Not so long ago I was wandering across Marrakesh’s main square, the Djemaa El-Fna, where hundreds of musicians, acrobats, snake charmers and henna tattoo artists congregate every evening and perform until the early hours to passersby. It is total chaos and a real feast for the senses!
On this particular evening I noticed a huge throng of people in a corner of the square. There were only men in the audience – maybe as many as a hundred men of varying ages, and almost all Moroccan. I snuck my head into a tiny gap in the crowd to find a man dressed in beautiful white robes and wearing a large purple turban, sitting cross-legged in front of dozens of pots and vials of different coloured powders and liquids. He was shouting and gesticulating in Arabic and pointing to what appeared to be a photobook of penises – big, small, fat, thin, soft, erect penises, healthy looking ones and ones bearing discharge or rashes. I wondered, was this perhaps the Moroccan version of a sex therapist for men?
I was desperate to know more. What was in these mysterious potions and concoctions? What problems and ailments was this man seeking to address? And who was he? A witch doctor? A shamanic healer? A herbalist? A psychologist? I imagined that he was offering treatment for a range of issues relating to male fertility, erectile function and for combating sexually transmitted infections. I wondered what his success rate was, and what kinds of responses he would have had in a more Westernised country such as the UK.
What struck me the most was that this man had the biggest crowd in the whole square and that his audience was totally captivated. Perhaps this was the only form of advice or outlet available to the male population? We know that for many people in Africa, the art of prescribing traditional herbal medicines is a way of life, and the only option available. Indeed, 80% of South Africans use traditional medicines as their primary source of treatment. I would also imagine that the stigma and taboos that surround sex and relationships, particularly in Muslim cultures, makes it all the more difficult for people to access modern sexual health services let alone something like psychosexual therapy.
Watching this group of men, so absorbed and eager to hear from the man in the white robes, made me also think of the clients I encounter in sex therapy practice, who often arrive in distress and badly wanting to feel better. Sometimes, we simply want an easy solution to our problems, and sometimes that comes in the form of a pill. Many men turn to Viagra because it produces immediate, visible results; it’s the quick fix solution to erectile difficulties. However, this is not always the most useful course of treatment; erectile dysfunction most often has a psychological component to it, and Viagra is unlikely to fully address this.
Psychosexual difficulties can be very distressing to live with. People who experience them are often in a lot of emotional, psychological and physical pain. They refer to themselves as ‘broken’ or ‘damaged goods’ and feel that they have failed in their role as a lover or sexual partner. The instinctive need to feel better, to heal, and to stop the pain, is strong. This is not helped by the fact that we generally live at a hurried pace and in a culture where fast and immediate results are the expectation – and where sexual performance is key to masculinity and virility.
Unfortunately, however, psychosexual problems are highly complex, and they often require a great degree of time and patience to fully understand, explore and unpack. Problems with sex and intimacy often have their roots in childhood – in the way that we were raised and the way we formed our primary attachments in early life – and this can be a challenging concept for anyone to grasp and make sense of. No herbal or medicinal concoction is going to fully address that.
As a sex and relationship therapist I am trained to work in a ‘systemic’ way, which means that I view my clients – and their sexual problems – in a comprehensive manner and in terms of the different ‘systems’ that they belong to. I consider the biology, psychology, couple dynamics, family of origin and larger contextual (including cultural and religious) factors of any psychosexual problem. Sometimes even just the process of revisiting these different aspects of our lives and relationships can help make sense of how we got to this place of difficulty and distress, and it is worth taking the time over it as it is often the little details which can shed light on why we feel or behave in a certain way in our sexual relationships.
So who knows if the mysterious man in the white robes was successful in helping those men with their sexual or erectile concerns; not speaking Arabic, I can only speculate.. Using herbal or natural remedies for any sexual difficulty is controversial as their safety and efficacy are typically not rigorously tested. I would never advise a client to rely solely on natural remedies for resolving a sexual problem. However, I will always try to support a client who wishes to try these approaches as an adjunct to therapy (as long as it is safe and unlikely to interfere with our work together).
As a matter of fact, there are a number of naturally-occurring substances which have been shown to positively impact on sexual function and particularly on erectile dysfunction (or ED). Chocolate, for instance, is rich in flavonoids, which can help improve cardiovascular health by increasing blood flow and the concentration of nitric oxide necessary for a good erection. Studies have shown that consuming pistachios can also help improve ED – and watermelon contains a compound called citrulline which helps to relax blood vessels and improve blood flow (much like Viagra does). Of course, the best and most effective natural remedy for ED is a change in lifestyle because ED is a problem of blood flow, and changing your diet and exercising more (and cutting down on alcohol and drug use) will help keep your blood vessels healthy.
There is no harm of course in filling your larder with chocolate, watermelon and pistachios! The key, however, is to try a number of techniques and approaches, and preferably ones which are backed by evidence in the form of research studies or randomised controlled trials.
Or, you could try your luck in Djemaa El-Fna…