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.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
