SRH Matters

What do female orgasms and male nipples have in common? It’s a question that is helping inform research into the purpose of female orgasm (other than simply as a form of pleasure).

Investigators want to know whether the female orgasm is an “adaptation” or “byproduct” of evolution. In other words, does the female orgasm, like the male orgasm, have its own evolutionary raison d’etre and contribute directly to reproductive success? Or is it just an awesome bonus? Make that totally awesome.

This question of whether the female orgasm is an adaptation or a byproduct came to the fore in 2005 with the publication of “The Case of the Female Orgasm: Bias in the Science of Evolution,” in which Indiana University professor Elisabeth Lloyd rigorously examined 21 theories that sought to promote the female orgasm as an adaptation and, ultimately, found all of them lacking.

Over the years, I’ve been lucky enough to have had some thought-provoking conversations with Lloyd on various topics – such as whether premature ejaculation makes good evolutionary sense – and recently, her work has been once again garnering much-deserved attention.

· One such theory involves “pair bonding,” the idea that orgasm bonds a couple emotionally so that they’re more likely to pursue parenthood.

· Another theory states that female orgasm is a part of mate selection: A woman will choose her mate based on his ability to bring her to climax.

· And a third main theory involves the belief that the contractions of female orgasm will draw sperm up the reproductive tract and into the uterus.

In her book, Lloyd argues that studies show that the vast majority of women do not experience orgasm as a result of intercourse alone, or do so inconsistently, so how could the female orgasm be an adaptation? If the female orgasm, like the male orgasm, was essential to the propagation of humanity, wouldn’t it need to occur consistently via sexual intercourse?

Instead, Lloyd argues to view the female orgasm through the lens of the “byproduct” theory, which holds that orgasm is a trait that is so heavily selected in males (reproduction wouldn’t happen without it) that women retain an inherent capacity – after all, men and women are physiologically the same during the first eight weeks of gestation: Penises grow out, clitorises grow in, but they share the same organic structure and tissue.

According to Lloyd, “It is crucial to note that the penis and the clitoris are the ‘same’ organ in men and women. … [T]he nervous and erectile tissues involved in orgasm in both sexes arose from a common embryological source.”

This same byproduct theory also explains why men have nipples: The biological necessity of nursing our young makes the nipple so highly selected in women that male embryos develop immature structures as an evolutionary byproduct. Similar to the clitoris, the male nipple contains highly sensitive tissue that contributes to male sexual arousal and pleasure. Male nipples: arousing? Yes. Necessary? No.

Yet a study of twins and siblings published recently in the journal Animal Behavior questions the byproduct theory of female orgasm. Researchers looked for similarities in orgasm function between 10,000 Finnish female and male twins. And although there were significant similarities between same-sex twins, the researchers found no such correlation in orgasm function between opposite-sex twins, a correlation one would expect if female orgasm is a byproduct of male orgasm.

All this debate of adaptation vs. byproduct shouldn’t really matter to the average person who just wants to enjoy orgasms. The problem, though, is that we tend to believe that what’s “natural” is better, even orgasms. And if we do argue that the female orgasm is some sort of “evolutionary norm,” then what should be said of all the women who do not orgasm consistently – that they are somehow not normal?

As a sex counselor, I frequently receive e-mails from women who are unable to achieve orgasm via intercourse and wonder, “What can I do to change this? What’s wrong with me?”

Well, if we stop thinking of female orgasms as something that should naturally result from intercourse, then we can also stop feeling that there’s one right way to have orgasms. In this sense, the byproduct theory offers a more expansive and encompassing view of female sexuality.

Unfortunately the term “byproduct” doesn’t exactly resonate with a sense of the exalted, so perhaps we should stick to Lloyd’s later rephrasing of the female orgasm as a “fantastic bonus” – or as I like to say, totally awesome!

If you’re a woman contemplating surgery on your female parts, you’ll find plenty of ladies chatting and blogging away about their experiences, often on websites adorned with pink ribbons.

But if you’re a man considering male surgery there’s not so much out there. There’s no ribbon for, say, penis surgery, and comparatively few men trading stories and sharing advice.

“Women are much more engaged with their health,” says Dr. Dennis Pessis, president-elect of the American Urological Association. “It’s gotten better in the past 15 years, but still, men don’t always seek out the best treatments for themselves.”

Penis surgery has been in the spotlight this week as a civil trial in Kentucky made national headlines. Phillip Seaton, a Kentucky truck driver, sued his urologist, Dr. John Patterson, saying he went in for a circumcision but left the surgery with part of his penis amputated. Patterson says Seaton had cancer and needed the amputation or he would have died. The doctor won the case on Wednesday, according to CNN affiliate WDRB.

Seaton’s experience is certainly rare, surgery on the penis isn’t. While good statistics are hard to find, tens of thousands of men in the United States get circumcised as adults. Other common surgeries include implants for men suffering erectile dysfunction and removal of genital warts. Here’s the Empowered Patient list of questions every man should ask before having these procedures on this most valued and delicate of organs.

1. Do I really need this procedure?

Think twice (or more) before having the surgery. It’s a highly vascularized organ, which is a fancy way of saying there is a lot of blood running in and out of it, so cutting into it can be risky. Men getting circumcised as adults should consider the risk of bleeding, especially if they’re on a blood thinner, including aspirin.

Getting implants requires cutting, too, and doctors urge men with erectile dysfunction to try other, less risky, treatments first, such as drugs like Viagra, penile injections, or a penis pump, an external device that fits over the organ.

You’ll also need to choose what kind of anesthesia you’ll want for your circumcision. You can opt for a local anesthetic and a sedative — you’ll be (or should be) relaxed but awake. Men who are especially anxious about the surgery often opt for general anesthesia, which is slightly more risky but ensures they’ll be totally out for the procedure.

As for genital warts, if a man is not experiencing problems such as itching, burning or pain, he may not need treatment, according to the Mayo Clinic.

2. What are my treatment options?

There is more than one type of penile implant and there is more than one way to remove genital warts. Doctors tend to specialize in one method over the other, so make sure your doctor lays out all the options and refers you to another doctor who can perform the procedure the way you prefer.

There are two types of implants. With inflatable implants, doctors put cylinders inside the penis, a pump in the scrotum, and a fluid reserve inside either the scrotum or the abdominal wall. Before sex, you pump the fluid into the cylinders to create an erection. After sex, you activate a release valve in the scrotum to let the fluid out.

The second type of implant involves putting semi-rigid rods into the penis, and it is bent away from the body to have sex (think of it as a goose-necked desk lamp that can be pointed in various directions). For more on various types of penile implants, see information from the Mayo Clinic and the American Urological Association.

For warts, you can treat them yourself or your doctor can treat them. If you choose the DIY approach, your doctor prescribes a medicine for you to apply at home. If you prefer to have your doctor treat the warts, there are several options: Your doctor can apply a medicine, which is sometimes a stronger version of what you can apply at home. There is also an option to cauterize or laser the warts, or to freeze them off with liquid nitrogen.

“You should give yourself some time to make the right decision,” says Dr. Gopal Badlani, a urologist at Wake Forest Baptist Medical Center. “You don’t want to decide at the first appointment.”

For more information on the various options for removing genital warts, see information from the Centers for Disease Control and Prevention.

3. Doctor, how many of these procedures have you done?

Look for a urologist who regularly performs the procedure you need.

“Some urologists do nothing but treat kidney stones or urinary incontinence, and you don’t want that urologist doing your circumcision,” says Dr. Irwin Goldstein, director of San Diego Sexual Medicine. “They need to know what they’re doing so they don’t remove too much or too little skin, or create a new problem like an angled penis.” While there’s no magic number, Goldstein says if you’re having a circumcision, find someone who does at least two or three a month. Plus, you should ask the doctor for names of his or her previous circumcision patients.

“It’s sort of like fixing your roof — you want to talk to a client who’s used that roofer,” he advises. “Ask about the doctor’s follow-up: Was he available, or did he just do the surgery and you didn’t hear from him again?”

For implants, also try to find a doctor who does at least two or three a month, Goldstein advises, not someone who just dabbles in the procedure.

“We did three implants Monday, just to give you a sense of how often some doctors do these,” Goldstein adds.

The removal of genital warts isn’t as complicated as circumcision or implant surgery, but still make sure it’s something your doctor does regularly.

4. Will the treatment really cure my problem?

Badlani says no matter how much he counsels his patients before implant surgery, most are disappointed the implants didn’t give them as large an erection as they had when they were 18.

“Ninety-five percent of the time, after the surgery the patient feels shortchanged. They say, ‘Doc, I expected it to be much longer,’ ” Badlani says. “Men need to have more realistic expectations.”

Men are also sometimes surprised that their genital warts come back after treatment. But the Mayo Clinic says genital warts “are likely to recur” because even after you remove them, you still carry the virus that causes warts, called the human papillomavirus (HPV).

5. Should I clean up before the surgery?

Cutting into the penis leaves you vulnerable to infection, so ask your doctor if you should be scrubbing at home before surgery day.

Goldstein tells his circumcision patients to clean with a special antiseptic once a day for three days before the surgery. He has his implant patients wash up morning and night for seven days before surgery, and take antibiotics for three days before.

“We’re inserting a foreign body into the penis. The chances for things to go wrong are magnified, so we want to take all precautions,” he says.