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“ Why Men Fake It answers qu/. / is about sex and relationships that beg to be asked but seldom are. Dr. Morgentaler’s sensitive, empowering manner and his unique perspective on the male psyche in the early twenty-first century make this a must-read for all men and women.”

-ALAN ALTMAN, M D,

past president, International Society for the Study of Women’s Sexual Health

In this groundbreaking book, Dr. Abraham Morgentaler, a maverick in the field of male sexuality, exposes an overlooked truth about men through the engaging stories of his real-life patients at their most vulnerable moment— when their pants are down. In his years at the forefront of sexual research and medicine, Dr. Morgentaler has seen it all: eighty-year-old men having the best sex of their lives, adolescent girls and boys who just knew they were born the wrong gender, women struggling to understand why the men they love refuse to have sex with them. Yet it is the minds of men that really interest Dr. Morgentaler—how men think and feel about sex and relationships and what they say when there is no one around to impress.

Dr. Morgentaler walks the reader through the remarkable upheavals in the world of sexuality, from Masters and Johnson’s “It’s all in your mind,” through the age of Viagra, to changing gender roles, and provides a candid discussion of what this has meant to modern sexual relationships. Why Men Fake It will force men and women alike to question their most basic assumptions regarding relationships, gender, sexuality, and, ultimately, society’s definition of a “man.”

Dr. Morgentaler’s groundbreaking work finally moves the conversation about men and sex from oversimplified concepts of men as Neanderthals or Martians to a view he has developed through decad; V Y-w arch of men as noble creatures who, for that very re wo: :\\;w even fake an orgasm.

Carnegie Library of Pittsburgh

Lawrenceville

REG'D MAY 01 2013

Also by Dr. Abraham Morgentaler

Testosterone for Life:

Recharge Your Vitality, Sex Drive,

Muscle Mass and Overall Health

The Viagra Myth:

The Surprising Impact on Love and Relationships

The Male Body:

A Physician’s Guide to What Every Man Should Know About His Sexual Health

WHY MEN FAKE IT

HQ28.M673 2013 Morgentaler, Abraham, author.

Why men fake it : the totally unexpected truth about men and sex New York : Henry Holt and

WHY

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Library of Congress Cataloging-in-Publication Data Morgentaler, Abraham.

Why men fake it: the totally unexpected truth about men and sex / Abraham Morgentaler. p. cm.

Includes index.

ISBN 978-0-8050-9424-4 (hardback)

1. Men—Sexual behavior. 2. Sex (Psychology) 3. Sexual health. 4. Man-woman relationships. I. Title.

HQ28.M673 2013

306.70811—dc23 2012036217

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First Edition 2013

Illustrations by Megan Rojas

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To Addy

CONTENTS

A Note to Readers xi

I. DO MEN REALLY FAKE IT?

1. Introduction 3

2. The Man Who Faked His Orgasms 11

3. The Fretful Penis, and Other Natural Reactions

to Unfair Expectations 34

M. THE VAS DEFERENS BETWEEN MEN AND WOMEN

4. What Is a Man? 53

5. A Penis by Any Other Name 83

III. KEEPING IT UP

6 . Better Living Through Pharmacology 95

7. Listening to Viagra 117

8 . A Husband’s Duty 138

9. The Bionic Penis 154

10. Male Menopause

CONTENTS

IV. THE MEASURE OF A MAN

11. Am I Normal? 205

12. No Balls at All 225

13. Narcissus and the Penis Reflected 247

14. Men Are People Too! 263

Appendix: Diagrams and Illustrations 277

Notes 283

Glossary 291

Additional Reading 295

Acknowledgments 297

Index 299

A NOTE TO READERS

The stories presented in this book are based on actual cases during the author’s twenty-five years of medical practice treating men with sexual and reproductive problems.

However, to preserve the privacy of his patients, names and details have been changed, and some cases presented are composite accounts, although those are also based on Doctor Morgentaler’s actual clinical experiences.

The information in this book is not intended to replace the individualized advice of the reader’s own physician or other medical professional. You should consult a medical professional in all matters relating to your health, especially if you have existing medical conditions, before deciding on any treatment, and before starting, stopping, or changing the dose of any medication.

Individual readers are solely responsible for their own health care decisions. The publisher does not accept responsibility for any adverse effects individuals may claim to experience, whether directly or indirectly, from the information contained in this book.

DO MEN REALLY FAKE IT?

I. INTRODUCTION

A fter almost twenty-five years of medical practice specializing in the treatment of men with sexual and reproductive problems, I thought I had heard and seen pretty much everything. But when David, a twenty-five-year-old man, walked into my office and told me that he faked orgasms with the new love of his life, Sarah, I had to make sure I’d heard him correctly. What a fantastic twist! Once I got past the immediate, practical question of how David faked it, what really interested me was why a man would do this. David’s answer was simple and touching. He was in love with Sarah and was simply trying to do what he believed was the right thing by her. That is a refrain I hear regularly from men in one form or another, yet this admirable, loving aspect of male sexuality is hidden among the detritus that passes as wisdom for what men are all about.

This book is about the fascinating, rich, nuanced, and surprising world of men and sexuality. In these pages I share the stories of David and so many other men who have come through my offices at Men’s Health Boston, seeking help for one type of “guy problem” or another. Behind those closed doors, men from all walks of life—laborers and celebrities, professors and new immigrants—have shared with me the most intimate details of their lives. Often I have been the first and only person brought into

their confidence. I share these stories and my perspectives here because I have come to believe that what we think we know about men, sex, and relationships is totally incorrect. The truth is, we know next to nothing.

It’s obvious that some men behave badly, but as a culture we have focused far too much on the bad behavior of the few. Usually, the men we ridicule are public figures with lives so different from most of ours that a man would be well within his rights to say, “What does Tiger’s behavior have to do with me?”

For every man who behaves badly, I can give you ten who are dedicated and thoughtful, doing the best they know how to be a man and a solid partner. When men share their most intimate stories about sex and relationships, what I hear repeatedly is a determined effort to be for their partners what they believe their partners want them to be—responsible, reliable, strong. It is confusing to know how to be a man these days. Sexual roles may have become muddled, yet the desire among men to be “good” to one’s partner remains.

The comedian Robin Williams jokes, “Why did God give men two brains but only enough blood to run one of them at a time?” In family-friendly newspapers we find comic strips depicting men with eyes bulging out of their heads as a pretty woman walks by. These jokes about men could have been lifted unchanged from the late 1960s and 1970s when I was a teenager, even though the world of gender and sexuality is so different today, thanks to major cultural events such as women’s liberation, the advent of the birth control pill, the high prevalence of women in the workforce, and the introduction of Viagra, to name just a few. Our concepts regarding men are stuck in a time warp. How did we get to this point when women lament, “Why can’t I find a good man?” and “Men just don’t ‘get’ it”? Men, having bought into the Zeitgeist, fall all over themselves trying to prove to a potential or current partner that they are different from the insensitive, overly aggressive Neanderthals that make up the rest of the male gender. A

friend who lives in a house filled with women—his wife, three daughters, and two stepdaughters—has a framed poster hanging in his kitchen that always makes me chuckle: “If a man speaks in the forest and no woman hears him, is he still wrong?”

We live at a moment of history when we have more information about sex at our fingertips than any time before, yet we know so little about male sexuality. If we are so ignorant of basic information, how well can we hope to have a true and meaningful understanding of something as complex as the male psyche when it comes to sex? *

A recent front-page story from the New York Times reported on a study in which young fathers in the Philippines were found to have lower testosterone levels than similarly aged men without children. A professor of anthropology at Emory University concluded that the lower testosterone in young fathers was Nature’s way of making the father behave better in a relationship: “I’m here, I’m not looking around, I’m really toning things down so I can have good relationships.” As another professor, from the University of Nevada, put it “A dad with lower testosterone is maybe a little more sensitive to cues from his child, and maybe he’s a little less sensitive to cues from a woman he meets at a restaurant.”

The conclusions drawn by these highly educated professors perpetuate the myth that a man and his behavior are directly influenced by his moment-to-moment blood concentration of testosterone. In this standard narrative, men with high testosterone are so highly sex-charged that they are likely to cheat on their partners and make poor fathers, whereas lower testosterone allows a man to become more domesticated. We see some version of this familiar story in magazines and newspapers every week. However, it is false. As a physician who has raised and lowered testosterone levels in several thousand men, I can assure you that the relatively small changes noted in this study do not impact a man’s behavior or his “nurturing capacity.” In fact, testosterone levels decline by as much as 50 percent in young men every single

day from morning to evening, without causing a change in mood or behavior. Indeed, the most likely explanation for the drop in testosterone in the young fathers is sleep deprivation. Any kind of disordered sleep lowers testosterone, which explains why in this study the lowest levels of testosterone were found in fathers of newborns.

This is a perfect example of how quick we are to believe that a man’s true nature must be altered, for example, by lowering his testosterone, to become a faithful partner and nurturing father. What an insult to all the great husbands and dads out there!

It’s not easy being a man these days, and certainly not a sexual man. Seismic changes in our social landscape have fractured the era of male dominance. As the father of two capable young women, I applaud the leveling of the gender playing field. Yet it is naive to assume there has not been a cost to this relatively sudden cultural change. There are now far fewer opportunities for men to feel powerful and, well, manly.

Recently, Mara and George—both thirty-two, with two young sons—came to see me in my office. George was a building contractor, Greek, a little stocky, with a round face, a solid-looking man. George told me, “Mara doesn’t think we have sex often enough. I start my days at five am, I want to play with the kids when I get home, and then most days I collapse after dinner. Mara thinks it’s strange that I’m too tired to have sex more than once or twice a week.”

I looked toward Mara, pretty, slender, with long, dark hair. She looked very fit. “Doctor, I thought guys were supposed to always want sex. And before I had the kids, George was always ready. Now I want it, and he doesn’t. Is it me? I worked hard to get rid of the baby fat from my last pregnancy, but it doesn’t seem to matter to him. I’ve asked him whether he’s found someone else, and he says ‘No,’ but I just don’t get it.”

Alone with me during his examination, George took the opportunity to tell me more. “Doc, it’s worse than you can imagine. Mara is sure that I’m cheating. She’s been snooping through all my

WHY MEN FAKE IT

stuff. I feel like I constantly have to reassure her that we’re okay, that I still find her sexy, that I still love her. It’s a bad time for my business, and I’m stressed. Truthfully, some of the time we have sex, I’m doing it just to keep Mara happy.” The idea that a man would have sex with a woman for her benefit rather than his own runs counter to the traditional story line about the selfish, egotistic sexual male seeking only his own gratification. Yet there is nothing unusual about George’s story. Women have always had expectations from their men; now this expectation has shifted in new ways to the bedroom.

A young man in his midthirties, without any erection problems, asked me for a prescription for Viagra. When I asked why he wanted it, he replied, “It’s tough out there, Doc. The last woman I dated told me when she wanted sex, how she wanted it, and how many times she needed it. I’m just trying to keep up!”

It is tough out there for men. The world is changing rapidly, and the misinformation that passes as conventional wisdom about male sexuality leads many men to have anxiety, low self-esteem, and conflict within relationships.

Let’s get something straight: sex is how animals reproduce, from the smallest single-cell organism to insects, fish, reptiles, birds, and mammals. We tend to forget about the reproductive part of sex because humans have been clever enough to find ways to separate sex from reproduction via various forms of contraception. What is important to understand is that the drive for sex is not a choice, a luxury, a human invention. It is one of the most powerful drivers for all species on this planet. If tuna didn’t have a powerful sex drive, there would be no tuna. If dogs didn’t have a powerful sex drive, there would be no dogs. And if humans (male and female) didn’t have a powerful sex drive, there would be no humans. This is a biological fact.

My perspectives on sexuality were influenced greatly by my initial choice of biology as a career. In my very first class as an undergraduate at Harvard College, the Nobel Prize laureate George

Wald presented the big bang theory and described the subsequent primordial soup that eventually led to organic molecules and the beginnings of life. I was hooked. For three years as an undergraduate I worked in the reptile laboratory of the brilliant biologist David Crews (now at the University of Texas at Austin), studying the effects of testosterone on the sexual behavior of male lizards. Reptiles are extremely important in evolution because they represent the common ancestor of the “higher” animals, namely birds and mammals. It is the primitive reptilian portion of our brain that drives our sexual behavior, with input from higher centers in the cortex.

It makes perfect sense that the sexual centers in human brains are deep, old in evolutionary terms, and anatomically distinct from the “thinking” part of our brain, namely the cerebral cortex, because sex has very little to do with thinking. Indeed, lust, libido, sex drive—whatever one wishes to call it—seems to be almost a form of madness. It is irrational, primal. In the throes of lust, women and men behave differently than in every other sphere of their lives. Individuals who are germ-phobic and who wouldn’t dare to touch a doorknob without first wiping it down with a cloth will, when sexually excited, throw themselves into skin-on-skin, sweat-on-sweat, full-body contact with another person, even exchanging body fluids along the way. Powerful men and women who experience rage at any perceived disrespect at work engage happily in sex play in which they are subdued, dominated, demeaned. Sex is a break in the normal fabric of our lives. One can no more reasonably separate sexual desire from normal men and women than one can separate wetness from water.

Despite our sexual nature it is unacceptable to be sexual whenever the urge arises. All human societies have found ways to bind our sexuality by rules, norms, culture. It is endlessly fascinating to me how we manage to incorporate the “madness” of our sexuality within the framework of a rational life in which we aspire to be honorable and productive. One of the consequences of the inevitable tension between primitive urges and civilized

behavior has been to make sexuality into a big secret, something not practiced in public, and not spoken about.

I would argue that a key component of the women’s movement and the rise of feminism was the way that women educated themselves about their bodies and their sexuality. A landmark event in the 1970s was the publication of Our Bodies, Ourselves, a book with graphic illustrations that could be found on almost every woman’s college bookshelf; the book encouraged women to take a mirror and examine their genitalia, find their clitoris, and to experiment with masturbation so that they could experience orgasms more easily. It explained anatomy, menstruation, birth control, the whole works.

There has never been a similar book for men, at least none that gained any national attention. A book that explained, discussed, and normalized male sexual behavior. Perhaps this book can start the conversation. Certainly there is a need for such a dialogue, for the benefit of women as well as men.

What will emerge from the stories in this book is that men are complex, thoughtful, and eager to be a valued and respected partner. It will be surprising to many to learn that a man’s sense of his own masculinity is intimately related to his ability to regard himself as a successful sexual provider.

There are other challenges to overcome in the realm of male sexuality besides ignorance, particularly physical ones. The medical world was stunned when the Massachusetts Male Aging Study in 1994 revealed that 52 percent of relatively healthy men between the ages of forty and seventy reported some degree of impotence. So many men! We never knew.

Premature ejaculation affects as many as 20 percent of young men and nearly an equal number of older men. It is difficult to feel great about oneself as a lover when sex ends almost as soon as it begins. And new data show that one-third of men over the age of forty-five have abnormally low levels of testosterone, which can cause poor erections, low sex drive, and difficulty achieving an orgasm.

This book is about real men in real situations. By providing a behind-the-closed-door perspective on men, sex, and relationships, I hope that we will move out of the darkness and toward a more realistic, and kinder, view of what men are all about and how their minds work. Female readers may be happy to learn that there are good men out there. And male readers may take comfort from realizing that they are not alone. The truth is that men are so much more interesting and complex than we would ever have believed.

2. THE MAN WHO FAKED HIS ORGASMS

The secret of success is sincerity. Once you can fake that you've got it made.

—Jean Giraudoux (1882-1944), French novelist

O ne of the great misconceptions of male sexuality is that men are only concerned with their own orgasm. The classic stereotype is the guy who rolls over and falls asleep once he’s climaxed, unaware or uncaring that his partner might still need a wee bit of stimulation in order to be satisfied herself.

This stereotype is inaccurate. Men feel awful if they believe they have sexually disappointed their partner. Does this mean that the “slam, bam, thank you, ma’am” attitude of men is total fiction? Of course not. Some men, and some men under certain circumstances (e.g., hookups where there is no emotional connection), really do not care about pleasing their partners. But in my practice, I have yet to meet a man who did not wish to be regarded as a knowledgeable, capable lover.

Sal, a forty-two-year-old muscular construction worker, cried in my office upon sharing with me that after twenty-one years of marriage his wife had just told him that she’d never had an orgasm with him during sex. “All this time I thought everything was okay,

that I was giving her pleasure.” He dabbed at his eyes with the tissue I handed him. “I never knew. I’m nothing now. I can’t even call myself a man!” he exclaimed through his tears, disgusted with himself.

Sal had no idea whether his wife was even able to experience an orgasm at all. Indeed, various studies have reported that between 15 and 25 percent of women in the United States are anorgasmic, that is, unable to achieve an orgasm. And many women who do have orgasms find it impossible to get there via intercourse, requiring direct manual stimulation of their clitoris. Sal was down on himself for not “satisfying” his wife, without knowing whether or not it said something about him as a man.

Of course, a woman’s degree of satisfaction may be difficult to read for a man. One would assume that if she had multiple screaming orgasms, a man could take comfort in a job well done. Not necessarily. Joseph was a thirty-eight-year-old, recently divorced man in a new relationship. “Fiona was much more experienced than me. One day after sex she held up three fingers to me, and I asked, Three what?’ and she told me she’d just had three orgasms. That sounded pretty good to me, but I wasn’t really sure. I’d never been with a woman who could have multiple orgasms. In magazines, though, I’d read that some women can have a dozen orgasms in a row just by fantasizing or by squeezing their legs together. So even though three orgasms sounded good to me, I worried that maybe Fiona had expected more from me. Later, when I asked if it was good or bad that she’d had three O’s, she kicked me so hard in the shin that I still had the welt two weeks later!”

Men find the female orgasm mysterious since it seems so much more complex and variable than their own, which we think of as automatic. Moreover, the female orgasm isn’t accompanied by an ejaculation to make things obvious. Yet the male orgasm has its own share of complexity.

David, whom I introduced earlier, was a nice-looking engineer, twenty-eight years old, with wavy, dark brown hair and dark, deep-set eyes. He wore a baseball cap turned backward. Black

I 3

T-shirt over a trim torso, blue jeans ripped over both thighs, and slightly distressed leather loafers completed an image that said, “I am one hip dude.” On the intake questionnaire David had encapsulated the reason for his visit in a single word: ejaculation.

“How can I help you?” I asked, once we were seated after introductions. Based on what he had written on his intake form, I expected David to tell me that he ejaculated too quickly, by far the most common sexual complaint among young men. However, his problem was more unusual.

“I can’t have an orgasm during sex,” he answered. “It’s no prob*

lem when I’m by myself,” he continued. “It’s just an issue when I’m with a woman.”

“Tell me about it,” I said.

“It’s been this way my whole life. I’ve had my share of girlfriends, and I’ve just never been able to come during sex. Well”—he corrected himself—“maybe once or twice, but not in quite a few years. It’s never been a real problem, though. As a matter of fact, because I could keep going and going, a lot of the girls I dated thought I was a stud. I’ve had girls tell me that most guys came before they had time to get off themselves, but with me they didn’t need to worry about it because I lasted so long. That made me feel good. For years I thought I had a special gift because I didn’t come during sex.”

“So what brings you to see me now?”

“It’s because of Sarah.” He paused. “We’ve been dating for a few months, and we’re really into each other. Sex has been a problem, though. I started off doing my usual thing, but after the second or third time we hooked up, she told me she thought it was weird that I didn’t come. I told her it was probably just because I was nervous. It bothered her that she couldn’t get me off, even though I told her I was fine. Sarah is pretty hot, and she said she’d never been with a guy who didn’t come during sex. I think it made her worry that I’m not that into her, or that she doesn’t know how to do it right for me.

“She is persistent, though.” He smiled wryly. “One night I could

tell she was on a mission to make me come. She tried everything, and we kept going until I was raw. I was sore the whole day afterward.” David broke eye contact with me and turned his gaze downward. That’s when he confessed his unusual practice. “I faked an orgasm that night. And now I fake it whenever we have sex.

“I don’t like doing it, but it works for now. Sarah seems to enjoy sex more, and the relationship is going great otherwise.”

“How do you fake it?”

“When I figure it’s time, I do the whole thing. I groan and tense up for a while and then relax.” David described this as if it were the most natural thing any man might do.

I was trying to take it all in, but I was still stuck on something. “Tell me again, why do you fake your orgasms with Sarah?” I asked.

“Sarah is a beautiful woman, but I could tell she was feeling bad about herself because I couldn’t come. Less feminine, less sexy. She was getting frustrated with sex, even though she always came with me. Faking my orgasm seemed like an easy, harmless way to solve the problem. And it worked. Sarah is much happier now, and the sex is great.”

“It sounds as if you’ve come upon an ingenious solution. How can I help?”

“Sarah is under the impression that I didn’t come at the beginning because I was nervous and needed time to get comfortable with her. She thinks my ability to have an orgasm more quickly now is a sign that we’re doing better together. It’s okay for right now, but I’m afraid Sarah will figure it out eventually.” David inhaled deeply and gathered himself. “This is the most serious relationship I’ve ever been in. Sarah might even be ‘the one,’ if you know what I mean. She’s big into honesty, though, and if she found out I was faking it, I don’t think we’d survive it. She’d be too hurt. And I can just imagine her calling me a faker, an imposter. I need you to help me start having orgasms during sex.”

It was Barry, a patient of mine, who convinced me that it may not be all that rare for a man to fake an orgasm. When I asked him if

I 5

he’d ever done it, he replied, “No. Of course not—why would I? But I dated a girl once who I thought was a little crazy. Every time we had sex, she would stop me on my way to the bathroom and inspect the condom before I pulled it off, checking the end of it. It seemed strange to me, but I figured she was nervous about getting pregnant and was checking for a leak. So one day I asked her why she did that. She said, ‘I’m checking to make sure you really came.’ What a nut! How could a man ever fake an orgasm?” he wondered aloud.

Too Slow, Too Quick

Whenever I’ve shared David’s story I’ve heard two fairly uniform responses. Women say, “That’s impossible! There’s no way a guy could fake it!” usually followed by, “And if a guy were crazy enough to try to fake it with me, I’d know for sure.” The response from men tends to be a more quizzical: “Why would a man need to fake it?”

Indeed, most readers would find it difficult to imagine that a healthy young man like David would be unable to have an orgasm during sex. Many men have experienced sex as a lifelong pitched battle to stave off a too-quick orgasm. In fact, in order to prolong the sexual encounter, and to increase the likelihood that the woman will also have time to reach a climax, men have hit upon some curious strategies to avoid orgasm.

“Think about death” is a classic chestnut passed on to inexperienced men to help them avoid the embarrassment of premature ejaculation. Another is “Imagine you’re having sex with your mother,” a disturbing idea with the potential to precipitate a Freudian crisis. Some men have even told me they’ve tried to delay ejaculation by causing themselves pain during sex, attempting to undercut the irrepressible delicious feelings with noxious sensations—bending their toes against the bedpost or biting their forearms, sometimes breaking the skin. Ouch! Men do what they can to delay ejaculation because they feel inadequate when it

happens too quickly; they fear they have disappointed their partner. Although some men with premature ejaculation might wish upon a magic lantern that they could trade their rapid ejaculation for no ejaculation at all in order to be a more successful lover, David’s story illustrates that this poses its own set of challenges.

Strange as it may seem, David’s difficulty achieving an orgasm (a condition called delayed, or retarded, ejaculation) can be caused by a number of medical conditions. It can result from side effects of certain medications. Sometimes the problem is due to a physical interaction between man and partner that is insufficiently exciting or even unpleasant (“she looks so bored”). And sometimes it can be psychological.

Timing

In sex, as in comedy, timing is key. One doesn’t think about it much, but timing during sex is more complicated than it might appear. Imagine that both partners are able to have an orgasm within three seconds after beginning sexual activity. Mission accomplished, no effort or sweat required. Would that be a good experience?

In Woody Allen’s futuristic movie Sleeper (1973), the women are all “frigid,” that is, unable to climax, and all the men are impotent, “except those with Italian ancestors,” deadpans Diane Keaton’s character. The solution to this sexual impasse is a machine called the Orgasmatron, which provides a nearly instantaneous orgasmic experience for couples who enter the tiny cylinder. When Allen’s character is chased by the police, he hides alone in the Orgasmatron and closes the door behind him, activating the machine. Moments later the doors open and the police escort him away, hair mussed, a silly grin on his face.

I don’t think we’re at risk of an Orgasmatron replacing sex, even if it were available today. The orgasm may be the payoff, but the buildup, the arousal, the crescendo toward a wonderful cli

I 7

max, is indisputably part of the pleasure of sex. And all of this takes time. For most men and women, an instantaneous orgasm without any additional activity would be a major disappointment. Sex is one of those activities where the journey is definitely as important as reaching the destination. This is a big part of the disappointment when a man ejaculates too rapidly.

David’s story raises questions about the opposite circumstance: What if men and women had the capability to have sex indefinitely without orgasm? When would sex end? Although the idea of an endless night of sex sounds great in concept, there are practical

issues ready to burst that bubble, like chafing. And sometimes life needs to go on, whether it’s being ready for work in the morning or just getting enough sleep in order to be functional the next day.

A friend of mine once shared with me over drinks how excited he was about a new relationship. He and his new girlfriend were having sex “all night long.” When I met up with him again a couple of weeks later he had dark bags under his eyes and looked haggard.

“You look exhausted,” I told him.

“I am,” he replied. “This woman I’m dating is a freak! She wants to have sex every night, for hours. I’m falling asleep at work, and I can’t get anything done. I’ve got to break up with her—she’s killing me!”

There is a downside to overly long sex, just as there is for sex that is too brief.

So how much time is enough? One of the challenges of sex is to be able to time it so that both individuals are satisfied. Usually it is the man who controls how long sex lasts, since once he comes the game is over, at least for a while. Yet indirectly, it is the woman who usually determines the duration of intercourse, since most women require more stimulation than men to climax, and the man will do what he can to defer his own orgasm until the woman comes. This unspoken “rule” of sex was cleverly captured by the title of the popular relationship book She Comes First by Ian Kerner. However, if the woman is among the 15 to 25 percent

who cannot achieve an orgasm during sex at all, how long should a man continue sex play?

“Some nights I can tell it’s just not going to happen for me,” one woman explained to me. “It’s not a big deal. But guys are so goal-oriented. With my last boyfriend, I had to fake an orgasm if I didn’t think I was going to come, or else he’d be rubbing on me till tomorrow. Once he thought I’d had an orgasm, real or faked, he felt that he’d done a good job, and he’d let himself come too. And then we could both get some sleep.”

David’s practice of faking an orgasm turns this story on its head. So let’s get to a critical question. Can a man really fake an orgasm?

Can a Man Really Fake It?

When David told me he faked his orgasms with Sarah, I immediately thought of the classic movie When Harry Met Sally (1989), in which the title characters, played by Billy Crystal and Meg Ryan, are in a deli discussing his love life. When Sally suggests that Harry’s girlfriend is probably faking her orgasms with him, he says that would be impossible, because he would know if she were faking it. At which point Sally begins simulating a fullthroated orgasm right there in the middle of the restaurant to prove how easy it is to fake it, building up to a crescendo of moans and groans, climaxing with “Yes! Yes!” When she’s done, a woman at a nearby table tells the waiter, “I’ll have whatever she’s having.”

We’re familiar with the idea that a woman can fake an orgasm. It’s an act, a performance, designed to make the man feel okay about himself, and to bring the activity to what feels like a satisfactory conclusion. But can a man fake it? The female response, “I would know instantly if a man tried to fake it with me,” sounds suspiciously like Harry’s in the movie.

When I pointed out this similarity to a female colleague, her response was “Oh no, it’s different.” And then, with a triumphal flourish, finger raised in the air like a prosecutor summing up a

criminal case on television, she exclaimed, “With a man, there is evidence!”

Okay. Is that the extent of the argument? If there were no “evidence,” that is, no semen, would a woman be able to tell if a man faked an orgasm? This raises a series of questions. Does fluid always come out when a man has an orgasm? Can he withhold it? What about if a man has had a vasectomy—is there still fluid that comes out? Before we can explore why David faked it, it is necessary to understand some of the incredible details regarding the biology of the male sexual response.

What Is Sex?

A visitor from another planet who landed in any grocery store checkout aisle in the United States and perused our magazines (assuming her advanced intellect allowed her to instantly understand English) might be excused for believing that earthlings do not reproduce via sex. If our visitor picked up a magazine like Cosmopolitan, she might read a dozen articles about sex (e.g., “Seven Amazing Sex Positions” or “Learn About His G-Spot”), with not a single word mentioned about pregnancy. Unless a person is actively interested in achieving a pregnancy, or preventing one, sexual thoughts are devoid of any reproductive content.

Sex has become an end in itself. There’s nothing wrong with this, but it is useful to recognize the reproductive origins of sex if we are to understand our sexuality.

For the last twenty years I have taught a medical school class, lecturing to second-year students on the male contribution to fertility. For my first class, we review how sperm are made, how they mature, and how they are transported along the tubes within the body from the testicles* and eventually out the urethra. This first

* A point of terminology. There are two medical words that are interchangeable for a man’s seat of power: testicles and testes, pronounced “test-ease” (the singular is testis, pronounced “tess-tis”).

class is about the sperm “factory” and the transport pathways. My second class is about sex.

I begin with the statement “All animals have sex” and present a series of slides showing a variety of animals in the midst of sexual activity. “One-celled organisms do it,” I explain, and show a cytoplasmic bridge between two microorganisms. “Insects do it,” and a picture of mating flies appears. I continue with images of turtles, birds, and other creatures, all in the midst of having sex.

When an image of a mud-covered male hog mounting a female comes on the screen, I say, “I wonder if this male is worried about his body odor.” The students snicker. And when a huge bison appears, mounting a female, I ask, “Is this male thinking about whether he is now supposed to call her tomorrow, or if this means they are now in a committed relationship?” The students laugh, because it seems so silly to think of these animals pondering relationship issues or being self-aware. Finally, I show my last slide, saying, “When it comes to sex, humans are different.” An image then appears from the television show Seinfeld with the neurotic character George in bed with his girlfriend.

Thanks to human inventiveness, we have devised contraceptive methods that allow us to separate sex from reproduction. In developed countries fewer than 1 percent of all human sexual encounters result in a live birth, placing humans among the most reproductively inefficient species. Any animal in the wild with such a low fertility rate would quickly find itself on the endangered species list. For humans, though, this is the entire intent. Most of the time we want sex to be about nothing other than sex. For humans, sex can be regarded as a social event, arguably the most intense of our social interactions. Men and women may remember details of sexual encounters for years, even decades— the buildup, the flirting, the excitement, the minutiae of the act itself. We view sex among animals as natural, and instinctive, whereas for us it is an event, filled with conscious (and selfconscious) thoughts. Human sex is so much more than a biological imperative leading to a reproductively promising climax. We think,

we choose, we hope, we worry, we wonder, we enjoy, we judge. How we feel about ourselves in sexual terms influences our overall self-esteem. For men and women, sex is more than just a way to make a baby.

Orgasm and Ejaculation

From a reproductive perspective, the male contribution to sex and reproduction is straightforward. The man’s penis becomes engorged with blood until it is firm enough to penetrate the vagina, and soon afterward sticky fluid is released, called semen or seminal fluid, which contains the sperm. That’s it. The rest is up to the woman.

Not so fast. The details that lead up to this “simple” story are complex and fantastic. In chapter 6 I will describe in detail how erections work, but for the moment I want to focus on the release of semen, since this is a key to the puzzle of whether David could really fake his orgasms without Sarah knowing. First, a terminology quiz.

What is the difference between orgasm and ejaculation? This question seems easy enough, right? These are words everyone is familiar with. Do they have the same meaning? If not, how are they different? Don’t feel bad if you don’t know the difference. Every year I ask my second-year Harvard Medical students this question, and I’m still waiting for someone to answer it correctly.

Ejaculation and orgasm are two distinct biological events for men. The confusion arises because we use the terms for these events interchangeably. Under normal circumstances, if a man says “I ejaculated” or “I had an orgasm,” it means the same to us, because both took place together. Here’s a hint to teasing apart the different meanings: Can a woman have an orgasm? Of course. Can a woman ejaculate? Hmm. That’s harder to answer, isn’t it?

Orgasm is the full-body experience of reaching that magic point of release. The fireworks, if you will. Climax is merely a synonym for orgasm. Ejaculation, however, is the expulsion of the

sexual fluid. Orgasm and ejaculation normally occur simultaneously in men (which is why we tend to think of orgasm and ejaculation as interchangeable terms); however, there are a number of circumstances in which they do not.