Male Sexual Dysfunction: An Interview with Dr. Sandor Gardos

Male Sexual Dysfunction

An Interview with Dr. Sandor Gardos
by Tamar Love

Dr. Sandor Gardos, the founder of MyPleasure, is more than just the head of a successful sex-toy company. A licensed clinical psychologist and board-certified sexologist, Dr. Gardos has seen thousands of patients whose concerns run the full gamut of human sexual experience, from both the clinical and emotional sides of sexuality.

The author of over 100 articles, chapters, presentations, books and other publications, Dr. Gardos' expertise in matters of sexuality is often called upon not only by universities worldwide, where he is a frequent lecturer and visiting professor, but also by the courts, for whom he often serves as an expert witness.

After receiving numerous email questions about male sexuality and sexual dysfunction, we decided to ask our resident sexuality expert for his opinion on a few male-oriented topics.

From what I've heard, there are a number of different types of male sexual dysfunction. Can you tell us a little bit about some of the more common ones?
Basically, you can divide or classify most sexual disorders into one of several groups:

  • Erectile dysfunctions are any disorder in which a man has a problem obtaining or maintaining an erection.
  • Orgasmic disorders have to do with orgasm -- some men find it very hard to have an orgasm or can't have one at all, but this is fairly uncommon.
  • Much more often, men will complain they can't last as long without ejaculating as they or their partner would like, a condition known as premature ejaculation or, more correctly, ejaculatory incompetence. Finally, there are desire disorders in which a man just does not feel "horny" or does not want to have sex. It's not that he has a problem getting physically aroused; he just doesn't want to put himself in a sexual situation.
Each of these disorders can be caused by physical, medical, pharmacological or psychological conditions -- or all of the above. In fact, men most often experience a combination of several different conditions and dysfunctions, and it is not unusual for one form of sexual dysfunctions to lead to the other.

Many of these disorders can also be a sign of another illness, such as diabetes. So, the first step is always to make sure there is no physical problem.

As with any medical condition, it is important that men speak to their physicians about any kind of sexual dysfunction. Even if the doctor thinks it is probably psychological, a physical condition can also contribute to the problem.

What about men who have paraphilias? Are these desires dangerous?
In common parlance, paraphilias are what most people call "fetishes," and usually involve a sexual obsession with one or more focuses that are usually perceived as nonsexual. Most fetishes are fairly harmless, though they can cause a great deal of distress to the man or his partner(s), who may not be emotionally or psychologically equipped to deal with the condition.

As for being dangerous, it really depends on the particulars: if a man really gets off dressing like Bullwinkle the Moose and happens to find a partner who enjoys dressing like Rocky the Squirrel, then you have a match made in heaven! As long as everyone is happy and no one is being harmed, then I don't see an issue. Of course, what you consider to be "harm" would require a whole book in and of itself!

If a straight man likes to dress in women's clothing, does that mean he's gay or sick?
Not necessarily. While interrelated, gender and sexual orientation are different constructs, which is why you frequently hear about men who have sex change operations, but continue to have sex with women.

Wearing women's clothing doesn't even necessarily mean that a man wants to be a woman or has a gender disorder. It can be more of a fetish. Again, it depends a great deal on the particulars and whether or not he is harming anyone by it. If not, I don't think there is necessarily a problem.

Traditionally, only women have been thought to suffer from lack of sexual desire. Can men really experience it, too?
In our society, it is often thought that men are always ready, able and willing to have sex at any time, with anyone. This is far from the truth. The reality is that everyone has different "appetites" when it comes to sex, just as they do with food. Sometimes, people don't have the appetite for sex, men as well as women. We think of this situation as lack of sexual desire, low libido or decreased sex drive.

Lack of sexual desire only becomes a problem when the man or his partner is unhappy with the situation, what is known as a "desire discrepancy," the number-one condition seen by sex therapists. As most therapists will tell you, it is equally common for the man or the woman to be the one with lower desire.

Remember, there is no "correct" amount of sex to have or desire. Yes, there are norms, but what really matters is whether you and your partner are in harmony about how often you have sex.

I know many therapists differ in their views on sexual addition. Do you consider sexual addiction a form of sexual dysfunction? Why or why not?
Like many sexologists, I do not subscribe to the concept of sexual "addiction." I do believe that people can develop a compulsive or obsessive approach to sex, but I think the term "addiction" should be reserved for those things that meet the usual medical criteria for such conditions.

To say that someone who masturbates ten times a day is an "addict" is a moral judgment, not a scientific one. Similarly, someone who has sex twice a day can be just as healthy as someone who has sex once a week. It all very subjective.

Those little "tests" you see that claim to tell you whether you are a sex addict are worthless. I have rarely met anyone who doesn't meet criteria based on them. When I see a patient who thinks he is suffering from sexual addictions, I ask questions such as:
Do you feel like you "have" to have sex?
Do have sex even though you may not enjoy it?
Have you lost your job because of your desire for sex?
Has your sexual appetite affected your relationships?
Do you frequently decide not to go out with friends or family, preferring to indulge in sexual activity?
Is this behavior making you unhappy?
If a patient answers "yes," to one or more of the questions, then we look at the source of the problem, rather than just labeling the patient as a "sex addict" and sending him to a recovery group.

What is your opinion of Viagra?
Viagra was an amazing invention. It was the first highly effective medical treatment for erectile disorders that did not require painful medical procedures or cumbersome devices. You just take a pill and boom. However, Viagra *is* a prescription drug and should not be taken indiscriminately.

It is very important that anyone experiencing erectile difficulties get properly evaluated by a physician. Viagra is not a cure-all. In fact, it can mask other underlying problems, whether medical or psychological. In an ideal world, a man would first be examined by a physician, and then meet with a sex therapist if physical reasons are ruled out.

As far as all these versions of "herbal Viagra" that have popped up in the last few years, the vast majority are completely worthless. Save your money.

Can you discuss the merits and/or drawbacks of using prosthetic devices, such as PPAs?
Honestly, I have mixed feelings about PPAs. I think they are invaluable for men with certain types of disabilities or physical conditions who still want to have intercourse with a partner. But the average guy really doesn't need them. They can be fun to play with occasionally, but most women are just not clamoring for a man to have a twelve-inch penis.

If you are using it as an occasional enhancement, that's fine; just don't expect your partner to suddenly have to scream, multiple orgasms because your penis is now an inch longer. It just doesn't work that way.

Can men really increase their penis size through exercises? What about "grow larger" creams ... do those work at all?
No, no and NO. The ONLY way to increase penis size permanently is through surgery, which I strongly discourage. The surgery is an experimental, dangerous, painful procedure with numerous side effects and serious risks and consequences. Many men are quite unhappy with the results, and there is no going back.

In fact, the College of Cosmetic and Restorative Surgeons has come out very strongly against penile lengthening operations and said that none of its members should perform the procedure except in extreme cases. Far better to learn to love what you have and learn how to use it.

Finally ... our most-often asked the question: do penis pumps really work?
It depends how you define "work." Yes, you might be able to make yourself more fully erect and thus maybe a little larger, but penis pumps do not cause a permanent increase in size.

Penis pumps force extra blood into the penis by creating a vacuum. Many men and their partners enjoy the sensation and the extra feeling of "fullness." However, the results are short-lived. In order to keep the blood in the penis and sustain the "larger" appearance, you would have to use an erection ring in conjunction with a penis pump. Just remember to never leave one in place for more than 30 minutes, or you could create a dangerous situation.