What is the difference between Westerners' and Arabs' attitude towards sex? The habits of these men are controlled by the social circumstances, religion, permissiveness, alcoholism and many other factors.

While the Western boys start having sexual intercourse with their girl friends, from the age of 15 or 16, an Arab boy cannot dream of this till he gets married, which is usually after the age of twenty or twenty-five. And till then, he has to hide facts of even nocturnal emissions and masturbation from all persons including his family members! Naturally homosexuality in Arabs is practised off and on at this age—due to non-availability of the opposite sex and not as a new desire, as in Western countries where certain males would prefer homosex to heterosex.

Coming to married adult Arab who is, by his religion, allowed to have four wives (of course majority of them cannot afford to maintain more than one wife), the main difference in this population and the Western society is the increased frequency of sexual intercourse. Although many of the Arab men would exaggerate and you must discount some of their statements, the fact is that they do make many more frequent visits to their wives.

These Arabs have no other entertainment available in their country. Sports are hardly heard of in an average Arab family. Also at all the social get togethers, men always boast of their sexual athletic achievements! To this is added plenty of spare time and "less" tension in the population than in Western, fast moving society.

One more factor is the climate. Because of hot weather, their day starts early and finishes by lunch time so that afternoon "nap" is available to majority of them and then why not to take advantage of bedding with their wives at that time!

I am convinced that an average Arab does the sexual exercise much more often than an Indian or a Westerner. An Arab phallus is more often bigger in size, and is maintained very Clean. Part of the looks are because of "clean" circumcision done on them and absence of smegma. Part of the "big" look is due to the absence of pubic hair. The pubis is shaved every few days. Also their semen production is much faster. Many of them would remember their young days when they did, what I have termed as "status coitus", when during a single intercourse they have ejaculated three to four times without withdrawing the phallus, which got erected soon after every ejaculation!! After discussing in detail the sexual habits of most of my Arab patients, I find, following is the average frequency of the sexual intercourse in this population :

Between the ages of 20 to 40, many Arabs would have (either attempt or wish to have!) a session three to four times a day. Although many of them would have a session in the afternoon or early morning before bath, most of them do have more than one session at night before going to sleep. After that age and around fifty, many would have twice a day. After the age of sixty, most of them continue to have one session per day even till the age of 70 to 80 or more. This habit is not universal though I have had patients who tell me that sexual intercourse has become such a routine that they feel funny, weak or abnormal if they abstain for more than two to three days!

And yet I do see so many "Westernised" Arabs who, in the middle age visit their wives only once or twice a week! But they would be mocked at by their friends (or young wives) if they heard of this "standard" sexual performance!

The sexual problems of Yemenis are complex. Many of them are away from their wives for months together serving in the surrounding countries. Also, though some types of 'Qat' are sex stimulating, majority of the times 'Qat' depresses the sexual desire and the performance.

The wives of Arab men are covered by veils ("Burkka") and are often very shy. Because of this discordance and the "joint family" system, with a number of married couples in the same family, many Arabs would like to satisfy their instinct without any "fore play". This in fact is the most common cause of 'premature ejacuIation', which is the main type of sexual weakness complained of by many of them. More so, fore play would be required much more when an elderly male is trying to enter the tight introitus of a young wife!!

I have hardly ever heard any one complain of lack of sexual desire, except a few Yemeni psychoneurotic patients.

The only other sex problem is the erectile impotency. So far, I have not found any organic cause for this symptom, (except a solitary case of shy Dragger Syndrome). As mentioned elsewhere Tabes Dorsalis (Syphilis of C.N.S.) is not seen in this population. Diabetes Mellitus does not seem to affect sex so much as it does in other populations, though, off and on, I do see marked impotency in diabetics. (Vice-versa, I have seen so many diabetic Arabs, who continue to have a normal sex life as described above) .

Most of these patients would agree to and say that they get nocturnal or early morning erections (at the wrong time! according to them) and have functional impotency. There are a lot of factors responsible for"keeping up" this erectile impotency.

1. A single experience of premature ejaculation ("Soraye") brings about a suspicion in their minds of sex weakness and this leads to erectile impotence
2. They then start communicating with their friends, and hear of their sexual habits, which further increases their inferiority complex and causes more impotence.
3. They then start noticing the quality, quantity and the thickness of semen and get "ideas" that the semen may be defective. More often the specialists would ask for the semen examination as an investigation of erectile impotence (new fashion or is it to satisfy the Arab visitor)! Very often if the report shows slightly low sperm count, it causes more anxiety and leads to more impotence. If one notices the column of "abstinence period" in semen examination reports, it is always blank (may be because of language difficulties). And that is, in fact, many a times, the cause of oligospermia reported in semen examination.

The serum prolactin levels and testosterone levels done on hundreds of my patients were invariably normal.

Most of these patients develop low backache in the morning if their sexual performance has been poor on the previous night. Many of them develop constant psychogenic backache due to sex weakness.

Others develop symptoms of neurosis.