Now that the journal has been launched, I'd like to use this editorial column as an opportunity to offer observations on matters that pertain to sexuality, reproduction, and menopause. On this occasion, the topic is sexuality.
In recent months, a controversial legal decision has been reached by the Massachusetts Supreme Judicial Court legalizing gay and lesbian marriages. It has been the subject of discussion and opinions from all walks of life, ranging from average citizens to leaders of the clergy to the president of the United States.
Regardless of one's opinion on the matter, it is clear that the gay and lesbian community is seeking to provide a legal vehicle for relationships to evolve into ones that are both committed and legally protected. During this same window of time, an article in the Boston Globe (Bella English, “Dinner and a movie? No thanks.” B17, December 11, 2003) highlighted how many in the heterosexual community are choosing a diametrically opposed life style. In total contrast to the United States before the late 1960s when marriage was the best guarantee for regular heterosexual sex, on-line dating and a total change in the significance of sex has transformed the heterosexual experience into one of less commitment and more casual sexual experiences.
In the first half of 2003, Americans spent $214.3 million on personals and dating sites, and according to comScore Networks, which monitors consumer use of the internet, 40 million consumers visited at least one online dating service in August of 2003. That is more than one-fourth of all Internet users for that month. The new dating paradigm is to get together casually, called “hooking up,” a term that defines a lack of commitment or expectations other than sex and implies some degree of alcohol consumption to set the stage. A survey of 1,000 college women conducted in 2001 by a conservative group called the Independent Women's Forum found that only half of the seniors surveyed reported being asked out on a date six or more times during their entire time in college. Ninety-one percent reported “a rampant hookup culture.”
All of this has led to an interesting twist in an article that appeared in the last issue of SRM on erectile dysfunction. Rather than impotence drugs, such as Viagra, Levitra, and the new Cialis which stays in the bloodstream for 36 hours giving it the name “the weekender,” being used exclusively by the 15 to 30 million American men the National Institutes of Health estimate who have erectile dysfunction, they are increasingly being used by sexually healthy men, many in their 20s, 30s, and 40s (Warren St. John, “In an oversexed age, more guys take a pill,” The New York Times, December 14, 2003).
The emphasis has switched from finding a mate to simply finding someone to share the physical act of mating. According to The New York Times article, the hooking up generation goes out for a date and the woman believes she “ couldn't judge a man without first having sex with him.” As a result, an increasing number of the men are experiencing performance anxiety, resulting in the use of impotence drugs as psychological safety nets.
Perhaps that is why advertisements for impotence drugs pop up so commonly on the internet as one of the most common forms of spam (“Pill peddlers cough up more spam,” The New York Times, December 16, 2003), why more of our patients are older when they finally decide to have a baby, and why households that contain both a mother, a father, and their child(ren) are on the decline. According to the students surveyed, as reported in the Boston Globe article, the young men are fearful of being “stuck with a wife” and the women are “fearful of losing their independence.”
Clearly, the nature of sexuality and sexual relationships in our society is changing significantly. How does this impact on us as gynecologists? I believe it will in several ways.
The first is that we will no doubt be seeing an increase in the number of gay and lesbian couples seeking family building as a result of their increased legal status. The next issue of SRM will contain an article by Dr. Paula Amato on specific treatment issues associated with treating lesbian couples.
The second is that we will have to be diligent in screening for sexually transmitted diseases (STDs), which continue to be on the rise. Multiple casual encounters make this trend rather inevitable. Infections such as Chlamydia are often asymptomatic yet have great potential impact on reproduction. According to the Centers for Disease Control, there were 3 million estimated new cases of Chlamydia and 5 million estimated new cases of Trichomoniasis last year. The next issue of SRM will have an article on STDs.
We will also have to be more aggressive in counseling women on the significance of age on reproduction. This issue's article on Fast-Track Women and the Quest for Children speaks to the significance of balancing career and family and Pamela Madsen's article in the last issue strongly encouraged open dialogue on this subject with our patients.
Finally, given the level of concern surrounding sexual performance that many young healthy men are currently experiencing, we can anticipate that the prevalence of sexual dysfunction will increase dramatically during the next decade among both men and women. Dr. Brill's article on antidepressants and sexual dysfunction in this issue describes how to take a sexual history. Also, because depression afflicts as many as one-third of the population, overcoming the impact of the disease or its treatment is of particular relevance to a growing number of our patients.
I hope you enjoy this issue of SRM.
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