Today, we're pulling back the curtain on erections with renowned clinical psychologist, Dr. Barry McCarthy, a diplomate in sex therapy and distinguished author of 14 books and over 100 scholarly articles on sexuality. Dr. McCarthy is here to tear down the walls of misconception surrounding erectile functioning. We'll be exploring the facts, debunking prevailing myths, and gaining a fresh and enlightening perspective on how to love your penis, or your partner's penis, through thick and foreskin.
Show notes:
00:07 90% of people with a penis who are between 35 and 55 have struggled to get an erection firm enough for intercourse
03:17 What is Erectile Self Efficacy?
03:40 Autonomous sexual erections aren’t realistic
04:42 The alternative to panicking and apologizing
04:52 The "Good Enough Sex" Model
05:26 It's almost always the man's choice to stop having sex
07:32 Where did we go wrong in having guys believe that sex is always supposed to be this one way?
07:53 Men have been lied to about their sexuality
08:21 Responsive male sexual desire
08:45 Men lie to each other about sex
08:51 Using medications as part of erectile self efficacy
09:14 Self-consciousness is the most anti-erotic thing you do
09:37 How to reduce performance anxiety
10:39 Grandfather of sex, Bill Masters
10:50 How do you know a man is cured of erectile dysfunction?
11:14 What to say when penetration isn't going to be part of the sexual experience
11:33 Good Enough Sex Model and Michael Metz
12:37 Working together as an erotic ally
13:44 Desire is not based on performance - desire is based on sharing pleasure
14:27 Orgasm is not the best measure of satisfaction
14:52 Waxing and Waning of erections exercise
16:44 Sex is more than penetration
16:48 What is sex?
17:13 Prostate cancer
18:46 How to know when you are ready for penetration?
19:34 Why do men fail with pro erection medications?
20:17 Pro-penis approach
20:48 Medical evaluation is very important
21:49 Don't assume that because you have a medical problem, like cancer, diabetes, or heart condition, that you cannot be sexual
22:15 Missionary style is not the best position in your 60's. 70's, and 80's
25:26 This show is produced by Katie Jensen at Vocal Fry Studios
25:32 Show ideas or questions? Email michelle@getsome.ca and follow me on Instagram @getsome_podcast
Michelle: One of the most interesting discoveries I've made as a sex therapist is how misunderstood male sexuality is. 90% of people who have a penis between the ages of 35 and 55 have struggled to maintain an erection that's firm enough for intercourse, insertion, or penetration. My name's Michelle Fischler and this is GETSOME.
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[00:00:26] So much about masculinity has been wrapped up in the penis and whether or not it's gonna get hard and whether or not it's going to ejaculate. And if the penis doesn't do one of those things, it can feel like a failure. And sometimes people avoid having sex altogether. Men's sexual needs have been narrowed down to just three little things, spontaneous erections, insertion, and ejaculation.
[00:00:54] And if one of those things aren't happening, watch out because people get extremely anxious and worrying about the problem can sometimes make it worse.
[00:01:04] Barry: Anxiety is the enemy of erections. Relaxation and acceptance is a friend of erection.
[00:01:13] Michelle: I've seen men suffering from the pressure they put on themselves, as well as the pressure their partners put on them to perform a certain way in bed.
[00:01:21] Locker room culture doesn't help.
[00:01:25] Barry: Traditionally men lie to each other about sex. That's why it's easy to lie to yourself. One
[00:01:32] Michelle: way of managing this is the good enough sex model, which is exactly what it sounds like. It's showing up exactly how you are and being open to experiencing pleasure with your partner without there being a destination or an end goal.
[00:01:48] It's just going along for the ride, going along for the journey.
[00:01:51] Barry: When I think about healthy masculinity, whether you're straight or gay, whether you're married or partnered, the issue is finding a couple sexual style that integrates three very different dimensions. Intimacy, pleasure, and eroticism.
[00:02:05] Michelle: Another way is erectile self-efficacy, which is exactly what it sounds like.
[00:02:10] It's accepting your penis exactly the way that it is. It's almost like becoming friends with your penis, and it's where sex becomes more about the experience of pleasure and less about whether or not you're hard being
[00:02:27] Barry: Being good to your penis, accepting your penis, treating your penis with empathy and respect and understand. That if you are not involved in giving or receiving, touching, your erection's gonna wane, but that if you stay relaxed and comfortable and open, it'll wax again.
[00:02:45] Michelle: There is no one better guest to show us how to do this than my guest today. Dr. Barry McCarthy is a well known sex therapist who has published a billion books and a ton of chapters, and a zillion journal articles, and he's here to give us the Tea.
[00:03:08] Here is my conversation with Dr. Barry McCarthy.
[00:03:17] Barry, please tell us about erectile self-efficacy.
[00:03:22] Barry: Well, the concept is one that is meant to motivate and empower men. And couples to really enjoy themselves sexually, and that what the man asked them, whether it's a mental health person or medical person to do, is return them to autonomous sexual erections that they experienced in their twenties.
[00:03:44] Basically, what the man is asking for, we cannot give him. That's an important concept. What we can give him is a new set of attitudes, behaviors, and emotion, and give it to his partner so that their sex is going to be better quality, more desirous, and more satisfying. The goal that it makes so much more sense is to adapt a variable, flexible approach to desire, to pleasure, to erection, and to intercourse.
[00:04:15] And that includes intercourse and orgasm as a really good thing, but not as a performance where it's either failure or success. And he's so used to the idea that he needs to return to sex in his twenties by its nature, sexuality is multi causal, multidimensional, and it's complex most of the time. It's wonderful.
[00:04:38] But when it doesn't flow to intercourse and orgasm, rather than apologizing or panicking, he turns toward his partner and says, this is not gonna be an intercourse night, but let's have a good time sexually. It's called good enough sexuality. You're really embracing pleasure, intercourse and orgasm, but not as a individual pass fail test, but as a couple process of sharing pleasure and sharing erotic.
[00:05:05] But it means adopting a new approach that says responsive male sexual desire is more genuine and more teachable than return to spontaneous erections and spontaneous desire. Spontaneous erections do not work so well in your thirties, forties, and doesn't work at all in your sixties, seventies and eighties.
[00:05:26] One of the things that surprises people, in fact, it shocks people. Is when couples stop having sex with aging, it's almost always a man's choice cuz he's lost confidence with erections and intercourse. And what we do with them is we say this idea of genuine, satisfying sex, turn towards your partner. And some of the time it's just gonna be sensual.
[00:05:49] Some of the time it's gonna be playful. Some of the time it's gonna be erotic, and some of the time it's gonna be intercourse. This idea that you can enjoy healthy sexuality without intercourse is very freeing for men, women, and couples.
[00:06:04] Michelle: Right, like when you're younger, it's the spontaneous erections are just more common.
[00:06:10] It's something that you're used to and you develop this belief that's just always how it's supposed to be, right? That, oh, you know, this feels good. Or you start touching yourself, you get an erection and then you ejaculate, but there's not a whole lot of room, or maybe not even an understanding that it's actually quite normal that there will be sexual encounters, especially I think over the age of 30 where it becomes more common that that's not exactly how it works anymore, right? That there are going to be moments where maybe you would think that you should be getting an erection and you don't. And I think it's how people handle that particular situation is incredibly important because when it happens once, depending on how they psychologically process situations and whether or not they have a tendency to be more of a worrier or feel more anxious, that then they start to hyper focus on whether or not they have an erection versus, "wow, this feels really good" and being in the moment. Where did we go wrong in having guys believe that sex is always supposed to be this one way?
[00:07:42] Barry: Well, I think that's what most men learn for the first 10, 15, 20 years of their sexual lives, and for some men, it can be to the 30 and 40 years of their sexual lives. Where we went wrong is we lied to men.
[00:07:55] We over promised, we said, this medical intervention or this psychological intervention is gonna return you to autonomous sex, rather than being truthful to him and saying, you can learn a new sexuality now. You can be a wise man and continue to be sexual, not just in your thirties and forties, but in your fifties, sixties, seventies, and eighties.
[00:08:17] But what wise men do is they embrace the idea of responsive male sexual desire. They embrace the idea that penises need to be treated in a nice way with respect, and that interactive, flexible sexuality is healthier than autonomous sexuality. And that makes a lot of sense to women. But it's a hard buy-in for men because men lie to each other about erections.
[00:08:44] They lie to each other about sex. That's why it's easy to lie to yourself. I, by the way, am in favor of biomedical resources. They're part of, uh, erectile self-efficacy. One of the best examples, non-medically, is instead of having three drinks before sex, have one drink. Hmm. Because basically alcohol is a central nervous system depressant, which is bad for your penis, but for many men it makes them less self-conscious.
[00:09:14] And self-consciousness is the most anti-erotic thing you do. But the other is many men really enjoy pro erection medications, especially low doses of daily Cialis. And it does two things. It doesn't give you an erection, but once you're turned on subjectively, It allows you to maintain the erection, plus it reduces anticipatory or performance anxiety, and that's really important.
[00:09:41] Anxiety is the enemy of erections. Relaxation and acceptance is the friend of erection.
[00:09:49] Michelle: Pornography doesn't exactly help.
[00:09:50] Barry: It makes for great erotic fantasy and to be able to stimulate yourself to orgasm when you masturbate, but it makes a terrible model for real life couple sex, and a real life couple sex is not second class.
[00:10:06] It isn't that young sex is best, middle year sex is poor, and old age sex is really problematic. No, it really is this idea of a challenge to see your partner as your intimate, and erotic ally. The new approach, which sees them as intimate, erotic friends who enjoy and turn toward each other, whether the sex was marvelous, whether it was good, or whether it was dysfunctional.
[00:10:33] It's normal to have occasional dysfunctional sex. The grandfather of the sex field, Bill Masters, when I was a much younger man, I finally got the courage at a workshop to walk up to him and ask him the question about erections. And he looked at me and said, you know how you know a man is cured of erectile dysfunction when he doesn't have an erection sufficient for intercourse, and he doesn't panic and he doesn't apologize, you know he is cured.
[00:11:00] Adopting good enough sex is the healthiest thing that the man and the couple can do for each other. And that means that most of the time the sexual experience is gonna flow intercourse, and it's gonna be positive. But when it doesn't flow or it's disappointing, you still turn towards your partner and say, this isn't gonna be an intercourse night, but let's have a good time sexually.
[00:11:24] Or you turn toward her and you say, let's have a warm, cuddly, sensual experience and feel good about that. No apologies, no drama.
[00:11:33] Michelle: Let's talk about the Good Enough Sex Model. I have heard you talk about this over the years, and the model makes. Complete sense to me. And there's also the way that you talk about it, which is continuing the legacy of your friend Michael Metz.
[00:11:55] Barry: It's basically Michael's model. Michael died about 10 years ago. He'd had a bone marrow transplant about 20 years before he died. And one of the things that he did was to see having his cancer. Part of that was being a biomedical challenge, but part of it is a psychological relational challenge that rather than apologizing, he said, I wanna really have a better relationship in my life and in my marriage, and to feel good about sexuality in my life up until the time that I die, which it was a wonderful, wonderful model.
[00:12:31] And the big essence of the model is not that it's second class or settling at all. It's first class you turn towards your partners, your intimate, erotic ally, that the essence is not individual performance, it's sharing pleasure, and that you need your partner in a way that you hadn't before you first experienced an erectile disappointment, and so the sex is more satisfying and it brings about increased rather than decreased desire. When
[00:13:04] Michelle: people come in to work with me, usually there's this idea that one person is the problem, right? Whether it's the person who's not able to perform or having erectile disappointment, or it's the person who's struggling with low desire or struggling with having an orgasm, and it really is working together as a good sexual team.
[00:13:39] Barry: Here's the concept that I think is a crucial concept, and that is desire is not based on performance. Desire is based on sharing pleasure. And that responsive desire, which means you're open to giving and receiving touch and you're open to each other's emotion is actually more teachable, but it's also more genuine.
[00:14:01] It really does feed desire and satisfaction in a way that performance doesn't. When I think about healthy sex, the mantra is desire first, pleasure, second, satisfaction, third, eroticism, fourth. All of them are really important for men, women, couples, straight, gay folks, whatever. I'm a great fan of orgasm for both men and women, but orgasm is not the best measure of satisfaction.
[00:14:30] The best measure of satisfaction is feeling good about yourself as a sexual man and more bonded as a sexual couple. That's the idea of satisfaction. Satisfaction is accepting yourself and feeling good as a desired and desirable person and a bonded person. There's an exercise that I always have my clients do, it's called waxing and waning of erections. Michael did it with over 2000 men, I probably did it with about 1200 men. Neither of us ever did it with any man who enjoyed it. It's a panic exercise; and what you do is when the man has an erection, he stops stimulation, so his erection will wane. If he stays relaxed and mindful and you engage in sensual and playful touch, his erection will wax again. Let it wane a second time. Don't go to intercourse until your third erection. Nobody likes that. I don't like it either.
[00:15:29] Michelle: Why is it that people really struggle with this whole concept of waxing and waning?
[00:15:35] Barry: I think they struggle because I wanna go back to the old days of a hundred percent predictable erections, rather than being good to your penis, accepting your penis, treating your penis with empathy and respect, and understand that if you are not involved in giving or receiving, touching, your erection's gonna wane.
[00:15:55] But that if you stay relaxed and comfortable and open, it'll wax again,
[00:16:01] Michelle: being in the moment, allowing sex to be more than just intercourse. That can feel so vulnerable for people, especially when their sex is very one-dimensional, where it goes straight from hanging out and right over to intercourse.
[00:16:20] Right? And it means then that there's all this space in the middle that people really have to work on and I think come to terms with some of their own beliefs and feelings about sex to be able to work together through this change in how their bodies are working
[00:16:43] Barry: and it means accepting the idea that sex is more than intercourse. Sex includes sensual touch, it includes playful touch, and it includes erotic, non intercourse, touch, and all of them are valuable and it isn't the frequency we had intercourse or we didn't have intercourse. We shared a sexual pleasurable experience, and that really does matter.
[00:17:06] Michelle: This conversation I think, is so important as well for people who have gone through prostate cancer, right, and where their erections aren't functioning in the same way, and even understanding whether or not they can even ejaculate or have an orgasm with a flacid penis.
[00:17:30] Barry: You don't need a firm erection to ejaculate. Now, after prostate cancer, you usually will not be ejaculating, but you're gonna have orgasms and you don't need a firm erection to have an orgasm.
[00:17:43] Michelle: Does the intensity of the orgasm change?
[00:17:46] Barry: For some people it does. For many people it does not. And often the partner, especially with heterosexual couples, will say, I like it better because I don't have to deal with the semen.
[00:17:57] Michelle: Is it just that it gets redirected back into the bladder?
[00:18:00] Barry: That's correct. For most men that's exactly what happens. Three out of four men do not re-establish their sex life after prostate surgery, but the quarter that do are really glad that they do. You deserve sexual pleasure after cancer. You not only survive cancer, and you should be proud of that, but you wanna enjoy your life after cancer and don't give cancer more controlled than it deserves.
[00:18:28] Michelle: What comes up often is guys who struggle with erections is what they will do is as soon as they start to get hard, will want to rush into intercourse or penetration. And sometimes this is before they're ready because they're afraid that they're gonna lose it. How are people supposed to know when it is that they should be attempting penetration in terms of like the firmness of their erection and also how they're feeling in their mind and in their body?
[00:19:03] Barry: The most important one is subjective arousal. Think about it on a 10 point scale. One to three is feeling pleasure, or feeling receptive. And then there's four out of six, which is getting into a playful approach to sexuality. Think about eroticism is going from six to ten, including ten being orgasm. What I say to people is, don't transition until your subjective arousal is at least a seven, ideally an eight. The major reason that men fail with pro erection medications is as soon as they get erect about their subject arousal, four or five, then they rush to intercourse for negative reason. And that's fear. Yeah. Remember, the essence of healthy sexuality is pleasure and it's relaxation, not fear and not performance.
[00:19:56] But I think the biggest struggle with the man is saying "is this really first class. Or is it just settling?" And I look them right in the eye, especially when the partner is there and I say, I definitely believe it as first class. I believe it theoretically. I believe it scientifically, and I believe it personally.
[00:20:16] And I think there's not enough of that pro male, pro penis approach. There's a kind of a contingent view of your penis as being not good enough.
[00:20:26] Michelle: And I think what we know right now about erections, is that the majority of erectile problems, especially for men under 50, are caused by psychological or relational factors, not necessarily medical or physiological factors and I mean, that being said, it is incredibly important to go for a comprehensive medical evaluation just to rule out any medical factors including side effects of medication or getting a referral to an internist or a urologist with training in erectile function and dysfunction.
[00:21:03] Barry: Probably the best doc is not a urologist, the best doc is an internist, uh, especially an internist with a subspecialty in endocrinology.
[00:21:15] Michelle: Can you say more about that? What exactly does an internist do?
[00:21:18] Barry: The internist was looking at the whole person, their whole body, and that one of the things you wanna do is you wanna look at the vascular system.
[00:21:26] The vascular system is the most important neurological, the second most important hormonal, a third most important, but do it in a comprehensive way. What is gonna promote and what is gonna subvert healthy sexuality? And again, don't assume because you have a medical problem, like cancer, diabetes, or heart condition, that you cannot be sexual.
[00:21:49] There is no medical problem, stops you from desire. It does change function, but it doesn't have to change desire and satisfaction. Again, it's a more humanistic, pro penis approach to men.
[00:22:04] Michelle: Exactly. And it's just this idea that sex does not equal to intercourse,
[00:22:10] Barry: And especially the old way of having intercourse. You know, 90% are men begin traditional intercourse men on top, short, rapid thrusting. That is not the best way to have intercourse for the man, the woman, or the couple in their sixties, seventies and eighties. Just
[00:22:28] Michelle: physically, you may not be able to hold yourself up in that way. Right? It's okay to find other ways, other positions that are more comfortable, and I think you've spoken to this as well around sometimes people are more used to having penetration or used to the sensations of, let's say, a vagina to orgasm and it doesn't mean that you can't then start to work on how you self-pleasure and self pleasuring in a way that feels good, and that is also then transferable to a pleasurable shared experience with somebody else, right? It's like transferring those skills, Right?
[00:23:24] Barry: And again, if sex was just about orgasm, neither the man or the woman would have couple sex. You're much more efficient in masturbation. Then again, I'm a big fan of masturbation, regaining your comfort and confidence with masturbation, but that in fact, what most people wanna do is that they want.
[00:23:45] To be able to integrate manual, oral, and rubbing stimulation into their couple sexuality, that sex is certainly involves intercourse, but it's much more than intercourse. Intercourse is not the essence of sex and it isn't a pass fail test.
[00:24:01] Michelle: Barry, we are going to start wrapping up and I was wondering before we do so, is there anything that I haven't asked you about that you would think would be really helpful for people to know?
[00:24:15] Barry: Well, I think the most important thing for your audience to know is the desire is the core of healthy sexuality more than erection. And desire is all about positive anticipation. It's a feeling that you deserve sexual pleasure in your life, no matter what's going on relationally, what's going on medically, what's going on in terms of aging and that freedom and choice, including your choice of being able to say, to veto something to say, I don't want this. You know, one of, when I work with couples, one of the things women are really enjoy having the power of Veto. Men usually do not use the power of veto. They say, real man never says no to sex. But one of the best ways of freeing up men is saying, I don't like this. This is too anxiety provoking or too performance oriented for me.
[00:25:09] Michelle: Thank you so much, Barry, for being here.
[00:25:12] Barry: Okay. It was definitely my pleasure and I hope it was valuable for your audience. It was a pleasure.
[00:25:21] Michelle: That was my conversation with Dr. Barry McCarthy.
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[00:25:26] This show is produced by Katie Jensen at Vocal Fry Studios. If you have show ideas or a question you want me to answer in an episode, email me at michelle@getsome.ca and don't forget to follow me on Instagram @getsome_podcast You'll get insights on sex and sexuality, dating tips, and behind the scenes between episodes. Thank you for listening.