Healing the Infertile Family: Strengthening Your Relationship in the Search for Parenthood, by Gay Becker. Reviewed by Matt Chamberlain. (order on-line)

This book review also touches on the reviewer's and his wife's struggle with infertility. Matt and his wife are now looking forward to having a child of their own.

Impotence. The one subject men won't talk about--even in men's councils and men's groups where men openly share their deepest feelings and fears.

For National Men's Health Week I thought I'd pull together some thoughts, ideas and resources about impotence to support men grappling with the issue and to encourage men to talk to other men about it. I stress that I have no special expertise on this subject.

What is impotence? Is it loss of sex drive, not being "turned on" by the sight of a beautiful woman or not wanting sex with your wife or partner as often as you think (or she thinks) you should? Is it failure to reach climax? Is it failure to obtain or sustain an erection? Or is it that the erection is half-soft, not as hard as it used to be? I don't know. The clearest answer I've seen in my research so far is "all of the above." Yet each seems to involve a different mix of attitudinal, psychological and physiological factors.

So why don't men talk about it more? It strikes too closely to the core of our own masculinity--what it is to "be a man." If we admit vulnerability or "weakness" in ourselves, other men and women, we fear, will think we're "less a man."

This is not simply a matter of "performance." I know there are many out there who are quick to put men into the "macho" role--"all they think about is their dicks." That misandrist attitude that men only think of "performance," indeed, is part of the reason why men don't seek the help they need. But what of the man whose wife is experiencing what Margaret Meade calls "post-menopausal zest"? And haven't feminists encouraged women to express, rather than hide or be ashamed of, their sexuality and sensuality? Is a man suffering from impotence simply a "macho" man worried about having the biggest, hardest dick in the valley? Well, maybe he's simply anxious to provide his wife or partner with the physical intimacy that they both see as important to their relationship. Not every man reaching for the Vagira is a dirty old man trying to act like an adolescent, despite the all-too-common misandrist media caricatures. Women, as well as men, are hurt by male impotence.

Because men don't talk honestly to each other about their sexuality, they often have no idea that a waning interest in sexual "endurance" and a less-hard erection are a natural part of growing older, and mean a shift of emphasis in sex rather than the end of sex. As men get older--as I get older I see the beauty and intimacy of a more laid-back, leisurely sexual encounter. It always struck me as unfair that men only have a few seconds of orgasm--of "coming." But as I focused less on "how hard, how quickly, how often and how quickly I'm ready for the next one" I found that the orgasmic state is not limited to that instant of "coming." For this, I credit in part one book, Mantak Chia's The Tao of Male Sex. His more recent book, the bestseller The Multi-Orgasmic Man, has more information. This approach, I feel, helps remove one's fears of impotence and allows a man to enjoy new levels of intimacy with his partner, regardless of sexual "performance."

Jed Diamond has a very helpful overview of factors contributing to impotence and treatments for impotence in his book Male Menopause. He uses the definition "consistent inability to have or sustain a consistent erection." He observes that impotence used to be thought of as a psychological disorder best treated with psychotherapy. But recently researchers have found most cases of impotence are based in the body. Specifically, 80-90% of all chronic impotency problems are based on physical imbalance caused by a variety of stressors, including diabetes, heart disease, hypertension and medications taken to treat these disorders. But psychological factors are also key, especially for men who are often angry or who are depressed. Anti-depressants like Prozac also contribute to impotence.

Regardless of the "primary cause," Jed points out, once it begins psychological, physical and interpersonal factors interact in a downward spiral that makes it difficult to return to full function.

So how does Pfeizer's new impotence "wonder-drug" Vagira fit in? Jed will address this topic in the updated paperback release of Male Menopause, due out in September. Off the top of my head, I'd say that Vagira may temporarily restore potency and thus break the downward spiral that Jed talks about, but if the underlying psychological, physiological and interpersonal factors aren't addressed, Vagira will remain only an expensive and temporary solution, albeit better than the penis pumps and injections and other treatments that Jed outlines so well in Male Menopause.

Herb Goldberg's out-of-print The Inner Male, published over a decade ago, is still a valuable book on relationships. His thesis is that, no matter how "liberated" men and feminists think they are, relationship patterns are still often very heavily influenced by what he terms unconscious gender "undertows." He has a major section devoted to impotence. He asks a very interesting question, "Do you have difficulties with sex with your wife, but still get aroused by other women?" Even when both parties will tell you the relationship is going well, he asserts, the body does not lie. Impotence may be a message from the body that there is hidden anger or resentment that needs to be addressed if the relationship is to work.

Gail Sheehy, author of the bestseller Passages, New Passages and The Silent Passage (about menopause) has a new book, Understanding Men's Passages: Discovering the New Map of Men's Lives. (I have just completed an interview with Ms. Sheehy, which will be published in Men's Voices and on MenWeb soon.) Here are some bullets from Part IV, "Who's Afraid of Male Menopause?"

• The major change in the last five years has been the increasing youthfulness of men complaining to doctors of impotence.
• The most common complaint of married couples today is a lack of sexual desire.
• The problem for these premidlife men is inflated expectations.
• The chances are, if you're a 45-year-old boomer male, there's nothing wrong with you.
• 52 percent of healthy American men between ages 40 and 70 can expect to experience some degree of impotence.
• 40 percent of normal, healthy males remain completely potent at 70.
• You may slow down a bit, but you are an awful lot better at it. You are more cooperative.
• Sexual desire and activity are a barometer of a man's general health.
• Vast improvements in mid- and later-life sexual vitality can be created by making changes in an unhealthy lifestyle and taking a more positive psychological approach to aging.
• Prevention--through exercise, good nutrition and other healthy habits, and cultivating intimacy with a mate and more friends--is the key to minimizing the adverse effects of aging and stress on male potency.
• First question: Are you really suffering from impotence? "If he tries to make love to his wife or companion and fails, but when he's alone and wakes up and masturbates he reaches orgasm, he's not impotent."
• Second question: Could it be a hormone deficiency?
• Most males go to sexual dysfunction clinics because of their spouses.
• In the near future most men should be able to manage the middle-life male potency crisis as successfully as women have learned to manage their menopause.

Conclusions from all this information I've presented? I have none. I hope that somewhere in this information there is something that will help you or a man who you know, who is worried about impotence.