Several years ago, a 25-year-old male patient walked into Dr. Abraham Morgentaler's office with a surprising problem: He was faking orgasms.

A man faking it? Morgentaler, an associate clinical professor of urology at Harvard Medical School, had never heard of such a thing. After he got over the puzzle of how a man could effectively pull off such a ... sleight of semen, he got to the patient's motivation. As Morgentaler writes in his new book, "Why Men Fake It: The Totally Unexpected Truth About Men and Sex," his patient was having trouble climaxing during sex with his girlfriend, so he feigned pleasure for her benefit. He "was simply trying to do what he believed was the right thing by her."

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Morgentaler came to realize that faking it was more common among men than he had realized -- and that this general sexual sentiment was, too. "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 about what men are all about," he writes. His book -- which paints a portrait of men who feel anxious about their erections, pressured into having sex and concerned about their partner's pleasure -- is all about correcting that.

Morgentaler has treated men with sexual and reproductive problems for 25 years and bases much of his book on his decades of experience with clients. Clearly, his sample is a bit skewed: These are men who have sought out sex-related medical help. But Morgentaler says it's important to know the range of experiences that are out there. Men are more sexually complicated -- and kinder-hearted -- than we realize, he says. "For every man who behaves badly, I can give you 10 who are dedicated and thoughtful and doing the best they know how to be a man and a solid partner," he writes.

I spoke with Morgentaler by phone about everything from the prevalence of erectile dysfunction to myths about testosterone.

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One of the first myths that you address in the book is that "men are only concerned with their own orgasm." So how did the men you’ve worked with feel about female pleasure?

The big surprise to me when I started doing this work 25 years ago is that once a man is in a relationship, men seem to care more about their partner than themselves. Early in my career, I remember a guy walked into my office ... In the waiting room, he looks too cool for school; he thinks he’s just the cat’s meow. But when he gets in the exam room, he’s totally torn apart talking about his girlfriend and how he can’t satisfy her because he has premature ejaculation.

I have a case in the book of a 27-year-old paraplegic who can’t feel or move anything from the waist down. I treat him so that he can have sex, and he comes back and is totally thrilled. His whole personality is different. What he says is, “It’s fantastic. I feel like a man again!” I think the natural response to that would be, "Yeah, he’s having sex so it must be good for him." But here’s the thing: This is a guy who feels nothing down there. He feels good about himself as a man; [it's] not because he’s getting off or having these pleasurable sensations from sex, but it’s about what he’s able to provide for his wife.

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The other angle on this, which shows how far we’ve come and how much has changed over the past 40 years or so, is that I have men who are divorced or widowed and are dating again, and they’ve got a problem like ED. Men who have ED can almost all still have an orgasm. So in essence, they still have the pleasure from sex, but [ED] is an insult to their masculine identity. This guy in his mid-50s who saw me the other day said, “I can’t even date like this. What woman would want to be with a guy that can’t satisfy her?” The idea that a man might be rejected because he can’t be an adequate provider sexually turns everything upside down. It wasn’t that long ago, the '50s or so, that we saw this term about women doing their “wifely duty.” It was assumed that women didn’t enjoy sex and that part of the marriage relationship was that the woman had to submit to it for the benefit of the relationship.

You also argue that the belief that men’s sexual behavior is influenced by testosterone is false. Can you explain that?

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So, like a lot of myths that persist, it’s partly true. Testosterone is critical for a man’s sexual desire and functioning. What’s out there in news stories, and frankly even in some academic papers, is the idea that men are the product of their minute by minute, moment by moment variations in testosterone. A week or two ago, a British newspaper reported that men aren’t designed to be monogamous and that if a woman wants to find a man who will be faithful, she should find a man with low testosterone. Now that’s crazy. It doesn’t work that way!

It’s part of a picture we have where we accept complexity for women but we simplify the story for men. It’s as if people think we know everything there is to know about men, and it’s false. It’s actually very challenging and complex times for both genders. Women have entered the marketplace and [they] graduate at higher rates -- from high school, college, medical schools, law schools -- which is great for them. There’s absolutely been a need for gender equality. But there’s been an impact for men. There are a lot of men now who are in relationships or may enter into relationships where it’s the woman who has the better-paying job or more prestige. The challenge for men is how to feel good about themselves as a man while still embracing the strength and capability of today’s woman.

And how specifically does that dynamic affect men’s sex lives?

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Well, I think part of what’s happened is that the opportunity for men to be the provider, if you will, in most realms of life, like [they were] in the 1950s, has decreased. For a lot of men, it’s in the bedroom that this role may still be there, and if anything, it becomes more important now than it was in the past. That’s why one of the things that’s a cruel joke is that men are stuck with a very high rate of sexual dysfunction now. So as much as they want to feel great, to sexually feel like they’re the provider, if you will, we have slightly more than 50 percent of men between the ages of 40 and 70 who have some degree of erectile dysfunction.

And why is that so common?

It just is. Part of what happens is that almost anything that’s bad for blood vessels is bad for that part of the man’s anatomy. Diabetes, heart disease, atherosclerosis, obesity, lipids like cholesterol -- all of them are bad for blood vessels, and they’re all risk factors for ED.

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So, to the book’s title, how exactly do men fake orgasms?

That’s the question everyone wants answered. When a patient first came to me with that, which was probably five or six years ago, I confessed that I’d never heard any such thing and I was fascinated myself. Since then I’ve realized it’s not so rare. But what really interested me about that story, after I got over the question of how did he do it, is the mind of men and why a man would do that. It turns out the reasons men fake it are actually pretty similar to the reasons that women fake it. In their minds -- and we can argue whether or not it’s productive thing to do -- but in their minds, it’s actually a form of kindness. They’re kind of letting the other person know that they’ve done a good job. In this particular case in the book, this guy had trouble having an orgasm during intercourse, but it had never bothered him before. He's felt like a stud. The problem happened when he fell in love. Once he got his feelings involved, he became concerned that she was feeling bad about her own feminine charms and skills, and so to solve that for her he started to fake it.

How common is it really, though?

There’s not a lot of work on it, but there was an online survey from a men’s website, which probably attracted mainly younger guys, where 31 percent of the guys said they had faked it at one point or another in their lives. It’s a pretty high number! And I can tell you anecdotally that when I got a first copy of my book, I went out to a restaurant to show it to a friend. We’re sitting at the bar, and there’s a group right next to us who saw the cover of the book, and a woman said, “Faking it? It can’t be about faking orgasms because men can’t do that.” One of the men with her said, “Sure they can. I’ve done it many times!”

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So how was it really done? The assumption is often that it can’t be done because with men there is actual ... evidence.

I know. Would it be terrible of me if I left that as a tease for your reader to actually get into the book? It feels like giving away the ending of a whodunnit.

Sure, that’s a fair bargain. Moving along, how have you noticed the rise of Viagra in your practice?

It’s changed so much of how we think about men and sex. First off, let me tell you that I was in practice a long time before Viagra was available. The numbers of men who would admit to having ED was tiny. Matter of fact, we didn’t know how common it was until 1994, when there was a big study called the Massachusetts Male Aging Study, which blew the lid on this issue. It was only a little while before that that the Masters and Johnson idea was universally held, that if a man has a sexual problem it was all in his head. When I started my practice in the late 1980s, a lot of the guys who did come to see me for ED would start telling me about how they thought they had their problem because they slept in the bed with their mother until age four or they wet the bed until they were age eight. They were all grasping at this psychological failure that had somehow led to this problem.

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When Viagra came out, all of a sudden there were ads on television with the presidential contender Bob Dole talking about it and introducing the term ED to the public, and everybody was fascinated. We started seeing ads on television that talked about erections -- even the four-hour erection that required medical attention. That was wild. It brought this whole issue to the forefront; we had words for it in public discourse that were acceptable, and of course it was in Pfizer’s interest to actually inform the public that this was a common condition that could be treated. Now what’s happened as a result is that it’s changed expectations for men and their sexuality. Now men have the idea, which I’m not sure they had before, that they can be sexual even if they live to be 120. Every day, we see patients who request the pills or who already take them but who actually don’t have true ED. Then the question is, if the guy has adequate ability to have sex and he’s able to have a climax, then what does he gain by being a little bit firmer? And it goes back to this idea that it’s not really about his pleasure. Most guys will say that they think they’re providing a better experience for their partner. A guy’s sense of his masculinity, especially in the sexual realm, is not about what he experienced himself; he gets his sense of masculinity through the eyes of his partner.

I'm curious if your observations of these dynamics are different when it comes to gay male patients.

One of the issues for gay men is they all share the same equipment. Masculinity in the gay world is a different story, to some extent, than in relationships between men and women. Part of the struggle for straight men and women is that the traditional roles we grew up with are shifting. I would suggest to you that in the gay world those relationships have never been terribly well established. There’s talk of tops and bottoms, but if you have two men, regardless of whether they’re a top or bottom, how much is their essence and idea of self attached to being a provider? I think it is a different story for them.

This idea of defining masculinity while social roles and ideas are so rapidly changing is a challenge for everybody. To me, one of the reasons I thought it was worthwhile to write this book now is that we have so little information regarding the truth about men. There’s been an ongoing conversation and evolution for women over the past 40 years. For men, there’s been almost nothing. When we have such a big void, it gets filled by something. And I think the void has been filled by mythology, by negative impressions created by the bad apples that show up in the scandal sheets, and by the loudest and most brazen. I think that there’s a tremendous need for men to enter into the conversation and for people to know, especially in the sexual realm, what’s real.