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‘Size Matters’ for more than just the bedroom

In their new book "Size Matters," New York urologist Dr. Harry Fisch and author Kara Baskin answer the questions about men's sexual health that women often wonder about but are too embarrassed to ask. An excerpt.
/ Source: TODAY

How should a woman react when a man is sexually dysfunctional? How long do sperm live? What's the deal with fertility and "boxers vs. briefs"?  In their new book "Size Matters," New York urologist Dr. Harry Fisch and author Kara Baskin answer the questions about men's sexual health that women often wonder about but are too embarrassed to ask. An excerpt.Introduction
Kara Baskin:
I am a woman. Chances are, if you’re reading this, you are too. And I, like you, have spent countless hours — commiserating with friends, chortling at how-to-date books, whining to therapists, roommates, coworkers — picking apart the seemingly capricious, confusing male mind. It can be a thankless task. Men mean mystery. For my friends and me, anyway, there are always behaviors that simply beg to be decoded: the way he speaks to a waitress at a restaurant; his voice mail greeting; the way he signs his e-mails; his Wii technique. Anything’s up for analysis, and everything foreshadows something potentially wonderful ... or something sinister.

Meanwhile, the male anatomy — something that can actually be scientifically explained — remains overlooked.

We’re discriminating creatures. We wouldn’t buy stocks without doing the proper research; or rent an apartment without scouting out the neighborhood; or begin exercising without mapping out a precise plan to demolish that excess ab fat. Shouldn’t we do the same when it comes to our sexual lives? Be honest: When you’re entering into a serious relationship with someone, you want to know everything about him. You Google him. You know where he works and maybe even how much he makes. You know the names of his last four girlfriends; you know all about his last bad breakup (the chick was psycho — you’ve determined this from stealthy Facebook stalking); and you know all about his childhood puppy, his embarrassing college roommate, and his meddlesome mom. You can talk late into the night about your favorite movies and books; you cook dinner together; you’ve met his friends; and you keep toothbrushes in each other’s apartment.

But, ladies, do you understand his penis?

Outwardly, the male body seems so simple, of course. Guys don’t have to worry about annoying things like periods. Their sexual organs dangle outside their bodies, arousal is easy to identify, and what you see seems to be what you get. But once you’ve dated enough, the plot starts to thicken. We all have our war stories: There’s the dreamy guy with the semen that tastes like turnips; the sweet Emo guy whose penis curves terrifyingly to the right when erect; and that burly football player who couldn’t get an erection at all. Untrimmed pubic hair; hairy balls; lopsided testicles. Each guy is a little weird in his own special way. And if he isn’t weird? Well, that’s weird too.

What does it all mean? In this book, we’ve tried to answer some of your most common and pressing questions about the male anatomy. These are things you’d probably never ask the man in your life. Most guys aren’t burning with desire to talk about their ejaculation problems or masturbation habits, after all. And your friends might not be much help, either. Good information, like a good man, is hard to find.

This book is a fun, prescriptive, easy-to-understand troubleshooting guide for women who’ve spent oodles of time analyzing what’s going on inside the male mind. What we really need is a book that tells us, smartly and humorously, what’s going on inside a guy’s pants. As such, you might ask why I, a woman with a husband and without a medical degree, am qualified to cowrite this probing chronicle of the male form. Good question. The same thing that could qualify any of you — because when it comes to unsatisfying sexual experiences, confusion, dating disasters, and nagging questions, I’m right there with you. Though I’m now happily hitched, I’m fairly well-acquainted with the male form (sorry, Mom; very sorry, Brian).

And let me be the first to tell you: Just because you’ve walked down the aisle, the Good Sex Fairy doesn’t automatically sprinkle orgasm dust on your new Pottery Barn sheets. If anything, the stakes become higher. After a spate of bad sex, you can’t just lose his phone number. If you’re considering having kids, fertility questions come into play. And then there’s the whole familiarity conundrum: After a man begins clipping his toenails and naming his farts in front of you, the mystique of romance really begins to fade.

Married or not, my girlfriends and I often blame ourselves when sex turns sour. We think, if the sex is bad, it must have something to do with a deep, meaningful, soul-shattering revelation about our relationship. He can’t stay erect? Maybe I don’t talk enough. Wait, maybe I talk too much! His libido is low? He’s clearly offended by the fact that I make more than him — unenlightened jerk. Falls asleep after sex? I’m smothering him! It must have been those tampons I left in the bathroom ... Accuse me of offensive gender stereotyping, but each one of these statements has come directly from the mouth of a twentysomething female. Women often overanalyze. Men, well, don’t.

And so I say: Ladies, rejoice. You are not at fault. Stop beating yourself up over bad sex! As you’ll learn in these pages, thanks to the medical insight of Dr. Harry Fisch, there’s actually a scientific explanation for most bedroom blunders. And these explanations have nothing to do with misplaced tampons. It’s just that, more often than not, there’s a real physical explanation for the things we attribute to psychological incompatibility.

This isn’t to say that you shouldn’t date guys with whom you’re intellectually matched. But if your relationship is otherwise healthy save some sexual snafus ... don’t despair. Just keep reading. This book is intended to assure you that, no, sometimes the problem really is him — and sometimes the problem is easily solvable. Like you, I’ve dated men with whom I’ve clicked; like you, I’ve also languished in dead-end courtships too long, thinking that maybe, if only I behaved differently, was quiet when I was loud, loving when I was overbearing, I could change things. The only thing you need to change is your anatomical knowledge, my friends. Armed with the information this book provides, you’ll have an educated idea of when to run, when to stay, and most of all, why things happen the way they do. And from better understanding will come better sex.

A word about my humble coauthor, the man who provides the answers in our fun-to-read Q & A format. Dr. Harry Fisch is a renowned New York urologist who’s been seeing a parade of men in his office every day for 20 years. He sees men who struggle with fertility and erectile dysfunction, but he also sees guys who just want to know why their penis is behaving a certain way, or why their testicles hurt, or whether or not they’re satisfying their partners. When Harry and I met, questions flew. Wouldn’t it be nice, Harry and I thought, if there were a handy, fun-to-read, informative book about the male anatomy? We’re not out to make light of sex, or to exploit guys, or to tell you how to please your “man” in seven seconds with the most mind-blowing orgasm of his life, glossy girlie magazine–style. There’s plenty of that stuff out there. We believe women are smarter and deserve better.

Consider this book your own personal goodie-drawer road map to the male physique. Think of it as the sex-ed class you didn’t get in seventh grade. You may never know why he’s not that into you, but with our book, you’ll finally understand him better when he’s in you.

Harry Fisch, M.D.: 
How does a professor at Columbia University come to write a book titled Size Matters? Well, in addition to being a professor, I’m a urologist and a fertility doctor who treats men having problems conceiving a baby. I’ve become an expert in examining men and diagnosing problems with fertility and/or sexual performance — problems that are becoming more common these days as the average age of parents keeps rising. I have learned over the years that there are certain common “flags” of sexual problems. And one of those flags is the origin of the title of this book.

You see, one of the first things I examine in any new male patient is the size of his testicles. It turns out that the larger the testicles, the greater the likelihood that fertility, testosterone levels, and sexual function will be normal. On the other hand, the smaller the testicles, the greater the chance for infertility and sexual problems. This is definitely a situation in which size matters.

Here’s the thing, though. As director of Columbia University’s Male Reproductive Center, I frequently give lectures to medical residents about the diagnosis and treatment of male infertility. Usually, half of the audience is women. Very smart women. They’ve excelled through four years of college and four years of medical school, and are in their final stage of training. And yet, time and time again, I’ve found that neither they nor their male colleagues know about such seemingly simple things as the fact that, when it comes to fertility, the size of a guy’s testicles is all-important.

Here’s another example of something I’ve come to take for granted but that few people outside my profession seem to know: The size of a guy’s belly is related to his testosterone level and, therefore, likely sexual performance. Men with large bellies (potbellies) tend to have low testosterone levels, for reasons I’ll explain later. That’s right, the fatter a guy is, particularly around the waist, the greater his chances for low fertility and erectile dysfunction.

These kinds of experiences were the germ of the idea for this book. Then I started asking women what they thought about the title. They all immediately thought I was talking about the size of the man’s penis. One woman immediately raised her voice and said, “You’re damn right, size matters!” Before I could tell her that I meant the size of the testicles or belly, other women jumped in with their own very vocal opinions. That’s when I realized that “size” really does matter and that there was more to talk about here than just fertility.

At cocktail parties, I began talking about the book. Boom! I was suddenly the center of female attention. Women started pelting me with all sorts of questions regarding male sexual function. Then I started writing down the questions. I discovered that women talk about men and their sexual problems a lot. One woman said to me, “What did you think we talk about?” I had no idea. But I quickly realized that most women had very little understanding of male sexual health. That’s a big problem, because if the man has a problem, the woman has a problem. Not only will both of them not be sexually satisfied, but the woman often feels responsible somehow. It’s hardly ever the case, actually, but that seems to be a common emotional response. (Men aid and abet this, of course, with their prodigious capacities for denial and with their tendency to avoid talking about sex in general.)

Let me give you an example. Premature ejaculation is when a man ejaculates before a woman is satisfied. Many, many women have told me this happens all the time with them. Many said that they thought this was just the way sex is for guys. Well, not true. When I explained how long a man should last, they were astonished. And when I explained how they can help prolong the man’s erection and prolong the time to ejaculation so that they could have an orgasm, they were thrilled. These are the kinds of explanations that can make a real difference in the quality of your sex life. This book is loaded with many more.

The more I talked to women about this book idea, the more questions I was asked. How often are couples having sex? Does age affect sexual ability and by how much? Can you get a sexually transmitted infection if a guy wears a condom? Then came some questions that I did not expect. Why does semen taste the way it does? Why is it sweet or salty at different times? Why and how often do men masturbate? What are they thinking about? How does Viagra work? (And do you have samples you can give my husband?) One woman asked how often couples their age had sex. I told her that in her age group, the average was about twice a week. Her face dropped. “We only have sex about twice a month,” she said. This told me that size and frequency matter. I informed this woman that what really matters is whether she and her husband were satisfied with how often they had sex. If not, there were plenty of things they might do about it — including checking to see if there were physiological problems going on with her husband that could be corrected.

The point, again, is that information can be empowering. It’s ironic to me that we give “sex education” to kids in middle and high school, then let the adults fend for themselves. It’s clear to me that despite early education (such as it is) and despite our sex-saturated society, most people really don’t know enough about this most basic and potentially wonderful part of life.

So now you know how this book came about. It’s not a book for guys. It’s for you: an intelligent, curious woman who wants to know more about the male sexual machinery. Maybe you’ve had a few sex partners in your lifetime and you’ve seen enough variety to make you wonder why things are so different. Maybe you’re worried about STDs and trying to be more careful when handling male body parts. Or maybe you’re trying to get pregnant (or trying not to get pregnant!) and you want to know if there are any signs that the problem might lie with your partner (there are). Or maybe you’re just curious about some quirk of male anatomy — why your guy’s penis curves when it’s erect, what sex and orgasm feel like for a guy, whether it’s normal for one testicle to hang lower than the other. That kind of thing. Whatever your motives, I can guarantee you’re going to learn something here.

Although I’ve written my answers to Kara’s questions in a deliberately casual-sounding way, there is a great deal of medical and scientific rigor behind the answers. If no data exists to guide an answer, I’ll tell you — and clearly say I’m giving you my opinion as opposed to facts. Most of the time, however, my answers are backed up by high-quality research. I provide a fairly extensive set of notes so you can dig deeper into a particular issue if you want. But a second purpose of the notes is to assure you that even when things sound bizarre, like my discussion of the flavors of semen, I’m not making this stuff up. Believe it or not, somebody, somewhere, has studied these things.

So that’s it. The book is in question/answer format. If you have a specific question, you can use the index and go right to the topic that’s tickling your curiosity. Have fun with this ... and do me a favor — leave it lying around where your partner is likely to find it. Maybe he’ll read it and become one of those rare men who actually know how their body works — and how it can work better to pleasure you!

Excerpted from "Size Matters." Copyright (c) 2008 by Harry Fisch, M.D., and Kara Baskin.  Reprinted with permission from Three Rivers Press, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.