In Plato’s Symposium, Aristophanes tells us that the first humans were both male and female. They were very beautiful, insufferably pleased with themselves, and, above all, self-sufficient (as many of us surely would be if there was never the need to woo and keep a mate!). According to the story, these early humans were so enchanted with their own perfection that they planned to attack and conquer the gods themselves. Zeus, king of the gods, decided to punish their arrogance by dividing each of them into two sexes: male and female.
The newly separated humans were so lonely for their missing halves that they found themselves unable to work or function, eventually dying off from sheer longing. When he saw what he done, Zeus had second thoughts and consulted Apollo, the god of medicine, to devise a method to reunite the two sexes, if only temporarily. Apollo obliged with the ingenious idea of sexual intercourse. (Evidently, the sensation of boundaries dissolving between people during a passionate encounter has a mythological basis, if not a scientific one.)
Poetic as this may be, and as mystical a sex may seem to well-suited lovers, the reality – what actually happens between two people in bed – may in fact be quite different. Instead of finding our long-lost missing half, many people find sex unsatisfying, uncomfortable, or undesirable. To judge from popular magazines and television, you’d think the sheets were on fire, but the statistics (and my patients) tell us otherwise. The sad statistic is that sexual dysfunction (low desire, difficulty in becoming aroused and / or reaching orgasm, and painful intercourse affects 43 percent of women and 31 percent of men. You’ve probably noticed the proliferation of medications designed to address sexual dysfunction.
Doctors tend to reduce sex to a very specific and well-regulated cascade of events, requiring the coordinated activity of a cast of thousands of nerves, blood vessels, and chemicals. Sometimes this viewpoint can result in oversimplification: “Low libido? Here’s a prescription for Viagra or a testosterone patch.” In defense of my colleagues, many patients want an instant fix for boredom, pain, or anxiety and prefer a pill to the difficult business of sorting out what’s really wrong and what to do about it. It’s much easier to believe that faulty hormone levels are to blame for lackluster performance in the bedroom than other, more difficult problems requiring time, sacrifice, or a difficult conversation.
But clearly, hormones aren’t the whole answer. If the wags are right, the brain is the largest erogenous zone (especially for women) and will need a great deal more research on how that organ operates to ensure a satisfactory sex life. Dissecting sex may not be very appetizing, but I’d like to know more about how everything works when patients tell me what’s going wrong in the bedroom and ask me what to do about it.
As you’ve probably noticed in your own life, there are some stark differences between men and women in this area. Are the sexual differences between men and women the result of differences in our brains? I can’t tell you because we don’t know. But what we do know about the differences between the way men and women experience sex may help us improve our relationships, not to mention our general well-being. Because no matter how you try to temp it down, ignore it, chase it, avoid it, fear it, enjoy it – and whether you revel in anonymity or surround it with the trappings of romantic love – sex occupies an elemental, perhaps even primal, force in our lives.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.