I had the opportunity to watch “Hope Springs” with Meryl Streep and Tommy Lee Jones as part of inflight entertainment last year- a movie with a subject matter that is strangely close to my heart as they seemed to be like a lot of my patients. For those who have not seen this movie, its about a 50 something seemingly contented couple with underlying currents of discontent. The wife (Streep) is increasingly bothered by this and decides to seek ‘intensive’ therapy which the husband (Jones) has no choice but to go to. And so ensues multiple cringe worthy exercises they have to do under direction of the therapist (Steve Carrell). One exercise in particular led them to rip each others clothes off (ok, not quite rip!) and have intercouse. While thrusting, Jones is on top and looks away, Streep looks at him and wants him to connect with her and so turns his head towards her and wham! The erection is gone. What ensues is quite typical, she gets mad and takes it personally that he has indeed lost interest in having sex.
Now, I bring this up because I realise that my view of some of the scenes are actually quite contrary to common perception (including Streep’s in the movie) and possibly even the man in this particular instance mostly because its something that’s hard to admit.
I believe that what actually happened is this: Its been a while since they had had sex and he’s probably really relieved its even up, not to mention super thrilled. He is probably able to get it up most of the time but has trouble maintaining his erection and usually really needs to concentrate really hard so that it doesn’t go soft halfway- the slightest distraction is usually enough to derail things. Hence the eyes closing (yes, it possibly might mean plunging into the deepest depths of memory archives to dig up whatever it takes to keep it up- but not necessarily). Because he knows that if he loses it halfway- the partner may take it personally; the partner may think he’s a lesser man; the partner may think he’s cheating; most importantly, he may himself think that he’s a lesser man, that he’s losing it for good.
What usually happens in this instance is that the man, like all normal human beings, tries to avoid these situations- one tends to choose the path of least resistance. However much he tries not to think about it, its there in his subconscious- and stays there. The kinder the partner is to him in regards to intimacy- the worse he feels that he’s letting her down. So he pulls away. If the partner then treats him badly for being a ‘lesser’ man, at least he is allowed to be angry (somewhat soothing to be able to be angry legitimately). Some may even decide to stray to see if its different with other women- it could very well be for the first couple times (novelty does make a difference) but it invariably raises it ugly head eventually. They then either ignore the situation and hope it goes away or go online for cialis or viagra or see their GP.
This is just one example of the people who come to see me during my time in Harley Street and my advice helped a good number of them but not all. Naturally it is not realistic to expect treatment to help everyone but I felt that there was something missing. It didn’t feel right to treat only the one symptom (when it had multiple causes) and I felt powerless to help in other ways where their main carers, their family GP, was supposed to help but couldn’t due to NHS time constraints and targets. This was a holistic problem which required a holistic approach which couldn’t realistically be dealt with in the half hour I had with my patients (I was employed then and had to go by the employer’s rules which by all accounts was a fair amount of time compared to a GP’s 10 mins). I felt like I needed much more time to educate them, to talk to them, to find out the gist of the problem, to speak to their partners, to examine them, to get a feel for my patients, to really help them.
In my search for answers, I stumbled upon age management medicine. A logical, completely evidence based form of medical practice, which prevents problems before they happen. A movement that puts the responsibility in the patient’s hands- not a bad thing- empowers a patient with knowledge and know how- keeps the patient vital with a little help from me. I signed on to learn more in the USA (where else) where the movement is gathering momentum, met more inspiring people in a week than I have in years- all people who believe in change for the better and were not afraid to put themselves out there. Passion times infinity! What a wonderful way to start the journey!
Bioidentical hormones are the mainstay of vitality management and my average patient will be 40-70. Occasionally I see younger people who may be depleted for any number of reasons, one of the commonest being Androgen Induced Hypogonadism (post anabolic steroids for building muscle mass). Most hormonal levels go down with age and contribute to the ‘growing old’ feel we all get. The good news is that it doesn’t really need to happen. I also have developed a special interest post pregnancy blues and menopause alongside my main interest of sexual dysfunction. However, the most important category of people that should come to me does not need to have a ‘problem’. You should just want to feel like the way you did when you were younger- vital, full of energy and life! I will equip you with the know how to do your part and I will do my part.