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Impotence: A Cultural History.

Impotence: A Cultural History, by Angus McLaren. Chicago: The University of Chicago Press, 2007, 332 pp.

Impotence, the old term for male erectile dysfunction, is a unique problem. From the medical point of view, it is a disease defined as the "consistent or recurrent inability to achieve an erection sufficient for intercourse." However, it is also associated with several other aspects of men's lives, including masculinity, social domination, and fertilization. In an era of the medicalization of human sexuality, it is important to understand that male sexuality is not simply equivalent with having an erection. Impotence: A Cultural History is interesting in several respects. It considers history, culture and current attitudes towards sexuality, shedding light on men's overall health and subjective well-being. Why is it important to know the cultural history of sexual dysfunction? Because male sexuality is a complex behavior that is intimately related to social and cultural contexts. As such, sexual dysfunction is not a disease that can be simply managed by a specific treatment.

The author does a fine job of incorporating historical data on human sexuality in a discussion of current trends in pharmacotherapy. Starting from the Greek and Roman world, Impotence: A Cultural History proceeds through Christian Europe and the domination of the Church, which discussed impotence in the context of marriage. When the power of the Church declined, impotence was again made a laughing matter as it had been in ancient Greek and Roman jokes. Discussion and analysis of impotence occurred outside the context of religious belief.

A new perspective on impotence as a physiological problem appeared in the eighteenth century. While modern medicine later discussed the problem from a more scientific perspective, the specialty known as andrology appeared only later. Sexologists and psychoanalysts wrote sex manuals that were based on a psychogenic theory of impotence. In the late twentieth century, impotence was recognized to be both an organic problem and a sexual couple's issue.

The author finally comes to the era of Viagra. It is characterized by the medicalization of sexual dysfunctions. There is no doubt that drugs have revolutionized the treatment of erectile dysfunction. However, the author is rather pessimistic about this, stating that while pharmaceutical companies make billions of dollars, men still feel sin and guilt about their impotence, which puts them at an increased risk of performance anxiety. Sexual dysfunction must be seen from a more optimistic perspective. Many papers in the medical literature suggest the importance of understanding the distinctiveness of patients with erectile dysfunction. New treatment approaches have evolved, such as evaluating the man's attitude to resuming a sexual life with his partner, the female partner's physical and emotional readiness to resume lovemaking, the meaning for each partner of using medical intervention to enable intercourse, and understanding the quality of the nonsexual aspects of a couple's relationship. Certainly, the simple prescription of a pill for erectile dysfunction is not enough. Pharmaceutical companies have recognized this and are changing their strategies accordingly.

The author states that the book's goal was "to understand the main tendencies that have historically structured representations of masculine sexual inadequacy" (p. 263). There is no doubt that he succeeded. The cultural history of impotence is of importance to understanding why a man wants to have sex. Sexual performance proves his masculinity. A male's sexual performance has always been an important theme. The ways in which love and affection are expressed in one's family of origin, the unique and sometimes traumatic sexual experiences one has growing up, the religious, cultural, and societal messages one receives about sex from peers, teachers, and relatives, and the ever-increasing impact of the media on one's beliefs and behavior clearly play a role in promoting sexual health or causing sexual dysfunction.

I would agree with the author that "impotence has a future" (p. 266). We can expect a completely different approach to the problem that will be patient-centred. Treatment will be individualized, based on an assessment of what the patient expects from his sexual life. Probably, this will be the topic of a new chapter in a future book discussing the cultural history of impotence in the twenty-first century.

Konstantinos Hatzimouratidis

Aristotle University of Thessalonika
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Author:Hatzimouratidis, Konstantinos
Publication:International Journal of Men's Health
Article Type:Book review
Date:Jun 22, 2009
Words:694
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