每天一篇经济学人 | Sex 性（2022年第101期）

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，抑郁或焦虑（更不用说有严重的心理健康问题了）意味着大部分时间都在默默忍受。耻辱意味着很少有人愿意交谈。医生睁一只眼闭一只眼。大多数人认为精神疾病令人遗憾，但对病人的身体健康并没有太大影响。如今，这种耻辱就算没有完全消失，也已经逐渐消失了。早期治疗往往会将疾病扼杀在萌芽状态。

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.

类似的转变也将发生在性问题上，它就像曾经的精神健康一样，都隐藏在同样的禁忌和尴尬之下。在美国和欧洲，每五名男性中就有一人在人生的某个阶段患有勃起功能障碍; 一半的英国女性表示，她们在过去的一年里有过性问题，包括性交时疼痛或难以达到高潮。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? 一个最好不要提及的话题? 性问题可能是其他疾病的先兆，比如糖尿病。勃起功能障碍与吸烟和有心脏病家族史的人一样，都是心脏病的前兆。询问相关问题的医生可以做出早期诊断，并提供预防性的冠状动脉治疗。

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.

人们普遍认为性问题是五分之一到一半的离婚的原因; 减少这一数字将使许多成年人和儿童免于痛苦和贫困。勃起问题既是焦虑的原因，也是焦虑的结果，这会让生活变得更加艰难。有这些问题的男性工作效率低下的程度是没有这些问题的男性的两倍。

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.

解决性功能障碍既简单又便宜。一个简单的胜利就是改变孩子们了解性的方式。与其只关注避免疾病或意外怀孕等负面影响，教师可以鼓励讨论快感，以及如何与伴侣谈论快感，以及如何沟通和理解热切的同意。性问题经常在青少年时期突然出现，由于青少年在异性(或同性)周围的尴尬而变得更糟。所以也要教他们这些，不要在意后面的笑声。

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.

批评者可能会反对说，性在现代文化中无处不在，任何人最不需要的就是更多的性。但这没有抓住重点。电影和电视剧中的性，更不用说色情作品了，与现实生活的关联微乎其微。试图从好莱坞了解性，就像看詹姆斯·邦德寻找英国公务员的职业秘诀。最好是向青少年指出更现实的信息来源，比如BISH，一个英国网站，它可以解答年轻人在性关系中遇到的各种各样的令他们困扰的小众问题。

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，性问题应该成为医学教育的核心部分。只有到那时，医生才会开始例行公事般地讨论这些问题——就像他们对待疖子、运动、心脏病和其他与健康有关的问题一样。只要简单地告诉人们发生在他们身上的事情以及为什么会发生这样的事情，就可以减轻很多痛苦。再加上几次疗程的治疗，一些骨盆肌肉锻炼，或者简单改变生活方式的建议，这通常就是病人所需要的一切。这些东西现在被打包在APP中，其中一些APP已经得到了医疗监管机构的批准。

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.)

科学家也应该摆脱他们的拘谨。不先了解问题是很难解决问题的。研究项目经常被叫停，因为委员会成员觉得这个课题令人不适。对于那些怀疑仅仅是快感就足以成为改变事物的理由的清教徒来说，值得注意的是，更好的性研究可能会改善公共健康。研究发现，当讨论快感成为艾滋病毒预防计划的一部分时，人们会更多地使用避孕套。(例如，戴上一个避孕套可能是前戏的一部分。)

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?

性是人类生活中最大的乐趣之一。在最好的情况下，它是一种狂喜的来源，是一种持久情感的共同表达。尽管如此，还是有那么多人感到痛苦或失望，这是一个悲剧。然而，对他们中的很大一部分人来说，它可以变成一种令人愉快得多的东西。对性更加开放是增进幸福和健康最简单的方法之一。为什么不试试呢?