TODAY'S GUEST: barry mccarthy, erectile dysfunction and male sexuality expert

I'm extremely happy to welcome Barry McCarthy to Hard Conversations!

Barry W. McCarthy, PhD, ABPP, is a board-certified clinical psychologist (ABPP), certified marital and sex therapist, and a tenured professor of psychology at American University. His clinical expertise focused on integrating sex therapy strategies and techniques into individual and couples therapy, assessment and treatment of the most common male and female sexual problems, and a special expertise in the treatment of sexual desire disorders. 

Dr. McCarthy earned his BA from Loyola University and his MA and PhD from Southern Illinois University. His professional memberships include the American Psychological Association, American Association of Marriage and Family Therapy, Society for Sex Therapy and Research, and the Association for Behavioral and Cognitive Therapies. He is a Diplomat in sex therapy, earning this from the American Association of Sex Educators, Counselors, and Therapists. 

As a leading expert in this field, Dr. McCarthy has presented over 450 workshops around the world, and his extensive list of publications includes over 120 professional articles, 32 book chapters, and co-authorship of 16 books, including "Finding Your Sexual Voice: Celebrating Female Sexuality, 2018 and " Cognitive-Behavioral Therapy for Sexual Dysfunction, Sex Made Simple, Enduring Desire, Discovering Your Couple Sexual Style, Men’s Sexual Health, Coping with Erectile Dysfunction, Getting It Right the First Time, and Coping with Premature Ejaculation.

In 2016 received the Masters and Johnson award for lifetime contribution to the sexuality field.

• WEBSITE:

  https://www.psychotherapynetworker.org/author/bio/2202/barry-w-mccarthy-phd-abpp

• BOOKS:

  https://www.amazon.com/Rekindling-Desire-Barry-McCarthy/dp/0415823528

• https://books.google.ie/books/about/Contemporary_Male_Sexuality.html?id=h9oMEAAAQBAJ&redir_esc=y

YOU'LL LEARN

• Why it’s often better to work on sexual issues in couple’s therapy

• The importance of desire and arousal during sex

• The way eroticism is portrayed in movies in porn in novels is not in fact healthy, integrated eroticism

• The detriments of sexual shame

• Practical tips you can try at home

• The upside and downside of Viagra

• Insights on sexuality

• Differences between how erectile issues affect men and women

• The benefits of online sex therapy

• And more!

THANK YOU FOR LISTENING to my male sexuality and sex therapy podcast!

To get more hard conversations sent directly to your device as episodes become available, you can subscribe on iTunes or Stitcher!

Also, reviews on iTunes are extremely helpful and greatly appreciated! I read each and every one of them, and feel free to share your URL there so I can contact you later on and say thanks!

And lastly, if you have any questions (or would like answers to previously submitted voicemail questions!), head on over to Tim’s website.

About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations podcast transcript

Tim Norton: Hello, and welcome to hard conversations. Could not be more excited for my next guest. Barry McCarthy, is a board certified clinical psychologist. Certified marital and sex therapist and a tenured professor of psychology at American university, his clinical expertise focused on integrating sex therapy, strategies and techniques into individual and couples therapy, assessment and treatment of the most common male and female sexual problems and a special expertise in the treatment of sexual desire [00:01:00] disorders.

Dr. McCarthy earned his BA from Loyola university, his MA and PhD from Southern Illinois. His professional memberships include the American psychological association, American association of marriage and family therapy, society for sex therapy and research, and the association for behavioral and cognitive therapies.

He's a diplomat in sex therapy, earning this from the American association of sex educators, counselors, and therapists. As a leading expert in this field, Dr. McCarthy has presented over 450 workshops around the world. And his extensive list of publications includes over 120 professional articles, 32 book chapters, and co-authorship of 16 books, including finding your sexual voice, celebrating female sexuality.

Cognitive behavioral therapy for sexual dysfunction [00:02:00] sex made simple. And during desire discovering your couple sexual style, men's sexual health coping with erectile dysfunction, getting it right the first time and coping with premature ejaculation in 2016. Barry received the masters and Johnson award for lifetime contribution to the sexuality field.

Wow. Hello and welcome to hard conversations, Barry. 

Dr. Barry McCarthy: Well, I'm very glad to be here. Great, great.

Tim Norton: right, perfect. Let's let's just get into it.  the reason I know your name is cause one of the first books that I'm I was handed when learning how to be a sex therapist was coping with erectile dysfunction, which you wrote with Metz, rest in peace, and the other one was coping with premature ejaculation. And I gotta say, I mean, I haven't been doing this nearly as long as you, but I've given those books to a lot of people. [00:03:00]  have you gotten a lot of, thanks for writing those. 

Dr. Barry McCarthy: But, you know,  those books were more Michael's books.

And my books, Michael, is the one who developed the concept of good enough sex, which I think is the core issue in understanding male, sexuality and male erectile problems. But yes, it's, it's still cells that are kind of amazes us. 

Tim Norton: Yeah. And so if, if that was,  Something, you know, I'm giving away this book that you guys wrote.

What, what would you consider your number one resource to hand out to two guys for, for this kind of thing, 

Dr. Barry McCarthy: in terms of problems? It is the coping with erectile dysfunction book in terms of healthy sexuality. It's a book that I wrote with Mike Metz called men sexual health. About preventing problems about a new approach to male sexuality.

 and I think that's really important that,  the way I learned about sex [00:04:00] and I think the way most men learn about sex works fine as an adolescent, it works fine as a young adult, it works terrible as an adult, especially in adult and an ongoing relationship. So this notion of totally predictable autonomous sexual performance, that's the theme of what real male sexuality is.

It's reinforced still in the environment. It's very much reinforced in porn videos that a man always has an erection is ready to have any sex with any woman, any time in any place. And that. It's crazy-making. Yeah, it really is. You know, one of the things that most people don't know, including sex educators and sex therapists, is that when couples stopping sexual, especially after age 40, it's almost always the man's decision.

Who's in a joint decision and he's made it because he's lost his comfort and confidence with erections, intercourse, and orgasm. [00:05:00] And he says to himself, I don't want to start something I can't finish. And that's very self-defeating 

Tim Norton: and is it's very sad. 

Dr. Barry McCarthy: It is very sad. Again, let me give you both a positive statistic and a sad statistic.

The positive statistic is there's good science now. That it's clear that you can be sexual, not just in your twenties and thirties, when you're 60 seventies and eighties, the bad news is about one out of three. Men stopped being sexual in her sixties, two out of three in their seventies. And the major cause of that is the field that they're a failure sexual that they can't have sex.

The way quotes real men are supposed to have sex. 

Tim Norton: Hmm. And so that book that you're talking about, it gives a lot of information about how to, how to think differently about male sexuality, 

Dr. Barry McCarthy: right. And at the [00:06:00] key to male sexuality, as it is to the key to female sexuality is that the essence of sexuality is not performance, always in favor of intercourse, orgasm, ructions.

Totally. In favor. No. Hidden agendas, but that's not the essence. The essence of sexuality, the new mantra sexually is desire, pleasure, eroticism, and satisfaction. And the most important thing is desire. There you look forward to being sexual. You feel that you deserve for sex to work in your life, even if it is not perfect sex.

And that is a message. That the culture doesn't say to men, it's a message that the drug companies don't say to a man, but it is the key to staying sexual throughout your life 

Tim Norton: desire. Desires the first pleasure eroticism 

Dr. Barry McCarthy: measures. The second neuroticism, big, big fan of a Raddison it's [00:07:00] integral to sexuality.

And then the last one is feeling satisfied and feeling satisfied means you feel good about yourself as a person, you feel more energized and bonded as a sexual couple, and that is not contingent on perfect performance. 

Tim Norton: Yeah, you and you write, I think pretty extensively. And you presented extensively on this topic as well of, of inhibited inhibited sexual desire.

Dr. Barry McCarthy: Right? The new term is a low desire, but I'd like 

Tim Norton: inherited low desire, low libido. 

Dr. Barry McCarthy:  but you know what happens with so many men is that they attached desire to a spontaneous erection. Any idea in the learning as you go to intercourse, an orgasm on your first direction. Again, there's nothing wrong with that, except when it becomes a mandate.

If you look at the typical man [00:08:00] who's been in a relationship and has been, and is over, let's say over age 30 or 40, that often his desire comes not from spontaneous erections. It comes from giving and receiving pleasure oriented, touch it. And then the major reason that men fail at Viagra, if you want, we can talk about the Cialis versus Viagra.

I have very strong opinions about that, definitely, but the reason he fails is as soon as he gets an erection, in other words, his subjective arousal on a 10 point scale is like a four or five that's when you get an erection. He immediately rushes to intercourse. Cause he's afraid he's going to lose the erection.

And it becomes a self-fulfilling prophecy that the drug companies basically lied to me. What the drug company say to the man is you'll get [00:09:00] erections like you did in your twenties. It's not true. You'll get when you're aroused, your erection would last longer. But you're not going to get those totally predictable spontaneous directions.

And you know, it's funny cause the good enough sex model really sells with female clients and female clinicians. It doesn't sell very well with the drug companies, with male physicians or even male therapists. But certainly not male friends. 

Tim Norton: Hmm. The good enough sex model, a 

Dr. Barry McCarthy: good enough sex model. Then what that talks about is it's a couple oriented model and that for 85% of encounters, sex flows from comfort to pleasure to arousal, to erotic flow, to intercourse, to, or guests.

But when it doesn't flow, Rather than panicking or apologizing, which is incredibly anti erotic for both the men and the woman. What the man [00:10:00] does is he turns toward his partner. And this is also true of gay men, not just straight man. He turns toward his partner and says the guy isn't going to be an intercourse night, but let's make it either essential sexual night or let's make it an erotic non intercourse, but I'm not going to apologize and we can still have a good time.

Tim Norton: Hmm. I love that. And I love how that starts with comfort. Right. And the cause one of the things that is so challenging is if we're expecting this spontaneous erection to occur just anywhere in the world,  they w people learn quickly that, that doesn't, it doesn't always happen. It often doesn't happen.

Well, especially 

Dr. Barry McCarthy: after age 40, it does one of the things, again, it is not talked about at all among either therapist or male clients or couples. Is that the great majority of men by the time they reach 40 or [00:11:00] 45 have had at least one sensitizing experience do what that means is he doesn't get an erection sufficient for intercourse, and that can happen in your teens or twenties, but as much more likely to happen in your thirties and forties, the key element after sensitizing experiences, you don't go back to our time with sex.

You can't what the drug companies promise is not going to happen. You're not going to go back to the totally predictable auto sector. What you can do is you can be a much better lover, much better sexual partner, but then you've got to accept this concept of variable, flexible male and couple sexuality.

Yeah. And I say to my man, you can be a traditional man. And you'll stop being sexual in your fifties and sixties, or you can be a wise man and you can be sexual in your 60 seventies and eighties and men embrace good enough [00:12:00] sex. And when they turn toward their partner, as their intimate neurotic friend, not as somebody to perform for.

Tim Norton: There, there are so many golden tidbits here that you're offering. It's hard for me to,  to remember all the questions cause,  I mean, I'm taking notes here on things I want to say in sessions. No, this is, this is really, this is really wonderful. 

Dr. Barry McCarthy: One of the things that is very important, I want your listeners to hear loud and clear is that when you're talking about penile stimulation, I'm a big fan of peanuts, but it's only orotic when your subjective arousal is four or five on that 10 point scale.

If you are not turned on and your partner says, I'm going to turn you on, I'm going to give you the best oral sex in the history of California. It's probably going to be counterproductive. You're probably not only not going to get turned down, but you're going to feel more. [00:13:00] Self-conscious. And there's nothing more in diarrhetic and stuff consciousness.

So, so what I think of as basic facts about male sexuality and couple of sexuality, so many people, including physicians and therapists, I'm not that aware of or comfortable with. And so 

Tim Norton: what should the partner be doing in that situation? 

Dr. Barry McCarthy: I think that it isn't her job or her partner's job to turn him on and give him an erection.

What the partner's role is, is to be both an intimate and erotic ally that says let's enjoy each other. Let's enjoy touching again. The hope is it's going to flow into intercourse and orgasm, and if it doesn't flow, I still want you to stay with me. I don't want you to turn away for it. And I want to have either essential experience or playful experience or erotic non, and of course it can be [00:14:00] neutral or it can be asynchronous, but I want to have fun with you sexually, and I want you to have fun with me sexually.

Hmm. And what 

Tim Norton: kinds of things tend to slow that process down or make that process more challenging? 

Dr. Barry McCarthy: The most, the major distraction, the major turnoff. Is where you're always monitoring your penis. Is your penis responding the way it's supposed to respond or not. And that just takes you out of the pleasure eroticism process, and it puts you into a performance orientation, performance anxiety in both anticipatory and performance.

Anxiety is the major. Reason that males develop and maintain rectal problems and erectile problems lead to inhibitor desire, and then a major cause of inhibited desire for adult men is a rectangle. Mm. 

Tim Norton: And then it's, then it's a vicious loop. 

[00:15:00] Dr. Barry McCarthy: It's a terribly vicious loop and think about it positively first, but then let's talk about it negatively.

Okay. So positively what you want the man to be doing is you want him to anticipate he's going to have fun. It's going to be a pleasure oriented experience. And he really does get into not just turning on the partner one way Singlish, but he's open to giving and receiving stimulation. And then Anne's arousal bills in advance.

When you talk about eroticism, an erotic flow, and if, if you. If your listeners want to take one specific technique from today's podcast, it is, do not transition to intercourse until your subjective arousal is about a seven or eight. So many men, as soon as he gets an erection rush intercourse and they lose their erection.

And then especially for men and they're [00:16:00] over 40. A key element in enjoying intercourse is giving and receiving multiple stimulation during intercourse. So it isn't like it you're in your 18 or 22 where you're worried about premature ejaculation. When you don't want additional stimulation as an adult, man, you want to give and receive additional stimulation.

Those common stimulation that demand receives his testicle simulation. The most common he gives is. Clitoral stimulation to his partner, but actually the most common stimulant model simulation for both men and women is using erotic fantasies during couple sex. That's normal and healthy. It serves as a bridge to keep you more involved in a couple of sexuality 

Tim Norton: using erotic fantasy, like verbally and talking about it, or just kind of thinking 

Dr. Barry McCarthy: for most people, most of the time.

Again, one of my favorite lines is sexually one size, never [00:17:00] fits all, but for most people, most of the time, one of the best ways of losing the erotic charge from fantasy is verbalizing and playing it out for most people would makes the fantasy erotic is that it's totally different than who you really are and what you really want to be doing, but it's very charged.

So enjoy your erotic fans. Don't feel shameful. Don't feel guilty about people. Most of the time you want to keep them private. It works so much better. 

Tim Norton: Right. But, and keeping them private, a lot of people feel that's kind of disconnecting. 

Dr. Barry McCarthy: Well, the best way of thinking about that is in a healthy relationship, a healthy sexual interchange.

It's a bridge to increase pleasure, increased eroticism. In an unhealthy use of fantasy. It is surfaces a wall to keep you walled off from your part. But that in fact, that reading allows you emotionally and physically to feel more [00:18:00] present with your partner. That's the positive role of erotic friends. I know it's very controversial, right.

But I know it can be really misused, but in general, that is true for the great majority of men and couples. Hmm. 

Tim Norton: And so the couple would have to get on the same page about that, that they're trying to build that bridge. 

Dr. Barry McCarthy: They don't have to be on the same page. One of the better thing for them to say is I want you to have a good time.

Centrally playfully, erotically, intercourse wise, or gasoline. And I don't care what you use internally to have a good time. That's okay. As long as it doesn't negate me or negate us, 

Tim Norton: as long as it doesn't negate me, but it's another woman or it's another man. 

Dr. Barry McCarthy: No, it is another person, nobody fan. And again, let me be blunt.

Okay. Nobody fantasizes about having [00:19:00] intercourse in their bedroom, in the missionary position with their park. No, by its nature or erotic fantasies or non socially acceptable sexual behaviors and feelings.  but it has a positive role in people's lives. If they let it have a positive role. Hmm. Now, let me say one other myth that I want to make sure we talk about please.

And that is that, you know, the best sex is mutual synchronous sex. And what you mean by that is both new and your partner feel desire. You both enjoy pleasure. You're both erotically turned on and you're satisfied with the sexual experience. You feel good about yourself? That's the best sex. But it's really important to understand that among Hambling married personally, sexually functional couples, less than 50% of their encounters [00:20:00] are mutual and synchronous, that the majority of sex is better for one partner Mia.

And for folks under 40, it's usually better for the man woman. The thing that's so interesting to me is I've gotten older and studied this more. Is that for folks over 60 asynchronous sex is typically better for the woman than the man and that men who can accept that and feel good about it. That's my emotion of the wise man.

He learns the piggyback, his arousal on his partners. And so it makes it for much better sex. 

Tim Norton: I really like the bluntness of that. There there's a lot of pressure, I think, in the narrative about this to strive for totally quality. 

Dr. Barry McCarthy: And that really kills sexual function and sexual desire. Sex is not a politically correct experience.

The more you [00:21:00] understand it has different roles and different meanings and different outcomes, the better off you're gonna be. Hmm. 

Tim Norton: Okay. But then, so some, there might be some female listeners out there saying, well, he has more orgasms than I do. That's not unfair. 

Dr. Barry McCarthy: He does have more orgasms than you do. And again, one of the myths about female sexuality cause females about 15, 18% of women are multi-orgasmic.

And the myth is that multi-orgasmic women are more satisfied in singly, orgasmic women. It's not true scientifically. There's no evidence for that at all. Let me tell you a different approach. And again, I want us to focus on male sexualities, but just the tooling. You know, our newest book that came out last two weeks ago, I guess it was, is called.

Finding your sexual voice, celebrating female sexuality. And then one of the things that we say in there and read very much, believe we're not hypocrites is a [00:22:00] females. There are many more similarities sexually between men and women. When there are differences, it's not true in socialization. It's not true going up.

It's not true in adolescent, but it is true in adulthood. And males do have more orgasms that's correct. Their sexual functioning tends to be more predictable and reliable, but it doesn't mean that they have more desire or more satisfaction. And then the big issue with adult women, but one out of three women, adult women reports, inhibited desire.

And what we used to believe as the answer to inhibited desire is more orgasms. And it turns out that there's no, there's no truth to that at all. That the, the, the key element in female sexuality is her feeling like a first-class sexual woman and accepting the variability and flexibility of female sexuality.

So that's what we'll do too. Great. 

Tim Norton: Great. And so [00:23:00] if we equate satisfaction with orgasm, Then we were going down the wrong road. 

Dr. Barry McCarthy: You're going to, you're going down a performance road, which is the wrong road. I love orgasm. I love male orgasm. I love female orgasm, but sexual satisfaction is so much more nor yes.

And this idea of. Coming to the performance model. It says the way you hand sanctioned your teens in your twenties is the right way to have sex in your forties. 50, 60, 70 is absolutely destructive. Hmm. 

Tim Norton: Okay. And this is at the beginning of. One of your books. I was glancing through it, re rekindling desire, said that you've worked with over 3000 couples and that, that came out a while ago.

So that numbers presumably gone up since then. So would you say that a lot of what you're saying you're drawing on from that experience, but you also seem like you [00:24:00] read the studies? 

Dr. Barry McCarthy: Yeah, I do read the studies. I go to the meetings. I still do. I actually go to more meetings, do more workshops and do more writing.

Since I retired from clinical practice in 2012. So I practiced for 42 years and sexuality and a couple of sexualities, my specialty. So I've seen all kinds of different folks, both mainstream, traditional value folks and gay folks in non traditional value folks. In one of the things that I really do believe is that everybody deserves a first-class sexual life.

 being self-accepting and developing a couple of sexual style with your partner, whether your partner is straight or gay, whether your partner is traditional or non-traditional you. One sex sex is very paradoxical folks, but when it works well, it's not a major factor. It [00:25:00] plays this 15 to 20% role.

Feeling good about yourself as a person and energizing your boss. The paradox is that when sex is dysfunctional conflictual, or you're fighting about it like affairs or you're fighting about it with a painful sexual secret, it plays an enormously powerful negative. It really breaks. So six can save a relationship, but it can break up a relationship.

Tim Norton: Oh, that's 

Dr. Barry McCarthy: too bad. It is to wrap and sometimes it's actually the right decision. But most of the time, if people would actually disclose who their authentic sexual self is with their strengths and their vulnerabilities, their partner is usually, and this is especially true when the woman is usually much, much more accepting of the man than he is accepting of himself, you know?

 sexual trauma [00:26:00] occurs much more with women than it occurs with men, but it's also much, much more impactful and destructive for men than it is for women in that it becomes his shameful secret. He basically never tells anybody, including his part about his trauma history. And that's a terrible mistake that you need to need to honor your history.

But don't give it control over you. You are much more sexually than your trauma. What is your trauma is part of your authentic sexual self, but don't give a control. And I know this all sounds too easy way too easy, but I rethink it's true. 

Tim Norton: Yeah, no, it doesn't sound easy to me.  you, I think as a, as a couples sex therapist, you probably.

Heard about a lot of sexual trauma or a lot of non-sexual trauma. How do you [00:27:00] generally, I guess that's a really difficult question, but how do you work with trauma? 

Dr. Barry McCarthy: Well, I work with it in two ways, and again, this is way too simplistic and it's much more challenging that for people, but the one is a clear message to them.

That you want to be a proud survivor. You don't want to be an angry, anxious, or depressed victim. And the cognition is that living well is the best revenge, but that the best way of dealing with your history is actually processing it with somebody who you trust, whether that's your best friend. It is your partner.

Elrod is a therapist. Or you can tell all of the whole story about who you are psychologically relation and sexually and feel you're accepted. That makes it so much easier to then take the step of [00:28:00] saying, I want to be a proud survivor and that feeling that you can not get a do over, you cannot change the past.

You can learn from the past. You can honor it. But you can't change your power for changes in the present or future and in a healthy relationship. When you experience again, desire, pleasure, rotten system satisfaction. You've taken back control of your sexuality. It doesn't reside back in a trial. 

Tim Norton: I'll get that question a lot.

When I'm seeing an individual and they're processing their own trauma and they wonder how much to share with their partner about what happens to them.

Dr. Barry McCarthy: The easy answer is share all of the themes, do not share the details. What happens when people. Share the details was it [00:29:00] usually re sensitizes them and they feel more and more controlled by the past when they share all the themes, it really does free them to be the authentic sexual person that they want to be in the present.

You know, one of the things that is a, again, easy to say, hard to implement, is it the challenge for folks whether they're married or they're partnered, whether they're straight or they're gay? Is how you integrate intimacy and eroticism into the same relationship. And then part of the issue with intimacy is it's about feeling warm, close, and secure, totally different experience than eroticism.

Eroticism is all about taking risks, breaking boundaries, it's mystery, it's creativity. It's not socially acceptable. It's an interesting issue in terms of the past sharing. Feelings about yourself. [00:30:00] The intimate feelings are, I think are really, really helpful. Sharon, the erotic details, including the sexual abuse and trauma is really destructive for most people most of the time.

Hmm. 

Tim Norton: Okay. That's that's really helpful. And we keep talking a lot about couples. Going through these experiences. Do you prefer when there is a, an issue like erectile malfunctioning, do you prefer to work with the couple 

Dr. Barry McCarthy: yes. Far and away? I think you not only get better results when you see intimacy and sexuality as a complication, rather than a man's, it's a convolution, but you get much less relapsed.

And it's partly because in doing couples therapy, You Rayanne, trying to build a bridge and a couple that says we're both intimate and erotic friends, so many men. And I know I [00:31:00] don't want to overstate this, but it is true. So many men feel intimately connected to their partner, but they have de eroticized their partner that they see her as a good person, a good spouse, a good mother, somebody to share feelings with.

But not somebody to share. Right. And then in healthy relationships, you value both intimacy and pleasuring and eroticism. Hmm. One bike that scored so much better as a couple. 

Tim Norton: Yeah. Oh, that's, that's another great piece of advice. And I, you know, I guess a lot of the times. I'll be on the phone with the guy.

He said he wants to come in for individual and I'll, I'll, I'll not nudge him toward bringing in his partner, but a lot of time the guy just wants to sort this out on his own. And then, yeah, I guess it's kind of a compartmentalization and then take it home and show his partner. Hey, my Dick is fixed.

[00:32:00] Dr. Barry McCarthy: He's performing for his partner. He sees his partner. There's somebody who's judging him and he's going to win her over or him over. It's not a good way of doing it. Let me make a specific suggestion for clinicians watching this. And that is in that first phone call to say to them, you know, I've done this awhile.

And, well, my experience has been is that if we do a four session assessment, I can make a good recommendation of whether you should come alone or as a cup in the four session assessment. The first session has done as a couple, and then you do individual psychological, relational sexual histories. If you do the history with the partner in the room, you're not going to get the genuine near, you're not going to get the truth.

They're going to get a sanitized version again. I've done a lot of these. I've done a little over. Probably 4,000 of them,  [00:33:00] 85% of people have sensitive skin sensitive or secret materially haven't shared with their partner. Hmm. And,  so I want to know what it is. And then we, the fourth session is we talk about them as individuals, but what are their strengths?

Where are their vulnerabilities as a couple? What other strengths and vulnerabilities and make a recommendation? Usually the recommendation is to work as a couple, but not always, sometimes it is much better to work with the man alone. 

Tim Norton: Okay. And I want to go back to eroticizing a partner. We were just talking about that.

And I feel like when I was first starting out, I was on the lookout for a seminar on how do you. Teach someone how to reroute assize their partner. Once they've become the family member or, you know, the mother or the sister, like, like when you, you know, for the listener that when you've been with somebody a [00:34:00] long time, you stopped seeing them as a sexual object in you, because they've done so many things for you.

They've raised your children and they've, you know, you guys go to the library together and you do lots of nonsexual things. Yes. Right. Which is a good thing to do, which is great, which is the hallmark of a long lasting relationship. But, so how do 

Dr. Barry McCarthy: you. Unnamed vital resilient, sexual desire. Eroticism is an integral part of it.

And again, we've got to be blunt here in that. The way eroticism is portrayed in movies in porn in novels is not in fact healthy, integrated eroticism. What integrate eroticism is about is that you own your sexual voice and you are inviting your partner to share in that sexual voice. And then,  you don't split it.

You don't compartmentalize, you know, one of the things that I hear over and over again, [00:35:00] and this is probably more true, cause you're in Los Angeles, right? I am. Yeah, so you're close to Las Vegas. So we are in North Carolina or Washington DC where I practiced there's. So many men will go to Las Vegas and they'll pay somebody $250 and they'll get an erection.

And the reason that they do that is that they see it's the woman's role. I gave you 250 hours. You owe me an erection. So it reduces the performance anxiety.

You can do that with your intimate partner, whether it's just married or a sexual friend where you say to your intimate partner, you don't own me interaction, but what we always, each other is a, have a good time in terms of pleasuring in terms of playfulness and in terms of eroticism. And then one of the things that becomes important is rather than our assuming of what is really a turn-on.

Is it we'll do psychosexual skill exercises, which I'm a big fan of [00:36:00] to try to identify what are Roddick turn-ons for each of us, as in the big key element is it can't be at the expense of the partner or the expense of the relationship. And for most people, the thing that feeds eroticism is cost. Partner interaction, arousal, more aroused.

You are the more grouser partners, but for some it's also self and arousal of taking turns. One of you turns on the other one, but the key thing that I'd really like you to hear is that everybody has their own erotic voice. So for example, in the media, the assumption is no, all men 99.9% of women. Really liked being filled-in you've heard that, sir.

I that's what people believe. And again, there's not great science, but probably somewhere around one out of five men is [00:37:00] uncomfortable receiving oral sex. He would never tell that to his partner, but it's the truth. Part of eroticism is you're being honest with yourself and you're. About what really does work for you.

But what I think the key, the key is element with eroticism is you, is that you've got a solid base of feeling comfortable in pleasure. And then the eroticism is integrated. 

Tim Norton: So I can hear a guy sitting there saying, okay, well, what turns me on is, you know, porn, you know, Watching somebody else have sex. So how am I going to share that with my boss?

Dr. Barry McCarthy:  well, let me give you the overview with porn. The way of understanding porn is it's an erotic fantasy gear. So we talk and I writing about five gears of [00:38:00] touching. Affectionate touch sensual, touch, playful, touch, erotic touch, and intercourse stuff. Think about porn is like a supercharged six gear. It's an erotic fantasy gear.

And what works in porn is totally different than works in real life sexuality. The reason that people do well with porn is it's often attached to masturbation, but it's also attached to you letting yourself let go, and really go with the erotic fantasy.  what makes porn problematic for people is where they make this differentiation between fantasy and reality in that what works in fantasy often.

And in fact, usually does not work in reality, or what happens with porn is you get this combination of about the 15% of men who misuse boy is that it's high degrees of secrecy. High degrees of eroticism and high degrees of shame. [00:39:00] You put that together. It's like taking a cancer pillar poison pill. Now there are couples who will use porn together as a way of having an erotic turnout, but it usually works better if they've played before and they're already open and receptive.

And then the porn is like a supercharge gear. 

Tim Norton: They. Watch it individually before, or they want 

Dr. Barry McCarthy: to know, okay. They play with each other and then together, they turn on the porn scene that they find erotic. Now, the problem with traditional porn is it gives a really crazy message about women that the crazier, the woman or more orotic, she is in the craziest situation.

Little robotic shit. If you can understand it's about fantasy and not think it's about reality, you're not going to get in trouble. When you blur those lines, you get. And especially when you add shame, no, of all the emotions, shame is the most [00:40:00] destructive for men and women, but especially 

Tim Norton: the, the biggest libido killer.

Dr. Barry McCarthy: It is a Beto killer, but it also, this combination of secrecy, eroticism and shame is very powerful and very destructive. 

Tim Norton: Yeah, really 

Dr. Barry McCarthy: isolating it is isolating and it doesn't serve as a bridge to anywhere it serves as a bridge to you feeling more isolated and shameful. Yeah. Hmm. 

Tim Norton: Okay. Wow. There's so much good stuff in here.

We, we spoke earlier about Viagra. And if you were, you said you were in private practice for 42 years. So there was a good couple of decades before Viagra came out. That's 

Dr. Barry McCarthy: correct. And I've also almost 15 years when very Agra was out. Yeah. So. [00:41:00] Here's what let's say it positively first. Okay. Yes. The advantage.

Let me tell you why. Let me actually let's start positively with YCL is for most men is a better medication. Okay. And that is, it fits better into your couple sexual style of intimacy, pleasuring and eroticism. The problem with Viagra is that you have this narrow window of opportunity for desire.

Basically an hour to four hour opportunity window. It works well for procrastinators and people who like structured, but it works less well for most couples where Cialis gives you much more degrees of freedom in terms of, of windows of opportunity. And,  the other is the notion with reactor is that a gives you an erection.

It doesn't give the man in erection. What it does is that when he is subjectively aroused, it makes it easier to [00:42:00] become objectively aroused and to maintain his erection. That's the advantage of Viagra and Cialis.  and then using it as a anti-anxiety medication, which has half of its function. The other hand is an increased.

The efficacy of your vascular system is fine. No, here's where it's really problematic. And that is where the nobody gets the results that you see in the ads. Nobody period, exclamation point, even among the best Viagra and Cialis users, they don't get a hundred percent predictable erections. They usually get between 65 and 85% erections, which is good.

Not bad. But they, the dropout rate is high because they feel they're the only one in LA who's failed a pre-algebra based on the ads everybody's failed. If you think about [00:43:00] Viagra as an additional resource, both anti-anxiety and firmness of erection. That's it's good. Use the thing that's interesting about medical interventions is that the more invasive the intervention.

The more effective it is, but it's more difficult to integrate it in a couple sexual style. So for instance, penile injections are much more efficient for getting erections than Viagra Cialis, but for penile injections to work, the partner's got to feel that they haven't,  rolled in there. The man who goes into the bathroom, injections himself comes out with an erection meeting, wants to go to intercourse.

That is not going to, you're going to have that high dropout rate because the partner says, I don't understand what's going on. It's not. And often he has a hard time reaching orgasm as he isn't. He's not turned on the reason he's not [00:44:00] reaching orgasm. He's not turned on. Even though he's got objectively from direction, he doesn't have subjective arousal.

That's the other thing in treatment, that a message that is very hard for people to accept, but I think is really a true message. Is it subjective? Arousal is more important than object, or it really is true. Feeling turned on is more important than having an erection, you know? The reason, you know, a Janka Tori inhibition, which we don't talk about enough with men, especially men over 50, because I think it's as many as 15% of men have trouble with the janitorial inhibition, is it the reason he doesn't reach orgasm is that his penis is lying.

His penis says I'm turned on, but he's not really subjectively aroused. And he's trying to have sex. Like he had sex when he was in his twenties, just doing trusting the key element, re in overcoming a jacket terrain [00:45:00] division. Is don't transition to intercourse until you're an a seven, eight or even a nine in terms of subjective arousal.

And then do some multiple stimulation during intercourse. Don't to just throw stuff. Is that too much or is 

Tim Norton: that that's wonderful. I'm kind of processing that and, and just wondering. You know, you, you saw the transition from guys who are having much more sex when they really weren't, that turned on because of, you know, now they can with, with Fiat GRA would you say it's been genuinely, generally beneficial to couples and class 

Dr. Barry McCarthy: if they use it the way it's supposed to be used, which is the integrated in their couple sexual style, it's been helpful.

It's caused more non-sexual relationships than anything else in history now, because it's not a good drug, but nobody tells man about these two [00:46:00] guidelines about transitioning intercourse when you're highly turned on and doing multiple stimulation and adopt the good enough sex model. You know, let me say one last thing and to make sure we get it in.

You know what, I'm a big behavioral person in terms of the psychosexual skill exercises, the psychosexual skill exercise, and I think has the most value. And Michael did it probably with 2000 men before he died. And I probably done it probably not 2000, maybe 15, 1800, when, and that is the exercise of waxing and waning of erections, neither Michael or I ever did it with a man who enjoyed it.

It's just not an enjoyable exercise, but it's a crucial exercise. It's kind of an anti panic exercise. And that is when man is turned on you stop stimulation. So his erection wanes, if he stays relaxed, mindful, and open to central and playful touch, [00:47:00] his erection will wax again. Let him lose it again. Let him let it wait a second time.

Don't go to intercourse until your third direction. All men that I've met personally and professionally prefer to go to intercourse on their first direction, which I think is a great preference. It's a terrible mandate. You got to understand your penis and don't be the enemy of your penis. Be the friend of your penis.

Understand that it's okay for penises to be variable and flexible. 

Tim Norton: Yeah. One of the things that. I will talk about what guys sometimes is. If, if lubrication in, in, in a female waxes and wanes, we don't know. Yeah, of course.  but, but it's, it's obviously not as visible.  yes. And so to, to clarify that, that waxing and waning technique, you're [00:48:00] letting the situation and then all of the erotic charge of it create the erection.

You're not trying to.  jerk him off to get the erection. It just letting it 

Dr. Barry McCarthy: happen again. You're it's about pleasure, not a month,  orgasm and performance. So you're trying to play and your body responds with interaction. If you stop your Wrexham away, if you become obsessed with your penis and panic and apologize, your retro will never wax again.

But if you're mindful, relaxed, and open to sensual and playful touch, your erection will wax again. Let it wait a second time and then go to intercourse and orgasm the third direction and in any, because I'm in favor of third directions, I really want him to understand, be nicer to himself and to his penis to understand it's normal.

One other point, whether you're using Cialis or Viagra or not, or even if you're using injections, [00:49:00] the likelihood is the weather happens once a month. Once every 10 times a once a year, you will not have an erection sufficient for, you know, the man is cured when he doesn't have an erection sufficient for intercourse and he can accept it without panicking or pods.

That's the cure for erectile dysfunction. Hmm. 

Tim Norton: Oh, I love it. It's so good. Thank you so much.  so what's,  You know, you've, you've done a lot of work and it, over the years you've been at this for multiple decades. What are you most proud of? 

Dr. Barry McCarthy: Well, the thing that I think about, about my legacy, you know, when Michael died about six years ago, when I gave a presentation at a conference about his legacy and his legacy was the good enough sex model.

I [00:50:00] think Michael would still roll in his grave if he, if he would be so frustrated, the good enough sex model has not been adopted, especially by physicians. I rethink that. That's key. When I think about my legacy, I think about my legacy being about a couple approach to desire, especially this idea of valuing both intimacy and eroticism and positive, realistic expectations.

No, I'm always in favor of positive experiences, but the real test of a couple is when they have a lousy experience, can they turn toward each other and shrug it off or laugh it off and say, let's be sexual again in a day or two we're more awake alert and really receptive and responsive. So the legacy I would like to have people think about me is about desire issues.

And about relapse prevention about how you [00:51:00] maintain healthy sexuality and ongoing relationship. 

Tim Norton: Hmm, I'm wonderful. And I like even thinking about it with the waxing and waning exercise, we talk about what the male was learning, but also what his partner is learning about penises and waxing and waiting, and both of them being on the same page of, of achieving that good enough sex.

Dr. Barry McCarthy: So I did that. There's so many more similarities and differences between men and women. Remember that book that's so, so many copies back in the eighties, when are from Mars, women are from Venus. There is no science to that at all. He's a very nice man, but there's no science to that. That's just the opposite is true.

Yeah. And,  I do think the reason good enough sex so much more, much better with women is it fits their sexual socialization about variable, flexible sex and fantasy.  when I teach my undergraduates, I still teach an [00:52:00] undergraduate psych sex class in American university. And there's always more women than men take the class.

 but that one of the themes for men is you want to be a wise man and wise men think of women as intimate, neurotic preps. Hmm. 

Tim Norton: Hmm, love it. And gosh, those kids are so lucky over at American university. Getting that class as a part 

Dr. Barry McCarthy: of it. You think about it as primary prevention. We think about as a clinician, you're always doing tertiary intervention.

Would we so much better? And again, one of the things with books though, I think books work much better when you're in therapy. It's self help books, but sometimes when they work well, the self-help book really helps somebody do secondary prevention. That's does. Huh? I didn't know that. Now I know it. I feel so much better about myself as a sexual person.

Yeah. 

Tim Norton: Great. [00:53:00] Okay. And all this work that you're doing, it seems like at some point you and your wife started working as a team. 

Dr. Barry McCarthy: Right. Emily, Emily and I have been married for a long time since we've been married 52 years from we come from nine middle-class backgrounds. We were the first ones in our family ever graduated college.

We have a lot of pride in what we've created as individuals as a couple.  but it's been fun. Working writing together. Her background is not mental health, it's speech communication. And I think her approach really does put a, a humanness and a,  nitty gritty newness to it. I mean, I talked more as a scientist and she talks more as a human being.

Tim Norton: Okay. And you guys, do you also present together or it's mainly the writing together? No. 

Dr. Barry McCarthy: It's the writing together that we do many years ago.  I [00:54:00] tried to talk her into switching careers and getting into the field and she says, you know, I love what I do now. Sex therapy is a weird profession. 

Tim Norton: It's pretty weird.

Isn't it? Okay. Well, you know, thank you so much for, for agreeing to this.  Well, you know, you've made such incredible contributions to the field with, with your writing. And, you know, I can tell from just his dozen or so questions, what a depth of knowledge you have on this subject and you were offering really good advice to our listeners.

I really appreciate 

Dr. Barry McCarthy: that. Well, it's been fun. I hope it is. 

Tim Norton: Yeah. Yes. I know it will be. All right. Well, thank you again. And any, any w what are you working on now? 

Dr. Barry McCarthy: I love to work and I love presenting. I present. I actually, I would love to present the lay public, but I present the professions, the book, the second book that we're now working on, which [00:55:00] supposedly is going to come out in the summer is called enhancing Cabo sexuality, creating an Intuit neurotic bound.

And then the book that'll come out in 2020 is the third edition of rekindling desire. 

Tim Norton: Okay. And 

Dr. Barry McCarthy: you know, the book that I'd love to write, if I can get a contract for it is about what women need to understand about male sexuality. That would be good for her, for him and for the couple. That's a book that's the back 

Tim Norton: of my head.

Okay. So for all the agents out there listening,  where, where can they find you if they need to get ahold of you for that? 

Dr. Barry McCarthy:  probably the best places by email. So it's Barry McCarthy, forty3@gmail.com. 

Tim Norton: Okay. Then do you, do you tweet, do you get out in the social media sphere? 

Dr. Barry McCarthy: I don't, I probably don't. I probably should, but,  you know, everybody, one of the things that has been helpful to clients and talking to me, I have this [00:56:00] notion that everybody has their strengths and everybody has their vulnerabilities for somebody who writes as much as I do.

I have a perceptual motor learning disorder so that I cannot do computers and I cannot type. So it's really, as a board becomes more online, as you said, the social media, I am totally overwhelmed. I mean, for, you know, to write an email for me, like an email to you, I think I would imagine it takes you. Yeah, 30 seconds for me, it takes me about seven minutes.

Oh, 

Tim Norton: wow. Okay. Well then thank you more times over for all the work that you've done. Right? Cause that sounds like it was quite a feat. 

Dr. Barry McCarthy: I'd love to do it.  and I also, it's not my line that you need to own your vulnerabilities, but don't give them control. So like what we say about trauma, you want to own it.

You want to learn from it. You don't want to give her control. 

Tim Norton: Okay, well, I'm, I'm going to tweet probably 10 different cores from you [00:57:00] following this over the next couple of weeks. Cause there are some, yeah, absolute gems in here. Thank you again, Dr. Barry McCarthy: and  hope to run into you out in the field.

Dr. Barry McCarthy: Thank you. 

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex, surrogates, academics, sexual health, medical community, sex workers, the tantric community, and everybody else involved with having hard copies.