From the Vault: (No) Wonder 2023
Patriarchy (Originally Published 3/8/23)
The Toxin in Toxic Masculinity
Hi there, (No) Wonder-ites!
Senator Josh Hawley, the insurrection-cheerer whose wife kisses him with obvious less-than-passion, frequently bloviates about how masculinity is in crisis. Dude even wrote a whole book about it, just in case you’re ever tempted to care what a guy the Kansas City Star called a “fleeing coward” thinks about masculinity. (1)
May we all have the confidence of mediocre white men.
I do actually agree with him that masculinity is in crisis, though. But we are diametrically opposed as to the nature of the crisis and its solution. Senator Hawley laments that a waning patriarchy – loss of “traditional” values, institutions, and societal structures that discount the autonomy of all but wealthy white cishet Christian men – is the problem, and proposes the return to rigidly restrictive gender norms as a solution. When people’s autonomy doesn’t align with the patriarchal expectations of white cishet men, his solution is to limit people’s autonomy to match cishet white men’s patriarchal expectations, not to help white cishet men develop the emotional skills and literacy to help them meet their emotional needs in a healthy way that recognizes and honors the autonomy of those around them.
I propose that the real masculinity crisis is this: cishet men have bought into a patriarchal myth that our emotional needs will automatically be met – with no emotional effort on our part. Society has catered to the emotional state of white cishet men for so long that we never developed emotional awareness, communication, or literacy… because we never had any incentive to do so. (Why should we have uncomfortable, vulerable conversations about our feelings, if our emotional satisfaction is our God-given right?) When other people’s autonomy conflicts with our patriarchal Weltanschauung, we feel aggrieved because our expectations haven’t been met. And because we never developed the emotional skills to process it, we blame women, LGBTQIA+, people of color… well, anyone with the audacity to diverge from the patriarchal script. Patriarchy thus sets cishet men up for emotional failure by raising their expectations to a level incompatible with real-world contentment – AND by keeping them from taking responsibility for their own emotional state, putting the onus on others to do so. Ever wonder why so many of our parents exemplify that famously toxic narcissist/codependent relational dynamic? That’s not a coincidence. It’s a feature of patriarchy, not a bug.
Patriarchy is the toxin in toxic masculinity.
Read it again. Take it in. Quote me on it. Make it my epitaph.
MERRIT DEBARTOLO, 1983-20XX. “Patriarchy is the toxin in toxic masculinity.”
You may be saying to yourself, “Self, what does this social commentary have to do with intimacy and sex-positivity?” In her book Come As You Are – a truly EXCELLENT read – Dr. Emily Nagoski frequently and correctly notes that intimacy and arousal are exquisitely context-dependent. Intimacy does not occur in a vacuum, but in the context of relationships – and in the context of society. Any of a number of contextual factors can enhance or impede intimacy. A relationship with clear boundaries, mutual respect, open communication, and the expectation that each partner will take responsibility for their own emotional health while trusting the other to do the same… enhances intimacy and minimizes external interference on intimacy. On the other hand, a relationship fraught with resentment from tacit unmet expectations, exhausting power struggles, emotional ambiguity, and a constant run-and-chase dynamic… will leave very little room for enjoying intimacy together.
However, the stakes of patriarchal/toxic masculinity are much higher even than this. Studies on the involuntarily celibate (“Incels”) demonstrate that their defining characteristic is a “high tendency for interpersonal victimhood,” i.e. abdicating responsibility for their own emotional state and putting the onus instead on others around them. (2) Patriarchy sets the tone for this interpersonal victimhood complex; when people around them don’t honor their end of the tacit patriarchal “bargain,” they feel they are an unfairly wronged victim. At its worst, this can become deadly for all involved. Show me a mass shooter and I’ll show you a young, most likely white, cishet man who became disillusioned when patriarchy’s empty promises left him unsatisfied and lacking the emotional tools to process it in a healthy manner – and a written manifesto documenting the same.
Your feelings are no one’s responsibility but your own. And other people’s feelings are their responsibility, not yours. Your emotional needs won’t get met unless you take the initiative to own, process, and vulnerably articulate your feelings – asking for and receiving professional help if and when necessary to do so. How’s that for “manning up?”
Down With Patriarchy,
Merrit
PS. In our Sex Therapy graduate school classes, we watched this poem “10 Responses To The Phrase ‘Man Up’” and it has lived rent-free in my head ever since.
https://www.youtube.com/watch?v=QFoBaTkPgco
1. https://www.kansascity.com/opinion/editorials/article263718073.html
2. Costello, William & Arevalo, Vania & Thomas, Andrew & Schmitt, David. (2022). Levels of well-being among men who are incels (involuntary celibates). 10.31219/osf.io/tnf7b
“Normal Sex?” (Originally published 2/28/23)
“Normal Sex” is that to which all involved parties enthusiastically consented.
Hello there, (No) Wonder-ites,
“I just want to have normal sex again.” It’s a common presenting complaint among patients looking to address their erectile dysfunction. And whenever a patient alludes to “normal sex,” I ask them to clarify what exactly they mean.
“’Normal sex.’ Could you please explain that further? What is normal sex to you?”
When I ask this question, it often stops patients in their tracks. It makes me wonder if I am the first person who has ever asked them to clarify specifically. Even if I’m not, they are rarely ready to explain something they feel to be as painfully obvious as it is uncomfortable to discuss.
What follows is almost always some variation of explaining Vanilla Missionary-Position Penis-In-Vagina (PIV) penetrative intercourse. Some will do that Index-Finger-Of-One-Hand-Going-Into-And-Out-Of-A-Circle-Created-By-The-Thumb-And-Forefinger-Of-The-Other gesture. Some impatiently repeat themselves, “You know… NORMAL sex!” as if to imply “WTF man, how are you a whole-ass DOCTOR – a UROLOGIST no less – and you don’t know NORMAL sex obviously refers to Vanilla Missionary-Position Penis-In-Vagina penetrative intercourse?!” Another responded, “You know… the sex that’s NORMAL to EVERYONE” before explaining they were referring to PIV.
(Normal to everyone? That’s just, like, your opinion, man!)
Somehow, Vanilla Missionary-Position PIV intercourse – an activity in which the vagina owner orgasms only 21-30% of the time (1) and which excludes many enjoyers of sex (e.g. LGBTQIA+, disabled, kinky) – became the gold standard. The activity we are supposed to ASSUME is being referenced when talking about “sex” or “normal sex.” To such an extent that many patients call it “normal sex,” and some even assume it’s normal for everyone.
The cisheteronormative, patriarchal assumption that “normal sex” refers to PIV may spare a (very select) few folks an uncomfortable, vulnerable discussion about what type of sex they enjoy and who they are as sexual/erotic people. Avoidance of clear and vulnerable conversations about sexual and erotic identity, fostered by the pervasive sex-negativity in our society, is likely why the “PIV as default” trope persists and patients will sheepishly be all like “you know what I mean…” rather than clearly communicating what it is they actually mean.
But assumption is a POOR substitute for earnest discovery and clear communication. As my sex therapy mentor, Dr. Markie Twist (https://drmarkie.com/about/) often says: “If you can’t talk about sex, you shouldn’t be having it.”
Assuming that PIV is the “normal” or “default” sexual activity holds us back from exploring, accepting, and communicating what intimate and erotic activities turn us on most. Once we’ve told ourselves as inviduals, and as a society, that intimacy begins and ends with PIV, then exploration and communication stops. Assumption replaces communication. At best, this “PIV as default” assumption limits the depth and breadth of our intimate expression and fulfillment – even among those of us who enjoy PIV. At worst, it prevents people from discovering and realizing their gender, sexual, erotic, and relational identity. At its VERY worst it allows people to mistakenly think that they are inherently flawed because they don’t enjoy PIV, or because it excludes and doesn’t apply to them. Just because PIV doesn’t include or excite you, that doesn’t necessarily mean you aren’t into sex or have low sexual desire. It simply means you are not into one specific, narrowly-defined version of sex.
If you went to Baskin-Robbins and had the little taste spoon of Vanilla, and didn’t like it, would you immediately conclude that you don’t like ice cream? Of course not! They’ve got 30 more flavors to try! So while it may yet be possible that you still don’t like ice cream (which is also valid/normal/grand, hence the A in LGBTQIA+) it’s also possible that you may not yet have found the flavor that gives you the most satisfaction. That is not your fault, and woe to anyone who suggests otherwise.
I’m not here to yuck PIV if it is your yum, but to expand the definition of “normal sex” to include any intimate activity to which all involved parties enthusiastically consent. This encourages discovery and clear communication, while including sexual identities and expressions that PIV excludes.
More Communication Less Adjudication,
Merrit
The Intimacy Portfolio (Originally published 3/4/2023)
Diversify your 401(lay)
Hi (No) Wonder-ites!
I often reflect on how finance and sexuality are two of life’s most important topics – and also two topics the Powers That Be consider “inappropriate” to discuss openly.
But… who benefits when we don’t discuss these topics? And who suffers unnecessarily? (And how did “not talking about Bruno” work out for the family Madrigal?)
Staying silent about your salary allows your employer to get away with paying you less than your coworker because it’s “impolite” to talk about finance. On the other hand, talking openly with your coworkers about your salary may reveal inequity, that your coworker is making more than you despite that you both have similar training and qualifications – knowledge which may ultimately require your employer to (gasp!) pay you more fairly. Similarly, silence around sexual/gender identity may allow queer folks to think (mistakenly) that they are inherently flawed because cisheteronormativity doesn’t resonate with them. But allowing open discussion of their identity would allow them to (gasp!) live as their authentic selves and receive validation.
When communication stops, assumptions take over – for the benefit of a very select few and the needless suffering of many. When we don’t communicate knowledge about finance, we assume that we are being paid fairly even if this isn’t the case. When we don’t communicate about sexuality, we interpret society’s failure to validate our identity as a personal shortcoming rather than a societal problem. Inequity thrives in silence.
Another parallel between finance and sexuality is the importance of diversification. If you’re fortunate enough to have discretionary income – now a rarity thanks to the Boomers and their FYIGM mentality having wrecked the economy – you may have had an opportunity to allocate this to different asset classes such as stocks, bonds, real estate, gold/silver, or (LOL) cryptocurrency. Similarly, we can cultivate many different kinds of intimacy in our Intimacy Portfolio: intercourse (PIV), touch, massage, clitoral stimulation, use of vibrators, role playing, tantra, fetishism, BDSM… and pretty much anything our imaginations can come (cum?) up with as long as it’s consensual.
It makes sense for an investment portfolio to have holdings from different asset classes, as strong performance from one asset class can sustain the portfolio even if another asset class performs poorly. Investors who went all-in on cryptocurrency are probably wishing they had allocated some assets differently.
And so it is with intimacy. As I’ve discussed previously, PIV enjoys widespread preferential status as the “default” or “preferred” mode of intimacy in our society. This belies the unreliability of PIV as a form of intimacy – 40% of penises start exhibiting signs of erectile dysfunction after the age of 40. (1) Thus PIV is the most volatile holding in your Intimacy Portfolio, a poor long-term intimacy investment. You’re loving life and enjoying the ride while it’s performing well… but when it inevitably crashes, you and your partner(s) are in for a rude awakening if you haven’t developed other intimacy skills – not unlike the crypto bros who honored PT Barnum’s memory by taking L’s so publicly and hilariously.
Save the L’s for the crypto bros, not your intimacy. Use your imagination, creativity, and communication to diversify your Intimate Portfolio. This way, non-PIV intimacy will win the day and sustain the intimacy when erectile function inevitably declines. By all means enjoy PIV while you still can, but remember that erectile function won’t last forever. Memento mori.
It’s also worth mentioning that cultivating non-PIV intimacy can help improve erectile function. It may sound paradoxical, but it’s absolutely true. Before the advent of phosphodiesterase-5 inhibitors such as Viagra, the mainstay of ED treatment was Sensate Focus Exercises. (2) Popularized by Masters and Johnson, the idea behind Sensate Focus Exercises is to take the intimate focus off of erectile function (with its associated uncertainty and anxiety) and shift it to the reliably pleasurable stimuli of touch, texture, temperature, and pressure. With enough practice of Sensate Focus Exercises, patients eventually become so proficient at enjoying intimacy through reliably pleasurable means that they no longer have to fear ED… and this lack of anxiety improves erectile function. Once you learn where the clitoris is (and how many different ways there are to stimulate its 10,280 nerve fibers), the comfort of knowing that ED won’t automatically and abruptly end sexy time will improve your erectile function.
Lastly, similar to investing, small gains in intimacy compound over time. The idea of broadening your repertoire of “outercourse” may not sound so appealing now, but when you’re 50 and erections are no longer what they used to be… you and your partner(s) will be glad you did.
A Penny Saved Is a Penny Earned,
Merrit
Hurts So Good (Originally published 3/5/23)
At the Intersection of Pleasure and Pain
Hi (No) Wonder-ers,
I generally try to avoid shopping malls like the plague (Aside: We should probably retire that phrase given how weakly people resist plagues anymore… but I digress). But when I’m unfortunate enough to find myself in a shopping mall, I look for the Pepper Palace. Pepper Palace sells every type of hot sauce imaginable, covering a wide range of flavor profiles and Scoville Unit thresholds, and allows potential customers to taste before buying (or not buying).
Years ago, I had completed an errand that required me to go to the mall. I had almost escaped when I saw the Pepper Palace beckoning. Its logo, a smiling sunglasses-wearing anthropomorphic red cartoon pepper, invited me in for a tasting sesh. Having completed the necessary mall task, I accepted the cartoon pepper logo’s invitation. I’d earned it, right?
I briefly glanced at the wooden shelves of hot sauces and rubs before noticing the tasting display. I requested new little tasting spoons and went to town. After sampling their mostly sweet tasting offerings, I asked the clerk if they had anything hotter than the featured tasting selections. They pulled a black bottle off a nearby shelf: “REAPER BARBEQUE.”
“This is the hottest product we have.”
“May I please have a try?”
“Sure, but be warned that it’s VERY-“
“Yeah yeah, may I please have the spoon?”
The clerk obliged, poured some of the sauce onto a plate, and gave me the spoon. I scooped some of the Reaper Barbecue with the spoon and took a lick. It started off with a smoky essence for about 2 seconds. 2.2 million Scoville Units later I was flushing and sweating from every pore, sinus, and lacrimal duct. I felt so hot, so uncomfortable… and yet so alive?
Through the tears, sweat, and snot I blubbered, “I’ll take it!”
Reaper Barbeque took me right to the intersection of pleasure and pain. Its stinging, scorching heat stretched my sinuses and taste buds to their limit… bringing a wave of inexplicable pleasing satisfaction.
It turns out there is a biological explanation for the pleasure that comes with certain forms of controlled pain: in response to pain, the pituitary releases endorphins that block pain receptors (mu-opioid receptors) and increase release of dopamine. (1) However, this phenomenon (“hedonic flip”) is highly dependent on context and emotional state; if the pain experience is not voluntary and there is no consent from the participant, the hedonic flip does not occur and the painful experience remains so. (2,3)
We subject ourselves to all kinds of pain that ultimately brings with it some pleasure: long-distance running, weightlifting, hot massages, tattoos, piercings, medical school, residency… the list goes on. So is it really a surprise that some folks enjoy incorporating this into their intimacy in the form of bondage/domination/sadism/masochism (BDSM) activity and kink?
Why do marathon runners and weightlifters get medals, while enjoyers of BDSM kink get a DSM diagnosis – along with the legal/societal implications it brings? (4) Does that make sense? Is that fair? They all reach that same intersection of pleasure and pain, albeit through different mechanisms that honor the consent and autonomy of all involved. Endurance athletes and BDSM kink enjoyers are thus more alike than different. So long as there’s enthusiastic consent among all parties involved, take those endorphins however you can get them.
Let Your Freak Flag Fly,
Merrit
1. https://www.sciencedirect.com/science/article/pii/S1389041720300772
2. https://medium.com/illumination/the-spice-of-life-why-pain-might-cause-pleasure-and-enjoyment-170c0663d93f
3. https://pubmed.ncbi.nlm.nih.gov/31010393/
4. https://www.theatlantic.com/health/archive/2015/01/bdsm-versus-the-dsm/384138/
The Quality of Quantity (Originally published 3/12/23)
“We’re talking about practice.” – Allen Iverson
“How many of these have you done before?”
Whether we are discussing kidney stone surgery, prostate surgery, or vasectomy… patients frequently ask me how many of a particular procedure I have performed. It makes perfect sense: If I am going to undergo surgery, I’d like to know how frequently the surgeon performs it. I’d like to know how much practice the surgeon has had in performing the procedure. Not only is it common sense, research shows that a surgeon’s operative mortality and volume are inversely related – the more frequently you do something, the better you are at it. (1)
Yet somehow, many discount this common-sense evidence-based notion when the subject changes to sexuality. Instead of embracing science and common sense, many unironically believe the reverse – that antiquated notions of virginal purity and (shudder) “low body count” matter more than experience and practical knowledge.
By the way… if you are on a date and someone mentions “body count,” and they are not referring to slasher movies or Shakespearean tragedy, then you would do well to realize that you *left something in your car* and drive right away that very instant. There are 8 billion people in the world, and life is too short to waste any of it on that person.
Imagine if we all got similarly weird about surgery, if we a favored a surgeon’s “virginal purity” and “low body count” over operative volume and experience – “I don’t want you inside me if you’ve been inside anyone else.” Patients prioritizing virginal purity over practical experience would be choosing a “pure” rookie over a “promiscuous” seasoned surgeon – and choosing a worse outcome. It would contradict both common sense AND a body of objective evidence.
Given this, why let such a focus dictate our sexuality? If science matters to you – and it should – you would view potential partners’ sexual experiences with favor rather than scorn. They likely went through some awkward first-time experiences so you won’t have to. (You’re welcome!) The science is clear, and it doesn’t care about the feelings of slut-shamers.
So once you have done your due diligence with regard to STI precautions… by all means embrace the sexuality improvements, “tweaks,” and lessons potential partners may have learned along the way – and build upon them.
Practice Makes Perfect,
Merrit
1. https://pubmed.ncbi.nlm.nih.gov/14645640/
Context: The Mood (Originally published 3/15/23)
Creating Your Own Luck
Hi there, (No) Wonder-ites!
Many cis men I see in clinic for fatigue, low spontaneous sexual desire, and/or erectile dysfunction have already diagnosed themselves with Low T. No, it couldn’t possibly be the poorly controlled diabetes, the decades-long pack-a-day tobacco habit, the sleep deprivation, the economic uncertainty, the overbearing boss, the physical pain of their literally back-breaking work, the blood pressure medications, the strained family/relationship dynamics, the traumatic past, or the internalized sex-negativity.
Nope, couldn’t be any of that. It’s gotta be Low T, the commercials said so.
Wait, testosterone level is normal?! Now what?
The “now what” is addressing the aforementioned, which is invariably more involved than simply injecting some testosterone. However, it also involves doing what (sometimes very little) we can do to ameliorate the context in which intimacy occurs. As Dr. Nagoski, author of my favorite intimacy resource Come As You Are, reminds us… intimacy is exquisitely context-dependent. The same touch, the same stimulus, can be sensually titillating in one context and annoying in a different context. A gentle caress on the nape of the neck after the kids are sleeping and y’all are snuggled onto a couch watching cheesy Rom-Coms over Reisling? Titillating. The same caress while there’s much work to be done and unfed kids noisily scampering about? Annoying.
I sometimes semi-joke with patients that given the baseline stress level inherent simply to existing as a human in 2023, it’s a small miracle anyone experiences sexual or genital arousal anymore. It usually elicits a polite chuckle from patients, but the joke has truth.
Thus, improving the context can help enhance our intimacy – or even create intimacy opportunities where there were none before (Looking at you, Mr. “My Penis Still Works But I Never Get A Chance To Use It Anymore!”). But how can we improve our context? If cheesy Rom-Coms reflected reality, all you’d need to do is hoist an ‘80s boombox above your head, play Peter Gabriel’s “In Your Eyes,” and – Bob’s Your Uncle – instant intimacy, just like that.
However, improving context is rarely (if ever) as simple as performing one Grand Romantic Gesture or buying That Thing Advertisers Promise Your Partner(s) Will Love You For (and GOD HELP YOU if it’s a vacuum cleaner!).
Creating a favorable intimate context is an ongoing, collaborative, communicative process. Each partner infers what turns the other(s) on and off, and *ideally without external prompting* acts surreptitiously in a manner that enhances the turn-ons and eliminates (or at least mitigates) the turn-offs. (N.B. The *without external prompting* part is key, because even asking how you can help, though well-intentioned, still puts a mental load on the one creating the To-Do List… so while it’s good to ask when you need clarity, it’s ultimately best to spare partner(s) the mental load of discerning what needs doing.) For example, your observations may reveal that a disorganized or unclean living space causes your partner(s) to feel overwhelmed, anxious, or otherwise not “in the mood.” In this case, grabbing a broom and taking some initiative to clean the place will do much more for your intimate context than simply plopping a vase of red roses onto the table next to last week’s unsorted mail. (Never underestimate Mr. Clean’s sex appeal!)
Unfortunately, society does create adverse contextual factors beyond our ability to control them. Unless you have the power to create a living-wage job and hire your partner(s), economic uncertainty will remain a damper on intimacy and life. In the real world, sometimes there is only so much we can do to optimize our context. It bears repeating that many of these societal turn-offs are rooted firmly in patriarchy. Patriarchy reduces cishet men to entitled, poorly communicative, empathy-bereft emotional lightweights… and curtails the freedom and socioeconomic prospects of everyone else. It is thus a turn-off for everyone, even those who are “supposed” to benefit. So if you want to get serious about optimizing your intimate context, you had better get serious about smashing patriarchy.
Lastly, optimizing context may involve assessing the relationships themselves. Needless to say, an exhausting – or worse, abusive – relationship will create a context where intimacy of any kind is virtually impossible, and the only way of improving the context may be to end the relationship altogether. Which of course is always easier said than done, especially given the physical threats to which one exposes themselves (and their children, if any) in doing so.
Or, optimizing context may be more introspective in nature. It may involve a vulnerable admission that for any number of reasons (e.g., trauma, mental health conditions, chronic medical conditions, neurodivergence) your current state is not conducive to intimacy, and vulnerable but clear communication of the same to partner(s). You may need to take some time – and formal professional help, when indicated/available – in order to get to a place where you can be truly intimate… however you ultimately define “intimate.”
So if you were expecting quick, clear, step-by-step, “one-size-fits-all” instructions on how to to optimize intimate context… well, I’m sorry. But some thoughtfulness, initiative, communication, vulnerability, and honest reflection can reveal some data on how best to devise such instructions for yourself, tailored to your own intimacy goals.
Keep Reading the Room,
Merrit
Save $999 using this ONE WEIRD TRICK! (Originally published 3/17/23)
Semen retention grifters HATE him!
Hi there, (No) Wonder-ites!
In 2007, American Idol invited P!nk to perform on their results show. She was originally scheduled to perform “U + Ur Hand,” until the show’s producers realized that the song’s title and chorus (“Keep your drink just give me the money / It’s just you and your hand tonight”) was a reference to masturbation. Then, in a move that makes me question whether they listened to even one P!nk song in their lives, the producers asked P!nk to change the words to the song to make it more “family friendly.” Of course, P!nk being P!nk, she didn’t. She ultimately performed a different song instead.
I, a urologist, should not be the first person in 50-year-olds’ lives to tell them that masturbation is healthy and normal. Yet, thanks to knowledge gaps and sex-negative attitudes such as those espoused by the American Idol producers, it happens. ALL. THE. TIME.
Not only do people go literal decades without this key information… but this lack of information creates a vacuum that invariably fills with misinformation, shame, and negativity. Mendacious grifters will shamelessly exploit this by positioning themselves as “masculinity coaches” so that they can guilt people into buying some product, book, coaching session, etc. They will also make bogus claims about their products’ benefits with no supporting evidence (1,2,3).
I’m here to tell you that these predatory charlatans are full of shit, and you can keep your money.
Sexual desire is normal, as is the urge to satisfy this desire through masturbation. Gritting your teeth and stifling the urge confers neither any inherent virtue nor any health benefit that’s ever been documented in scientific peer-reviewed literature. The semen retention grifters do love to quote a study that supposedly linked semen retention to higher testosterone levels… but they usually leave out the ITTY-BITTY TEENY TINY detail that this paper had to be retracted (4). They also discount masturbation’s documented health benefits: improved sleep, decreased stress, decreased incidence of high-tone pelvic floor dysfunction, and higher levels of the “feel-good” hormone oxytocin (5, 6).
In addition to its aforementioned here-and-now benefits, masturbation can also help you discover and embrace what arouses you and your partner(s) – and facilitate communication about the same. It can amount to a rep of the practice to which I referred in a previous article. If through masturbation you discover what arouses you, you can communicate this information to partner(s) and use it to improve the arousal you experience in partnered sexual activity. Lastly, allowing oneself to feel pleasure without shame can help uncouple the two.
Lest anyone misread “masturbation is healthy and normal” as a condonement of masturbating in front of nonconsenting individuals – this is the internet, after all – I reiterate that masturbation is a normal and healthy sexual function – and as such, it requires the enthusiastic ongoing consent of all involved.
Lastly, if you are an abstainer from masturbation… you do you (or don’t). If semen retention is your thing, far be it from me to yuck your yum. However, if you go out onto Al Gore’s internet and start grifting, shaming others, and/or spreading misinformation… we’ll have a problem.
Keep Your Money and Treat Yourself,
Merrit
1. This guy’s Twitter account consists almost exclusively of shaming men for having sexual urges… but for £125 he will graciously spend an hour on the phone with you and offer resources that are guaranteed to break your pornography “addiction” in “13 Days or Less[sic]”
https://masculinetheory.gumroad.com/l/ELJgH
2. For just $297 this guy will take you on a 21-day semen retention journey that promises to “build your sexual power” and “unlock your inner king.”
https://www.taylorjohnson.life/semen-retention-mastery/
3. “The Wild Masculine.” Semen Retention Training for $999?! In this economy?!
https://manhoodacademy.podia.com/the-wild-masculine-course
4. https://link.springer.com/article/10.1631/jzus.2003.r236
5. https://www.insider.com/men-shouldnt-do-no-nut-november-no-health-benefit-2022-10
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360917/
Sex-Positivity in Young Humans (Originally published 3/21/23)
“Won’t someone PLEASE think of the children!”
Hi, (No) Wonder-ites!
Y’all like the new logo? While the 7-year-old and I were drawing in the pillow-and-blanket forts we constructed next to one another, she noticed I was trying to make a logo out of the letters in (No) Wonder. When I tried to connect the parentheses around (No) into a rounded W, she critiqued, “That looks like a BUTT, Daddy!” Then, after she experimented with the color schemes, she produced the current logo and submitted it as her application for the job of (No) Wonder official artist. Needless to say, she got the job. She promptly drew up some business cards for herself and started thinking bigger. “I’m going to need more clients, Daddy.”
That kid is going places.
I think often of how I can do right by her. After all, she never asked to be born. So the least my wife and I can do is love her unconditionally, affirm her, encourage her, teach her, answer her (many) questions, value her autonomy as a person, and set a loving example for her. You may be a parent to small human(s), and be thinking the same thing about them.
To this end, many of us are tempted to cling to a notion of “childlike innocence” and protect them from anything that threatens it. Good luck with that. Elected officials are creating a world where the concept of “childlike innocence” is irrelevant: mass shootings in schools, child marriage (1), child labor (2), children being forced to carry rapists’ babies to term (3).
Zooming back in on (No) Wonder’s subject matter, we find that the average age of first pornography exposure is 11-12 years and, depending on which study you read, can be as young as 5 years. And when kids consume pornography without first having a foundational knowledge base against which to appraise it (or at least someone with whom they feel comfortable discussing it), it can be traumatizing – with potentially adverse effects on their sexual and relationship scripts. (4, 5)
So you can cling all you want to the idea of “childlike innocence,” but doing so doesn’t make it relevant or helpful. Avoiding conversations about sexuality doesn’t prevent kids from learning about it – it only prevents them learning about it from you. A meta-analysis published in PLOS One last year concluded that sexual health outcomes (including STI rates and condom use) were improved when sexuality education focuses on pleasure (6). And if you’re thinking, as many do, that teaching kids about sexuality will “give them ideas,” promote promiscuity, or entice them into an early sexual debut… published data suggest the direct OPPOSITE – that Comprehensive Sexuality Education actually delays the age at which kids start having sex (7). So if we are serious about getting kids to start having sex later in life – and having better outcomes once they do – then we grownups had better be comfortable talking about sexuality early and often.
Where to begin? The Sexuality Information and Education Council of the US (SIECUS) has an entire 112-page set of guidelines regarding what specifically constitutes Comprehensive K-12 Sexuality Education (8). The SIECUS curriculum stresses the importance of consent, bodily autonomy, (“your body belongs to you”) respect for boundaries, and identifying private parts by their anatomical names (penis, scrotum, testicles, vulva, vagina, clitoris, etc.). This is a good place to start what will become an ongoing conversation about sexuality, where we give accurate and matter-of-fact answers to questions driven by kids’ curiosity. We neither can nor should try to convey 112 pages of sexuality knowledge into one perfunctory “birds-and-the-bees” talk, but to keep the lines of communication open so kids can establish a foundation and build gradually upon it. Given how private many of us were raised to be about sexuality, it is common for many of us to feel uncomfortable discussing it with our children; sexuality-positive children’s books, like those in a series written by Robie Harris (It’s So Amazing, It’s Perfectly Normal, It’s Not the Stork!) might be helpful for breaking the ice.
As for kids, they tend to be only as “weirded out” by the discussions as we grownups are. To illustrate… as a urologist, I get all kinds of urology-adjacent gag gifts. Last December one of my administrators gave me a plastic container in the shape of anthropomorphic sperm, filled with… wait for it… crème liqueur. When I brought it home, my 7-year-old took a brief break from playing Minecraft on her tablet to acknowledge it.
“Hey Dad, is that a sperm?”
I responded briefly and matter-of-factly. “Yes, it is.”
“Oh OK, cool.”
Then back to Minecraft she went.
In the last chapter of her excellent book How to Raise Kids Who Aren’t Assholes, author and journalist Melinda Wenner Moyer recalls her child responding in a similarly matter-of-fact way when asking whether Mommy and Daddy had sex, as described in the Robie Harris book they were reading at the time. Mom responded, “Yes we did.” The kid acknowledged the answer and asked Mom to keep reading. Mom did. Becoming comfortable answering the questions helps kids get their answers quickly, and get on with life. In contrast, when we awkwardly avoid these questions, it discourages them from asking us any more – and drives them to the Weird Part of the Internet for the answers they seek.
Lest anyone misread my enthusiastic, evidence-based support of Comprehensive Sexuality Education as “Dr. DeBartolo says to replace my kid’s Cocomelon with Fifty Shades of Grey…” by all means let kids be kids, but being a kid doesn’t require naïveté. An important part of being a kid is being curious and wanting to make sense of the world – like Einstein, who described himself as having “no special talents, I am only passionately curious.” We should foster our kids’ curiosity and give them the information they need in order to regulate their emotions, advocate for themselves, embrace rather than fear friends’ identities, and enjoy their sexuality fully and responsibly. If you don’t address your kids’ curiosity… someone else will, as was the case for almost a quarter of the 18-24 year-olds who cited pornography as an educational resource (9). Conversely, by being an example of openness and sex-positivity – and communicating accordingly, early and often – we become our kids’ go-to resource for all sexuality-related matters. This gives them the knowledge base against which to appraise anything they might approach when they invariably reach the Weird Part of the Internet. Or at the very least, a desire to approach us for information when the Weird Part of the Internet doesn’t make sense to them (as opposed to taking the Weird Part of the Internet at face value).
By engaging kids’ curiosity head-on, we can help them enjoy a lifetime of healthy, satisfying, pleasurable relationships and sexuality… or at least minimize how much they end up having to learn and unlearn later in life.
Stay Curious and Nonjudgemental,
Merrit
2. https://www.arkleg.state.ar.us/Bills/FTPDocument?path=%2FBills%2F2023R%2FPublic%2FHB1410.pdf
3. https://www.politico.com/news/2022/07/14/anti-abotion-10-year-old-ohio-00045843
5. https://www.apa.org/news/press/releases/2017/08/pornography-exposure
6. https://thepleasureproject.org/wp-content/uploads/2022/06/journal.pone_.0261034-1-1.pdf
7. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11388-2
8. https://siecus.org/wp-content/uploads/2018/07/Guidelines-CSE.pdf
9. https://www.researchgate.net/publication/348214099_The_Prevalence_of_Using_Pornography_for_Information_About_How_to_Have_Sex_Findings_from_a_Nationally_Representative_Survey_of_US_Adolescents_and_Young_Adults
Sexy Like MacGyver (Originally published 3/24/23)
Necessity is the mother of inventive intimacy
Hi (No) Wonder-ites!
Over the course of 139 episodes spanning seven seasons (1985-1992), secret agent and engineer Angus MacGyver (played by Richard Dean Anderson) regularly solved problems he encountered using whatever materials he had available. In one episode of MacGyver, he constructed a lie detector out of a blood pressure monitor and an alarm clock. In another, he took all of 35 seconds to build a telescope out of a newspaper, a magnifying lens, and a watch crystal. He did this so regularly that in September 2022, Merriam-Webster added “MacGyver” to its dictionary as a verb meaning “to make, form, or repair (something) with what is conveniently on hand.” (1)
The CDC estimates that 26% of US adults have a disability (2); thanks to our country’s white-flag AMFYOYO approach to public health, long COVID keeps adding to this figure. (3) To those with a disability, merely existing in a society that doesn’t want them to is an act of persistence and ingenuity beyond anything on MacGyver. Let alone intimacy, which for all its pleasure and fulfillment requires significant energy investment. When merely existing saps the lion’s share of an already limited energy reserve/“spoons” (4), it adversely affects the intimate context. I have disabled patients who are just too damn exhausted from daily living even to entertain the notion of intimacy. If that’s you, I see you.
That said, contrary to what systemic and often internalized ableism would have us believe…
SEXUALITY IS FOR EVERYONE.
Or, in the words of disabled sex worker Billy Autumn: “Disabled people fuck.” (5) Research, including one study in which 68% of women with spina bifida reported being sexually active, supports this. (6)
It’s easy to think otherwise when we as a society, and we in the medical profession, do very little even to acknowledge – let alone encourage – sexuality in people with disability. Even though cinematic representation is trending ever-so-gradually toward disability inclusion, 2.3% of characters in 2019’s top-grossing movies had a disability… saying nothing of how people with disabilities are portrayed, which is rarely in a way that highlights or even acknowledges their sexuality. (7) Mainstream pornography is similarly centered on able bodies, with disability fetishized when included. (5) Because sexuality in people with disabilities is rarely represented, we largely ignore it and view people with disabilities as asexual – even those of us in medicine, who should know better given ample evidence to the contrary.
I previously discussed the PIV-centric nature of society’s emphasis on sexuality, and the benefits of diversifying intimacy. Emphasis on able-bodied penetrative activity as the way sex “should” look amounts to ableism, systemic exclusion of people whose bodies don’t allow it. People incapable of PIV might be gaslit into discounting their own sexuality, or thinking of themselves as asexual simply because their sexuality doesn’t align with prevailing ableist sexual narratives. But sexuality, like disability, is not a monolith – and viewing it as such does us all a disservice by stifling sexual communication and creativity. And as long as everyone involved consents enthusiastically, it is ALL SEXY.
MacGyver’s newspaper telescope might not have looked the way snobby naysayers would say it “should,” but it got the job done. Moreover, its style and creativity gives it an appeal it would have otherwise lacked had MacGyver mindlessly purchased a fancy one from The Sharper Image. No wonder Patty and Selma from The Simpsons were smitten!
.
Keep on MacGyvering,
Merrit
1. https://www.merriam-webster.com/words-at-play/what-does-macgyver-mean-slang-definition
2. https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html
3. https://www.bmj.com/content/378/bmj-2021-069868
4. https://www.healthline.com/health/spoon-theory-chronic-illness-explained-like-never-before#1
5. https://news.yahoo.com/disabled-porn-performers-changing-talk-013235827.html
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582639/
7. https://variety.com/2020/film/opinion/holiday-christmas-movies-disabilities-1234850127/
Beyond “Hall Passes” (Originally published 4/4/23)
Consensual Non-Monogamy
Hi (No) Wonder-ites!
In 2011, the Farrelly brothers (“There’s Something About Mary”) released a forgettable comedy called “Hall Pass.” The only thing I remember about it was that Owen Wilson and Jason Sudeikis felt sufficiently slighted by their wives (Jenna Fischer and Christina Applegate), and the wives felt sufficiently annoyed, that the wives issued their husbands a “Hall Pass.” This gave the husbands carte blanche to have sex with anyone, no questions asked. The husbands have a shitty time – in one scene very literally. By the end, the husbands develop renewed appreciation for their wives and double down on their monogamy. The End.
“Hall Pass” touches upon the idea of consensual non-monogamy, but only as a comedic premise that ultimately reinforces society’s prevailing monogamist narrative.
Religion, society, and media all reinforce the idea of monogamy: “one true love,” “soul mates,” “happily ever after,” yada yada yada. These influences encourage us to assume that there is one other person on this planet who can help us satisfy all of our sexual and emotional needs and desires, that there is one other person on this planet for whom we can do the same, and that this person is one and the same. Research suggests that this monogamist worldview may be overly optimistic. The US had had at least 600,000 divorces per year every year since 2000, with almost 1 million/year in the early 2000s (1). Saying nothing of loveless marriages artificially propped up by various actual and/or perceived obligations… or that 20% of married people (15% of women and 25% of men) engage in cheating, which is NON-consensual non-monogamy (2). Given these data, it’s likely that many of these folks are trying to shoehorn themselves artificially into a monogamist “ideal,” rather than uncomfortably and vulnerably questioning whether monogamy is actually consistent with their relational identity.
Research also shows that a small but significant percentage of studied individuals are authentic and real enough to admit, even amid pervasive societal pressure to conform to monogamy, that they are polyamorous. Specifically, 10.7% of respondents to a 2021 survey of single people have engaged in polyamory while another 16.8% already had (3). And given the legal and logistical implications of polyamory with regard to housing, medical insurance, childcare, and family structure/rights (4); the number of people and families centered around consensual non-monogamy is almost certainly under-reported.
So if you are someone who has trouble wrapping your mind around the idea that there is exactly one other person on the planet whose needs you satisfy and by whom your needs are satisfied… you are not alone. If you wonder why society accepts a serially cheating thrice-divorced man while it maligns an egalitarian consensually polyamorous family structure… you are also not alone. Monogamy is not for everyone – including (espcially!) those who try to make it happen like Gretchen Weiners trying to make “Fetch” happen in “Mean Girls.”
As difficult and vulnerable as it is, it is ultimately better to honestly appraise and communicate your needs – and structure your intimate relationships accordingly – than it is to reframe your perception of your needs to fit a rigidly monogamist view. The latter may be “good enough”… until it isn’t, and resentment sets in. Then when you’re going through a messy divorce, you’ll wish the communication at the outset had been better – even if it nipped the relationship in the bud before it could get complicated.
Because this is the internet and someone is bound to misread the above as “Dr. DeBartolo said I could cheat on my wife by raw-dogging the married secretary.”… My acknowledgement and validation of CONSENSUAL non-monogamy is not an encouragement of any NON-CONSENSUAL activity, and should not be construed as such.
But as long as all involved parties enthusiastically consent and abide by clearly-defined terms, we need not artificially confine ourselves to monogamy.
Consensually More is Consensually Merrier,
Merrit
1. https://www.cdc.gov/nchs/data/dvs/marriage-divorce/national-marriage-divorce-rates-00-21.pdf
2. https://www.livescience.com/56407-how-many-people-cheat.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023325/
4. https://lgbtqbar.org/bar-news/what-polyamorous-multi-parent-families-should-do-to-protect-their-rights/