’s sexualities precede this book. Dr. Ellison pays tribute to two female pioneers in the field of human sexuality research, Clelia Mosher (1863-1940) and Katherine Bement Davis (1860-1935).
Mosher interviewed 45 married women about their sexuality in the beginning of the 20th Century, but her findings were not published until 1980 (6). In 1929, Davis published the book Factors in the Sex Life of Twenty-Two Hundred Women (2). Her sample was split about equally into married and unmarried women, and the age span of respondents in Davis’ study ranged from twenty-one to eighty-three years.
Mosher and Davis may have received little lifetime recognition for their research, but their contributions to the field of human sexuality research have recently been publicly acknowledged also in Dr. Vern L. Bullough’s speech to the European Federation of Sexology (EFS) in Berlin (1). In his presentation titled “The History of Sex Research in the USA,” Dr. Bullough included Mosher and Davis in the list of the ten most important pioneers in American sexuality research. Interestingly, John D. Rockefeller, Jr. also was included in this list, primarily for his financial support and facilitation of early sex research, including Katherine Bement Davis’s work. Rockefeller, who along with his parents had been involved in Christian programs to help young people maintain high moral standards, in 1911 established the Bureau of Social Hygiene to conduct studies on prostitution in the United States and Europe. Davis, one of the first female Ph.D.’s in the country, was appointed to the advisory board of the Bureau and this position allowed her to gradually move into researching other areas of sexual behavior. Under continued sponsorship by Rockefeller, she became involved in her own study on the sex lives of 2,200 women, (1, 2). As it is today, funding for sexuality research was generally difficult to obtain, and without Rockefeller’s financial support few studies may have been conducted at that time.
Another early researcher of female sexuality, not mentioned in Ellison’s book, was the gynecologist Robert Latou Dickinson (1861-1950). His research began in the 1890’s, but his study on 4,000 married and 1,200 single women was not published until after his retirement four decades later (1, 3, 4). And then there was Alfred C. Kinsey (1894-1956), whose publication Sexual Behavior in the Human Female (5) is well known.
Dr. Ellison and colleagues, family and friends distributed approximately 6,000 questionnaires. 2,632 anonymously completed forms were returned and provide the foundation for this study. Many women added personal comments, some of which are included in the book. The respondents were 83% Caucasian, relatively well educated American women, born between 1905 and 1977.
Most aspects of female sexuality are covered in this book, resulting in a colorful picture of how women differ with respect to past experiences, evolving values and morals, and expectations for their partners and relationships. With her gentle style, Dr. Ellison takes the reader on a fascinating journey through the sexual lives of women of all ages. Her examples are enlightening and educational. The author invites the reader to think actively and to reflect on her own sexual life as she progresses through the book. In an appendix, Dr. Ellison presents outlines for various discussion topics relevant to each chapter of the book. She suggests that women gather in Sexual Self-Acceptance (SEXSA) Circles in order to share their own unique sexual development, and possibly to enable each other to reach a state of sexual self-acceptance.
I often have women come to my sex therapy clinic with the expectation that they and/or their partners are doing something wrong. Dr. Ellison offers a refreshing perspective on intimacy and her strong message to all of us is that a couple is “… sexually successful when they create mutual erotic pleasure, to whatever level and in whatever form they desire on any particular occasion, so that each ends up feeling good about herself or himself and the other, experiencing a good time and enhancing their relationship (page 217).”
Two chapters are devoted to women’s orgasms, and the chapter on sexual choreography contains an outstanding description of the physiological changes taking place during women’s sexual arousal. Dr. Ellison educates the reader with an “…intergenerational smorgasbord of suggestions (page 253)” for increasing erotic pleasure and enhancing orgasms (page 245).
I can highly recommend this substantial book. It contains considerable, educational material beyond what I have mentioned in this review. Dr. Ellison’s focus is away from sexual performance and achievements and towards the creation of intimate moments, whatever form they might take. Men may benefit as much as women from reading Women’s Sexualities.
More information about the book can be found on www.womenssexualities.com.
1) Bullough, Vern L. (Oral presentation) The History of Sex Research in the USA, European Federation of Sexology (EFS) meeting, Berlin; June 29th, 2000
2) Davis, Katharine Bement (1929) Factors in the Sex Life of Twenty-Two Hundred Women, New York: Harper & Brothers Publishers
3) Dickinson, Robert L. & Beam, Lura (1931) A Thousand Marriages, Baltimore: Williams and Wilkins
4) Dickinson, Robert L. & Beam, Lura (1934) The Single Woman, Baltimore: Williams and Wilkins
5) Kinsey et al. (1953) Sexual Behavior in the Human Female, Philadelphia: W. B. Saunders
6) Mosher, Clelia Duel (1980) The Mosher Survey: Sexual Attitudes of 45 Victorian Women. James Mahood and Kristine Wenburg, eds. New York: Arno Press
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
25-August-2000
By
Richard F. Spark, M.D.
Perseus
Publishing (2000); ISBN: 0-7382-0206-1; 440 Pages, Paperback; US $20.00; CAN
$29.95;
Richard F. Spark, M.D., F.A.C.E. is an Associate Clinical Professor of Medicine at Harvard Medical School and Director of the Steroid Research Lab at Boston’s Beth Israel Deaconess Medical Center, where he continues an active research program. The author of two other books on male sexuality and fertility, he has written for The New York Times Magazine and The New Republic on health related issues and has published widely in major medical journals. A Fellow of the American College of Endocrinology and the American College of Physicians, and a member of the Endocrine Society, the Andrology Society, and the Federation of Clinical Research, he has a private practice in Chestnut Hill, Massachusetts.
The book contains a wealth of information related to men’s sexual health, with merely a few minor shortcomings worth mentioning:
1) “Impotence” with its negative connotation suggesting weakness, is used throughout the book. The terms “erectile difficulty (ED)” or “erectile dysfunction” would have been preferable; the latter of these is only used a few times.
2) According to the book cover, Dr. Sparks’ wants to address men in general and of all age groups. However, the focus is largely on heterosexual men, ignoring the homosexual population. Sex is often described as heterosexual sex between a man and his female partner, and none of the case stories or references to couples mentions homosexual men and couples.
3) As a sex therapist who helps clients focus on intimacy and pleasure without emphasizing sexual performance, some of the remarks I disagree with: “.... Ideally, the duration of thrusting will be sufficient to allow the man and his partner to achieve orgasm at about the same time (page 49).” It is implied that not only should one “ideally” achieve orgasm during sexual activity, but also it is desirable to climax simultaneously. This is in direct contrast to the messages I usually extend to my clients: that it is O.K. to have sex without climaxing at all, that instead of focusing on performance and goals such as “achieving” orgasm, it is more important to simply enjoy the existing intimacy between partners, whatever form it may take. The statement “… the sexual act does not end with penetration. Ejaculation must occur (page 76)” is a strong argument and in my opinion not true.
4) References to only selected chapters are listed in the back and without numerical links in the text. This makes it impossible to identify the exact origins of some of the statements made.
5) In the section on the risk of heart disease and sex, I was surprised that a recent study by Mueller et al. (5) was not cited. Research has shown that patients after a myocardial infarction (MI) benefit from enrolling into a cardiovascular rehabilitation program. The low risk of triggering a MI during sexual activity is nearly unchanged whether one has a history of heart disease or not. Regular exercise can reduce the risk even further (5).
6) Incorrect terms such as “alpha impulses (page 25)”, “nerves of the alpha type (page 253)” and “alpha signals (page 253)” are used to describe physiological events during arousal/erections. Maybe the author intended to present complex cellular events in an easy, understandable language, but I believe that he has introduced confusing terms. Also, the substances nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) are incorrectly described as having separate effects on smooth muscle cells (pages 26 and 104, table 11.1). To my knowledge, as described in the appendix, NO exerts its effects through the intracellular second messenger cGMP, and therefore the two substances act through one and the same mechanism. Using correct terms, and based on recent research (1, 2, 3, 4) the mechanism of tumescence/detumescence is described in the appendix.
7) The reasons why Viagra is not recommended (contraindicated) for people taking nitrates should have been mentioned following the section “…. Men who routinely use a class of medication called nitrates like nitroglycerine or isosorbide (Isordil), commonly prescribed to prevent or alleviate a form of heart pain called angina pectoris, should not take Viagra. No ifs, ands, or buts (page 117).” The paragraph ends here. In my opinion, an explanation, such as that given in the appendix related to why Viagra should be avoided in these cases would have been appropriate.
Sexual Health For Men deserves much praise. Dr. Sparks clearly is a very experienced endocrinologist with a thorough understanding of the function of male hormones. His section on the origin, release, metabolism and function of male hormones such as testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and anabolic steroids is captivating, and the reader learns how male hormones affect prostate growth, hair loss, muscle mass and other bodily changes. It becomes clear how popular drugs such as Finasteride (Proscar, Propecia) exert their effects in the male body. This section of the book is truly educational, and the clinical vignettes make it entertaining.
The chapters on different treatment options for erectile difficulties, such as penile injection, vacuum devices, and penile implants are informative as well. The author offers thorough and richly illustrated explanations for how individual treatment options function. The book constitutes a valuable source of information for readers who want to learn about contemporary treatment for erectile dysfunctions.
Two other sections deserve praise: the chapters on the prostate and its problems, including prostate cancer; and the chapter on fertility. Again, readers may find valuable and up-to-date information on these topics, including detailed descriptions of physical exams, tests and treatment options.
In a separate chapter, The Lure of Alternative Medicine, Dr. Spark offers a fair discussion of why some alternative medicines work and others do not. Ginseng, Vitamin E, Zinc, Yohimbine, and over-the-counter male hormones such as androstendione and DHEA are thoroughly discussed.
The book ends with a discussion on normal ageing, the issue of whether or not to restore youthful hormone levels in mature men, and finally an outlook on what is next for men in the new millennium.
Sexual Health For Men is truly a complete guide, an important and up-to-date resource for information about this wide topic. My praise for this substantial book far exceeds my criticisms. I recommend Sexual Health For Men highly.
The smooth muscle cells in segments of the penis (corpora cavernosa) can either 1) relax, thereby allowing increased blood flow to the penis, or tumescence, or they can 2) contract, resulting in detumescence, or the flaccid state of the penis. Both events may be initiated in different ways, and it is ultimately the degree of contraction or relaxation of these smooth muscle cells that determines whether the penis is flaccid or erect.
Nerves to the penis release the neurotransmitter noradrenaline (a catecholamine), causing stimulation of alpha-receptors on the surface of adjacent smooth muscle cells. This leads to smooth muscle cell contraction, allowing only limited blood flow into the penis, which is now in the flaccid state, or undergoes detumescence if it was previously erect. Catecholamines can also be released during stressful situations associated with sexual activity such as fear of failure, performance anxiety, anger, shame, or embarrassment (3). Or they may be released in painful situations such as genital pain from infection of the prostate, epididymitis, and Peyronie’s disease, or non-genital pain such as headache (3). In either case, smooth muscle cells are stimulated to contract, resulting in reduced blood flow to the penis and detumescence.
To complicate matters further, different types of alpha-receptors (alpha-1 and alpha-2-subtypes) are located not only on the smooth muscle cells, but also directly adjacent on the nerve-buds, from where catecholamines and other neurotransmitters are released. From this location alpha-receptors modify how much of the transmitter substance is released from the nerves, and then reaches the smooth muscle cells (2).
By blocking alpha-receptors on the smooth muscle cells with drugs like phentolamine (Regitine, Vasomax, mentioned on page 136), contraction of the smooth muscle cells can be prevented or at least reduced, allowing an erection to persist longer. This is why the drug phentolamine is effective in the treatment of ED and is currently being tested for possible FDA-approval as such a treatment option (3). The drug is already used as a blood pressure lowering medication for people with pheochromocytoma, a condition where excess catecholamines are produced in the body.
Alpha-2-receptors are blocked by Yohimbine, an alkaloid obtained from the bark of the African tree, Coryanthe yohimbe (2, 4). For over a century Yohimbine has been used as an aphrodisiac, and only recently has it become clear that Yohimbine has central effects (in the brain), increasing sexual arousal, as well as peripheral effects, blocking the catecholamine induced contractility in the smooth muscle of the penis (1). Alpha-2 receptors are located throughout the body on blood vessels and in the intestines as well, which explains some of the side effects (indigestion, nausea, dizziness, headache) experienced following the intake of Yohimbine (2).
There are other ways smooth muscle cells in the penis can relax, resulting in an erection: During sexual arousal penile nerves release nitric oxide (NO), which activates the smooth muscle cells to release the messenger cyclic guanosine monophosphate (cGMP) inside the cells. It is this messenger signal which tells the contractile proteins inside the smooth muscle cells to stop contracting and to relax. The more of the messenger cGMP that is available inside the cells, the more they relax, and the more blood is channeled to the penis through widened pass ways, causing tumescence and erection.
Viagra enhances erections by increasing cGMP levels in erectile tissue smooth muscle cells. It increases the amount of intracellular cGMP by inhibiting its breakdown through the enzyme type 5 phosphodiesterase (PDE 5). Viagra only works in men who are sexually aroused (take a Viagra, mow the lawn, and nothing happens) and who produce some cGMP on their own. The drug can enhance a minor erection by making sure that the cGMP produced stays around in the cells for a while longer, instead of being removed by PDE 5. For men taking heart medication such as nitrates, Viagra can fatally potentiate the medicine effect and the cGMP released upon medicine intake may be increased to dangerous levels, causing a potentially deadly drop in blood pressure. It is important to emphasize that this only applies to situations where men take Viagra while simultaneously being on nitrates, and that Viagra otherwise is a safe drug to use. It is of utmost importance that Viagra is prescribed by a doctor and is not shared or taken without a doctor’s consent.
1) Bancroft, J. (2000) Effects of alpha-2 blockade on sexual response: experimental studies with Delequamine (RS15385); International Journal of Impotence Research; Vol. 12, Suppl. 1, S64-S69
2) Crenshaw, T. L. & Goldberg, J. P. (1996) Sexual Pharmacology. Drugs That Affect Sexual Function. W. W. Norton & Company. New York. London; ISBN: 0-393-70144-1
3) Goldstein, I. (2000) Oral phentolamine: an alpha-1, alpha-2 adrenergic antagonist for the treatment of erectile dysfunction; International Journal of Impotence Research; Vol. 12, Suppl. 1, S75-S80
4) Morales, A. (2000) Yohimbine in erectile dysfunction: the facts; International Journal of Impotence Research; Vol. 12, Suppl. 1, S70-S74
5) Muller, J. E. et al. (1996) Triggering myocardial infarction by sexual activity. Low absolute risk and prevention by regular physical exertion; Journal of the American Medical Association; 275, 1405-1409
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
20-September-2000
By
Susan Bordo
Farrar,
Strauss and Giroux, First editions: hardcover (1999), paperback (2000) ISBN:
0-374-52732-6 (pbk.); 358 pages, US$ 15.00, CAN$ 24.95
Susan Bordo holds the Otis A. Singletary Chair in the
Humanities at the University of Kentucky, where she is also a professor of
English and Women’s Studies. She has written and edited several books,
including Unbearable Weight: Feminism, Western Culture, and the Body,
nominated for the Pulitzer Prize, and Twilight Zones: The Hidden Life of
Cultural Images from Plato to O.J.
I read Susan Bordo’s book The Male Body during my recent summer vacation. It proved to be a perfect combination of entertainment and mental challenges. On my flight overseas I noticed interested glances from across the aisle, whenever the page turned to one of the photographs and reprints of fashion ads displaying beautiful male bodies, more or less dressed. One young man, completely naked, is getting ready to put a pair of underwear on, or maybe he just disrobed? Other illustrations show Susan Bordo’s cigar smoking father sitting at a table at a convention, or an apron-clad Jim Backus in a scene from the movie Rebel Without a Cause, or G. I. Jane pumping muscles. My seatmates on the plane clearly were confused. What is this book about?
As the title indicates, the book is about men’s bodies and changing cultural perceptions over time. Susan Bordo not only takes a close look at men in public, including past and present presidents; she also shares some of her private experiences with us. Many of the illustrations from the book have been scrutinized and discussed in a class setting, and Susan Bordo offers in-depth interpretations: however, she does so without imposing her view on the reader: “…You may not see the same things in this ad that I do. Representations of the body have a history, but so too do viewers, and they bring that history - both personal and cultural – to their perception and interpretation. Different viewers may see different things. In pointing to certain elements in ads, or movies, or fashion, I’m not ignoring the differences in how people may see things, but deliberately trying to direct your attention to what I see as significant (page 29).” I found many of her interpretations thought provoking and refreshing.
One section of the book is devoted to men’s genitals in various contexts, including phallus worship, penile sizes and augmentation. Having grown up in the 50’s, Susan Bordo’s humorous recollection of her first encounters with penises reflects cultural morals at the time, but also demonstrates a level of consistency. I think many young women today can relate to her experiences: “…. Bobby Cohen, lying on top of me, humping away, was just a little boy masturbating with my body (Page 96).” As a mature scholar looking back on her first sexual encounters with men, Susan Bordo has some honest, surprising, and refreshing statements to make.
The book also deals with sexual harassment. Using the example of a female welder who feels harassed by her male co-workers, Susan Bordo emphasizes that the focus should be on the difference between sexes – and not so much on the act of sex. “….”Sex” can refer to two different things: the classification of people into beings that are “male” or “female” or the performance of certain acts. Sexual harassment law has been focused on the latter sense of “sex” when it ought to be focused on the former (Page 267).”
Having been an avid moviegoer since childhood, Susan Bordo offers her female perspective on the representation of male bodies in Hollywood films throughout the past 50 years. Her opinions and insights are inspiring. By the time I finished The Male Body, I had a list of ten movies that I want to either revisit or see for the first time.
I very much enjoyed Susan Bordo’s The Male Body. Covering changing perceptions of this broad topic over time, her views are current, refreshing and thought provoking.
The following book review was written by Dr. Owens for The Electronic Journal of Human Sexuality, Volume 3.
23-October-2000
By
Judith Mackay
Published
by the Penguin Group, 2000, ISBN: 0-14-051479-1, 128 Pages;
US$
18.95, CAN$ 26.99
Dr. Judith Mackay MBE is a medical doctor and senior policy advisor to the World Health Organization and health advisor to many national governments. She lives in Hong Kong where she is well known for her popular and groundbreaking radio programs on various aspects of sex and sexuality, as well as for her general work on preventive health throughout Asia.
In 1989 she received the US Surgeon General’s Medallion from Dr. C. Everett Koop. In 1997, she was presented with the World Health Award in New Orleans. Judith Mackay is a fellow of the Royal Society of Medicine, the Hong Kong Academy of Medicine, and of the Royal Colleges of Physicians of Edinburgh and of London. She is the author of The State of Health Atlas.
Did you know that:
| Flowers are sent by 94% of dating couples in Hungary. |
| 20% of Italian men visit a prostitute every week. |
| 80% of marriages in China are arranged and worldwide 60% of marriages are arranged. |
| In Hong Kong condoms are most likely carried in shoes, and sexual intercourse between sexually active 16- to 45-year-olds occurs less than 50 times per year and lasts an average of 13 minutes, while in the Unites States the average frequency is over 160 times per year and the average time spent during sexual intercourse is 28 minutes? |
The Penguin Atlas Of Human Sexual Behavior compiles fascinating, at times exotic information, here unusually condensed into one rich source. Whether the reader is a sexual health professional or a layperson, the atlas is an outstanding supplement to anyone’s knowledge regarding sexuality and sexual behavior.
Clear tables, illustrations, maps and figures present facts with consistent and often humorous symbols. Some illustrations manage to capture much information in a simple format, as for example a colorful listing of sexual practices that are either accepted or condemned by major religions.
The atlas consists of maps and tables organized into nine different areas:
1) Sexuality (Puberty, First Encounters, Sexual Practices, Homosexuality, and Transgender)
2) Mating (Sex Appeal, Dating, Choosing Your Partner, Marriage, Adultery, Divorce)
3) Reproduction (Contraception, Pregnancy, Infertility, Cloning)
4) Sexual Health (Sex Education, Safer Sex, Sexually Transmitted Infections, Counseling)
5) The Business Of Sex (The Economics Of Sex, Pornography, Prostitution, Sex Tourism)
6) Sexual Rites (Religion, Female Genital Excision, Circumcision)
7) Sex Crimes (Sexual Harassment, Sexual Violence)
8) Evolutions (The Future Of Sex)
9) Tables (Chronology Of Human Sexual Behavior, Aphrodisiacs, World Table with sexual health related information about countries from A(fghanistan) to Z(imbabwe).
The book concludes with a glossary, commentaries on each map, and references.
In only a few incidences did I find the data inadequate. The map on circumcision lacks data from European countries other than the UK, resulting in an imbalanced view with a focus on geographical areas where the majority of men are circumcised. In general, however, data is available from many different regions of the world.
Any reader who enjoys maps and visual presentations of information will likely find this atlas of sexual behavior exceptional. I am personally eager to share it with my own colleagues, family and friends. Some of my Christmas shopping is already done.