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It is theoretically possible to cure one member of a family by treating another. Freud, in the notable “Little Hans” case, did just that, curing a phobia in a small boy through work with the boy’s father. Some people claiming to be family therapists never see families, only individuals, basing their claim on the “ripple” effect of successful individual therapy. Similarly, some family therapists treat all individual intrapsychic problems as family problems, amenable to family therapy techniques. It is true that the resolution of family problems often eases the intensity of the intrapsychic difficulties of family members. Still, these seem inefficient ways of doing therapy: while the individual is being treated, the overall family can deteriorate (such cases are known to the author), or while the family is being treated as a unit, the intrapsychic problems of some members can be slighted or repressed. It would certainly appear to be true, and it has been my own experience (Witkin) that the most efficient individual, dyadic, or family therapy is when all of the significant people in the problem are treated in therapy at an appropriate time.

Holistic therapy, then, is primarily distinguished not by utilizing a variety of modalities but by the therapist’s attitude toward the patient. “What is transpiring in any therapeutic setting is not determined by whether it is distinguished as individual, marital, or family therapy. It is determined by the needs of the patients and the capabilities, versatility, and training of the psychotherapist” (Martin). In brief, the patient is treated as a whole person, the dyad is treated as two whole people trying to maintain a rewarding relationship, and the family is treated as several whole people in various stages of development with various, mutually dependent needs and satisfactions. Many treatment modalities may be required, since techniques sufficient for treating individuals may not be appropriate to treating families.

It seems likely that holistic therapy will develop along the lines of family and dyadic therapy, that is, a host of approaches and techniques deriving from the myriad backgrounds of the practitioners. It also seems likely that the holistic therapist will need a variety of skills and modalities and that among these will be those associated with sex therapy.

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A third stage which was not discussed by Freud but has been suggested as part of the psychosexual progression is that of the urethral stage. Some analysts have envisioned this phase of psychosexual development as a transitional stage between the anal and phallic stages. As such, it shares some of the characteristics of the earlier anal phase and by way of anticipation some from the subsequent phallic phase. More often than not, the characteristics of this urethral phase tend to be subsumed under the phallic phase. Urethral erotism can be taken to refer to pleasure in urination and the pleasure in urethral retention similar to the anal erotic pleasure of retention or expulsion of feces. The issues here are issues of performance and control. The classic image of urethral expression is the pride of the little boy in seeing how far he can project his urinary stream. Such urethral functioning can also be contaminated with sadistic impulses, often reflecting the persistence of residual anal-sadistic urges. Similar to the loss of bowel control, loss of urethral control (enuresis) can often have a regressive significance that reactivates and assimilates itself into underlying anal conflicts.

The pathological traits deriving from this period are those of competitiveness on the one hand and ambition on the other, probably connected with the need for compensating an underlying sense of shame due to the loss of urethral control. The conflicts over this issue may be the beginnings of the development of penis envy in connection with a feminine sense of shame and inadequacy in being unable to match the male urethral performance. Successful resolution of the urethral phase builds healthy personality traits, which are somewhat analogous to those derived from the anal period. Urethral competence offers a sense of pride and a feeling of self-competence derived from successful urethral functioning. The area of urethral functioning is one in which the small boy can begin to imitate his father’s more adult performance. In this sense then the resolution of urethral conflicts begins to set the stage for and make significant contributions to the shaping of gender identity and the subsequent gender-related identifications.

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Changing the attitudes and beliefs of an individual who has accepted a traditional view of women is no easy task. As Rosen and Jerdee have pointed out, there are many potential motivations for holding sex stereotypes. They suggest, for example, that past costly experiences with women, perceptions of women as a potential threat, commitment to traditional values, or needs for clarity in our complex world all are reasons for the maintenance of stereotypes and rigid adherence to them. Depending upon which of these (or other) motivations support stereotypic belief systems, the most effective change-strategy would differ.

It also should be remembered that, as Terborg first suggested, sex stereotypes have two separate although often overlapping components. Different dynamics may underlie each, and thus different change processes may be needed to change them. It is conceivable furthermore that both have to be changed if certain forms of sex discrimination are to be eliminated. Even if one’s stereotypes about women’s attributes are altered successfully, and women are viewed as equally competent as men, it may still seem inappropriate for them to take positions of authority. Or conversely, even if one views a position as suitable to a woman, assumptions about her lesser competence can prevent her from obtaining it. At least in some cases, it would be essential to change both normative expectations and stereotypic perceptions of attributes if women are to be treated in an unbiased manner.

For the most part, the programs developed in recent years have been built upon the implicit assumption that the basis of the stereotyping of women is ignorance—ignorance of what women really are like and ignorance of what women’s life experiences are. Consequently, their focus is on raising awareness of stereotypical conceptions and on transferring information about the realities of sex discrimination.

Human-relations training and other workshops dealing with these issues have become common within organizational settings. A host of exercises have been developed for individuals and groups to explore personal and societal prejudices and misconceptions. Techniques such as role-playing have been utilized to encourage men and women to experience the other’s dilemmas. Educational programs have become widespread. To fill in the presumed knowledge gap, facts, theory, and research findings are presented and discussed.

Unfortunately, the effects of these programs are rarely assessed systematically, so no conclusions about their effectiveness can be made. It is likely that such programs are successful only when an individual’s assumptions about women have been sustained as a convenience, or because they simply have never been put to the test. In these cases, forcing people to confront their stereotypes about women and to come to grips with the consequences of them should be sufficient to bring about change. But when stereotyped views are deeply rooted in value systems, such programs are likely to fail. Information by itself has little impact on value-laden convictions.

An incidental but nonetheless important point about implementation should be mentioned. Kanter warns of the consequences of using mixed-sex group techniques in change efforts. The very activities necessary to explore sex stereotypes fully—expressing one’s emotions, being open and honest, being concerned about the welfare of others, and collaborating rather than competing—are those consonant with the stereotypic attributes women are assumed to possess. Although Kanter’s concerns were related to the lack of opportunities for skill development available to women in such groups, the point she raises is no less important when one’s concern is the altering of sex stereotypes. Participation in such groups conceivably can reinforce rather than change men’s images of women, unless care is taken to ensure that women also have the opportunity to display behaviors that contradict and challenge the stereotypes men are likely to have.

Changing individuals’ sex stereotypes can be a very complicated process, and it is likely to be an expensive one. The training and development needed to accomplish such a change, if indeed it can be accomplished, are not realistic in terms of the money and time required.

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In many societies, ideas about sexuality assume more concrete form. In fact, the pronounced nature of sexuality in other societies has taken some anthropologists by surprise. For example, Harold Schneider writes of his work with the Turn, “I did not set out to study sexual behavior, but became acquainted with an important dimension of sexual roles in the normal course of a predominantly social anthropological study”. Schapera made much the same transition upon contacting the Kgatla: “I was continually struck by the open importance they attached to the sexual aspect”. In addition to these comments from Africa, the openness of sexuality has left impressions on researchers working in Polynesia, South America, the Caribbean, and Melanesia.

However, that which takes the ethnographer by surprise—sometimes requiring her or him to re-think the focus of a project—comes as no surprise to the native. “Alligatoring” makes sense to the Mehinaku. Sexual segregation at work and in ceremony makes sense to them too. It is this sense that the symbolic anthropologist hopes to reveal and understand. With this approach symbols are investigated as the basic building blocks of the ideological system. Symbols stand in relationships; they do not stand for something else.

Returning to the matter of Mehinaku extramarital sexual activity, we find that Gregor resorts to a Durkheimian notion of mechanical social cohesion in his explanation. Mehinaku affairs create relationships which keep the community together, though one wonders how. “Extramaritality,” to coin a workable expression, is also an important basis of economic distribution, according to Gregor. Women receive “modest but regular amounts of fish throughout the year” if they are sexually active.

There is yet a third component in Gregor’s analysis. Extramaritality engenders what Gregor calls an “underground kinship system,” “wherein the relationships engendered by extra-marital affairs are performed discreetly so as not to embarrass or anger the cuckolded spouses”. Crocker, studying the Canela Indians of Brazil, reports on an “underground kinship system” that goes one step beyond the Mehinaku system. The Canela (or at least the men) appear to speak to their “underground kinsmen,” the consanguinal relatives of the “classificatory wives” or mistresses’ with the appropriate affinal term of address. He will even refer to their children as “my children,” and assume other aspects of the paternal role.

The Mehinaku and the Canela provide examples of systems in which the form of kinship relationships is extended to persons (and to persons related to persons, in the Canela case) understood to share paternity through sexual acts. In one case from Africa, however, the political dimension is constructed somewhat differently. Harold Schneider’s analysis of mbuya (“lover,” or “paramour”) among the Turn of Tanzania argues that the Turn family organization is based on productive cooperation, not romantic love. Apparently the Turu have learned that the political dimension of marriage is complicated enough without adding to that burden the emotional peaks and valleys of romantic love. In short, Turu love and marriage do not go together. Marriage is a “lease of rights in a woman to her husband in return for bridewealth”. A smart husband would hesitate to divorce a productive wife, so presumably the fact that they have romantic affairs outside of marriage is tolerated by the husbands. Wives show similar tolerance. Schneider argues that “this tenuous marriage . . . would be endangered by romantic love, with its ups and downs”. Whether or not Schneider is correct, that is, if romantic love would indeed contribute serious instability in a basically political relationship, he has directed our attention to a group whose ideology places marital relationships (I hesitate to call them sexual) and extramarital sexual relationships in tension and opposition.

The opposition appears to be somewhat differently structured among the Mehinaku and Canela for whom it has been reported that “kinship” is extended through the possibility of “multiple paternity.” For these people we probably will not find a sexual/political opposition as with the Turu; instead, they have achieved levels of kinship structure—the so-called underground and above-ground system of ratified kinsmen—that contribute to the tensions of social life. Although a Mehinaku or a Canela may have scores of kinsmen, groups of kinsmen are set off through an opposition between those who are related to ego through ego’s mother’s husband, and those whom ego knows to be related to him or her as partial fathers through their sexual activity with ego’s mother during her pregnancy. Acknowledgement of this latter group of kinsmen, on the instructions of ego’s mother, is a recognition of the multiple sexual relationships of the mother, in which case we can say that her sexuality contextualizes the child’s social world.

This cultural structure contrasts with the ideological universe of the Turu, who live in two worlds, a body politic and a body sexual, as it were. The important point here is that sexual symbolism can form part of the structure of a bisected world, the other world being political (e.g. the Turu case), or it can provide an overarching structure in which ratified and surreptitious kinsmen are identified and opposed (e.g., Mehinaku, Canela). These two contrasting cases illustrate the insight into cultural systems possible when sexuality is studied within a framework of ideology, rather than separately.

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According to the Kinsey data, masturbation is chiefly a phenomenon of young unmarried men, although it occurs to some extent among both sexes at every age and marital status level. Eighty-eight percent of the single males from sixteen to twenty in the Kinsey sample masturbated; the proportion of married males at this age level was considerably less (39%), presumably because marital intercourse was a preferred substitute. For young single males, masturbation represented the highest proportion of total outlet (60%). After age forty, masturbation was a relatively lower percentage of the total outlet (about 40% for the active sample). The average frequency of masturbation in the active single male sample dropped from 1.7 times per week in the teens to once a week or less by age forty. Kinsey did not report masturbation data for single males over fifty. Masturbation accounted for a lower proportion of the total outlet for married males than single males at every age. The average frequencies per week were from four to five times lower for married men.

Sixty-two percent of Kinsey’s total female sample reported that they had masturbated at some time, and 58% of these women had masturbated to orgasm. Among the single active sample, the average frequency of masturbation was .3 to .4 per week; for married females the mean was directionally lower (.2 per week). There was very little change in the active median frequencies for single and married women from the late teens through the fifties. Masturbation represented the highest percentage of total sexual outlet for single women; for married women, it accounted for 10% of the total outlet. Average frequencies of masturbation for single women showed virtually no decline with age (about 1 per week from the late teens through the fifties). For married women, average frequencies per week went from 1 in the teens, to .60 at age forty, to .2 at age fifty. For every age group, the percentage of total outlet was from three to seven times as great for single as for married women. Based on their clinical experience, Masters and Johnson suggest that both married and single women who masturbated during their adult years continue to masturbate in old age, although the frequency declines after age sixty. Christenson and Gagnon reported that 25% of a sample of postmarital women in their seventies were masturbating.

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After a recovery period, the doctor will instruct you to slowly and gradually pump up and deflate the implant. This is only to make sure the prosthesis inflates evenly as healing progresses. You should wait until your doctor gives the okay before attempting to have sex. If s important not to jump the gun and try inflating the implant too soon. Some men are so tender they don’t even want to think about doing this for several weeks.

Typically, a man has to wait six weeks before he can have intercourse, and even then it’s important to proceed slowly and gently. It will be a lot more comfortable, at least at first, to inflate the implant to about 75 percent of capacity at the most. It’s important that the implant be completely deflated most of the time. If it remains partially inflated, scar tissue can form around the reservoir and prevent it from filling completely. The end result can be a penis that is partially inflated all the time.

Surgery is necessary to correct this avoidable and relatively uncommon complication.

Of course the inflatable implant has drawbacks. A leak in the system is probably one of the most common problems. It takes just a tiny hole to sabotage the prosthesis. Usually, removal and repair is necessary—requiring additional surgery. Twisted tubing which prevents the fluid from traveling between the reservoir and the cylinders is a rarer occurrence. But if it does happen, surgery is necessary to straighten out the kinks. A weakness in the corpora cavernosa can result in a lopsided erection—because the implant balloons out to fill up the space. When most of the fluid ends up in one area, less is available to go elsewhere. The man finds himself with a mostly soft penis that has a big, stiff lump. Again, surgery can correct this condition; the physician replaces the cylinders with specially designed ones which won’t balloon, but also aren’t quite as big in diameter.

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Although flaxseed has been best known as a source of linseed oil, this ancient food which contains both soluble and insoluble fiber is also the richest known vegetable source of omega-3s. A food with incredible heart-protecting properties, flaxseed contains the highest levels of alpha-linolenic acid, a variety of omega-3 fat. Flaxseed oil is another option. Its omega-3s promote the formation of prostaglandins, the hormonelike substances that help to relax capillaries, decrease cholesterol levels, and lower blood pressure.

If you decide to use the seeds, sprinkle a few tablespoons on your cereal, mix them into yogurt, and, if you wish, grind them and add the powder to food. Use the oil as you would any salad dressing. You should be aware that this highly polyunsaturated oil has a shelf life of less than a month and that exposure to heat, sunlight, and air can turn it rancid. It should not be used for cooking. However you use flaxseed or its oil in your diet, just make sure you do so a few times a week in order to get your optimal dose of omega-3s.

Another heart-healthy ingredient, olive oil has been found to be especially helpful in transporting LDL cholesterol out of the body while at the same time guarding HDL cholesterol levels. It is the HDL which protects the heart. This has been observed in coronary disease studies of Italians and Greeks in their native countries. While these people consume about the same amount of daily fat as do Americans, their choice—three tablespoons of olive oil a day—has shown to be very beneficial to their health. (In this country, Americans average three tablespoons of olive oil a month.)

My recommendation is to cut out any butter and margarine you may be using and substitute the best olive oil you can buy instead. Your body will thank you for it.

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Developed more than fifty years ago to block the release of histamines from cells, these drugs are widely available in both prescription and over-the-counter forms. They work by counteracting the body’s reaction to allergens, the ordinarily harmless substances which trigger the immune system to produce antibodies to destroy them. When you’re prone to allergies, a special type of antibody, called IgE, is produced, making you super-sensitive to the allergen. Each time you’re exposed to the offending substance, it combines with the IgE antibodies, releasing histamines that bring on sneezing, watery eyes, and runny noses.

Antihistamines, which dry mucous membranes, can also be responsible for ED as well as a drop in libido. I have had success with patients who switched from antihistamines to Nasalcrom or Flonase nasal spray. These medicines control allergic symptoms without affecting sexual function.

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Another view of personal gratification can be seen in the case of fifty-five-year-old Edward. Married for the third time, he was besotted with thirty-year-old Nicole, and his concern about aging motivated him to see me.

Running his hands through his steel-gray hair, Edward made his wishes known. “I’m not deluding myself. I know my personal sexual clock is ticking and it’s bound to slow down. I want insurance that I can count on. The last thing in the world I want to do is disappoint Nicole and have her look to a younger man for satisfaction.”

The fact that Edward was in my office alone disturbed me, and I told him so. In order to be a part of the trials, he had made an appointment for them both.

“Well, I don’t want Nicole to know that I need help,” Edward said. “Right now we’re in a really good place, sexually, for both of us. But once in a while I’m not as hard as I’d like.”

When I asked what Nicole’s reaction had been on those occasions, he shrugged his shoulders. “It amazes me, but she doesn’t seem to care. She had a really bad marriage when she was twenty—the guy was very abusive to her—and she says that feeling safe and loved is one of the biggest turn-ons of all, sex or no sex.”

After I explained to Edward that the oral intervention could bolster his confidence as well as his erection, I made another recommendation. Given his closeness to Nicole, and her comfort with him, I strongly suggested that he speak to her first. He did, and they came in for a second visit. I prescribed the drug, and now they are prepared to override any sexual glitches that may arise in the future. The emotional issues in this case were:

• fear of incompatibility arising out of age difference

• concern about a partner’s level of pleasure

• the desire for increased pleasure

• expectation of an even better relationship

Think about your own feelings concerning:

• how often you have sex and how satisfying it is for you

• restarting sexual activity where none has existed for a prolonged period of time

• whether your sexual expectations have diminished or risen

• keeping your sex-life status quo

The most fulfilling sexual satisfaction is based on an understanding of the other person’s needs and desires.

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Behind the penis are the testicles, two ball-shaped glands that are vitally important to erection, Normal testicles feel something like hard-boiled eggs when you touch them. Men usually learn at a fairly early age that their testicles are vulnerable and quite sensitive to pain. (Falling off a bike or being kicked in the groin during a game of touch football can reinforce that knowledge quite effectively.)

In the womb, a male fetus’s testicles actually change location. They form near the kidneys, but during the last three months of pregnancy descend into the bag that holds them, the scrotum. Ifs not uncommon for a baby boy to be born with a testicle that has not completely descended into the scrotum. During the first year of life, an undescended testicle may actually fall into place on its own. If it doesn’t, a simple operation can place the testicle in the scrotum. Still, two normal, functioning testicles aren’t essential for healthy sex. Men with one normally functioning testicle don’t have any more problems with potency than their doubly endowed counterparts.

If you examine yourself (or your husband), you’ll notice a soft swelling on the back of the testicles. This sensitive area is called the epididymis, and ifs the home for the sperm as they mature. Lots of things—injuries, infections (such as mumps), certain other types of disease—may cause problems with sperm production, thus affecting a man’s ability to father a child. But nature has done a good job of protecting the hormones that play a major role in a man’s ability to have a healthy, firm erection. The production of male hormones in the testicles is separate from sperm production, and far more resistant to damage. That’s why the vast majority of infertile men have no more difficulty with erections than their fertile counterparts. In fact, there’s a big difference between fertility and potency.

Fertility refers to a man’s ability to father a child. Generally, in order for a man to do that, he has to ejaculate normal sperm. Potency means a man can get and maintain an erection. Erection is a separate process from ejaculation, so erection and fertility do not go hand-in-hand. It’s fairly common knowledge that a man can have an erection and not ejaculate; however, many people are not aware that a man can have an ejaculation without an erection. Many men who lose their ability to have an erection still become aroused and, with stimulation, can ejaculate.

This means that a man with erection problems can still get a woman pregnant. He can father a child using artificial insemination. Or, if he ejaculates in the entrance of a woman’s vagina, ifs possible that she could become pregnant. The chances of this happening, of course, are significantly less than with intercourse, when a man ejaculates very close to the entrance of the womb.

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