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New horizons in sexual medicine

[Text of talk given by Emeritus Professor Carlo Fonseka at the International Symposium organized jointly by the Sri Lanka College of Obstetricians and Gynecologists and the Family Planning Association on 22 April 2011]

Physiology and Sex

(May 01, Colombo, Sri Lanka Guardian) I wish to begin by informing those who care to know that in the last century, when I used to lecture to medical students on the Physiology of Sex, I always began with a certain disclaimer. In those days there was a theory to the effect that those who are bald in front THINK; those who are bald behind are SEXY; and those who are bald both in front and behind THINK THEY ARE SEXY! I pleaded then that I was the rule-proving exception to this theory. I make the same plea today.

Who are We?

This symposium is about new horizons in sexual medicine. To set the context I think it is appropriate to ask ourselves a fundamental question: Who on earth are we to seek new horizons in the field of sex? Well, one answer is that we are one of the 193 living species of monkeys and apes self-styled Homo sapiens. We also represent one of the 30 million branches of the river of life on earth. If the phenomenon of life on earth is likened to a river then, the river of life is the river of Deoxyribo Nucleic Acid (or DNA). DNA is the chemical basis of life on earth. DNA is the only chemical known to have the power of replicating or reproducing itself using the elements of matter. By virtue of this property of reproducing itself DNA survives. The river of DNA has some 30 million branches each of which represents one of the 30 million species of living organisms on earth. We represent the human variety of DNA. The bodies of each living species contain a specific variety of DNA. DNA appears to be hell-bent on perpetuating itself.

Human beings, male and female are really SURVIVAL MACHINES for the human variety of DNA. Having as we do, in relation to body size, the biggest brain and the biggest penis of all the primates (great apes) we are the brainiest and sexiest of all animals. That must be surely why we are exploring new horizons in the field of sex. DNA programmes us to love life, to love sex and to love children. That is the strategy by which human DNA perpetuates itself.

Physiology of Sex

What is the essence of the physiology of sex? Sex depends on two factors, chromosomes and hormones. At conception if your sex chromosomal pattern is XY a particular part of your embryonic tissue will develop into testes. They will secrete the male sex hormones called androgens, especially testosterone. Your testes will also produce sperm. Production of sperm makes you a male. On the other hand, if at conception your chromosomal pattern is XX you will develop ovaries which secrete the female sex hormones estrogen and progesterone. Ovaries will also produce ova or eggs. Production of ova makes you a female. When they reach adulthood males are programmed to attempt insemination of females; females are programmed to be receptive to being inseminated.

What is the Role of Sex in Human Life?

Normally sex is necessary for reproduction but at the human level there can be reproduction without sex and sex without reproduction. Thanks to modern techniques of artificial fertilization people can have children even without copulation. As we know sex without the possibility of conception and reproduction occurs naturally during the "safe period", during pregnancy and after the menopause. With artificial means there can be sex without reproduction at any time. Therefore, it reasonable to conclude the sole function of sex in human beings is not reproduction. In fact Desmond Morris the famous author of Naked Ape has described the following ten functional categories of sex. I quote him with just one explanatory comment on each function.

1. Procreation Sex – most basic function

2. Pair-formation Sex –to establish the emotional relationship between the pair

3. Pair-maintenance Sex – to maintain & reinforce the bond

4. Physiological Sex – to relieve the natural periodic physiological tension

5. Exploratory Sex – to experiment with new forms of mutual stimulation

6. Self-rewarding Sex – sex for sex’s sake brings its own reward

7. Occupational Sex – sex operating as occupational therapy, relieving boredom

8. Tranquillizing Sex – to calm shattered nerves

9. Commercial Sex – straightforward commercial transaction (like modern cricket!)

10. Status Sex – concerned with dominance and not with reproduction


It would be criminal to talk of sex without reference to love. The subject is complicated and some idea of its complexity can be obtained by considering the six words depicted in the same order shown below.

What is this thing called love?

What is this thing called? Love

What! Is this thing called love?

If I embark on this subject in any depth I should have to keep you here for much longer than the fifteen minutes allotted to me. So I will just repeat the Greek comic poet Aristophanes’s explanation of love. According to him the earth was originally populated by human beings whose bodies were made up of a combination of a male body and a female body. Each of them therefore had two faces, four upper limbs and four lower limbs. They felt so complete and so perfect and so superior that they planned to invade heaven and conquer even the gods. At that point Zeus the top Greek god, got hold of each of them and split them down the middle of their bodies and scattered the separated halves all over the world. Ever since that time, the two halves of the once united body have been consumed with an overpowering urge to merge into one again. This urge to merge, Aristophanes says, is love. Take it or leave it! If you don’t like that mythical explanation of love I urge you to read the reasons that drove the hard-nosed rationalist philosopher Bertrand Russell to long for love. They are set out in the opening pages of his autobiography.


Finally what are the myths about the physiology of sex?

They have been neatly summarized by psychiatrist and sex therapist Dr. Warwick Williams. I cannot do better than simply reproduce his clear, comprehensive, authoritative and self-explanatory classification under four heads.

A. Myths about the penis

i. The bigger the better!

ii. You should be able to get a hard-on whenever you want one!

iii. An erection is essential for good sex!

B. Macho Myths

i. A man should not show his feelings!

ii. A real man is always horny and ready for sex!

C. Age Myths

i. As you get older there is absolutely no change in your sexual interest, response or performance!

. As you get older you lose interest in sex and can’t do it any more!

D. Myths about love making

i. Love making ability comes naturally!

ii. Sex must be spontaneous!

iii. Its performance that really counts!

iv. Good sex must be super-sex!

v. Pleasurable physical contact must go on to sex!

vi. Males must always be active during sex!

vii. Men are responsible for what happens during sex!

viii. During sex the male is responsible for his partner’s arousal and orgasm!

ix. Sex must lead to orgasm!

x. Once started sex must continue until orgasms have been achieved!

xi. A man and his partner should reach orgasm at the same time!

xii. There is no such thing as sexual monotony if you truly love your partner!

A word about monotony is called for. There is indeed such a thing as sexual monotony, however much you may love your partner, for this truth there is ecclesiastical authority. Cardinal Sin who was father confessor to Imelda Marcos of the Philippines is reported to have said:

If a man has many wives, it is polygamy.
If he has two wives, it is bigamy.
If he has one wife, it is monotony.

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