PW, or penis weakness, is a major problem for the majority of men. What is most shocking, however, is that this epidemic is one of the best-kept secrets in America, and probably throughout the world.
If my experience as a busy urologist is an accurate gauge, the last twenty years have seen a dramatic rise in both real sexual dysfunction and imagined inadequacy.
There is far more of the imagined variety: huge numbers of men think they are deficient in some way, or assume there is something wrong with them, or fear they are abnormal.
Some come to see me specifically to talk about their sexual concerns. Most of my patients come because of other urologic problems—kidney or bladder disorders or prostate conditions—but even they find a way to bring up their penis anxieties.
A patient might have a minor complaint such as a blemish, an irritation, an itch, or a burning sensation when he voids (urinate). But my experience is that he also has something else on his mind. I can almost predict the moment—as he is putting on his pants or reaching for the exam room doorknob—when he says, “By the way, Doc …” and follows with a description of his true concern, as though it were a mere afterthought.
What are male patients usually concerned about?
Male Penis Anxieties: Common Questions About Size and Function
Male penis concerns boil down to two categories: size and performance.
With all due respect to Dr. Freud, women do not have penis envy, they have penis curiosity. It is men who have penis envy. “Is it of normal size, Doc?” they wonder. “Shouldn’t it be bigger?”
Some even ask if I have a way to make it longer or wider. (I cover the ever-popular issue of size in my book.)
The more frequent questions from men are actually about performance. These questions cover three areas: sex drive, erections, and ejaculation.
Older men worry because they seem to have lost their libido. Middle-aged men are upset because they used to desire sex as often as they could get it, but now make love only a few times a month. Even young men are occasionally concerned about their sex drive: “My friends are horny all the time. It’s all they think about. I’m not the same. Is there something wrong with me?”
Then there are erection worries: “I can’t get one”; “It takes me longer to get hard”; “I can’t get it up more than once a night now”; “I lost it right in the middle of foreplay!”
And, of course, there is ejaculation distress: “I can’t come anymore”; “I used to have a big payload, now it’s just a little squirt”; and “My partner complains it takes me forever.”
The biggest panic-inducer of all: “My lover says I come too fast.”
Is the Problem Medical, or Is It Mental?
Some of the questions my patients raise reflect serious medical conditions. Wherever that is even a remote possibility, I treat it as such. A small percentage of sexual dysfunction complaints come from bona fide medical problems. Most of these cases are older men with organic disorders that impede their ability to achieve an erection adequate for penetration (the classic definition of impotence).
A number of physiological conditions can cause impotence. These include arteriosclerosis, diabetes, hormonal disorders, injuries, multiple sclerosis, reactions to medication, substance abuse, and the physical effects of aging.
Physicians have made tremendous advances in the science of diagnosis and treatment of erectile dysfunction. Sophisticated tests can now determine the exact cause of the problem or, equally important, can rule out underlying medical causes.
We also have a varied repertoire of excellent treatments for medical penis weakness. All of these will be described in later chapters. Here, it is enough to say that only a small number of patients who complain about their penises have genuine medical conditions.
The majority of complaints I hear daily are expressions of insecurity. They have no medical basis. They are variations on one fundamental anxiety: “Am I normal, Doc? Am I okay?” In most cases, my answer is unequivocally yes.
Penis Power™ is largely psychological.
I tell my patients that Penis Power™ (the opposite of penis weakness) is 1 percent between the legs and 99 percent between the ears. Of course, this is more a figure of speech than a real statistic, but I stand by the spirit of my words—the majority of men have a perfectly normal apparatus. There is nothing wrong with them physically or anatomically. Whatever problem they have, or think they have, originates in their minds. This is the case even when the mind expresses itself with a penis that refuses to obey orders.
Some men have chronic sexual dysfunction that is cause for serious concern. This dysfunction not only affects their personal satisfaction and their self-image, but also their relationships and the happiness of their partners. When these problems are rooted in deep psychological conditions such as depression, childhood sexual abuse, or some debilitating inner conflict, they are served best by a qualified psychiatrist or psychotherapist.
Such cases, however, are the exceptions. Most men can help themselves with a simple change of behavior and an attitude adjustment. (Described in detail in my book.)
Most of the men who worry about their penises are perturbed because of the erroneous notion that they don’t measure up to some mythological standard.
When it comes to sexuality, ignorance can be disastrous.
The nature of the brain/penis axis is so delicate that a lack of confidence or a fear of failure can easily become a self-fulfilling prophecy. If you think you are abnormal, if you are anxious about performing adequately, if you are afraid that your partner might be disappointed, then chances are you have already worried yourself into creating the very problems you fear.