Hello and welcome. I’m Dr George Lundberg and this is At Large at Medscape.

Consider these thoughts to be medical musings after Harvey Weinstein.

You might wonder why I am bringing this onerous and revolting topic into the realm of medical discussion. Easy answer: Sex is an expression of human behavior and that makes it a proper medical topic.

Early on in my JAMA editorship, I added esteemed (then) Loyola University professor and sex therapist Domeena Renshaw, MD, to the JAMA editorial board, representing the field of human sexuality. Many traditionalists criticized me for doing that.

But I was right. Human sexuality is of enormous importance to health and well-being. "Abnormal" sexual behavior plagues the health and lives of vast numbers of people.

Consider the fruits of—largely male—sexual actions. Rape, sexual assault, child sexual abuse, unwanted sexual advances or touching in the workplace, incest, unwanted pregnancy, abortion, families fractured by sexual actions of family members, sexually transmitted diseases, HIV, careers destroyed and fortunes lost, homicides fueled by sexual jealousy, male rape in prison. All are tragedies resulting from uncontrolled libido.

There is a lot of talk about male sexual aggression being all about the exercise of power—powerful men using their dominant positions to gain sex. Domeena used to say that rape was about power but it was also about sex.

In his book Future Shock, Alvin Toffler posits that the greatest sources of human power are knowledge, money, and violence or the threat of violence.[1] I add sex as a huge source of power. Sex flaunted, sex hinted at, sex promised, sex provided, sex withheld.

I am a great fan of testosterone, especially my own. Without testosterone, Homo sapiens would cease to exist.

I have been a Sermo member since its beginning. Many of the Sermo discussions are very frank. One such discussion recently addressed the question of whether members of different genders could ever be really good friends without sex intervening. Discussion was vigorous. There was no clear-cut agreement.

There did, however, seem to be a general view expressed by many male and female physicians that as long as one of the individuals had normal male levels of testosterone, acting on sexual urges was an ever-present hazard.

Our current society purports to be of equality across lines of gender. Stephen Marche, writing on male libido in the New York Times op-ed section on November 25, 2017, states: "What if there is no possible reconciliation between the bright clean ideals of gender equality and the mechanisms of human desire?"[2]

Further: "Unable to find justice, or even to imagine it, we are returning to shame as our primary form of sexual control."

Many years ago, while sharing a cab to the airport in Palm Springs, a very famous psychiatrist told me, "An erect penis has no conscience."

Regarding the ubiquity of this age-old problem of control of male libido: Back during my 11 years of service as a regular Army officer in the Vietnam era, we knew that to get ahead in the Army, one needed to be reasonably competent, stay off the bottle, and keep one’s pants zipped, and everybody else eliminated himself.

We need a new informed sexual ethic. What would a workable sexual ethic look like? Tough to pontificate, but it would recognize both the imperatives of biology and the necessity of cultural shaping to strive toward a society with an acceptable level of human dignity for all.

That’s my opinion. I’m Dr George Lundberg, at large for Medscape.

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