A Generation Ago being depressed or anxious—let alone having serious mental-health problems—meant suffering mostly in silence. Stigma meant few people wanted to talk. Doctors turned a blind eye. Most saw mental illness as regrettable but not something that made much difference to a patient’s physical health. These days the stigma has faded, if not entirely disappeared. Early treatment often nips things in the bud.

在一代人之前，抑郁或焦慮（更不用說有嚴(yán)重的心理健康問題了）意味著大部分時間都在默默忍受。恥辱意味著很少有人愿意交談。醫(yī)生睜一只眼閉一只眼。大多數(shù)人認(rèn)為精神疾病令人遺憾，但對病人的身體健康并沒有太大影響。如今，這種恥辱就算沒有完全消失，也已經(jīng)逐漸消失了。早期治療往往會將疾病扼殺在萌芽狀態(tài)。

A similar transformation is due for sexual problems, which lie beneath the same blanket of taboo and embarrassment as mental health once did. One in five men in America and Europe has erectile dysfunction at some point in his life; half of British women say they had a sexual problem in the past year, including pain during sex or difficulty reaching an orgasm. Plain old lack of desire is common, especially among women.

類似的轉(zhuǎn)變也將發(fā)生在性問題上，它就像曾經(jīng)的精神健康一樣，都隱藏在同樣的禁忌和尷尬之下。在美國和歐洲，每五名男性中就有一人在人生的某個階段患有勃起功能障礙; 一半的英國女性表示，她們在過去的一年里有過性問題，包括性交時疼痛或難以達(dá)到高潮。缺乏欲望是很普遍的，尤其是在女性中。

Trivialities? A topic best left unmentioned? Sexual problems can be harbingers of other illnesses, such as diabetes. Erectile dysfunction is up there with smoking and a family history of heart disease as a predictor of heart trouble. Doctors who ask about it can make an early diagnosis, and offer preventive coronary treatment.

小事? 一個最好不要提及的話題? 性問題可能是其他疾病的先兆，比如糖尿病。勃起功能障礙與吸煙和有心臟病家族史的人一樣，都是心臟病的前兆。詢問相關(guān)問題的醫(yī)生可以做出早期診斷，并提供預(yù)防性的冠狀動脈治療。

Sexual problems more generally are thought to contribute to between a fifth and half of all divorces; reducing that number would spare many adults and children from misery and impoverishment. Erectile problems are both a cause and a consequence of anxiety, which can make life harder to cope with. Poor productivity at work is twice as high among men with such problems as among those without them.

人們普遍認(rèn)為性問題是五分之一到一半的離婚的原因; 減少這一數(shù)字將使許多成年人和兒童免于痛苦和貧困。勃起問題既是焦慮的原因，也是焦慮的結(jié)果，這會讓生活變得更加艱難。有這些問題的男性工作效率低下的程度是沒有這些問題的男性的兩倍。

Tackling sexual dysfunction can be simple and cheap. One easy win would be to change the way children learn about sex. Instead of focusing only on avoiding the downsides, such as diseases or unwanted pregnancies, teachers could encourage discussions of pleasure, and of how to talk to a partner about it, as well as how to communicate and understand enthusiastic consent. Sexual problems often crop up in adolescence, made worse by general teenage awkwardness around the opposite sex (or indeed the same one). So teach them about those too, and never mind the giggles at the back.

解決性功能障礙既簡單又便宜。一個簡單的勝利就是改變孩子們了解性的方式。與其只關(guān)注避免疾病或意外懷孕等負(fù)面影響，教師可以鼓勵討論快感，以及如何與伴侶談?wù)摽旄?，以及如何溝通和理解熱切的同意。性問題經(jīng)常在青少年時期突然出現(xiàn)，由于青少年在異性(或同性)周圍的尷尬而變得更糟。所以也要教他們這些，不要在意后面的笑聲。

Critics may object that sex is everywhere in modern culture, and the last thing anyone needs is more of it. But this misses the point. The sex in film and television dramas, let alone pornography, bears scant relation to real life. Trying to learn about sex from Hollywood is like watching James Bond for tips on a career as a British civil servant. Better to point teenagers to more realistic sources, such as BISH, a British website that answers all sorts of niche questions that trouble young people as they begin stumbling their way through sexual relationships.

批評者可能會反對說，性在現(xiàn)代文化中無處不在，任何人最不需要的就是更多的性。但這沒有抓住重點。電影和電視劇中的性，更不用說色情作品了，與現(xiàn)實生活的關(guān)聯(lián)微乎其微。試圖從好萊塢了解性，就像看詹姆斯·邦德尋找英國公務(wù)員的職業(yè)秘訣。最好是向青少年指出更現(xiàn)實的信息來源，比如BISH，一個英國網(wǎng)站，它可以解答年輕人在性關(guān)系中遇到的各種各樣的令他們困擾的小眾問題。

More ambitiously, sexual problems should be a core part of medical education. Only then will doctors begin to discuss them routinely—as they do with boils, exercise, heart disease and other health-related matters. A lot of suffering can be alleviated by simply giving people frank information about what is happening to them and why. That, plus a few sessions of therapy, some pelvic-muscle exercises, or suggestions for simple changes in lifestyle, is often all patients need. Such things are now packaged in apps, some of which have been approved by medical regulators.

更有雄心的是，性問題應(yīng)該成為醫(yī)學(xué)教育的核心部分。只有到那時，醫(yī)生才會開始例行公事般地討論這些問題——就像他們對待癤子、運(yùn)動、心臟病和其他與健康有關(guān)的問題一樣。只要簡單地告訴人們發(fā)生在他們身上的事情以及為什么會發(fā)生這樣的事情，就可以減輕很多痛苦。再加上幾次療程的治療，一些骨盆肌肉鍛煉，或者簡單改變生活方式的建議，這通常就是病人所需要的一切。這些東西現(xiàn)在被打包在APP中，其中一些APP已經(jīng)得到了醫(yī)療監(jiān)管機(jī)構(gòu)的批準(zhǔn)。

Scientists should shed their inhibitions, too. It is hard to fix problems without first understanding them. Research projects are often blocked because committee members find the subject uncomfortable. And for the puritans out there, who doubt that mere pleasure is sufficient grounds for changing things, it is worth noting that better research into sex is likely to improve public health. Studies find that when discussion of pleasure is part of HIV-prevention schemes, people use condoms more. (Putting one on can be part of foreplay, for example.)

科學(xué)家也應(yīng)該擺脫他們的拘謹(jǐn)。不先了解問題是很難解決問題的。研究項目經(jīng)常被叫停，因為委員會成員覺得這個課題令人不適。對于那些懷疑僅僅是快感就足以成為改變事物的理由的清教徒來說，值得注意的是，更好的性研究可能會改善公共健康。研究發(fā)現(xiàn)，當(dāng)討論快感成為艾滋病毒預(yù)防計劃的一部分時，人們會更多地使用避孕套。(例如，戴上一個避孕套可能是前戲的一部分。)

From tragedy to romance

Sex is one of the greatest joys in a human life. At its best, it is a source of ecstasy and a shared expression of lasting affection. That so many people nonetheless find it painful or disappointing is a tragedy. Yet for a large proportion of them, it can be turned into something far more agreeable. Being more open about sex is one of the easiest ways to enhance happiness and health. So why not try it?

性是人類生活中最大的樂趣之一。在最好的情況下，它是一種狂喜的來源，是一種持久情感的共同表達(dá)。盡管如此，還是有那么多人感到痛苦或失望，這是一個悲劇。然而，對他們中的很大一部分人來說，它可以變成一種令人愉快得多的東西。對性更加開放是增進(jìn)幸福和健康最簡單的方法之一。為什么不試試呢?