Episode 30: Barry McCarthy, PhD: Sexual Health for Men

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Here's at little true/false test, written by this episode's guest Dr. Barry McCarthy, for and about men:

Penis size is the most important factor in sexually pleasing your partner.______
Men are supposed to lead, to run the sex show. _____
The best sex happens when you're single. ________
Women control men with sex, that's just the way it is.______
"Real" men are always interested in sex.______

Barry W. McCarthy, PhD, is a certified marital and sex therapist. With his wife Emily McCarthy, he has coauthored 8 books on relationships and sexuality, including /Sexual Awareness/ (2002), /Rekindling Desire/ (2003), and /Getting It Right the First Time/ (2004). Michael Metz and Barry McCarthy have authored /Coping With Premature Ejaculation/ (2003) and /Coping With Erectile Dysfunction/ (2004). How many "true"? How many "false"? Dr. McCarthy says...all false. Join Chip and Barry as we blow away a lot of the myths and misconceptions our culture promotes about men. Listen in as we learn "the truth" about viagra, etc. And don't miss Barry's great exercise to boost your sex life.

Transcript

Chip August: Welcome to Sex, Love and Intimacy, I’m your host Chip August on today’s show we’re going to be talking to Dr. Barry McCarthy. Dr. McCarthy is a psychologist who has written a number of books about sexual health and satisfying sex. The book that really caught my eye is the book called Men’s Sexual Health: Fitness for Satisfying Sex and he just talks a lot about men and sexuality and what we can expect and how we can have satisfying sex lives well into our senior years.

Barry McCarthy: Good news is you’re a sexual person from the day you were born to the day you die. I’m 64 and people can and are sexual in their 60s, 70s, and 80s and really enjoy their sex.

The most important concept is that, unlike in your 20s and 30s where your sexual functioning was autonomous, you didn’t need anything from your partner in order experience desire, arousal, and orgasm, that isn’t the way it works in your 60s and 70s and 80s. If sex is going to continue to be enjoyable and satisfying, it’s got to be seen as a team sport.

They expect that you’re going back to automatic erection. That’s not true, you need both psychological but also physiological stimulation.

But for men over 50, it becomes 15% maybe even 20% of men at least on occasion experience ejaculatory inhibition and again what’s happening with them is they’re playing the sex game by the old rules rather than in the new healthy rules in your 50s, 60s, 70s, and 80s.

Well I think part of it is how men learn about sex and basically they learn about it in terms of highly controllable, highly predictable kind of sex and the idea of pleasuring, of foreplay is seen as for the woman not for the man.

Chip August: Welcome to our show Dr. McCarthy.

Barry McCarthy: I’m very glad to be here, looking forward to talking with you.

Chip August: Dr. McCarthy is a professor of psychology at American University. He teaches courses there. He has authored over 70 professional articles, 18 book chapters and 11 books. He’s written really some amazing books: Rekindling Desires, Men’s Sexual Health, Coping with Erectile Dysfunction, Getting it Right This Time in addition to a critical practice and teaching he also presents professional workshops all around the world I think. I’m pleased that you’ve made some time to spend some time with us.

So let’s dive right into this. I was looking through your book Men’s Sexual Health: Fitness for Satisfying Sex which by the way I recommend to any men or any woman who loves a man because this books has really lots of good information about sexuality and health and about fitness and how to make our sex better and wonderful so I was just really enjoying it.
The thing that I want to start with, I want to talk about sex and aging if that’s OK? Because I think that’s either the thing that men are experiencing or worrying about. I’m 54 and my sex life is still pretty good, I like it a lot. Can I hope to be having good sex well into my 80s, 90s? What’s in the future for me?

Barry McCarthy: Well let me give you the good news first. Good news is you’re a sexual person from the day you’re born to the day you die. I’m 64 and people can and are sexual in their 60s, 70s, and 80s and really enjoy their sex both as men and as couples.

Let me give you the bad news. The bad  news is when couples stop being sexual, well that’s at 50, at 65 or 75 it’s almost always the man’s decision over 90% of the cases and the reason for that is he’s lost his comfort and confidence with erections, intercourse and ejaculation and becomes frustrating and embarrassing and he avoids it. He makes the decision unilaterally and makes it non verbally. Sex has become more of a hassle than a pleasure and that doesn’t have to happen.

There’s all kinds of ways that people can enjoy being sexual in their 60s, 70s and 80s. The most important concept is that, unlike in your 20s and 30s where your sexual functioning was autonomous, you didn’t need anything from your partner in order to experience desire, arousal, and orgasm, that isn’t the way it works in your 60s and 70s and 80s. If sex is going to continue to be enjoyable and satisfying, it’s got to be seen as a team sport. You need to think about your partner as both your intimate and your erotic friend.

Rather than the way you learn to be sexual which is totally predictable intercourse, the name of the game is what we call the good enough sex model which is that not all sexual experiences flow into intercourse. When it doesn’t flow into intercourse, rather than apologizing or panicking, you’re comfortable transitioning either to an erotic non intercourse scenario or a cuddly sensual scenario and then taking a rain check and going back to being sexual later on.

Chip August: So one of things I’m hearing you saying is that we really need to get clear what we really mean about the word sex when we’re talking about having sex or being sexual with someone. I’m hearing you define sex as something more than just a wiggle my genitals around until they go pop, right?

Barry McCarthy: If you define sex as the way most men learn sex in their adolescence and young adulthood, they get one easy erection, they go inside the woman at the first erection and they ejaculate. Actually the big problem for young males is ejaculating prematurely and it’s very predictable. Those are the folks who stop being sexual in their 50s and 60s. People who adapt this new way of understanding and thinking about sex, the psychological factors, biological factors and couple relationship factors, those are the guys who continue to be sexual in their 60s, 70s, and 80s.

Now let me tell you the most controversial thing I’m going to say on this program.

Chip August: Sure let’s go right for controversy right from the start.

Barry McCarthy: This is about the pro erection medications. The pro erection medications are very good medications. I am totally in favor of pro erection medications.

Chip August: Just in case people don’t know what you mean. You’re talking about Viagra, Cialis, Levitra, medications prescribed for erectile dysfunction.

Barry McCarthy: Correct.

Chip August: All right.

Barry McCarthy: They’re safe medications for a great majority of men and they’re helpful however they don’t function at all the way it looks like it does in the ads. That the ads are hyped and they totally mislead men and couples.

Chip August: In what way?

Barry McCarthy: What they promise is a return to the kind of erection you had in your teenage years, it’s not true. What is true is that when you take Viagra, Cialis, or Levitra, that about 65% and 85% of the time you are going to have an erection sufficient for an intercourse which is really good. But the medication does not give you an erection. It does not create the desire. What it does is when you are feeling desirous and subjectively aroused, it allows your vascular system to be more efficient so that you maintain your erection longer and that’s a very good thing.

Chip August: As I understand it in very simplistic terms what the medications do is they decrease the blood flow out of the erectile tissue of the penis. Basically they constrict those blood vessels so that there is just more blood in the spongy tissue of the erectile area of your penis and therefore it is a little easier if you have the proper psychological motive to get you…

Barry McCarthy: Not just psychological but being open to being stimulated. You know there’s two major mistakes that people make with the Viagra and the Cialis and Levitra. They all basically have the same efficacy, 65% to 85% of the time.

Chip August: Right.

Barry McCarthy: They expect that you are going back to automatic erection. That’s not true, you  need both psychological but also physiological stimulation, that you need manual or oral rubbing stimulation. The second thing is that you should transition to intercourse at high levels of arousal. The biggest technical mistakes that men and couples make is they are afraid they’re going to lose their erection, so as soon as they get an erection, they better move to intercourse before they lose it. It’s a very understandable mistake but it’s a very self defeating pattern.

If you think about arousal being on a 10 point scale, where 5 is where you are just beginning to get aroused and get an erection and 10 is reaching orgasm. Most men, the way they learn to have intercourse, is they  have intercourse on their arousal is about a 4 or 5 and then they get more aroused during intercourse. The name of the game is the transition to intercourse when your arousal is at 7 or 8 when you’re highly aroused not just when you’re just beginning to be aroused.

Chip August: Of course as young men, we have all these experience that frequently if we wait too long, we won’t have enough control over ejaculation or orgasm and so we’ll cum sooner than we want to and I imagine in our senior year, when we feel it’s ready, it works, I better just do it now more play might make me have less control.

Barry McCarthy: All right, that’s the fear.

Chip August: That’s the fear, right.

Barry McCarthy: But that’s not the reality. In fact the reality is just the opposite. There’re very few young men, probably less than 2% young men have problems of ejaculatory inhibition in other words, they’re aroused, they’re having intercourse but they’re not able to ejaculate. Very seldom does that occur, 1-2%.

But men over 50, it becomes maybe 15% maybe even 20% of men at least on occasion experience ejaculatory inhibition. Again what’s happening with them is they’re playing the sex game by the old rules rather than new healthy rules in your 50s, 60s, 70s, and 80s. That is, you need more stimulation, both transitions to intercourse to higher levels of arousal but also doing multiple stimulation during intercourse because with young men they say I don’t anymore stimulation because I’m going to cum fast. With older men and I talk about older starting in your 50s, you’d be better off physically and mentally focusing on erotic stimulation because you are going to need that if you’re going to get into an erotic flow and ejaculate.

So many guys are trying to force erection at low levels of orgasm, at low levels of arousal, what they wind up doing is they end up running out of steam and they don’t ejaculate. They say well I loss my erection, I must have an erection problem. It is an erection problem. It’s a problem of ejaculatory inhibition. You’re not aroused enough.

Chip August: OK so I want to come back and talk more about it but I want to take a short break and give a little support to our sponsors. To let the sponsors support the show a little bit, I’m talking to Dr. Barry McCarthy. Dr. McCarthy is the author of a terrific book called Men’s Sexual Health among many other books and we’ll be right back in a couple of minutes for stimulus conversation. Please listen to the ad because we ask our sponsors to give us some special deals for our listeners so you might hear something that might make a great gift for Christmas and we’ll be right back.

[commercial]

Chip August: Welcome back, you are listening to Sex, Love and Intimacy. I’m your host Chip August. I’m talking to Dr. Barry McCarthy, he is the author of numerous books and articles and papers and presentations about sexual health and sexuality and that’s what we’ve been talking about. We’re actually talking about men’s sexual health, we’re talking about fitness for satisfying sex and we were talking about erections when we broke and I think there’s more to say about the subject.

I lead workshops in Love, Intimacy and Sexuality and what I noticed is, we have a western world that’s very confused about the whole idea about sex. When I was 12 or 13 or 14 years old, I was very clear the first time I was making out with my girlfriend. It was sexual. I might not have been having sex in the sense of having intercourse but it was clearly a sexual experience. I think the first time I held hands was a sexual experience.

In our minds we have this thought that if it doesn’t include penetrative sex and actual shooting of fluid then it isn’t sex and it amazes me, I don’t quite understand why we got there and I don’t quite understand the idea of somebody stroke my body and caress my body that is very turn on, it’s a very wonderful experience and doing that to my partner is a wonderful experience. And yet I noticed that men really, really orgasm focused. Is that something in our genetics? Is that something in our brain? What is that?

Barry McCarthy: Well I think part of it is how men learn about sex and basically they learn about it in terms of highly controllable, highly predictable kind of sex and the idea of pleasuring, of foreplay is seen as for the woman not for the man.

Now one of the best ways of understanding is when I work clinically with couples, I say you basically learn to think about sex as intercourse or nothing. You either hit a home run or didn’t play the game, or you failed the game. There’s a much better way of thinking about it and that’s the concept of five gears of touching. It’s like a stick shift car. The first gear is affection and touch which has great value in it itself. Whether it’s holding hands, hugging, kissing kind of thing. The second gear and I start thinking about by second gear that’s when I start thinking about it being sexual. Think of affection as being very important in terms of intimacy but it’s not basically sexual.

Sensually refers to non genital touching, it refers to cuddling together like kissing, holding when you wake up in the morning or when you go to sleep at night. It refers to body massages that are non genital and the way to think about sensual touch on our 10 point scale of arousal is sensuality allows you to feel 2 to 4 on that scale.

A third dimension of touch is what I think of as playful touch and what you mean by that, it can be nude, it can be semi nude, it can be clothed. It mixes genital and non genital touch. It’s things like doing whole body massages including genital pleasuring. It means taking showers or baths together. It means dancing in sexy or erotic ways and again in terms of arousal scale, it’s thinking about playful touching going from a 3 to a 5 or 6.

The fourth kind of touch is erotic non intercourse touch. What you mean by that is manual stimulation, oral stimulation or rubbing stimulation. Whether it’s taking turns or mutual and erotic non intercourse touch has great value in it of itself or as a way of leading into intercourse so we can be anything from a 5 to a 10 on our arousal scale.

Thinking of intercourse not as a pass/fail test apart from the whole sexual situation but as a normal another dimension, a gear 5 that most of the time it will flow to gear 5, but when it does, it doesn’t mean it was a failure or there’s something wrong wit you.

Chip August: Well if I understand your scale, the oral sex that I’m having in 4th gear may get me to that 10 on arousal scale anyway and be quite satisfying and fun once in awhile. The genital intercourse sex that I’m having in 5th gear sometime may not.

Barry McCarthy: Right, if you switch to intercourse and see it as a pass/fail test at a 3 or 4, it’s likely to give you trouble rather than enhance your good feelings about sex. That’s the danger that a lot of men fall into. It’s a totally unnecessary danger.

Chip August: This is pretty ingrained thinking, do I need to do affirmations everyday saying that I don’t really want intercourse?

Barry McCarthy: No, you don’t want to not have intercourse. You want to enjoy intercourse in your 60s, 70s and 80s but the big thing is you want to see intercourse as part of the sexual experience and not the pass/fail test of the sexual experience and you want to enjoy intercourse as a natural continuation of the erotic flow. You transition into intercourse at 7 or 8 in arousal and you do multiple stimulation during intercourse.

At 15% or 20% of the time where it doesn’t flow into intercourse, rather than panicking or apologizing, you’re comfortable switching to erotic non intercourse sex whether for both of you or just one of you or saying this isn’t going to be sexual night but let’s make this a sensual cuddling night and then be sexual the next couple of days when you’re feeling more open and receptive to being sexual. Take that rain check rather than just panicking. It’s a very hard sell with 20-30 year olds. It’s a very easy sell for wise 50, 60, 70 year olds and it’s much more of an easy sell for women than it is for men.

For women, most women, not all women but most learn sex as variable and flexible and value that. Men learn it as a predictable, controlled, pass/fail way and unfortunately the advertisements have reinforced that. Let me say one other thing that is, the Viagra, Cialis and Levitra probably caused more non sexual marriages than anything else in history since 1998. Not because they’re not good drugs, they are good drugs but because the man and the woman take with the idea that it’s going to give them the automatic erection and 100% of the time it’s going to go to intercourse and if it doesn’t they’re the only people.

You’re based in Seattle right?

Chip August: No I’m based in San Francisco.

Barry McCarthy: San Francisco, you’re the only person I know in the whole west coast whose failed in Viagra. The reality is, very few men go back to 100% erectile functioning. The great majority enjoy sex more, enjoy intercourse more but that 65-85% guideline is the way to go. Women say, look that’s my experience sexually. I’m not orgasmic all the time. That’s it’s OK to have variable, flexible experience. It’s the hardest sell for men.

Chip August: In my travels I meet many women in their 20s who may never had an orgasm or still find that orgasm with a partner to be a rare thing or a very special thing. I don’t think I’ve ever met a man in his 20s who hasn’t had an orgasm. It’s a very different relation to sexuality. The relationship to orgasm are very different between men and women.

Barry McCarthy: As men and women age though, two things happen that is the real plus. They need each other more, and I think that’s a real plus. The second is, that sex becomes more of a team sport. They need each other, it’s more a genuine kind of an experience that if it’s going feel good they’re going to need to enjoy each other and really value both the sensual, erotic and the intercourse experiences.

For the average, orgasmic woman, she’s orgasmic 70% of the time, not a 100% of the time. If you want a 100% orgasm, the way to go is to masturbate. With masturbation, you have that total control, with couple’s sex, it’s more nature, it’s more variable which I think is a good thing not a bad thing. But especially as you age people who adapt that view, those are the people who are going to continue to really enjoy sex as they age. Again the person who convinces not the woman, the person who convinces the man.

Chip August: I noticed that we’re not talking very much about fantasy here. We’re not talking so much about communication, about word and it seems to me that it’s such an integral. Everything you are talking about depends on a relationship where the couple can actually talk.

Barry McCarthy: One of the most interesting of all the new concepts in sex is this combination of intimacy versus eroticism. That the couples who focus talking a lot during the sexual experience, for most of those couples they wind up de eroticizing experience and getting self conscious. The best time to talk sex is not while you’re having sex, especially not after a negative experience. The best time to talk about sex is when you’re having a glass of wine on the porch or on a walk or sitting in a Starbucks.

Chip August: So this is more in your gear 2 range.

Barry McCarthy: Even on your walk, talking about what kind of erotic scenarios you want to try out when you’re being sexual rather than talking about it as you are being sexual.

Chip August: Right.

Barry McCarthy: The worst time to talk sex is after a negative experience when you’re nude in bed and you are vulnerable. People say thing that really  hurt each other’s feelings. So the question is, intimacy which is a really good thing, I’m always in favor of intimacy, is really about predictability, closeness and warmth. Eroticism by it’s nature is about taking personal and sexual risks. It’s about unpredictability. It’s about feeling highly turned on. The challenge for everybody is how you integrate eroticism into the same relationship.

You know I’ve done probably about 4045 sex histories and one of the things that depresses me is that half of the people say that their best sex was in their first 6 months of their relationship. That isn’t the way it should go. The first six months or the first two years of the time for romanticism and passionate sex and idealization. The challenge for on going couples whether married or unmarried, whether straight or gay is how to develop your couple style to integrate eroticism into your relationship.

Chip August: As long as we embrace it as a team sport, the team aught to get better and better the longer they play the sport together. It’s really kind of backwards when the thing run out of steam.

Barry McCarthy: Right and the idea that they need each other is a big deal because what most men find as early on is that they don’t need a woman but they very much do the woman as they age. And rather seeing that as a loss, I think you’re much better off, much healthier seeing this as a challenge and being smart and meeting that challenge so you can really enjoy sex as you age. If you enjoy sex as you age, it’s not only going to be good for your psychology well being, it’s going to be good for your physical health. There’s a lot of evidence and it’s more true of men than women that men who stop being sexual, it is really not good for their either psychological or physical health.

Chip August: I love that thought. I love that sex is actually good for my health.

Barry McCarthy: It is good for your health.

Chip August: We need to pause for a moment here for our sponsors. Listeners come back for the next segment because Dr. McCarthy is going to give us an exercise, something you can try at home which might help your own sexual health and your own sexual pleasure but right now we are going to pause for a break give a chance to support our sponsors. We’ll be right back.

[commercial]

Chip August: Welcome back to Sex, Love and Intimacy. We’re talking to Dr. Barry McCarthy and we’ve been talking about men’s sexual health and sexual fitness. Before we went into our break, Barry you were talking a little bit how a healthy sex life can help longevity in men and I want to just talk a few minutes about that so. Does that have documented evidence?

Barry McCarthy: Yes there is very good evidence about that. Men who are in healthy relationships including relationship that involve touching and sexuality live longer and have better quality of physical life. Let me be more specific about it, that the model that we talked about is a psycho bio social model. So you look at psychological factors and the big factor about aging is not thinking about it as loss but as a challenge. The biological issue, the big three is your vascular system, your neurological system, and your hormonal system and actually the biggest change is vascularly. One of the best ways of getting men to stop smoking is to tell them that it’s very bad for their penis. Stopping smoking including at 55 and 65  is a good thing to do. You want to do everything you can to keep a healthy vascular, neurological and hormonal system.

It’s also really important physically to understand that the average man over 60 is taking at least one medication, the average man over 70 is taking at least  two medications. Medications do not stop you from being sexual. What medications do is that they alter your sexuality so your vascular, neurological system is less efficient but that makes it more important for you to stay both physically healthy and to focus on the challenges and psycho sexual skills that we talked about.

The other thing is, if you are going to take testosterone replacement. You should definitely talk to an endocrinologist about that and do a cost benefit analysis but if you’re going to take testosterone replacement, make sure you take it in a gel form or the injection form. Do not take testosterone, systemically, in other words by mouth because that really rises medical risks for you that are totally unnecessary and not valuable. The best of the physicians, as your internist or an endocrinologist but basically you want to stay healthy. A lot of things I do, I have diabetes, I’ve had it since I was 30 is that I always walk 25 miles a week. Along with good eating patterns and reduced drinking and not smoking. Regular exercise is really healthy for your physical and sexual  health.

Chip August: Not really surprising and absolutely. I also think  that there’s a way that regular exercise promotes fitness which actually has a more in our body. The way I notice with America’s obesity epidemic, so many of us are embarrassed, ashamed of what our body look like and how our bodies feel that that also gets in the way of healthy sexuality.

Barry McCarthy: Absolutely, instead of accepting your body, you compare your body with the way the models with guys in R rated movies with people in porn video and that’s always going to intimidate you. You got to have a positive, accepting body image.

Chip August: It’s been great talking to you. I can’t believe the time has flown by so fast. If people want to purchase of your books or just learn more about some of the times you’ve been talking about, where would you send them?

Barry McCarthy: I’d send them to Amazon. The two books I most highly recommend generally for men, is the Men’s Sexual Health book which is published in 2007 and the Rekindling Desire book which was published in 2003. For men who are particularly concerned about erections, in 2004, first author called Michael Metz and I’m the second author called Coping with Erectile Dysfunction which I think is a dynamite and very helpful book for a bio psycho social approach to erection problems.

Chip August: Listeners we’ll highlight those on our website. You can actually go to the personal life media website and look at Sex, Love and Intimacy and find the interview with Dr. Barry McCarthy, where you’ll find text and transcripts of the whole thing. Also links so that you can just link right there to Dr. McCarthy’s book.

If you would want to contact me about the show or give me some feedback, you can reach me at [email protected] and for text and transcripts of the show or any of our shows you can just go to our website at personallifemedia.com. If you would like to call and leave a message for me about the show, we do have a voice mail system, you can call 206-350-5333. Please leave your name, leave the name of the show Sex, Love and Intimacy and your question or your comment and your phone number or your email address and  just know that when you leave a message there, you are indicating your agreement for us to potentially use it on air so if it’s something you don’t want on air don’t use that voice mail system.

Thanks for listening, I hope you join us again for our next show and until then have lots of sex, love and intimacy in your life. Bye for now.