Men's Health Blog

Male Sexuality After 35

2009-11-02T10:00:00.000-08:00

The media have frightened men. We're told, in no uncertain terms, that once we're into our late 30s, sex is downhill. We can't perform as well as younger men, we're not as attractive as younger men, and our potency will continue to decline until--when we reach our late fifties--we will be almost non-sexual.

What bunk--but powerful bunk it is. Like women and menopause, older men face dozens of unfounded fears--usually categorized by the dreaded "mid-life" crisis.

Yes, there are physical changes that occur as men age, but these changes do not adversely affect sexuality or the ability to have sex. But if you are silly enough to buy into the myth of the impotent middle aged male, then and only then will you have some problems.

In general, as men age it may take a little longer to achieve an erection. This slightly slowed response is meaningless-yet it frightens men because they see it as an indicator of declining sexual ability. It is nothing of the sort. This SLIGHTLY slowed response means nothing--it does not indicate the beginning of impotence nor does it mean that sexual desire is waning. It means only that you are aging naturally and gracefully. Instead of instant erection, it now takes a minute or two. That's meaningless in the grand scheme of things, unless you think sex is supposed to be completed in a matter of minutes. In fact, this slowed response means that men need foreplay, just as women do. This can be a blessing to your partner and to you. Enjoy the extra time--be creative, relax.

As men reach their late fifties and early sixties, it's possible that the erection may not be as hard or as large. But once fully excited, the erection will most likely be hard and steady. Many men find that manual stimulation by their partner is needed to gain a full erection. There's nothing wrong with that--both partners can enjoy the experience.

As men age, there's likely to be a reduction in the amount of seminal fluid, but this, too, is meaningless. And, in fact, it may be a bonus. Less seminal fluid usually means that men can delay ejaculation for a longer period of time. Again, this benefits both partners. It's common for the length of love making to increase as men age. There's absolutely nothing wrong with that.

Some men worry that their orgasms become less powerful with age. In some cases this may be true, but less powerful does not mean less enjoyable. And men will notice that it takes longer to have another erection after orgasm. As teenagers, it may take a matter of minutes after orgasm; in their forties, many men find it takes a matter of hours. In your seventies it may take a few days. But this increase in time in no way reflects a loss of potency, a decline in sexuality, or a loss of sexual drive.

And here's an important point: lovemaking does not always have to involve ejaculation. As we age both men and women realize that there are other parts to making love other than orgasm. Don't limit your lovemaking only to those times when ejaculation is possible. Experiment, have fun, there's lots to do once the pressure of performance is lifted.

Many men have fallen victim to the myth of male menopause. There is no such thing.

As we know, the female body will begin producing less estrogen as menopause begins. The male body, however, continually produces testosterone--the male hormone--throughout a lifetime. Earlier studies showing a decrease in testosterone as men age were flawed. If there is a reduction it is usually caused by health problems--obesity, smoking, emotional problems. Men do not face a male menopause--it's as simple as that.

Impotence

Male sexual performance is fragile. If it depended only on physical abilities, sexuality would be an easy thing. But for the man, physiology must be combined with psychology. It's the delicate balance of brain and body which makes sexuality so intriguing, and for many men, so problematical.

Impotence is spreading in America. Some say the reason is the rise of the assertive female--the women's movement has frightened men, leaving them unsure of their role in today's sexual adventure, and thus unable to perform with any degree of regularity.

Others agree the women's movement has played a part, but argue that it's the female's fault that American males face impotence. The women's movement, so the argument goes, has emasculated men. In their rush to equality women have debased masculinity--transforming the positive qualities of men, attributes like passion, enthusiasm, drive, into negatives attributes. The argument goes that men no longer can be themselves, and in trying to affect a false persona men have lost their sexuality.

But to blame the rise of impotence either directly or indirectly on women is unfair. Just as serious illness is on the rise in America, so are hidden conditions like impotence and frigidity. Ours is a fast paced world. We work more hours than did our parents; competition for good jobs is tougher than ever; the pressure to make money, to be a success has never been greater. Now add to these pressures the problem of sexual relations in the 1990s--choosing the wrong partner might not only mean a broken heart, it could mean an agonizing death at the hands of the mutating AIDS virus. It's not hard to understand why impotence, which is so dependent on psychological calm and confidence, is plaguing American men.

Impotence--the inability to get or maintain an erection--threatens a man's self image. Needless to say, impotence strikes fear in the hearts and minds of most men. And it's this fear which makes the condition so insidious. If men would realize that impotence has little to do with sexuality and lots to do with a reduced body function, the problem would be a long way toward being solved. Unfortunately, men see impotence as a challenge to their manhood--to the very core of their nature. For this reason, one sudden bout of impotence--which is, by the way quite natural--is suddenly turned into a fearful event. This fear creates another episode, the fear grows, then another. Soon the once instance is turned into a seemingly permanent condition.

To fight impotence what's needed is knowledge--knowledge of the cause and information about possible solutions. In the vast majority of cases, impotence can be quickly corrected. Only those cases involving a physical disability or a serious mental condition will not respond to some common sense treatment.

To begin, you must know that an occasional episode of impotence is perfectly normal. It happened to Don Juan as it will happen to almost all men. The reason is unknown. The situation could be ideal, the partner could be right, but somehow the body and/or the mind don't respond. Remember, an occasional episode means nothing--you're not losing your sexual drive. It's something that happens once, then goes away. Recognize it as that, and you'll have no problems. But begin fixating on the one failure, and you're on your way to a real problem.

Also know that a natural decrease in sexual drive will occur with ages. This, too, is normal. The decrease in libido--sexual drive--is slight, and really doesn't come into play until the late 50s or early 60s. Remember, this decrease in libido is a fact of aging, but it in no way diminishes a man's ability to have an erection. Older men can have erections at the same frequency and strength as younger men. So, don't let your decreased sexual drive frighten you into impotence. There's really no correlation.

And don't let age frighten you. So often both men and women assume they're losing sexuality because they're aging. The correlation between sexuality and age has not been made--at least until you enter your 70s or 80s. And even then, you can have a very fulfilling sex life.

Another fact: around age 40, men usually need more physical contact before achieving an erection. At one time it may have been possible to sustain an erection by looking at a beautiful women, once past 40 some contact is needed. Again, this in no way means that you're losing your ability to perform. It's nothing more than a natural change in your sexual appetite.

With this knowledge in hand, you can help increase and restore your sexual ability by trying proven home remedies.

Watch what prescription drugs you are taking: It's estimated that 30% of impotence cases are caused by prescription drugs. Often doctors don't warn their male patients about this possible side effect. If you're taking tranquilizers, even minor ones, your problem is likely drug related. Some prescription antihistamines and muscle relaxers can cause impotence, as can many drugs given to lower blood pressure. Vasodilators and diuretics can have an adverse effect, as well as MAO inhibitors and other anti-depressive drugs. If you're taking any of these kinds of drugs and experiencing impotence see your doctor at once. There's a good chance your problem can be easily corrected.

Quit using drugs: Alcohol, amphetamines, narcotics, even marijuana can cause impotence. The idea of a drink before sex is something best left to the movies, as is the idiotic notion that marijuana somehow makes sex better. It doesn't--in fact, marijuana could make sex impossible.

Lose some weight: If your obese, impotence could become a problem Excess weight strains your system--particularly your circulatory system. Especially in older men, the more weight you carry the more sluggish your circulation. Blood flow is reduced--including blood flow to the penis. The result? Impotence. But be careful: losing too much weight too quickly is harmful to your health, and can also affect sexual performance.

Relax, relax, relax: Tension is the number one killer of sexual desire. How can you perform sexually when your mind is filled with thoughts of work, bills, problems, the kids, you name it? To enjoy sex you must be there--physically and mentally. If tension has you tied in knots, it's a good bet that your sexual performance will be poor, at best. To beat impotence you must beat tension. If it takes meditation, a warm bath, a quick nap, self hypnosis, whatever, you must find a way to relax yourself so you can enjoy sex and life.

Stop blaming yourself: No one asks to become impotent. The condition has any number of causes, none of which is your fault. Nor is it the fault of your partner. Impotence can be solved, but adding blame on top of the guilt and embarrassment only makes things much worse.

Size doesn't count: Many times impotence is caused by embarrassment: men believe they are smaller than normal and this body image problem quickly leads to impotence. Two points to remember: most men are not smaller than average. First, when it comes to penis size the vast, vast majority of men are normal--that is, an erection of five to six inches. It's a good bet that you're average. Don't make the mistake of judging size by what you might see in sexy magazines or movies. Like the women, the men who pose are well above average. Compared to them, you may be small, but compared to most men, you're right on the mark. Second, size has little or no correlation with amount of pleasure a man can give a woman. When it comes to making love, technique and passion are they keys. Size is unimportant.

Analyze your problem: If you've suddenly been experiencing impotence, take a look at lifestyle changes, increases in stress, changes in prescription drugs, increased alcohol use, or anything else which has changed shortly before the problem began. If prescription drugs or alcohol aren't the problem, look to stress enhancers. Have you recently changed jobs? Has your financial situation changed for the worse? Are you long overdo for a vacation?

Exercise for your vital organs: Is there an exercise that can help impotence? Maybe. Something called the Kegel for Men is catching on as a natural way to strengthen erections. The Kegel is easy to do. Squeeze the muscle of your pelvic floor. Where are they? They're the muscles you use when you try to stop the flow of urine. The Kegel uses that same squeezing sensation to strengthen these muscle. Squeeze and hold for three to five seconds. Then release and do again. Try starting at 10 times, three times a day. Eventually work your way to approximately 200 squeezes a day.

Try an herbal solution: Yohimbe has shown particular promise as an herb that can make erections harder and firmer. Studies show that yohimbe, a tree bark extract, has been shown to increase blood flow to the penis. In clinical tests, the active ingredient in yohimbe was tested on a group of men who had been impotent for less than two years.

The study reported an improvement rate of 81% for those taking a moderate dosage of the active ingredient for one month.

More than 60% of men who experienced partial erections and had failed at normal intercourse at least half of the time reported fuller, more lasting erections.

Understanding Male Sexuality: Information You Did Not Learn From Your Parents, Your Friends or in Your High School Sex Education Class! (Part III)

2009-10-29T11:55:00.000-07:00

No one yet fully understands the mechanism by which sexual preference is ultimately determined, and theories cite genetic and environmental factors, with the theories involving primarily genetic factors gaining increasing support, in part based on studies of identical twins. In addition, the fact that many gays appear to have already determined a sexual preference at a very early age supports theories which suggest only a limited role for the environment and family-related factors. The determination of what is arousing and what is not is not a matter of conscious decision.

Gay men are very much like straight men, except for the fact that the sexual arousal mechanism is primarily if not exclusively triggered by persons of the same sex. Gays are just as mystified by why women trigger the arousal mechanism in straights as straights are mystified by why other men trigger the arousal mechanism in gays. From the gay perspective, it is the straight world that is "abnormal." Interestingly, other than for the problems in dealing with discrimination while living as a gay in a predominately straight world, I have yet to visit with a gay man who has expressed an interest in waking up tomorrow morning as a straight. The vast majority of gay men are not in any way dissatisfied with their sexual preference, which these see as the very essence of their being.

Gays are largely mystified as to why they are treated as they are solely on the basis of their sexual preference. Discrimination against and other acts of hatred toward gay men is a sad component of American culture as well as in cultures of many other countries where treatment by the majority can be even worse than it is here. I have a theory that many of the men who discriminate against and otherwise preach hatred toward gays are themselves struggling with their own inner unresolved conflicts with respect to their own sexual orientation. Acting in anger against gays is a way of dealing with their own anger with regard to inner conflicts about their own sexual preference! Those who cite religious and biblical teaching against gays are on shaky ground as well. First, the biblical passages relating to this topic are not at all clear, and can have many different interpretations. The basic message of
Christianity deals a lot with topics like acceptance, understanding and love, and speaks out boldly on issues such as hatred and discrimination. How anger and discrimination toward gays can be rationalized on the basis of religious doctrine remains a great mystery to me.

Many of the sexual stereotypes of gay men portrayed in the media--that sexual orientation is almost exclusively a sexual attraction--are inaccurate. Complicated story lines are difficult to follow, particularly in a half-hour television show. Many straights (in part, based on media stereotypes) believe that most gay men are really women living in men's bodies, that is, men who would have preferred to be women, if given a choice. I have found that this characterization, popular in the media, to be a description of only a tiny percentage of gays. The vast majority of gay men are very happy being male, have no interest in dressing or acting like women, or undergoing a sex-change operation. Indeed, from all outward appearances, they are indistinguishable from their heterosexual counterparts--except that their sexual arousal mechanism is triggered by persons of the same sex. In our predominantly heterosexual culture, this one tiny difference presents some major issues for our society. Straights often assume that the behavior of all gays is similar to what they see of a few gays in the news media. The vast majority of gays are living lives very similar to men in the straight culture, holding down stable jobs in all types of work and searching for loving, lifelong relationships with a partner--just as straights attempt to do. In terms of length of a same-sex relationship, the gay men who have written me all seemed to be convinced that their relationship is representative of the group as a whole. I have heard a gay man who has been in stable relationships for 20 years and is convinced that this is quite "average" for gay men of his age and normal. I have heard from another gay men who moved in and out of relationships for 20 years with each relationship only lasting
from 6 to 18 months. Interestingly, he was equally convinced that his particular situation represents the "normal" pattern of gay behavior. I conclude that there
are no truly reliable data on this. I do believe, however, based on the conversations I have had with gay men, relationships, on average, tend to be much shorter lived than in the straight community, often measured in weeks or months, but usually not in years. There is apparently some research evidence to suggest, however, that the pattern of short-lived relationships tends to recede as gay men age, just as it does among heterosexuals and that the AIDS epidemic has tended to foster a movement toward more long-term, monogamous relationships among gays.

Sexual Preference: Nature or Nurture?
Is sexual preference largely determined by genetics, or does the environment (i.e. family upbringing) matter? That is an interesting and important question. Twenty years ago, the vast majority of psychologists believed that the environment under which a child grew up played a major role in determining sexual preference. Distant or absent fathers along with overbearing mothers were often blamed for same-sex preferences of, particularly, male children. These theories of an environmental (family) basis for sexual preference have been increasingly discounted by researchers, as more credence has been placed on genetics. But even if genetics plays a major role in determining ultimate sexual preference, the rules under which the genetics laws must work are not simple. Not too many years ago, the laws governing genetic inheritance were viewed by scientists as very simple, largely following rigid rules laid out by Gregor Mendel, a monk who studied genetics by observing characteristics of successive generations of peas, and other plants. Mendel basically concluded that there were dominant and recessive genes, with dominant genes ruling unless the individual inherited recessive genes from both parents. Individuals with but one dominant gene could still transmit recessive genes to their progeny. The inheritance of eye color is an example, with brown eye color being the dominant trait and blue eyes being recessive. If the individual inherited one gene for brown eyes from either parent, the eye color would be brown. Only if both parents provided the blue, recessive gene, then eye color would be blue. These simple rules apply in most instances. But they did not explain the occasional green-eyed person, or the even rarer exception of people with one brown eye and one blue eye. These exceptions to the rigid laws--situations that didn't quite conform to expectations--were often discounted by scientists as being unimportant. But in recent year, these "sloppy" exceptions to the rules have assumed increasingly importance, as more frequently, exceptions to the established laws were discovered. In many instances, for example, the effect of a recessive gene might not be completely masked by the dominant gene. Or, certain combinations of genes may have impacts on the person intermediate between their individual impacts. Eyes are not only brown or blue--they may be slightly brownish or slightly bluish. Or complicated interactions among several different genes may be involved.

Another controversial illustration is the comparative role of cigarette smoking (an environmental factor) and genetics in the development of lung cancer. Many people who smoke heavily all their lives never develop lung cancer. However, many other smokers die of lung cancer, some at a relatively young age. Those who do not develop lung cancer likely have a genetic factor that protects them, or, alternately, those who develop lung cancer have a genetic factor that interacts with the environmental influence (smoking) to result in lung cancer. No one knows for sure, but clearly, the incidence of lung cancer is likely tied to both genetic and environmental factors.

There is increasing evidence pointing to a genetic basis for sexual preference, but just as in the cancer-smoking connection, that doesn't mean that the role of environmental influences can be completely ruled out. The evidence supporting the genetic basis includes (1) work by researchers pointing to a specific gene identified as present in many, if not most, gay men; (2) studies of identical twins which indicate that if one twin is gay the likelihood of the second twin being gay is increased; and (3) studies suggesting physical differences in brain structure between gays and straights. Interestingly, in the case of the identical twin studies, the probability that the second twin is gay if the first twin is gay is not 1.0, despite the fact that both twins inherited the identical genes from their parents.
A simple model would suggest that being straight is the dominant trait (as is having brown eyes) whereas being gay is a recessive trait, from which recessive genes must come from both parents. But that model is far too simple. Only a model that incorporates an incomplete manifestation of genes or complex interaction among genes, would be consistent with all the variations seen in human sexual preference. Further, while there may be a sexual preference programmed into our genetic makeup, the environment could still play a role, just as it likely does in the cigarette smoking-lung cancer connection. A simple Mendel-like model of the inheritance of sexual preference would suggest that nearly everyone would be either straight or gay. In this Mendelian world, virtually all straights would be absolutely disinterested in same-sex activities, and nearly all gays would be totally disinterested in different-sex activities. There would be few, if any, bisexuals. But this does not conform to the real world, and reality instead suggests that there are a lot of people--both men and women, where sexual preference is not clear-cut.
In addition, this opens up the possibility that while genetics may be a factor in determining sexual preference, other environmental factors may still play a role, at least for a portion of the population. It is widely believed and probably well documented that men in prisons, students in single-gender schools etc. tend to engage in more same-sex activities than occurs within the population at large. Interest in same-sex versus different-sex activities is likely, in part, determined by the available options, and part by genetic programming. Further, for some individuals, sexual preference is not static but dynamic, with comparative preferences for same-sex versus different-sex activities changing over time. I am aware not only of married men who are seeking to move into a same-sex relationship instead, but also of men with gay partners who are seeking to dissolve the gay relationship and marry a female lover. So making the assumption that for everyone, sexual preference if rigidly preprogrammed and static oversimplifies the case as well. Psychologists have long known that it is possible many individuals who can be aroused by either same-sex or by different-sex relationships to "develop" either the straight or the gay sides of their personalities and have a degree of control over sexual preference. Thus, the basis (cause) for human sexual preference remains
marvelously complex and interesting. For a different perspective dealing with some of the same issues see the Council for Responsible Genetics website.

Same-Sex Activities
Straight society is often somewhat mystified by the specific sexual activities that gays engage in. Current thinking in psychology is that perhaps as much as one-third of the adult male population has, at one time or another, engaged in some form of same-sex activity leading to orgasm. It's not uncommon, according to psychologists, for boys only recently past puberty to engage in mutual masturbation, or "jerk-off" sessions, with their male friends. Psychologists attach little significance to this sort of same-sex activity in terms of its implications for sexual preference. Psychologists refer to such activity as "incidental homosexuality, and do not necessarily believe that simply because young person, or even an adult man, irregularly engages in such activity that the man is gay.

However, many gay men are also very interested in mutual masturbation sessions where both partners manipulate their own or each other's sex organs. Such activity may involve more than two men. The sex-oriented newsgroups are filled with personal ads from men who are looking for jerk- off partners, and internet newsgroups have largely replace public restrooms for advertising. The true sexual orientation (preference) of many of these men can be ambiguous.

Some men appear to attach no more significance to the activity than, say, going out for beer and a pizza, and simply treat it as an enjoyable way to spend an evening. I've visited with married men who occasionally "go out with the boys" to engage in mutual masturbation. These men claim to very much enjoy sex with their wives as well, have no intentions of leaving their wives, and simply regard the jerk-off sessions as a different and interesting sexual activity. In the instances I am aware of, the wives are unaware of what goes on when the husband has a night out with the boys. Another common activity is watching erotic videotapes while engaging in mutual masturbation by male friends. Oral sex among gay couples is the next step, although even here some psychologists regard the oral sex as simply another manifestation of incidental homosexuality that does not provide sufficient evidence that the men involved are gay.

Anal intercourse is the type of sexual activity many psychologists regard as only taking place between men who are gay. This view, however, is by no means universally held. Some recent research suggests that anal intercourse ranks only third (behind mutual masturbation and oral sex) as the favored activity among gays. Of course, the AIDS epidemic and the subsequent emphasis on safe(r) sex has substantially changed not only the views of gays about activities such as anal intercourse but also the comparative frequency of the various activities, so data collected in recent research may have (undoubtedly has) changed substantially from that collected 5 or 10 years ago. Straights were initially confused by the spread of AIDS within the gay
community. Most straights assumed that gays primarily engaged in activities such as mutual masturbation which posed virtually no risk of disease transmission. The speed by which AIDS moved through the gay community strongly suggested to straights that anal intercourse was a favored sexual activity for many, if not most, gays. Why anal intercourse ever assumed such an important role in the gay community remains something of a mystery to me, in particular because the rectum and the penis are not designed to fit together very well. Gay couples have written to me to describe in detail some of the difficulties they were having with anal intercourse and complaining that the sensations they were experiencing in anal intercourse were not very interesting. The rectum is just a hollow tube, and contains no structure that plugs the end as the cervix does in the woman. Still, many gay couples appear to regard anal intercourse as a very necessary part of the relationship. This is the one activity that straight men probably have the most difficulty understanding and dealing with.

Sadly, since anal intercourse is the primary mechanism by which the AIDS virus is transmitted between gays, it is undoubtedly responsible for the vast majority of cases. While the AIDS virus can be transmitted via oral sex, the probability of transmission is very low, and would usually require open sores in the mouth. The rectum is very fragile and is easily torn in anal intercourse. Thus, anal intercourse can provide an excellent path for the transmission of the AIDS virus
from semen to blood and from blood to penis. The fact that many gay relationships tend to be fragile and short-lived, that anal intercourse was a favored sexual activity for many gays, and the easy transmission of the AIDS virus through the rectum has in large measure been responsible for the AIDS epidemic among the gay community. There are many sexual activities that gays could (and increasingly do) enjoy which would pose essentially zero risk of disease transmission--mutual masturbation, sex play involving clothing, sex toys and the like.

Male Sexuality Issues in Heterosexual Relationships
In sexual pleasure, do relationships matter? Of course! Relationships are not the key to sexual happiness, but for most men, they are certainly a key to sexual happiness. In re-reading this paper, I began to think that many of the discussions contained herein, while accurate, were treating some of the sexuality issues in a relationship void. I do not consider myself to be an expert on relationships. However, I hope that some observations I am making here about relationships might prove useful to others. For both men and women, much of what we learn about the members of he opposite sex is acquired in the early years of post-pubescence, that is, the early teenage years. Much of this information, if not wrong, certainly contains elements of inaccuracy. Teenagers spend a good deal of time not only developing the requisite social skills but also discovering their own and their friends' sexuality. The values and beliefs developed in the teenage years about the
opposite sex are often carried into adulthood with little modification. Teenage girls quickly become convinced that teenage boys are constantly thinking about sex. This observation is probably not far from accurate. At the same time, they become convinced that the number one objective of the vast majority of teen-age males is "scoring".

Many teenage males quickly come to the conclusion that the young women expect them to behave this way, and they are often more than happy to comply with these expectations. Somehow, it's unmasculine to not try to encourage a date to have sex. Young women quickly begin to believe that young men, as a group are crude boars, and insensitive to the more subtle parts of a relationship. Early on, young women become convinced that the only part of a relationship that matters to men is the sex part. The notion of sensitivity and caring somehow get lost in the process. So both men and women enter adulthood with some real misconceptions about sexuality and the role of sex in a relationship. Young men often fear that anything that borders on sensitivity will be interpreted as being somehow "unmasculine" and thus represent inappropriate behavior for a "real" man. Women believe that the only part of intimacy that matters to men is the sexual intercourse part,

Some couples never really get beyond these misconceptions. They muddle through life never really getting what either partner wants out of a relationship. Men don't really like being viewed by their partners as insensitive clods, but many do not know where or how to begin to change. Parents often provide role models in this regard, and young men who grew up in a family where the father was sensitive and caring to the needs and wishes of the mother--sexual and non-sexual--are at a great advantage in developing the requisite skills. Young women who have had the advantage of observing their parents loving and sensitive relationship are also at a significant advantage over those who grew up in families where the relationship is weaker or less stable. Why is all of this important? Simply put, sex is a good deal more enjoyable in a loving and caring relationship, and this is true for both men and women. John Gray became a best-selling author with his book Men are from Mars: Women are from Venus. The popularity of this and subsequent books stems primarily from some basic truths Gray was able to articulate so well.

In his book, Gray argues, not surprisingly, that men and women are very different with respect to their sexual and non-sexual needs and desires, and thus bring very different ideas about relationships to the table. Clearly, most men probably see intercourse as being far more important to their overall happiness than most women do. But these differences extend to non-sexual matters as well. Men see themselves as "problem solvers" in a relationship, not as sympathizers. If a women faces a problem involving a co-worker, for example, the male partner (husband), often believes that in order to make the woman feel better, the problem must be solved. In reality, what the woman is often looking for is not a solution to her problem, but rather expressions of caring sympathy. Phrases such as "You were mistreated and I can see why you are angry with the co-worker." may be far more successful than a sincere attempt to try to help her deal with the co-worker. Worst of all is to belittle the problem by saying "I don't think that's serious enough for you to be concerned or upset about it." In a relationship, that kind of help is asking for trouble.

Women often believe the myth that the only thing men enjoy about sex is intercourse. Foreplay is just something men put up with to please the woman. I hope that my foregoing discussions have helped explode that myth. But men believe some myths too. The first myth is that women don't enjoy sex nearly as much as men do, but sometimes "put up with it" to please their partners. It is true that the vast majority of women se the sexual act as part of a "package" deal. Sex is but one of many components of a worthwhile relationship. Most women would probably rate caring and sensitivity in a loving relationship as being far more important than the sex act itself. But its not true that most women feel only so-so about sex. There are many women who see sex as a very important part of the overall package.

So the package deal of a relationship for women involves a lot of things: a loving and caring relationship, perhaps a family, home, a big dining room table--that is, all the signals that suggest a stable, caring and protected environment. With the possible exception of the big dining room table, men want these things in a relationship too. The rankings may be different, but, in general, the same items are "on the list" for men too.

So, what's a man to do? Showing some sensitivity towards the female partner would be a good start. This is why florists have become wealthy selling long-stem roses. This sensitivity is important both in and out of a sexual setting. Strong relationships begin with both partners sending strong signals that they care for each other. Relationships are not built of the sizes of breasts and penises. Most men are far less concerned about breast size than women believe. Analogously, most women are not nearly as concerned about the size of an erect penis as men believe. These are leftover myths from adolescence.

In short, relationships are built on three words: sensitivity, caring and communication. That's how love develops. It's really all quite simple-- but at the same time, marvelously complex. Sex without these three factors is dull and meaningless. So, how does a man show to a woman that he is sensitive and caring. Communications is critical. John Gray is on the right track. A caring relationship is defined by both compassion and concern. Women don't marry men in order to have someone to solve their problems. They are searching for someone who can sympathize with their situation, whatever it is. In addition, expressions that indicate the man is thinking continually about the woman always earn high marks. Women are actually "turned on" by these expressions that indicate a caring love. And the sex will be better because of this. Many men are quite dysfunctional when it comes to revealing a sensitive side. In a sexual relationship, men are often unwilling to talk about what "feels good" to them, or that by asking the woman about what feels good to her, that somehow the myth of the "magnificent lover" will be exploded. Adolescent boys often like to act as if they learned all their was to know about how to make a woman happy at age 15, and frequently bring these views into the adult relationship.
I believe that men who are considered by women to be "great lovers" did not achieve this because of their skills at physical techniques. Great lovers become great because they are willing to communicate with women about exactly how they want to be touched without any embarrassment. In this regard, the man who considers himself to be "less experienced" with "more to learn" may actually be more successful in the lovemaking department than the man who claims to already know everything there is to know about lovemaking. The less experienced man will likely want to communicate with his partner on a continuous basis during the lovemaking session. Interestingly, the ability to communicate needs and feelings during intimate sexual activity often helps build better communication skills in non-sexual areas as well, solidifying the relationship in total. At minimum, this is certainly something to ponder. Sex without a caring, loving relationship is no sex at all!

Male Sexuality: Information for Single, Unattached Men
The issue of male sexuality as it relates to single, unattached men who are not having sexual relations with a partner has always been an interesting one to me. Some men are single by choice: others are single as a result of uncontrollable events that have taken place in their lives. Among those who are single by uncontrollable events that have taken place in their lives are those who are divorced or widowed, and some who are disabled. There are also those who for,
whatever reason, choose not to find a partner for sexual relations. Some men simply prefer a life of being single and unattached: others choose an occupation such as becoming a Catholic Priest, which requires a vow of celibacy. Being in this situation is a problem only if the man believes it is a problem. I have talked to a lot of single, unattached guys. Most, though not all, view this as a transitory phase of heir lives, and expect to at some future point to find a sexual partner. Some, however, see living single and unattached as essentially a permanent situation, and they have no particular interest in finding a sex partner. Some people might argue that many of those who fall in the latter category have low sex drives, that is, they are not driven by the same sexual chemistry which dominates society, but this is clearly not true in all cases. Another category of men who face an interesting set of issues are those who, by virtue of their occupational choices, must be away from their sexual partner for long periods of time for business or other work related travel. The media stereotype is that many, if not most of these men have sexual partners waiting for them at the locales where they are working away from home. Obviously, this describes the behavior of some men, but not the majority, I believe. I've observed that the vast majority of divorced men quickly enter into a sexual relationship with another woman, this despite the psychological turmoil as a
result of the divorce. Very few divorced men remain divorced for very long. However, I've also observed that a significant number of divorced women remain single, far more so than is true for men. While these women may have the opportunity to engage in sexual relations with men while they are single, I'm convinced that the real explanation lies in the differences in how the sex drive works in men versus women. Men are likely to see intercourse as being of major importance to their lives: Women, however, see intercourse as just one component of what a relationship is all about, and if the other components are not there, there is no point in sexual intimacy. So women who do not find the other things they are looking for in a relationship generally stay single. For women, sex is very enjoyable, but not so enjoyable that its worthwhile even when the other conditions necessary for intimacy have not been met. besides, if the other conditions have not been met, sex is not even that enjoyable for most women. John Gray puts it this way: men want to feel needed--women want to feel cherished. That's a good way of describing the differences. Widowed men are another interesting category, usually older than divorced men, Healthy, active widowers have demographics in their favor. Women tend to live longer than men, and there is always a big selection of widows seeking healthy, active males for companionship. Thus, a widower in good health is likely to have many potential partners to choose from.

Much of what goes on within the Catholic priesthood with respect to male sexuality remains a mystery to me. Not only do Catholic priests take a vow of celibacy, the Catholic church continues to have very "traditional" attitudes toward birth control, masturbation etc. But Catholic priests do have "housekeepers" and I am aware of an instance where a live-in housekeeper provided services that went well beyond cleaning the rectory. How commonplace this is, however, I have no idea, as Catholic priests have not exactly been writing to the "Male Sexuality Questions Answered " web page. As a practical matter, the Catholic Church's position on issues such as masturbation and birth control is sadly outdated. According to one of my readers, materials supplied to adolescents by the Catholic Church indicates that the Church regards a "wet dream" as normal, that is, not sinful. That is certainly good to know! My medical guide's assertion cited earlier that "every viable male should have a periodic release of sperm" in order to maintain good general health gives pause
for concern about the general health of priests who follow the doctrine of the Church to the letter. I would welcome additional letters that are able to fill in some of the details as to what actually goes on here.

Men who are away from their wives or other sexual partners for long periods of time face a special set of problems. Most men, in their 20s and older, I believe, gradually adopt an increasingly "regular" schedule for orgasms, the average probably being about every 2-3 days (though I get many letters from men who claim to be on a long-term schedule far more frequently than that). Once his schedule gets set in place, most men deviate from it only infrequently. Illness & stress may have an impact on the schedule, however. Business travel is a form of stress. While sexual partners at travel locations are not uncommon, I suspect that is not the primary sexual outlet for most of these men "away from home." Masturbation, or even mutual masturbation with the wife (or other "at home" sexual partner), over the phone is probably quite common. I would be interested in hearing more from married men, in particular, who are willing to talk about this. Every man seems to work out an individualized system that works in his special situation.

Men without sexual partners who are living with family members (parents, roommates etc.) face special problems. Masturbation is probably the primary sexual outlet, but masturbation cannot be pursued with abandon if the man is constantly concerned about being "discovered by a roommate or a family member." This sometimes makes it difficult to establish a regular "schedule" and in general getting adequate time to really "enjoy" the activity. I have visited with many gay men who do not have sexual partners. While there clearly is a subset of gay society that is hopping from one partner to another, my e-mail indicates that this is probably no different from the sub-set of the straight population that is doing the same thing with female partners. Gays are just as varied in personality, outlook, and attitudes toward sexuality as are straights. In looking for stable, long-term relationships, many gays go through periods of their lives in which they have no sexual partners. Gay men deal with this situation the same way straight men do: then tend to masturbate a lot. One difference I note is that the gays I have visited with are much more open with respect to not only admitting this but also in describing the specific techniques they use. Furthermore, gays seem to be a good deal more creative with respect to thinking up new and exciting methods. Straight men tend to be hung up on the notion that if they mention this, whoever they talk to won't regard them as "real" (that is, straight) men, and so it's best not to say anything. Gays frequently trade information with each other about interesting masturbation techniques, seeing this as simply a manifestation of their overall interest in other men (newsgoups that cater to gays are filled with this information: Straights seldom trade such information, for fear of how their interest might be interpreted by others. After all, they don't want to be called "jerk-offs," a very derogatory term! As a result, straights generally lack the information on masturbation techniques gays routinely trade. Men who remain single and choose to avoid sexual relations make this choice for a variety of reasons. Any intimate relationship, to a certain degree, is manipulative. While men manipulate women, women, on average, are probably more adept at psychologically manipulating men to get what they want. This goes right back to the "sex is just part of a larger package of need" that provides an
overall explanation for female attitudes and behaviors toward men. Women's magazines are filled with articles that help women develop techniques for getting what they want from men. The issue is not the question of whether women manipulate men. (This sounds chauvinist, but they do! Remember, however, I also said that men manipulate women to get what men want, so at least I'm a "fair" chauvinist). Rather, the issue is how individual men react to the female manipulation. A lot of married men regularly complain to their male friends that they are being psychologically manipulated by their wives. But individual men react and deal with this differently. Many men see the manipulation as simply the "price" they must pay in order to get what they want out of the relationship (for example, sex). These men don't even realize that this is (or was) a choice they made. For many men, this psychological manipulation by their female partners is so much an every day part of their lives that they no longer even think of it as psychological manipulation. Other men "fight back" to a certain degree, by refusing to do the things their wives suggest. But this strategy is fraught with dangers. Many women are very adept at withholding "important things" in an effort to regain control over what they regard as a deteriorating situation. The men who fight back too strongly or too frequently generally end up in divorce court.

Many men who remain single and who choose not to have intimate relations with a woman simply conclude that the price of intimacy (that is, a lifetime of female manipulation) is too large a price to pay. Everything comes down to a simple choice. Is it worth it to give up the freedom of a single life in order to find sexual intimacy? While most men say yes, some men conclude no. There is nothing wrong with that. But to compensate, these men may take masturbation activities to a higher level than their counterparts who have made other choices. With time and privacy available, why not experiment a bit! Keeping the sexual equipment in good order is an excellent idea for good general health as well. Perhaps I'm being a bit unkind here, but every man has the opportunity to make these choices. Many men make them without even fully recognizing the options that are available. Sexual intimacy is an explicit choice to be made.

Male Sexuality In the 21st Century: Where Do We Go from Here?
Sexuality issues change with each generation. In the 1950s and 60s, it was the development and increasing use of the birth control pill, making premarital sex increasingly widespread. This evolved into the free love culture of the 1970s. Sexually transmitted diseases were of no particular concern, because they could be controlled by ever more powerful antibiotics and other miracle drugs being developed. Anything was possible! Sex could be had without love or guilt. AIDS changed all of that. Suddenly free love was far more problematic. The 80s became a decade of increasingly sober attitudes toward sex, for both men and women. The
miracle drugs were not all they claimed to be.

Other changes have gradually occurred over the past three or four decades. The divorce rate gradually increased. Fewer and fewer children grow up in families were both parents are present. Fewer still grow up in families where the parents are in a loving, caring stable relationship. What chance do these children have in developing loving, caring relationships themselves? Certainly less of a chance on average, than children growing up in stable relationships. Other hot-button issues appear to be increasing concern. Despite the widespread availability of birth control measures, the abortion rate is still very high. Illegitimate births are up, even in states widely known for conservative values. The groups opposed to homosexual rights and the groups attempting to protect and increase homosexual rights under the law are shouting at each other. Religious groups that preach love and acceptance of every other kind of sin often appear to place homosexuality in a special place. Ours is a throw-away society. Both parents increasingly work, and family meals consist of take-out pizza on paper plates. Instead of buying an automobile with the intent of changing oil regularly and keeping it in top running condition for ten years or more, automobiles are leased, and traded in after three years. The notion of stability and continuity is lost. The same is true of relationships.

Instead of couples attempting to make repairs in relationships, they simply divorce and try again with someone else. Fragile relationships are consistent with a hedonistic, throw-away society with a focus on immediate fun rather than long term well-being. Perhaps we should be encouraged that divorce in now considered to be socially acceptable not a negative mark. Perhaps many more couples in the 1950s and 60s were living in unacceptable relationships that were held together only because
of the social stigma attached to divorce. Perhaps. But somehow, I doubt it. As the millennium approaches, these issues are not going to go away. Some of them may actually increase in comparative importance. The issues surrounding abortion and homosexual rights, for example, have become so emotional on both sides that I see little potential for progress. And the rhetoric gets increasingly strident, as each group attempts to shout down the group they disagree with.

But there is hope. I am increasingly optimistic that adolescents are getting more solid information about sexuality than ever before. But I too worry about access to information that is inaccurate or misleading. When I set up this web site, I was somewhat concerned by the possibility that some teenagers would get access to information here that they somehow shouldn't have. I considered an elaborate system of electronic "gates" warning of the explicit content of some of the material discussed here. But I finally concluded that there was nothing on this web site that was inappropriate for anyone to know. This site is not easy to find. To find it, you
have to be proficient at using the internet and the currently available search engines. Anyone smart enough to find the site is old enough to read its contents. I know some parents worry about their children's access to sex-related materials. I've heard from them. But in many ways, the internet is a far safer and better way to learn about sex than the traditional sources. And the information is likely more accurate too. So I'm reasonably confident that ever brighter teenagers will go into
relationships better informed than ever before. Information leads to responsibility. Information is also valuable in developing understanding and reducing prejudices, regardless of who they directed toward or for what specific reason. So, in the end, I'm hopeful. And I'm hopeful that increased availability of frank, open information will be valuable in smoothing out the rough spots in adult relationships as well. We will see...

Understanding Male Sexuality: Information You Did Not Learn From Your Parents, Your Friends or in Your High School Sex Education Class! (Part II)

2009-10-29T11:51:00.000-07:00

When other people travel, the process of getting to the destination may become as important as what happens at the destination. A few people even travel from place to place without even being concerned about reaching a particular destination. For these people, the real enjoyment of the trip is not what happens at the destination, but all the different experiences along the way. Some men, see the sexual experience in much the same way as travel is seen by the destination-oriented person. For them, the events, sensations and feelings leading to orgasm and ejaculation are of little importance, except that they are what leads to the "big payoff."

For other men--men whom I believe, on average, enjoy their sexuality far more than the "destination-oriented" men--the feelings and sensations involved in getting to the destination (the destination being orgasm and ejaculation)--take on as much or more importance than the orgasm itself. In short, these men are maximizing what they get from the total sexual experience, not just the experience in its last stage. An analogy may be helpful with respect to other kinds of sensations experienced by the human body. People who enjoy eating at fine restaurants are constantly bombarding their taste receptors with a continually changing collection of new, different and exciting sensations. Many human beings often get quickly "bored" if their eyes are not bombarded with new and different visual stimuli. Hence, the popularity of television!

Sexual feelings and sensations are not unlike the sensations of vision and taste in this regard. There is a constantly- changing panorama of sensations available to us, that change from one moment to the next during periods of sexual arousal. Men must simply learn how to take advantage of all of this.

Many men believe that it is somehow "unmasculine" to take advantage of (take time to "enjoy") these sexual experiences that occur prior to orgasm. They may have been taught at an early age that masturbation is somehow wrong, that is, either sinful or harmful to one's health. Young males are usually not reluctant to admit to each other that they enjoy "being" with a girl. But any discussion of sexual activities that do not involve being with a girl is considered inappropriate.

These same men bring these views into their adult relationships with their partners. Orgasm and ejaculation becomes the focus of their partner-sex as well, rather than full enjoyment of all aspects of sexual feelings.

As indicated before, arousal normally starts with a triggering mechanism. Boys learn at an early age that there are some arousal triggering mechanisms that are "ok", that is, socially accepted, and arousal triggering mechanisms that are "not ok." Arousal triggering mechanisms that are considered socially acceptable generally involve visual stimuli by a member of the opposite sex. In our "predominately straight" society, arousal that is triggered by a member of the same sex is not considered socially acceptable. Gay men have coped with this by forming separate (parallel) societies.

In addition to the problem faced by gays, there are many other arousal triggering mechanisms that work quite well but are not exactly coffee-room topics of discussion among the majority of men. For example, a close-fitting garment, a hand-held vibrator, an experience involving being "restrained" (bondage experience) or even simply a thought that is found to be sexually arousing. Most men are very embarrassed to acknowledge that these triggering mechanisms--those which do not involve visual or tactile stimulation by a woman--even exist, let alone spend time to learn how to take full advantage of them. In addition, while the vast majority of these arousal triggering mechanisms are quite harmless, sadly, several forms of illegal or otherwise inappropriate sexually deviant behavior have their origins here as well. Men often have questions that begin "Is it normal to be aroused by ___________ (Fill in the blank). I tell these men that if it's not illegal nor causes harm to someone else, then its "ok" and "normal."

Once the arousal has begun, there are physical and psychological changes that take place in men. As outlined earlier, typically, an involuntary message is sent from the brain to the nerves that control a series of valves on the veins by which blood is drained from the penis. At the same time, blood continues to enter the penis through the main artery, the heartbeat rate increases, and blood pressure rises. With blood flowing in faster than it is returned, the penis starts to become erect.
When the penis is flaccid, touch seems little different than touch on any other part of the anatomy. But as erection starts to take place, the nerve endings concentrated in the penis start to become more sensitive and pleasant to the touch. Sexual tension has started. The first sexual feelings are rather unfocused, but as arousal begins, the man's attention increasingly is focused on the sensations emanating from the groin area. Many men believe these sexual sensations occur only in the penis, but there are many other places in the groin area that are quite sensitive as well.
Equally interesting are the psychological changes that are taking place, something that few men acknowledge. At the initial stages of arousal, the man has no particular psychological "urge" to press forward to ejaculation. But as the arousal and erection continues, the psychological urge to press forward to ejaculation becomes stronger and stronger. This is the essence of building sexual tension. Psychologically, the man experiences the feeling of wanting more and more stimulation to continue and increase the intensity of the sexual feelings. The entire experience can be likened to the winding of a "sexual" spring. Increasing stimulation causes the "sexual" spring to be wound tighter and tighter, increasing the sexual tension. These sensations are extremely pleasant, but at the same time, the unreleased tension is also described as very "frustrating" by most men. Interestingly, some men describe this as a "delicious" frustration, and many agree that it is among the best, if not the best of experiences that life has to offer. The tighter the sexual spring can be wound, the more exciting the sexual "ride" and the more "extreme" the ultimate release will be. This is a human experience not to be missed. Fully recognizing this and fully taking advantage of these sensations and psychological urges in an effort to more completely enjoy them for a longer period of time without moving directly forward to orgasm is something that most men must learn. But the results are well worth the effort, both in terms of the man's own enjoyment as well as for the benefit and enjoyment of a sexual partner.

Testosterone Cycles, Refractory Periods, and "Wet" Dreams
Some research has suggested that testosterone produced by the sex organs in males and the adrenal glands (on top of the kidneys) in females, has less to do with whether a man will become sexually aroused than is widely believed. Other recent research suggests that it is not testosterone, but a compound closely related to testosterone that is important. Ordinarily, after ejaculation, a man has no further interest in sexual activity of any kind. For a period of 10 minutes to perhaps more than an hour for some men, a man is physically unable to achieve either another orgasm, even if he is able to either keep or achieve another erection. The is called the refractory period.

The internet references I have checked suggest that the generally pleasant feelings of satiety, a lack of interest in further sexual activity and sleepiness following the male orgasm (which many women do not appear to fully understand or appreciate) are primarily liked to a chemical called oxytocin that is released during orgasm. If a man has an orgasm in the early morning hours, he may want to sleep afterward for an hour or two at minimum. Testosterone levels in the body tend to rise, not fall, for a period of time after orgasm. Sexual activity (intercourse or masturbation) prior to sleep in the evening may act as an excellent, natural sleeping pill. Most men have a daily cycle of testosterone levels that peaks somewhere between 4:00 and 6:00 a.m. This coincides with the period of time when many men have early morning erections, but some research has revealed that these early morning erections are more a result of involuntary reflexes during dream sleep--not the sexually explicit content of the dream nor the testosterone level in the body.

Most men, however, (including me) have certainly had the experience of abruptly waking from an erotic dream to discover an erection on the verge of ejaculation, and I question whether these research findings are completely valid. These involuntary erection (in younger men particularly, sometimes leading to orgasm) are a normal part of the sleep cycle for most men, and according to research, most men have perhaps three or four during each night. there are various theories as to why nature planned it this way. One theory suggests that this is a way the male penis "renews" itself with an ample supply of oxygen.

These erection cycles are quite normal. In fact a man who does not have such cycles is likely physically impotent. A simple test that is sometimes used is to wrap the base of the penis tightly with a strip of postage stamps before retiring. If the circle of stamps tears during the night, the man is not physically impotent.
In the early years of post-pubescence, night-time erections are frequently accompanied by a full- fledged ejaculation, resulting in crusty spots on the
pajamas and sheets in the morning. Most young men are somewhat embarrassed by this, but it is quite normal. Wet dreams gradually occur less frequently as men grow older, and masturbation is more frequent and sexual intercourse become increasingly important.

There is considerable discussion in the medical literature I have read with respect to the exact role of testosterone in the body. There appears to be broad-based agreement that testosterone (or perhaps compounds closely related to testosterone) are primarily responsible for sexual desire in both men and women. In short, individuals with low testosterone levels tend to experience lowered interest in sexual activity and have fewer sexual fantasies.

Testosterone is not necessary, however, for a man to be able to have an erection or an orgasm--it's just that when testosterone levels are low or absent, the desire to engage in sexual activities of any form will be reduced. This conclusion, however surprising, is supported by research involving men who have been castrated. These men are still capable of both obtaining erections and having orgasms, though the semen will, of course, contain no sperm. Hence, the interest in the use of castration as an approach for dealing with sex offenders.

I visited with a woman whose husband had been tested to have virtually zero testosterone levels. He still had normal erections, and they were having intercourse about 8 times a week. In other words, his ability to achieve an erection from physical stimuli was unaffected by the zero testosterone levels. However, he was not aroused and could not achieve an erection by any visual or psychological stimuli--photos of nude women, pornographic videotapes or anything similar. So the contention that testosterone is not necessary to achieve an erection, but is necessary if a man (or a woman, for that matter) is to be interested in having sex (the sex drive) seems to be consistent with this evidence. Since testosterone is produced by glands in addition to the testis, castrated males still have testosterone at some level, albeit probably lower than normal without drug therapy.

Most, but not all, of the testosterone in males is produced by the testis, although small amounts are produced by the adrenal glands, and testosterone is also stored in large amounts in body fat.

Unwanted Erections and "Bashful Kidneys"
I have had a number of letters from men complaining of erections that occur unexpectedly in potentially embarrassing situations,for example, in a locker room, a public shower, while having a massage, or similar situation. Since your brain tells you when you are aroused, these responses are automatic and not under conscious control. The nerves running to the valves that control blood flow in and out of the penis are tied directly to the portion of the brain responsible for arousal and erection. Frequently, the situation in which the unexpected erections occur involve "novel" tactile stimulation from a massage, the texture or fit of an article of clothing, or something similar, There is no simple way to avoid the "problem" of an unwanted erection other than to avoid the stimulus that is causing it. The novelty of the situation is in part, responsible. Over time, when a man becomes familiar with the tactile sensations, the erections may subside, at least to a certain degree. It may be helpful to remember than men do not normally seek to avoid having erections, and erections should be enjoyed, not scorned.

Another common problem is the so-called "bashful kidney." A bashful kidney is a situation where a man has difficulty urinating in a public rest room, This problem was actually discussed in Ann Landers a number of years ago. The problem is exacerbated if the rest room is noisy, crowded, and the individual urinals offer little or no privacy. In addition, long trips in a car or on a bus or airplane seem to make the problem worse. Again, there is no simple solution as the muscles that control the flow of urine are not entirely under voluntary control. Over time, as a man ages, the problem tends to gradually recede. A rest room with private stalls may be the only solution.

Taboo Topics: Masturbation
Masturbation remains a taboo topic within much of American society. Parents who openly discuss nearly any other sexual behavior topic with their children often are embarrassed when the subject of masturbation is approached. There are biblical passages which suggest, at least in some people's minds, that masturbation is sinful. And the "Boy Scout Manual" in the 1940s made note that masturbation was somehow harmful. Various physical maladies over time have been associated with or blamed on masturbation. Examples include pimples (nearly every adolescent boy has them, so there must be a connection) lack of agility and ability in sports, near-sightedness, and even blindness.

I remember discussing the subject with a medical doctor during the 1950s when I was about 13 years old. His advice was, "I'm not going to discourage you from doing that, but I don't believe that it is a good idea, either. I thought to myself, "That is certainly strange advice, I wonder what he means." But I was too scared to ask any more questions.

Fortunately, today most medical doctors are enlightened, and now believe that masturbation is not only normal, but perhaps even necessary for good sexual health, at least for post-pubescent males who lack other "sexual outlets." A medical text published in 1975, "Funk and Wagnall's Family Medical Guide," in its discussion of treatment for enlarged prostate, notes that "All viable males need to have a periodic release of sperm. Years of such abuse can have an effect later in life." The text does not give advice, however, as to the specific techniques that should be used to ensure that this periodic release of sperm takes place.

Who?
Virtually all males masturbate, though some more frequently than others. Masturbation usually continues throughout adulthood, even when other forms of sexual activity are available. Most adolescent males are very embarrassed their self-stimulation activities. Only a small percentage of male adolescents discuss their masturbation even with close male friends, and most are terrified that their friends will find out. Many are also terrified that they will be " discovered in the act" by a parent. So, many adolescent males learn to get it over quickly, to minimize the chance of being discovered. Only later in life do they learn that the ability to delay orgasm is very important to learn in order to maximize sexual pleasure. So all the "quickie" techniques must be unlearned.

Frequency
Although as a man ages, the frequency of masturbation tends to gradually decline, but continues even for most married men. Some men believe they should not do this when they have opportunities for sexual activity with their partners and therefore try not to masturbate, in part, because they believe that masturbation implies partner rejection. As a result, they try to hide this from their wives (often by picking times and places where their wife is not around.

But I have visited with a number of men who have wives who are quite aware of their husband's masturbation practices and, indeed, encourage it. Some of the most happily married men I have encountered are those whose wives enjoy mutual masturbation, which becomes a regular part of the sexual activity. Part of the psychological problem that most men face is that this is a difficult subject to bring up with a partner, because any expressed interest in masturbation might be interpreted by the partner as a form of rejection. The men who have gotten past this point with their wives almost invariably report having a very satisfactory sex life. A favorite male sex fantasy is getting the opportunity to watch a woman masturbate, and many woman find watching men masturbate to be sexually exciting, once they get over any hangups with the basic idea. Unattached single men, and gay men, of course, tend to masturbate more frequently than married men. For gay men in a relationship, mutual
masturbation is a primary sexual outlet, if not the primary one.

While it is true that some women my interpret their male partner's interest in
masturbation as a form of rejection, other women may interpret this somewhat differently. By masturbating in front of the woman, the man is sharing the most personal of all activities. That a man is willing to do this with a partner is an expression of love, not rejection. Thus, mutual masturbation could be a highly erotic and loving activity for men and women. It could also be something
regularly done at the initial stages of love making.

Masturbation Techniques
Men employ a variety of masturbation techniques. The simplest technique is to begin by simply squeezing the penis. Once the penis becomes semi-erect, stroking normally takes place, from tip to base. By concentrating at first on the base of the penis and avoiding the tip permits the erection to proceed and is a basic technique for delaying ejaculation.

The entire groin area, including the penis, scrotum and the groin itself, gradually becomes more sensitive to the touch. Once the erection is underway, many men enjoy gently pressing on and massaging the scrotum. Gentle touch anywhere within the area can be sexually exciting, and even on other parts of the body, such as the male nipples.

Some men prefer to masturbate while lying prone on a bed, with the underside of the penis rubbing against the bed. Many men enjoy masturbating using a lubricant, rather than dry. Pre-ejaculate is an excellent lubricant, although the supply may be somewhat limited. Hand lotion or vaseline can be used, though, since these contain oils, they are probably not the best choice if intercourse with a condom is to follow. A clear, water based gel, such as KY gel, is made for this purpose and does not destroy condoms.

Some men enjoy using devices while masturbating--a vibrator, a shower massage unit or similar. Many of these devices produce an interesting, though short-lived effect. A shower massage unit or tub jet, for example, puts stimulation on the penis such that the feeling is much like having a giant vacuum cleaner sucking the semen out of the body. The whole thing is over in about 30 seconds, even without much of an erection. Interesting, but not something one might want to do on a regular basis,
Then there is masturbation employing articles of clothing, which can also be classified as a sexual fetish.

Taboo Topics: Fetishes
Fetishes are actually quite common among males, although men who enjoy fetishes are often very embarrassed by their turn-ons. Generally, a fetish is any situation where arousal occurs as the result of an inanimate object, most often an article of clothing. Fetishes are normally harmless, except for the possible psychological harm for a partner who does not understand what is going on. Fetishes are virtually entirely a male domain, and few if any women can relate to enjoying anything similar.I do not know for certain if a majority of men enjoy fetishes, but certainly a large number of men do, and they are quite "normal." College students who engage in "panty raids" of women's dormitories are revealing a very mild, and perhaps "peer group-acceptable" fetish. Men who enjoy seeing women dressed up in clothing that is over the edge of feminine attire--4 inch heels, fish-net stockings etc, are probably exhibiting a mild fetish. Most men, however, see this fetish as part of their overall heterosexual interest in women, and few men would regard this as "abnormal."
Transvestites--that is, men who are sexually aroused by dressing up in womens clothing, are sometimes treated by society as being abnormal, but many of these men are married to women and have otherwise normal sex lives. The only consequence of this fetish for many of these men is that they are sexually aroused by actually dressing in women's clothing.For a small percentage of men, however fetishes that involve women's clothing can ultimately lead to dissatisfaction with "being male."
Given the amount of e-mail I've received dealing with issues related to fetishes, I conclude that they are far more commonplace than is widely believed--even among professional therapists. Interestingly, the e-mail I receive suggests that among the most common are those involving clothing items not even mentioned in most discussions of the topics found in books--in particular, underwear, swimwear and jock- strap fetishes, and even fetishes involving other mens clothing items, such as lycra cycling shorts or tight-fitting blue jeans. In most instances, the clothing item that is responsible is worn, and is used in conjunction with masturbation or other forms of sex play. A combination of texture, fit and appearance seems to be involved in these kinds of fetishes.

While surveys on this are difficult to conduct accurately, one clue as to how commonplace a particular type of fetish might be can be obtained from the Internet. Internet newsgroups generally form on topics where there is widespread interest. So far, there is an internet newsgroup that deals strictly with underwear fetishes; another that deals specifically with garments made with lycra (that newsgroup attracts both men and women);and a third newsgroup dealing specifically with jock-strap fetishes. All of these newsgroups are quite active in exchanging information and preferences about brands and styles of garments that are best for the purpose.
Of course, there are newsgroups for many of the more widely known fetishes involving cross dressing and the like. There is even an internet site for those who get "involved" with plush (stuffed) toys! The list goes on and on! Just when you think you have heard it all, another, even stranger fetish pops up. For the men who have a fetish for blue jeans, a separate newsgroup has yet to form, so these men have been showing up on some of the other fetish-related newsgroups. A fetish based on a coarse-textured fabric. is somewhat different from fetishes involving lycra or silk garments, where the smooth, slippery rather than the rough-textured fabric plays a role. Also, many fetishes involve items of clothing normally worn in conjunction with sports activities, and there are small business operators who specifically cater to that market and sell products over the internet.

The recent popularity of boxer shorts made from silk is, at least in part, due to the fact that many men find the feel of silk against the skin arousing. Some men find the tight-fitting lycra or spandex compression shorts to also provide some interesting sensations in the groin area. Touch feels quite different through lycra than on bare skin. And there are plenty of fans of brief-style lycra swimwear. There are also mail-order clothing companies which cater to these kinds of interests.
Those who have underwear fetishes appear to be about equally divided between those who have a preference for briefs, bikinis and thong-type underwear, and those who have a preference for boxer-style shorts. The group interested in boxer- style shorts seem disinterested in other underwear styles, and vice versa. There is considerable specialization among the various groups.

Those interested in jock-straps have strong preferences as well, The various brands of jock-straps available on the market are carefully evaluated with respect to how tightly they "fit" and the feel of the material and the straps as well as the particular sensations they are capable of producing in the groin area. Some brands are clearly preferred over other brands, and there is considerable discussion on newsgroups over the comparative advantages and disadvantages of each brand.
A sub-group of jock-strap wearers are particularly interested in those which have plastic protective cups, such as those worn for sports requiring heavy protective gear. There are many different shapes and sizes of cups and each particular type has its own group of advocates. Some prefer the large cups often worn over clothing in sports such as hockey or boxing. Still others prefer tighter fitting cups that can be worn under other clothing items. Advocates of this form of activity claim that the sensations obtainable when even a slightly erect penis presses against a hard cup are quite enjoyable indeed. One unique activity engaged in my many men with underwear fetishes is underwear trading. This activity appears to take on a particular importance in gay society. The newsgroups are filled with requests by gay men to trade underwear, jock-straps, or other similar garments. Though there may be straight men who also engage in this activity,I have yet to hear from one, although some of the gay men I have visited with claim that their interest in underwear is incidental to their sexual orientation.

Among the underwear traders, there are specialists. Some prefer to trade underwear or jock-straps that are new, and still in the original packaging, much the same as someone might collect coins or model trains. They may catalog their collection in detail for other participants in the newsgroup to read. Other men, gays primarily, are interested in trading underwear, jockstraps or swimwear that are "used." A number of men have admitted to stealing (they call it liberating) these kinds of clothing items from laundry rooms, locker-rooms etc, when they are left unattended. Many of these men prefer, used, stained, garments, particularly if stained with semen. It's unclear as to whether the primary sexual interest is in the garment or the wearer. Garments from other gay men who are of a similar age and build appear to be most preferred. Underwear trading among gay men appears to be the first step in an internet dating ritual that, if the underwear seems ok, may eventually involve first a phone conversation and then perhaps actually meeting the underwear trader. In addition, many gay bars have underwear nights in which men dress up in
underwear.

Based on the internet sites and newsgroup activity, it may appear that underwear and jock- strap and similar fetishes are largely a gay activity, but straights engage in these activities as well. However, gays usually seem more willing to discuss fetishes, perhaps because they see many of the fetishes as merely a part of their overall interest in other men as objects of sexual attraction. I have visited with very happily married men whose wives not only knew about the underwear fetish, but help their husbands pick out underwear that is particularly arousing to them! In these instances, the underwear was simply part of the overall sexual chemistry between the man and his wife. All of these activities are quite safe, harmless fun. The only down side is the potential embarrassment for the man who enjoys these sorts of activities should someone "discover" them.

Sexual Repression and Sexual Enjoyment: Now and Then
Those who visit primate exhibits at zoos are often amazed at the speed by which the sex act takes place:in some instances, less than 30 seconds from start to finish. I understand this varies somewhat by primate species, with the sex act taking considerably more time (more "monkey play") in some species than in others. The idea to drag out the sexual act into something that lasts much longer than a few minutes is uncommon among living things and is part of what makes us human. I've often thought about the concept of "sexual enjoyment" in various societies and for those who grew up in various families which have either quite restrictive attitudes or quite liberal-minded attitudes toward sexuality and sexual activities. I also like to think about this issue as societal values change over time, from the restrictive views of the immediate post World War II era, to the free-love era of the early 70s, to the more conservative know-your-partner views increasingly favored in an era marked by AIDS and other STD's.

An interesting question, I believe, is under what conditions do humans secure the greatest enjoyment from their sexuality. Consider first a family with very restrictive religious or other views toward sexuality. Are those living in such
families actually experiencing less "enjoyment" from their sexuality. Those living in such families likely have less opportunity to date, engage in sexual intercourse and other forms of "partner sex may not be available at all." But under such conditions, whatever sexual activity does take place acquires a new meaning in terms of its importance. In addition, the "delicious frustration" of not being able to have an orgasm whenever one wishes in itself becomes a source of sexual pleasure.
Or consider sexual attitudes during the 1950s versus currently with respect to the role of sex in dating behavior. In the 1950s, I gather, pre-marital sex was considered quite "wild" and not something "good" young men and women engaged in. By the 1980s, sexual intercourse was common after the second or third date. The attitude of the 80s seemed to be "sex first, we will get to know each other later on." Does this new set of attitudes mean that the Generation Xers are enjoying their sexuality more than those living in the 1950s. Somehow I doubt it. The attitude in which sex after the second date is expected puts enormous pressure on he psychological relationship between the two people. Women reach adulthood believing "that's what men are after." Men begin to think that "If I don't offer to have sex with her after the second date, she will think there is something wrong with me" (that is, she will think I must be gay or something!). It's no wonder men and women stumble into relationships they don't really want, and find out only much later (often after marriage) that they are "psychologically incompatible". Many of the ills of current society, illegitimate births, high divorce rates, spouse abuse, are linked to these so-called "modern liberal attitudes" with respect to the role of sex in a relationship. This idea goes right along with the "orgasm centered" attitudes many men have about their sexuality. Or consider the free love of the 70s, a period of time when young adults experimented a lot with promiscuous sex, drugs and on and on. Did sex somehow acquire more meaning because of the then-new liberal views that prevailed in this time period? Did the young people who became adults during this period really get more enjoyment out of their sexuality than did their parents? Again somehow, I doubt it. The freedom to do anything you want in the sex department does not automatically mean that the sexual pleasure quotient has increased. Could it be that men living in societies where intercourse is less free and frequent are actually getting more out of their sexuality than those men living in societies where sex is more readily available? The quantity versus quality issue thus reappears. These issues are certainly worthy of pondering. If our response to the AIDS epidemic has accomplished anything positive, it has focused our attention on the importance of a relationship in partner sex. It is not at all sad that humanity once again focuses on the importance of knowing very well the partner you have sex with. If this delays intercourse a few dates longer, so be it.

Sexual Orientation and Preference Issues
I have visited with many men who are well past their teens and are still quite uncertain of their sexual preference. I conclude that this is actually quite common. The media portray male sexuality as if most men are either straight or gay, with but a few men falling in a middle category that is potentially aroused by members of either sex. I have visited with many gays who were aware of their sexual preference at a very early age, perhaps nearly from the moment they realized they were male. Obviously there are many men who are clearly heterosexual, or straight, and have no same-sex interests whatsoever. However, I have visited with a surprising number of men where the preference is not nearly that clear. One book I have--Sexual Happiness for Men: A Practical Approach--that discusses sexual orientation issues lists seven different categories of sexual preference, depending on the relative arousal in and
preference for same-sex versus different-sex activities. These categories are based on the original work by Alfred Kinsey (who, interestingly, was an entomologist by training). Using this categorization, bisexuals are only those who are equally aroused by both same- and different-sex activities, and thus have no preference for one over the other. Most men, however do have some preference for one or the other.
Sexual preference is, at least to a certain degree determined by whether a man is aroused by a member of the opposite sex or by a member of the same sex. You don't get to tell your brain what you find arousing: your brain tells you! Very few straight men are so straight that there are not certain kinds of same sex-activities that are at least slightly arousing. Most heterosexual men, for example, would likely get a bit aroused if they were placed in a room with a group of other men who were all masturbating! Similarly, few gay men are so gay that they would not be aroused by any form of different- sex activity. Sexual preference for most men is just that, a preference. This preference is often expressed by who the man falls in love with, and while what (or perhaps who) triggers the arousal mechanism is important, other factors are also involved, and expressions of same-sex sexual interest are quite common in situations where contact with members of the opposite sex is limited (army, boys schools, prisons, etc). When the situation changes these interests may recede as well, and many of these men return to a heterosexual life. Once a man discovers an activity that he finds very arousing, other available activities that are less arousing normally recede into the background. Thus, if a predominately though not exclusively heterosexual individual determines that certain kinds of different-sex activities are highly arousing, interests he might have had in same-sex activities will likely recede. Psychologists refer to this as a "psychodynamic" situation with outcomes that vary depending on the available options.

While many gays seem convinced that theirs was not a choice, this is not always the case, and it is possible for a man with some same-sex interests to go through life as a straight. I'm convinced this is part of what makes "coming out" difficult for many men with an interest in certain same-sex activities, because making a final decision as to preference is often not easy, and is a decision that cannot be easily reversed. This struggle seems to be critical for many of the men I have been visiting with who are having difficulty in deciding what their real sexual preference is. It is not surprising that this can be a difficult situation: A man who has come out as a gay will have difficulty if he decides that he wants to attempt to begin dating women, for example. Men who do not appear to have a preference often face a lot of problems, and are largely treated as if they were gays by the straight community, but these individuals are frequently rejected by the gay community as well for not being truly gay or comfortable with their "true" sexual orientation. Some recent research has suggested that a much higher proportion of men can be aroused by same-sex activities and images than is represented by the percentage of men who actually go into same-sex relationships and live as gays. Most of the remainder of these men undoubtedly primarily if not exclusively live as heterosexuals. So being gay or being straight involves both the arousal triggering mechanism and the ultimate choice of a partner. Even more interestingly, these choices do not necessarily remain constant over time.

I had a chance to discuss sexual orientation issues with two different men, both in their 30s or 40s who both were married, and both, I believe, also had families. Both claimed to have "normal" sex lives with their wives. Interestingly, however, both of these men occasionally had same-sex encounters (not with each other but each with another man) leading to orgasm. The wives in each instance were apparently unaware of the gay relationship. The decisions these two men faced were not simple. In one of the two cases, I was able to help the man come to the conclusion that ultimately the gay relationship could mean that he would have to leave his wife and family. He
ultimately reached the conclusion that this was not a price he was willing to pay for the same-sex relationship. In the other case, however, it was clear that the man was gradually leaning toward leaving his wife for the man he was having the affair with. I never did hear exactly what happened in this case, but I suspect very strongly that this man is no longer living with his wife. Despite the similar circumstances, each man likely made a different choice. I cite these cases to illustrate how complicated sexual preference can become!

Understanding Male Sexuality: Information You Did Not Learn From Your Parents, Your Friends or in Your High School Sex Education Class! (Part I)

2009-10-29T11:01:00.000-07:00

Preface
This information is intended for those who wish to learn more about male sexuality--particularly information about topics that are considered to be too complicated, controversial or perhaps too embarrassing to discuss. The topics discussed here are loosely based on my responses to several hundred e-mail questions that have dealt with a variety of complicated but interesting issues related to male sexuality.

Basic Plumbing and Electrical
A suitable starting point is to begin with a discussion of how the basic plumbing and electrical system of male sexuality works. The plumbing and electrical system is complex, but very well designed for its purpose. Medical doctors refer to the electrical system consisting of the portions of the brain governing male sexual response and the associated nerve system as the limbic system. This electrical system connected to the plumbing system--a series of arteries and veins that control the inflow and outflow of blood to and from the penis, and also is connected via nerves to assorted glands.

Arousal, Erection and Ejaculation
Men often tend to consider these together, but, in reality they are separate but interrelated events, although ultimately related to each other. Any of these events can occur in the absence of the others

The Arousal Mechanism
Suppose that a man encounters something that excites him sexually. (more about what this might be later on). What happens? First, of course, messages are transmitted to the portion of the brain dedicated to sexual response. The man says to himself "I'm turned on" which is slang for sexual arousal. Many men believe that sexual arousal is always accompanied by an erection, but this is not necessarily the case at this first stage. The experience of being aroused is followed by electrical signals to two tiny glands that lie along the sides of the urethra where the tube that leads from the bladder through the tip of the penis. These two glands, called the Cowper's glands, are located inside the body directly above a point behind the scrotum called the perineum.

These little-recognized glands play a role in the male sexual response. They are
primarily responsible for the production of glistening drops of a clear, slippery fluid sometimes called pre-ejaculate, but known also in slang as "ooze" or "precum". For many men, if not most, the first physical indication of sexual arousal is the formation of a drop or two of this fluid at the tip of the penis, even before erection occurs. Some men believe that when this fluid appears, they are already starting to leak ejaculate but this is not the case. This fluid acts as a lubricant for sperm and semen and lubricates the tip of the penis in sexual intercourse. It's pH level is quite high and it is very slippery. Research suggests that the high pH may help decrease the acidity of the vagina, thereby increasing the chance that the sperm will be able to fertilize the egg. Nature is very creative; it thinks of everything. Nature is at its very best when creating systems to ensure the continuation of the species, and the human system is one of its best and most elaborate efforts. The sexual arousal section of the brain sends signals to the cowper's glands (sometimes called the bulbourethral glands) telling them go into action. This is an automatic result of sexually-exciting stimuli, and thus outside of conscious control: the only way to stop it's production is to avoid the stimulus that is causing the sexual arousal.

These glands are present in many other mammals including the common livestock species. An internet resource dealing with the reproductive system of bulls, for example, indicates that the cowper's gland also secretes a similar clear fluid which is produced (and drips off the end of the bull's penis) during initial sexual arousal! Again, a function of the fluid is to reduce the acidity of the urethra, increasing the chance that sperm will survive.

A number of other things happen during the early stages of sexual arousal. First the man suddenly feels very good, psychologically. During arousal, the brain is flooded with natural chemicals that act similarly to drugs such as cocaine. These natural chemicals, called endorphins, make the man say to himself that whatever is causing the sexual arousal is very enjoyable and should be continued. If the sexual response is the result of observing another person, the man may make an effort to meet the other person involved.

Nature protects itself here and is very cunning. Nature's goal is to continue the species. If this is to occur, it's important that sexually attractive mates elicit a response that maximizes the chance that the two people involved will become better acquainted and perhaps eventually engage in sexual intercourse. (In case you were wondering, the arousal mechanism works identically for gay males, but the object of the sexual attraction here, is, of course, another male.)

Most men will produce pre-ejaculate when anything found to be sexually exciting occurs, perhaps even reading a sexually explicit story or watching a sexually explicit movie. The reason erotic books and videos sell well is because it often elicits this response in men along with feelings of psychological well-being, whether or not they have erections ultimately result in orgasm. There is no limit to the length of time that a man can be aroused, and throughout the man can continue to produce drops of pre-ejaculate. Pre- ejaculate may, of occasion, contain some sperm, and a woman can become pregnant even if actual orgasm and ejaculation does not take place. That is rare, although there are cases of this happening.

Erection
Normally, however, arousal is followed by erection. An erection of the penis occurs as the spongy tissues of the penis are engorged with blood. There is one large primary artery responsible for blood flow into the penis, but several veins that drain the penis of blood. When an erection is not happening, the inflow of blood and the outflow is maintained in balance and the penis remains flaccid. The valves (actually flaps, according to medical experts) that control the flow of blood, however, are opened and closed by nerves that run through the spinal cord to the brain. During erection, blood flows into the penis and holes in the spongy tissue in the penis fill with blood. At the same time, flaps in the veins leading out of the penis enlarge, cutting off the drainage. As a result, the penis fills with blood. As more and more blood flows in than out, the penis enlarges and becomes harder. Finally, veins in the penis are compressed from the increasing pressure from the erection itself. Not only that, the heart rate and blood pressure increase, the pressure of blood into the penis increases, keeping the penis the hardest.
What can go wrong with the plumbing system? Several things. Those with spinal cord injuries are frequently unable to attain an erection because the nerves that control the valves in the veins and arteries have been severed. If these valves cannot be opened and closed an erection is impossible. As a man ages, the valves (flaps) controlling the veins that must be shut off may leak a bit, and not prevent the outflow of blood. And the blood flow into the penis may be restricted.

Also, as a man ages, the main penis artery may fill with sludge, reducing blood inflow. Smoking may contribute to this, as it does to the buildup of sludge in other portions of the circulatory system. Furthermore, alcohol use may decrease the ability of the nervous system to close off the necessary valves. That's why intoxicated men often cannot get and maintain an erection. Bicycle and other injuries to the groin area can be dangerous in that the main artery controlling blood flow to the penis may be squeezed shut, making a firm erection difficult or even impossible.

The size of the erection may be relatively unrelated to the size of the non-erect penis. Typically, those with smaller penises tend to enlarge to a greater degree when erect, so the differences in the size of the erect penis may not be that great. According to the book "Man's Body," the average flaccid penis is about 3 3/4 inches long with most falling between 3 1/4 and 4 1/4 inches, though a few fall outside this range. The average erect penis is 6 1/4 inches, with most between 5 and 7 inches, though a few are smaller and larger.

A somewhat tongue in cheek primary data survey is at How Do you Measure Up?

A Newsweek article (September 16, 1996, p. 73) reported American Geriatric
Society average data on the angle of erection from horizontal of the erect penis
by age. The data are as follows:
Age Angle
2010 degrees up from horizontal
3020 degrees up from horizontal
40 1 degree up from horizontal
50 1 degree down from horizontal
7025 degrees down from horizontal

I wonder how data like these are collected!
An article in Men's Health Magazine (June, 1996) indicates that these data are overly optimistic, and that the average erect penis length now widely accepted by doctors is 5.1 inches. This seems a bit short to me, at least for an average number, but if these data become widely known, most men may be happy to find out that they are "above average." Part of the problem is that scientific data on this is difficult to collect by other parties, and men, if they measure themselves in private, are perhaps sometimes prone to brag a bit. Furthermore, erect penis length varies with the degree of erection.

Past puberty, in the teen years, and perhaps during the twenties, it is possible to get a full erection without any manual stimulation at all. As men age beyond the 20s, this occurs less and less frequently and increasingly some manual manipulation of the penis is needed. As the penis becomes increasingly erect, the nerve endings located there gradually become more and more sensitive to touch. In general, the harder the penis can become, the more pleasant the sensations from the touch. Other physiological changes occur. As the erection grows, the heart and breathing rate increases. During the initial stages of arousal, before erection occurs, the testicles and scrotum feel quite large and soft, and are very sensitive to touch. Gentle pressure on the testicles with the fingertips produces particularly pleasant sensations. As the erection proceeds, the testicles change as well, increasing in size by up to 50% as they also fill with blood. The become harder and are drawn up to the body as the point of ejaculation becomes nearer and nearer.

Many men think that an erection must ordinarily proceed to an orgasm and ejaculation, but this is not necessarily so. By repeatedly massaging and then stopping the manual stimulation of the penis, a man can go through many erection cycles that do not necessary need to lead directly to orgasm. With each cycle, often the man can learn to take a bit more stimulation without ejaculating. Research indicates that stimulation of the septum, a portion of the brain known to be a part of the limbic system, results in the feeling of an orgasm, but this stimulation produces neither an erection nor ejaculation. These findings support the theory that ejaculation and orgasm, though often linked together, are, indeed, separate events. Interestingly, this research finding also lends credence to the theories of those authors who advocate the view that men can learn to have multiple, closely-spaced, orgasms.

Learning how to achieve an erection just below the level which will lead to ejaculation is an important part of sexual enjoyment. It is important for the man to learn how to read his body's signals that orgasm and ejaculation are near. Psychologists call the point where the man can no longer delay orgasm the "point of inevitability" There are several physical indications. First, the hole in the tip of the penis will become more slit-like. Precum production will stop. Generally if the fluid at the tip of the penis becomes milky, the point of inevitability is already past.

Learning how to lengthen the arousal and erection period while delaying orgasm is an important part of maximizing enjoyment from sex. As the erection proceeds, the physical sensations become increasingly more and more exciting, and the psychological pressure to ejaculate becomes more and more intense. The trick is to lean to keep the stimulation just below the level required for ejaculation while learning to deal with the increasing psychological pressure to ejaculate. Like driving a racing car closer and closer to a wall at ever high speeds, the psychological pleasure becomes more and more intense, the longer the arousal can be maintained without ejaculation, but the greater the enjoyment for the man.

Furthermore, the longer this stage can be maintained, the more powerful and enjoyable the orgasm will be for the man. Thus, developing skills for doing this and dealing with the psychological desire to ejaculate for as long as possible are essential for the full enjoyment of partner (and solo) sex, and this is what requires practice. Women usually require a somewhat longer period of time to become fully aroused, so being able to delay orgasm potentially increases the enjoyment of sex by both partners.

Many women believe that men are happier the more frequently they can have intercourse. This is not really accurate. What men truly enjoy is being aroused with their partner (and as their partner is also aroused) while both remain in an aroused state for a long period of time, delaying orgasm for as long as is comfortable and possible. A continuing theme of the story lines in erotic literature is a situation in which the woman arouses the man and keep him for a long time at a level just below what is needed to achieve an orgasm. It's important in achieving marital happiness for women to learn how to do this for their husbands,

All of the sections of the erect penis are not equally sensitive. Thus, by varying locations being stimulated, the man can perhaps delay orgasm.

Stimulation of the base of the penis, near the body, while pleasant, normally will not be sufficient to achieve orgasm. The underside of the tip of the penis, called the frenulum, is very sensitive to manual stimulation. If this area of the erect penis is stimulated very much, an orgasm (and ejaculation) will occur almost immediately. Thus it is important to not stimulate this region, at least not until late in the sex play.

There is a reason for this. During intercourse, when the man's penis is fully inside the woman's body, the tip of the penis will touch the cervix at the end of the vagina. Unless the man is deep inside the woman, the vagina is simply a hollow tube, and the tip of the penis is not touched. By ensuring that the orgasm takes place almost precisely when the tip of the penis comes in contact with the cervix, the sperm will have the shortest distance to travel to reach the waiting egg. Thus, a man's "reward" for placing the semen in the location that will maximize the chance that the woman gets pregnant (and the species continues) is the pleasant sensations that occur when the tip of the penis touches the cervix. In sex play, the man can reproduce these pleasant feelings outside of intercourse by touching the tip, particularly the underside of the tip, although orgasm and ejaculation will likely follow almost immediately.

Because of the sensitivity and pleasant sensations, the frenulum is often referred to as the "male G spot." A significant portion of the penis, perhaps one- third to one-half of it, lies inside the body. This portion of the penis also responds to manual stimulation. It can be felt and externally massaged at a spot called the perineum area, which is directly behind the base of the scrotum. This is a little-recognized but highly spot on the male body. This spot is sometimes referred to as the "second male G spot" though many men are not even aware that it is a sexually sensitive area of the body In addition to the possibility of externally massaging the interior portion of the erect penis, a bundle of nerves terminate here, and the main artery that is responsible for providing blood for erections runs through this area. That is why bicycle injuries may lead to impotency. Surgeons are becoming increasingly talented in repairing damage to this artery. In addition, inside, but directly above this area lies the cowper's (bulbourethral) glands, and it is likely that external massage of this area will to a certain degree stimulate these glands. The prostate is a little further up, but close by. A have heard varying opinions as to whether it is possible to externally massage the prostate by touching the perineum area, but I believe it is possible. Massaging the prostate, a walnut-size gland responsible for secreting most of the liquid contained in semen can be very pleasant, and some men do this by inserting a gloved finger directly inside the rectum, as the gland is located only about an inch inside.

Orgasm and Ejaculation
With practice, a man can learn a degree of control over the point when he proceeds to orgasm and ejaculation. Some men believe that male orgasm invariably results in ejaculation, but this is not entirely true. Some men have learned techniques for having multiple orgasms without ejaculating. Many of these techniques involving squeezing of the urethra such that the semen is not allowed to leave the body. To me, this sounds potentially painful and perhaps even dangerous.

As indicated earlier, as the point of orgasm approaches, pre-ejaculate production will normally stop, and the hole in the tip of the penis becomes slit-like. The testicles become hard and are drawn up near the body in preparation. Breathing becomes heavier, and there may be involuntary contractions of major muscles (convulsions) throughout the body.

Finally, the psychological and physical pressure to ejaculate is released in a series of muscular contractions, usually about 8 major contractions spaced a second or so apart, followed perhaps by several smaller ones that can last 45 seconds or so. In essence, a pump has swung into action. Technically an orgasm is similar to a sneeze in that it involves a series of involuntary muscle contractions in response to an "irritation," though, of course, it is usually a good deal more fun. Semen consist of a mixture of sperm from the testicles and primarily fluid from the seminal vesicles and prostate gland, but also contains smaller amounts of other fluids secreted from glands along the urethra. Often the sperm is not very well mixed with the other liquids making the semen appear to have patches of cloudy and clear areas, and has about the same consistency as liquid dish washing detergent. (Somehow, I think of that every time I start my dishwasher!) Semen is usually creamy white in color.

Once the orgasm is complete, the valves which maintained the erection are opened, and the penis is drained of blood so that within a space of a few minutes it has returned to its flaccid state.

He Dribbles! He Shoots!
Generally the more frequently a man has an ejaculation, the less force that ejaculation will have. This results in a shorter shooting distance. Most of the differences, however, appear to be both genetic and age-related. Some men are able to shoot longer distances than other men, and younger men tend to have greater force of ejaculation then older men. The book "Man's Body" indicates that after prolonged abstinence - more than three days - a man may be able to shoot 3 feet or more, but the average is 7 to 10 inches with more frequent ejaculation. If one is able to ejaculate two to three hours after his previous ejaculation, the semen just dribbles out. The ability to shoot long distances not only declines generally with age, but probably varies somewhat according to the hardness of the erection, too. There is also a wide variation in semen production, also according to the book "Man's Body", ranging from 0.2 ml to 6.6 ml.This same book notes that 3.5 ml is average after a few days without ejaculation--about a teaspoonful--while 13 ml has been recorded after prolonged abstinence. So this must be judged in relationship to the frequency of ejaculation.There is undoubtedly normal genetic variation as well. Interestingly, most of he fluid--60 percent on average, comes from glands called the seminal vesicles, whereas 38 % comes from the prostate, with the remainder from glands such as the cowper's. The prostate contribution is responsible for the characteristic odor. The fluid from the seminal vescicles is high in fructose, a type of natually-occuring sugar, which provides primary nourishment for the sperm in their travels.

Frequency of Ejaculation
According to a number of studies, Many post- pubescent young men report daily ejaculation, if not more frequently than that. This frequency gradually declines for most males to 2-3 time per week which is typical of men in their forties. But there is still considerable variation among adult men of a given age. The same Newsweek article cited earlier reports the following data on "average" frequency of orgasm per year by age. These data appear 'conservative' to me, but perhaps that is good if nearly all men, like the children in the mythical

Minnesota town, are "above average." Anyway, here is the data :
Age Frequency
20 104 orgasms per year
30 121 orgasms per year
40 84 orgasms per year
50 52 orgasms per year
60 35 orgasms per year
70 22 orgasms per year

I wonder how many 20-year old men are content to "survive" on an average of fewer than 3 orgasms per week! Most older men should feel pretty good about their frequency of orgasm, based on these data!

Up or Down?
Endless discussions have been taking place on the internet newsgroups with respect to the "best" position to wear the penis--that is, pointing either up or down. Obviously, it would be difficult if not impossible to wear the penis in an up position while wearing loose-fitting boxer shorts, but closer fitting briefs allow that as a possibility. Each side in the discussions has its advocates. (There are even a few men who prefer a position "to one side or another". These men appear to have distinct preferences for either pointing right or pointing left, but not both.) The underside of the penis,that is, the outer side when pointed up, is generally more sensitive to the touch. For some men, the sensation of cloth across the underside of the penis is sufficient to sustain a slight erection and the penis produces a larger "bulge" which might be "inadvertently" touched in the up position.
Many people wonder why male ballet dancers as a group appear to be so amply endowed. Part of the answer is that the penis is positioned in an "up" position.

It is also not widely known that male ballet dancers wear a garment called a "dance belt" which is similar to an athletic supporter but holds the penis in the up position. Some of these belts are padded on the front so that some of the bulge is not actually penis! A "down" penis would ruin "the line" for male ballet dancers. Hence the popularity of the up position.

I recently received a letter from a former ballet dancer who claims that he, as well as the other dancers he knew, wore their penises in a "down" position. He argued that the dance belt does not force the dancer to wear the penis in the up position. So the discussion and disagreement on this topic continues.

A Curved Penis?
I've received a lot of letters asking questions about whether or not a penis that curves up, down or to one side or the other is "normal." That depends. There is considerable variation in this that is considered quite normal. Remember, the penis consists primarily of spongy tissue that fills with blood when erect. Since a delicate system of valves (actually flaps) controls the amount of blood contained within a penis, only slight differences in relative pressures on each side could result in a degree of curvature.

Joel Block's book,(pp. 207-8; see reference list) however, describes a more serious problem, called Peyronie's disease, in which the penis becomes so curved that it interferes or even prevents intercourse. According to Block's book, the penis may be bent into a J-shape. The exact cause is unknown, but is thought to be due to a buildup of scar tissue.Vitamin therapy has been used with success in some cases, but surgery may be required. If you suspect Peyronie's disease, it's a good idea to check with a doctor. There is an internet reference from the National Institutes of Health on Peyronies disease with detailed information about underlying causes and treatment.

Lesions on the Penis
I have also received questions regarding the presence of warts, pimples sores etc. on the penis or elsewhere in the genital area. I am not an MD, and could not diagnose these via e-mail even if I were. Any of these should be checked by a doctor. This is particularly true if you have been sexually active with a partner. These kinds of symptoms could be consistent not only with Herpes, but other, more serious Sexually Transmitted Diseases (STDs) as well. Self-treatment is not recommended. The STDs are cunning in that lesions often heal on their own, and yet the infection continues (as well as the possibility that the disease could be transmitted to a partner). This is nothing to fool around with, no matter how embarrassing you think a visit to the doctor might be.

Blood in Semen
I have received questions regarding the significance of the appearance of blood in semen, particularly whether or not this is a symptom that should be checked by a medical doctor. The internet references I have checked on this topic with respect to possible causes are not necessarily consistent. The consensus is that blood which appears anywhere it should not ordinarily be should be checked by a medical specialist, including blood appearing in the semen. The internet references indicate that the common causes of this symptom include certain kinds of infections of the prostate or perhaps elsewhere in the urinary tract. Another possible cause is slight tears in the blood vessels or walls lining the urethra, which is the tube that carries urine and semen. This symptom could be a result of more serious causes as well, so it should be checked out by a medical doctor.

Sexual Tension and Sexual Feelings
A lot of men are very "orgasm-centered" in their sexual lives. By that, I mean, a focus on orgasm and ejaculation becomes important to the point where many men do not fully notice the sexually-related sensations prior to orgasm. As a result, many men do not fully appreciate or even experience these sensations. Men may find these statement surprising, believing that orgasm and ejaculation is what "sex is all about."

An analogy may be drawn to differences in behavior among people who travel. Some people are very focused on getting to their destination, believing that whatever favorable experiences are to be had will be found at the destination. These people often do everything possible to make travel to the destination as unimportant as possible. If they drive, they drive over the speed limit, stopping only for lunch breaks at drive-through windows, so that they can get back on the road as quickly as possible, and not "waste time." These people tend to fly rather than drive, if possible, because it's faster.

All you wanted to know about Cialis

2009-10-02T10:55:00.000-07:00

If you’d made up your mind about Viagra as the only med that worked best for trouble in the bedroom department, expect plenty of surprises that may change in your mind in minutes. Beginning with the basics, Cialis is a medication that has been approved by the Food and Drug Administration (F.D.A) as a tested pharmaceutical for Erectile dysfunction, which as some of you may know, is the inability of the penis to obtain an erection or to hold it long enough for the completion of a sexual intercourse. As does Viagra and Levitra, Cialis belongs to a group of medicines called phosphodiesterase type 5 or PDE-5 inhibitors that regulates the muscle which assists the blood flow to the penis eventually leading to an erection.

From reported experiences, Cilais is known to have produced various side effects ranging from mild to moderate. Most reports from Cialis users were generally of ache, both muscular and of the head. It may also cause a sudden drop in your diastolic or systolic blood pressure, but that is only if you’ve been prescribed a bunch of nitrates for chest pain. In such an event, a close consultation with your physician is highly advisable. Another thing that you need to take care of is to remember not to mix alcohol with Cialis, especially not to the level of intoxication. Remember, ultimately, chemicals and alcohol ultimately don’t mix too well at all.

On the brighter side, Cilais works for a number of reasons, even besides Erectile Dysfunction! For starters, it works 50% faster than Viagra and Levitra. It is beneficial for pulmonary hypertension. To add to the list of additional benefits, it works just as well for angina and healthy muscular regulation. Some doctors in the United States have even gone on to say that perhaps Cialis has not been developed to it’s full potential yet! That perhaps explains the fact that this wonder drug has been proven to be safe even for men with a blood sugar problem, or even suffer from a co-existing ischemic heart disease (reduced blood flow to the heart due to a build up of plaque in the arteries.)

Available online at a number of pharmacies on producing of prescriptions, Cialis is best purchased from ‘Sqaure-Trade’ certified websites as they guarantee a decent inline trade and safety norm. With all the know-how, you can now begin on an easy quest for finding the right Cialis Deal!

Aggression Helps Men Fight Off Illness

2008-11-18T13:25:00.000-08:00

The big bullies of the world may have more than a muscle advantage over the 90-pound weaklings. Research now suggests they have stronger immune systems, too.

The reason may have to do with an evolutionary process in which hunters and warriors needed greater protection from disease, researchers report in the August issue of Psychosomatic Medicine.

In a study of more than 4,400 men who had served in the US Army, Dr. Douglas A. Granger and his colleagues found that those with a history of fisticuffs, run-ins with the law, and behavioral problems in school had immune systems that were equally aggressive. Specifically, the aggressive men had a greater number of white blood cells known as B cells and helper T cells, both key in the immune system's response to foreign invaders.

Granger, a professor of behavioral health at Pennsylvania State University in University Park, told Reuters Health that the link between aggression and immunity was strongest for men who were "moderately aggressive." For example, men who reported committing two aggressive acts in their lives were 70% more likely than passive men to be in the group with the most helper T cells. But the trend toward higher helper T cells leveled off once men had committed six or more aggressive acts.

"I don't think we'd want to encourage people to start being aggressive to strengthen their immune systems," Granger said. However, he added, unlike some research that has linked aggression to poorer health, these study findings suggest "it's not always bad."

Besides looking at aggressive behavior, Granger's team considered other factors that influence immunity, such as overall health and risky behaviors such as smoking, drinking excessively, and having many sex partners. The investigators also measured the men's testosterone levels because some research has linked the hormone to weakened immunity. Even when they accounted for these factors, though, aggression remained tied to stronger immune function.

The reason for the connection is unclear, but Granger speculated that it may have to do with evolution. "We're throwing out the hypothesis that this (connection) has been with us for a long time," he said.

Throughout history, Granger noted, men who were more aggressive may have been more likely to "be out" foraging, hunting, fighting, and otherwise exposing themselves to a high risk of injuries and infection. A strong immune response would have been an asset to these men.

Although the current study focused on men who engaged in bad behavior, Granger said that since stronger immunity was linked to moderate aggression, the findings may extend to men who merely have more aggressive personalities.

Experience With Injectable Caverject

2008-11-02T10:10:00.000-08:00

"Dec 19th

Hi to all,

Well I know that all are wondering what happened at my appointment
at 4 p.m. Monday (Yesterday)

I arrived and checked in at the window, and they checked and had
received the questionnaires that I had mailed back. They made a
photo-copy of my BC/BS card for my file. I then had a seat and
waited to be "called shortly" ... I waited and waited and waited.
I finally was called at 5 p.m. because they had really gotten
behind. They did have a nice 400 gallon aquarium with six fish
and a starfish inside. There was the big yellow one the big gray
one, the stripped black and white one, the spotted one, the blue
one and the little one... I KNOW.

When I went back I was asked about my drug allergies by the gal,
and then she left. The doctor soon came in and I told him about
my impotence and my diabetes. I mentioned the forum and that I had
recently received such positive messages about Papaverine that I
wanted to try it. I also told the doctor that I had heard of Caverject
too, but I thought it was a little more expensive. The doctor
was good, and explained that Caverject is "made" for this problem of
impotence and that Papaverine is not really for this, though it does
work. He went on to explain that Papaverine is not really FDA approved
for this use. He mentioned also that Papaverine is difficult to get
here for impotence but that Caverject goes through the pharmacy programs
and insurance coverage programs much more easily and there is a whole
lot less hassle with getting it at your drug store and a lot less hassle
with your health insurance company. My Doctor went on to tell me about
caverject and how you use it. Told me the benefits and also about
priapism (prolonged erection > 6 hrs) which sometimes can occur.
He then asked me if I wanted to try this medicine and we do a test injection
today. I answered sure !!!! Well at 5:35 p.m. I had received the info
about where the shot goes and so I held it out while the male nurse gave me
my first shot near the back end about 3 o'clock on the side. I thought
it would hurt, but it only hurts slightly as it goes through the skin.
After the needle is through the skin it really does not hurt any deeper,
though they put the needle in all the way. The nurse then put in one
C C in. The doctor and nurse came back in ten minutes at 5:45 and I was
some larger. I was then shown how the Caverject kit goes back together
with the supplies used up and the lid is put on the kit and it is
"locked" by putting a special piece of plastic key that locks this up
from any further use and you can throw this one away. I was then told
to come back on Thursday and **I** do my shot of Caverject in front of
them, and then they will get me a prescription and I will be on my
way. I stopped and got the appointment set up for Thursday, and left.

On the way home I picked up some divider sheets at a store for [wife].
I "felt" much larger than I have ever been since 1987 so I walked up to the
counter to pay,,, sorta covering up the action in my pants with the divider
sheets so no one will notice. (I can hear you all laughing already !!!)

Anyway I get home and it is just me and my wife. We go to a bedroom
together and by this time the medicine had **really** worked. It was about
35 minutes after the shot by now... She was a sweetheart.

I have a couple of questions for the Thursday appointment, BUT this
Caverject is going to work fine for me !!!! So this is what happened
Monday...

[ I will answer here the question you are all going to ask. Yes
we found one way (position) that we could have vaginal sex
in spite of impotence, and used this way almost every week. ]

Dec 22st
Subj : Thursday appointment
F m : [Somebody]
T o : All in 22

Hi to All,

Well I thought I would let everyone here know how the Thursday
appointment went. My appointment was at 4:00 p.m. and they
were behind again.. I watched the fish until 4:45 p.m. before
going back to a room. I found out that a starfish that I thought
was a decoration on the back of the aquarium was ALIVE. So add
one more starfish to the list...

I got back to a room and waited for quite a while. Finally the
doctor and a student doctor came back and we talked. They asked
what happened after I left the clinic. All of that info is listed
in my Monday Appointment message here. I then asked if Caverject
can be stored in a drawer or if it has to be in a refrigerator.
It can be stored in a drawer. I then asked about the strength
of the dose. There are two kinds. One has 10 Micrograms and
one has 20 micrograms. This is actually a dry powder that is
inside a bottle very similar to an insulin bottle. There is
a syringe in this kit that is prefilled with a liquid solution.
You give the bottle a shot and inject the solution in
the syringe on the dry powder in the bottle. You then mix this
up until all powder is dissolved. You can roll this like an insulin
bottle or shake it. Anyway after all is dissolved then you draw *all*
the solution out of the bottle back into the syringe. Now your
shot is ready. You then inject on the three o'clock side or
the nine o'clock side of your penis near the back, putting the
needle all the way in. You try to draw a little blood into the
syringe and as soon as you do, then go ahead and inject all the
contents of the syringe into the penis. Then you remove (pull out)
the needle and cover for a few moments with and alcohol pad.
I am truly surprised but this doesn't hurt. Really ...

You should keep track and inject on the opposite side of the
previous shot. I then replaced all the stuff back into the
Caverject plastic case where everything snaps into its storage
area. Then I replaced the 2 inch by 6 inch lid on the bottom part
and locked it on with a special plastic button key. Now a person
can simply throw this away this way, because you cant get inside
it anymore.

Anyway I did my own shot with the male nurse watching. The
Doctors came back and checked to see that action was taking
place and things were growing. It was. I asked a few questions
about what would happen at the pharmacy. It is such a new drug
to [city] that they are still gathering this information...
I then left to go home. I had supper first and then went to
the pharmacy. [Wife wasn't home.]

I had good news and bad news there.... The
good news is that my pharmacy was open and had SIX in stock.
Bad news is that the computer contacted my health
insurance computer and said CLAIM DENIED ! So I
will have to file a claim with receipts later today. If my insurance
doesn't help pay for these, they will be $20.50 a shot. SO
I better be very romantic when we use these.... I will.
(BTW, my health insurance did honor the claims and paid their
80 % of the total costs.)

On May 20th I was to have my 6 month check-up appointment, however
my doctor was going to be out of town during this week so his
office called me and my appointment was rescheduled for May 9th.

When I arrived for my 6 month check, I waited for quite a while
in the waiting room. The fish inventory is now 2 starfish, 1
black and white spotted fish, 1 black and white stripped fish,
one brownish grey fish, 1 large yellow fish, and one medium
orange fish....

I met with the doctor and he looked over my medical folder, and
asked if I was having any problems with the Caverject kits and
I replied that I was doing fine since we had increased the
strength to the 20 microgram kits. I told him that my time was
a little over an hour with most of them and that my best shot
had lasted 2 hours. My doctor then noticed something in my
records and we proceeded to talk about the financial cost of the
Caverject kits. He told me about a pharmacy on the west coast
and that I could try a liquid medicine called Prostaglandin
or PGE-1 that would be less expensive. I would need a 1 CC
syringe, but that was no problem for me, due to the fact that
I have a prescription for syringes anyway for insulin. He then
told me that this medicine would be cheaper and gave me a
prescription for it and their phone number. Well when I got home
I called them, and I think I must have confused the operator
because she quoted me a price higher than Caverject. I was
frustrated. My wife then called, and asked to speak to the
pharmacist. The pharmacist explained things to us much more
clearly than the operator had, and so we mailed for this prescription.
I received the medicine in just a few days, by overnight delivery
and last weekend we tried the Prostaglandin medicine instead of
the Caverject kit. The medicine worked just fine, in fact better
because it lasted two complete hours. I don't want to advertise
for this pharmacy and advertising is not allowed, but if you need
the address to give to your urologist, you can send an e-mail to
me and ask for it. I check in almost everyday.

Hi to all (Dec 11)
Monday afternoon December 9th I had an appointment with my urology
doctor again. I checked in at the window to let them know that I
was there and then sat down in the waiting room to be called...
The aquarium now has a new scene in back, and different rocks
inside... Fish inventory is now one black and white stripped fish,
one brown spotted fish, one gray fish, one orange fish, and
two starfish... The new rocks have a slight covering of moss
and the water looks cleaner ...
Soon my name was called and I was lead to an examining room. I waited
for about 15 minutes, and then my doctor along with a new doctor
came in. This new doctor was going into family practice, but I think
they have to shadow the regular urology doctors for part of their
training.. My urology doctor then began to ask several questions
inquiring as to how the medicine was working (fine) and how much of
the Prostaglandin I was using. He also asked how long the medicine
was lasting. I told him that I had had two shots that had lasted
4 hours and 5 hours so I had been using less medicine and everything
was fine and that 70 to 80 units was giving me 2 hours of "Fun time"..
For the new doctor's benefit, we switched the conversation to a discussion
about costs of Prostaglandin compared to the cost of Caverject kits.
I have used both in the past year and my our family health insurance
policy covered all both of them so I was able to tell the doctor
of what it was actually costing us out of the household budget.
After talking of this, my urology doctor asked if I needed a new
prescription. I had to tell him that I honestly did not know... He
gave me a new prescription in case I would need it for next year.
I then was checked for scar tissue that might be forming or building
up from shots.. No problem with this at all, I do give myself very
gentle insulin shots, so I am good at being gentle with Prostaglandin
(PGE1) shots too. Again too, I shout from the roof tops here just as
I do in section 22, you won't ever believe it, but truly these shots
DO NOT HURT as much as very firm handshake. At this
point my doctor also said that I could come back in a year. He gave
me a card to take to the window and they arranged an appointment in
December. I then came home. I called the mail order pharmacy
on their 800 number in San Diego California and asked if I should
send in this new prescription. They told me that when I needed to
have my prescription renewed that they simply had the pharmacist there
call my doctor long distance and get a renewal. Very easy.
Again, if you have any questions, you can write to me by email or
send me a (P)rivate message in any section of the forum or ask
me in public messages in section 22 (The Male Room) ... "

-- submitted by Craig 71064,73

Sexual Disorders & Dysfunction

2008-11-02T09:50:00.000-08:00

Although the majority of sexual dysfunction probably has a physical basis it is fitting to mention some sexual disorders here because dysfunctions, whether mainly due to physical or psychological causes, can result in distress. For example,
the individual with a sexual disorder may suffer related anxiety and sexual frustration which in turn leads to insomnia, and that insomnia may be the presenting complaint to the GP. The individual's close relationships may suffer and tension may build up in the family as a whole.

According to DSM-IV (the American Psychiatric Association's classification system) there are a dozen or so sexual disorders. All have to cause marked distress or interpersonal difficulty to rate as disorders. A brief overview follows:

1. Hypoactive sexual disorder
A persistently reduced sexual drive or libido, not attributable to depression where there is reduced desire, sexual activity and reduced sexual fantasy.

2. Sexual aversion disorder
An avoidance of or aversion to genital sexual contact

3. Female sexual arousal disorder
A failure of arousal and lubrication/swelling response.

4. Male erectile disorder
Inability to gain an erection or inability to maintain an erection once it has occurred.

5. Female orgasmic disorder
A lengthy delay or absence of orgasm following a satisfactory excitatory phase. The GP must take into account the patient's age, previous sexual experience and adequacy of sexual stimulation.

6. Male orgasmic disorder
A lengthy delay or absence of orgasm following normal excitation, erection and adequate stimulation.

7. Premature ejaculation
Ejaculation occurring with only minimal stimulation, either before penetration or soon afterwards, in either case ceratinly before the patient wishes it. Again the GP must take into account the patient's age, previous sexual experience, extent of sexual stimulation and 'novelty' of the sexual partner.

8. Dyspareunia (not due to general medical condition)
Recurrent pain associated with intercourse, but in women not due to vaginismus, poor lubrication, and in women and men not due to drugs or other physical causes

9. Vaginismus
An involuntary or persistent spasm of the muscles of the outer third of the vagina, again not attributable to physiological effects of physical causes. Vaginismus may be
either lifelong or recent; generalised to all sexual encounters or specific to certain partners or situations.

10. Secondary sexual dysfunction
Dysfunction secondary to illness eg hypothyrodism, mental disorder eg depression, or drugs eg fluoextine.

11. Paraphilias
Exhibitionism (exposure of genitals to strangers). Fetishism (finding nonliving objects erotic eg women's underwear). Paedophilia. Frotteurism (fantasies, urges or behviour centred around rubbing self against non-consenting other). Sexual masochism and sadism. Transvestic festishism (cross-dressing for erotic pleasure). Voyeurism (fantasies, urges or behviour centred around watching non-consenting others undressing, or having sex).

12. Gender identity disorder
Strong and persistent identification of the self with another gender. Persistent dissatisfaction with own sex. Desire to participate in stereotyped games and pastimes of opposite sex. Preference for cross-dressing. May insist that they are
wrong sex. May occur in children, adolescents and adults, (Green, 1985). Not concurrent with physical intersex condition.

Table One: Physical Causes of Male Erectile Disorder

Illness and disease

* Alcoholism (neuropathy)
* Diabetes mellitus
* Arterial disease eg Leriche syndrome
* Renal failure
* Carcinomatosis
* Neurosyphilis
* Hypothalamo-pituitary dysfunction
* Liver failure
* Multiple sclerosis
* and many others

Drugs

* Beta-blockers
* Thiazide diuretics
* Tricyclic antidepressants
* Phenothiazines
* Spironolactone
* Cimetidine
* Cannabis
* Anti-epileptics

Table Two: Physical causes of dyspareunia that would need to be excluded

Female

* Failure of vaginal lubrication
* Failure of vasocongestion
* Failure of uterine elevation and vaginal ballooning during
arousal
* Oestrogen deficiency leading to atrophic vaginitis
* Radiotherapy for malignancy
* Vaginal infection e.g. Trichomonas or herpes
* Vaginal irritation e.g. sensitivity to creams or deodorants
* Abnormal tone of pelvic floor muscles
* Scarring after episiotomy or surgery
* Bartholin's gland cysts/abscess
* Rigid hymen, small introitus

Male

* Painful retraction of the foreskin
* Herpetic and other infections
* Asymmetrical erection due to fibrosis or Peyronie's disease
* Hypersensitivity of the glans penis

How common are sexual disorders?

The majority of adults can recall times in their lives when they were troubled with low desire or problems with orgasms. Arousal difficulties increase with age. Sexual dysfunction may arise in the most well-adjusted and satisfied of couples. In 100 educated young couples Frank et al (1978) found that 50% of men had difficulties with erection, ejaculation or orgasm sometimes and 75% of women had problems with arousal or orgasm sometimes.

Table Three: Estimated lifetime prevalence of sexual problems in young adults (at some time).

Women

* Reduced libido 40%
* Arousal difficulties 60%
* Reach orgasm too soon 10%
* Unable to have orgasm 35%
* Dyspareunia 15%

Men

* Reduced libido 30%
* Arousal difficulties 50%
* Reach orgasm too soon 15%
* Unable to have orgasm 2%
* Dyspareunia 5%
(Source: Haas & Haas, (1993) Understanding Human
Sexuality)

What can be done?

Given that these disorders are relatively common and that they can cause such distress it is a matter of concern that patients often feel they cannot talk to their doctors about such matters.

Treatments break down into two main kinds: behavioural psychotherapy and physical. The former is largely derived from the pioneering work of people like Masters &
Johnson. Masters & Johnson type therapy addresses the sexual problem itself directly using the couple as a co-operative unit in the here-and-now rather than delving into an individual's unconscious for details of their past life. Masters & Johnson sessions may involve a male and female co- therapists who
sit with the couple and discuss the couple's sexual education and involve a medical examination by separate medical staff. If the problem is thought to be primarily medical then physicians usually take over the treatment. Within further sessions the couple is given guidance, instruction, and 'homework' - sexually orientated activities which the couple practice in their own bedroom alone.

Masters & Johnson Techniques:

Giving and Receiving Partners take turns in giving and then receiving touch and massage, i.e. giving pleasure, without at first touching breast or genital areas. This giving and receiving exercise is called sensate focus.

The early prohibitions on touching and orgasm hopefully reduce the couple's anxiety level and re-educate them that mutual pleasure can be derived from simple touching. Some authors have written about how it is possible to prescribe sensate focus without prohibiting sexual intercourse,(Lipsius, 1987). In the sensate focus process
each partner may use the hand over technique where the others' hand is guided. The receiver puts his/her hand over the giver's to show where touch should be and what that touch should be like. This further improves communication and teaches the couple what they can achieve rather than what they can't achieve. Masturbation, either alone or together may form part of the programme as may also the squeeze
technique which is sometimes used to prevent premature ejaculation - in this the partner places their thumb just below the coroanl cleft of the glans and places her other fingers opposite. Gentle, firm pressure for about five seconds usually stops the ejaculatory urge. After a rest of a few minutes sexual activity can begin again. The squeeze technique can be repeated several times during lovemaking.

Accurate information, to dispel false ideas, can often be enough to resolve problems. Indeed such a simple, straightforward strategy will obviate the need for specialist input in many cases. Jack Anon's PLISSIT approach is a pragmatic example (1976). Anon, acknowledging that all couples are different and require tailored solutions described a four stage model. Some couples/individuals are seeking Permission from their doctor/therapist i.e. reassurance about their activities. Others will respond to Limited Information or Specific Suggestions and a few may
require Intensive Therapy. This four level approach advances with the patient(s) as necessary.

Low sexual interest has ben found to respond to the encouragement of sexual fantasy. Orgasm and arousal difficulties often respond to the sensate focus approach described above. Dyspareunia and vaginismus may also respond to senate focus, although is some cases of generalised vaginismus treatment may involve teaching the woman to insert her own fingers into her vagina, and after practice, when the
woman is comfortable she may use the hand- over technique to introduce her partner's fingers into her vagina, whilst relaxing. Ultimately progression to penile insertion is encouraged.

Physical treatments are much more in vogue than they were. Useful though they were seemed in the seventies and eighties, Masters & Johnson type therapy has been re-eavluated. Like many treatments and drugs the initial enthusiasm has
been tempered with time. Initially a success rate of 80% was quoted for their techniques, but further evaluation suggest that in the medium term such techniques bring benefit to about 50% of patients. The current opinion suggests that a
high proportion of sexuxal dysfunction is attributable to psychophysical causes rather than purely psychological ones. In other words a man may complain that he is impotent, but there are several aspects to his problem - there is the tension caused in his relationship with his partner because they can't have a certain kind of sex - there is anxiety about performing which reduces his ability to begin to have an erection and there is an underlying transient or permanent physiological difficulty with erection. Once the latter is treated and the man is able to see that he can have
intercourse again after all some of the secondary anxieties (which were also affecting performance) begin to be dispelled as well.

Possible physical treatments:
o Premature ejaculation fluoxetine / clomipramine
o Erectile difficulties intrapenile injections of papaverine
and prostaglandin, inflatable prosthetic penile implants, suction
devices, cockrings

Audit Points

As a doctor, estimate how often people come to see you with their sexual problems? Do you think that the majority of people who come tosee you about their sexual difficulties can talk to you? What can you do to make it easier for people to
talk to you about these issues? What local resources are there to help doctors treat sexual disorders? If the resources seem scarce or have exceedingly long waiting times is there anything that can be done about this?

Self- Assessment MCQs

1. In terms of sexual function:

A women taking benzodiazepines may experience delayed orgasm
B men taking fluoxetine may experience delayed ejaculation
C sexual interest can be reduced by benperidol
D chlorpromazine may cause galactorrhoea in women
E libido can be reduced by digoxin therapy

2. Useful treatments for:

A erectile dysfunction include intrapenile injections of dobutamine
B premature ejaculation include the squeeze technique
C homosexuality include electric shock therapy
D vaginismus include the 'stop-start' technique
E premature ejaculation include fluoxetine

Answers

1. All true.
2. A=F, B=T, C=F, D=F, E=T.

Useful Addresses

Institute of Psychosexual Medicine, 11, Chandos Street,
Cavendish Square, London, W1M 9DE. Tel: 0171-580-0631

Relate, Herbert Gray College, Little Church, Rugby, CV21
13AP. (Look in UK telephone directory for local address/telephone
number).

References and further reading.

American Psychiatric Association, (1994). Diagnostic and
Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV).
Washington,
APA.

Bancroft, J. (1989) Human sexuality and its problems. 2nd
Edition. Edinburgh, Churchill Livingstone.

Covington, S. (1991) Awakening your sexuality. San Francisco,
Harper SanFrancisco.

Cranston-Cuebas, M A, Barlow, D H. (1990) Cognitive and
affective contributions to sexual functioning. Annual Review of Sex
Research. 1,119-162.

Fisher, R, & Brown S. (1988) Getting Together. Boston,
Houghton-Mifflin.

Frank, E, Anderson, C & Rubinstein D. (1978) Frequency of
sexual dysfunction in 'normal' couples. The New England Journal of
Medicine, 299, 111-115.

Green, R. (1985) Gender identity in childhood and later
sexual orientation: follow-up of 78 males. American Journal of
Psychiatry. 142, 339-341.

Haas, K & Haas, A, (1993) Understanding Human Sexuality,
St. Louis, Mosby.

Kinsey A C, Pomeroy W B, Martin C E (1948) Sexual behaviour
in the human male. Philadelphia, Saunders.

Kinsey A C, Pomeroy W B, Martin C E, Gebhard P H. (1953)
Sexual behaviour in the human female, Philadelphia, Saunders.

Lipsius, S H. (1987) Prescribing sensate focus without
proscribing intercourse. J-Sex-Marital-Ther. 13(2): 106-16

Masters W H, Johnson V E. (1970) Human sexual inadequacy.
London, Churchill.

Mathers, N, et al. (1994) Assessment of training in
psychosexual medicine. BMJ, 308, 969- 972.

Pollack-MH; Reiter-S; Hammerness-P (1992) Genitourinary and
sexual adverse effects of psychotropic medication.
Int-J-Psychiatry-Med. 1992; 22(4): 305-27

Walbroehl-GS (1987) Sexuality in the handicapped.
Am-Fam-Physician. 36(1): 129-33

Wyatt-GE; Peters-SD; Guthrie-D (1988) Kinsey revisited, Part
I:
Comparisons of the sexual socialization and sexual behavior
of white women over 33 years. Arch-Sex-Behav.17(3): 201-39

Penile Prostheses (Implants)

2008-11-02T09:47:00.000-08:00

The concept of the penile prosthesis dates back to early times when it was noticed that several species of animals had what was termed as an os penis or biaculum. This is a cartilaginous support noted to keep the penis erect. The first penile prosthesis was actually a rib graft implanted into the corporal body.

The recent history of penile prosthesis dates back to 1950, when Dr. Scardino implanted the first synthetic material into the penis. Penile implants improved dramatically with subsequent work of many investigators, and penile implant surgery has progressed to a very high level.

The indications and contraindications for penile implant surgery include vascular disease, diabetes, bladder or prostate cancer surgery or for benign prostate disease, Peyronie's disease, neurologic disease, hypogonadism, pelvic fractures and impotence related to many medical diseases including chronic renal disease, alcoholism, multiple sclerosis, genital trauma, Parkinsonism, drug therapy.

Some of the relative contraindications for penile implant include a poorly controlled diabetic, mostly because of the patient's high susceptibility to infection and significant symptoms of bladder outlet obstruction because a prosthesis
can cause a relative increase in the outflow obstruction and, thereby, produce urinary retention.

When choosing a penile prosthesis, it is important to recognize the major categories. These include:

1) rigid, semi-rigid and malleable rods, which produce varying degrees of rigidity and

2) inflatable prostheses which include two types; a) the multi-component inflatable prosthesis, and b) the self contained inflatable prosthesis. The main objective is to leave the patient with a penis that when sexual intercourse is desired it is
achieved with no complications and with a penis that satisfies both him and his partner.

There is no single penile prosthesis that is best for all patients. It is, therefore,
imperative that the urologist sit down and very carefully review the risks, benefits, and drawbacks to each of the different types.

When discussing the semi rigid prosthesis, the balance sheet includes an erection sufficient for penetration. This is termed axial rigidity in the urologic spectrum and means the amount of torque that can be placed on the penis. Most of the rigid prostheses are associated with a low mechanical failure rate because there really are no moving parts and a fairly simplistic implantation is possible. The down side
is that they produce an erection that may be noticeably unsightly, and because these are the most obstructing of the devices can interfere with urination. Also prostate surgery if needed in the future can be very difficult in this situation. The rigid protheses is however good for men with poor hand mobility, who are relatively elderly, or who do not wish to have the increased risk of malfunction because there are more moving parts.

The one-piece inflatable penile prosthesis offers a compromise between the multi-component inflatable and the semi-rigid device. The downside to this device is that it can sometimes be difficult to manipulate. It doesn't get as erect as the rigid and it doesn't deflate as much as the multi-component inflatable. Additionally,
this device is very limited to the "average size penis," and if the patient has an extremely long penis is not an adequate device.

The multi-component inflatable prosthesis is what we term the "Cadillac" device. It gives the best appearance when erect and is the softest when deflated. It is probably the most popular and there are several major manufacturers including
American Medical Systems and Mentor.

Several penile prostheses are no longer in vogue and do not have a place in modern implant surgery.

The small carrying prosthesis introduced in 1973 was available in numerous sizes and lengths was a reasonable device, but really failed to produce the axial rigidity necessary for intercourse and was supplanted by better models.

The Jones Prosthesis was a malleable rod consisting of an outer silicone shell and silver wires and a twisted configuration that allowed some degree of torquing and thus causes some loss of axial rigidity. This was implanted with a trimable version to ensure adequate sizing.

American Medical Systems introduced the malleable prosthesis. This gives a very adequate erection, but one that can be very unsightly. That the normal erection
is a hydraulic event was really the rationale behind the inflatable device. It has three pieces including a reservoir to store the fluid, cylinders, and a pump which is placed in the scrotum. The pump transfers fluid from the reservoir into the cylinders, thus creating erection and when one desires to end the erection this process is reversed with a releaser deflate valve.

Another American Medical Systems product is the controlled expansion inflatable penile prosthesis which increases the actual rigidity. It has reinforced non-kinking tubing, revised pump, and a rear-tip system to allow adequate sizing. Mentor also
has an inflatable prostheses with both a two-piece and three-piece inflatable prostheses.

The type of surgery used for the implant is generally left to the surgeon's experience and type of device, but can include:

1) a perineal approach which is under the scrotum;
2) a penoscrotal approach which is at the base of the penis on top of the scrotum,
3) the protheses may be placed in the penile shaft, or
4) an infrapubic incision, which is an incision above the penis.

There are advantages and disadvantages to each device, and the most important part of penile prosthesis includes the proper selection of length and diameter to fit the corpus cavernosum, general dilation of the corporal body to avoid perforation proximally, with meticulous attention to detail to avoid infections, including preoperative preparation, intraoperative antibiotics, and copious irrigation during the procedure.
Complications of the penile implant include infections, which can be disastrous and treating an infected prosthesis actually can exceed the cost of the original prosthetic implant. Attempts to avoid infection include use of a surgical
bubble system to prevent particles and bacteria from getting access to the device.

Other complications include perforation of the corporal body which is the area where the prosthesis is held which can cause migration of the device. Management for this includes creating a Dacron graft to prevent migration. Perforation into the
urethra or glans penis can be disastrous and any perforation to a potentially infected area, such as the urethra, should require termination of the procedure.

Other problems include tubing kinks, fluid leaks, aneurysm, dilatation of the cylinders, breakage of the wire, the Silicone spillage, loss of rigidity to the prosthesis, erosion of the reservoir, spontaneous deflation, spontaneous inflation, penile curvature, which is a variant of Peyronie's disease, pump or pump reservoir
migration, phimosis, paraphimosis, things that go along with circumcisions.
All of these can be tremendous problems during the placement of a penile implant.

Male Sexuality and Impotence: "How's your love life?"

2008-11-02T09:37:00.000-08:00

"How's your love life?"

That's a question many of us have heard, often in a casual, off-handed way. But if we're having problems with sex, it's not a joking matter. And the fact is, a lot more of us are having trouble than most people imagine.

The latest statistics suggest that as many as one out of ten adult American males have problems with sexual inadequacy. Among certain groups the percentage is even higher. For example, adult male diabetics may have erection problems up to 50% of the
time. Men with disorders of the arterial system heart disease, hypertension and vascular disease may have an even higher likelihood of being unable to function well sexually.

In some men, the problem is a complete inability to get an erection. The system simply does not work. More often, the problem is a partial one. A man cannot depend on an erection each time he wants one, the erection is not hard enough, or the
erection does not last long enough for mutual satisfaction. In these situations, sexual intercourse can present insurmountable difficulties, and attempts at it can be the source of anxiety and unhappiness. Of course, this affects not only the men, but their partners as well.

What we are talking about here is impotence. Not only is impotence more common than most of us suppose, but nowadays it is much more treatable than ever before. The first step is to take a good look at our own situation. If there's a problem, ignoring it won't help.

In this post we'll examine how men are able to achieve erections, and we'll try to shed some light on why some men cannot function well. We'll discuss what can be done to correct serious problems and then we'll consider some simple ways to make sex more exciting, more satisfying and more enjoyable for both parties.

How does a man have an erection?

In the human body, male or female, there's no other organ that works the way the penis does. When a man is sexually aroused, his penis changes from a limp phase to become longer, wider and heavier. Most importantly, it becomes firm or rigid,
allowing penetration to occur. For both men and women, of course, this process provides a high degree of pleasure.

First, let's take a look at how the penis functions when we are not sexually aroused.
In this state, a small amount of blood trickles into the penis, bathing the spongy tissues in the two erectile chambers of the penis, which are called the corpora cavernosa (literally, "spacious bodies.") There is just enough blood flow to furnish
oxygen and nutrients to the tissues. The blood then readily leaves the corpora through tiny veins, and returns to general circulation. Since there is little pressure in the spongy tissues, the corpora are not filled out, and the penis is limp.

The process by which a man gets an erection depends on increasing the blood flow into the chambers of the penis, and then trapping the blood inside. This fills and expands the spongy tissues and causes the entire penis to become firm.

But what makes more blood flow in? This is the role of sexual stimulation or "arousal." All forms of sexual stimuli work through the nervous system, and they depend to some degree on testosterone, the principal hormone made by the testicles.
Testosterone is necessary for male sexual functioning. Without sufficient quantities of this hormone, men cannot be sexually stimulated, nor can the internal structures of the penis function properly.

So, when testosterone is present in sufficient quantity, a man can be "turned on" by any number of stimuli. For example, the stimuli can be visual, they can be tactile (touch), they can be sheer fantasy or even certain fragrances. The brain sends a
series of nerve signals to the penis and, under ordinary conditions, an erection develops. The proper nerve signals cause the tiny arteries bringing blood to the penis to widen, allowing more blood to enter. These same nerve signals also cause the muscular walls of the spongy tissues to relax. Then, as the spongy tissue fills with more blood under pressure, the tiny thin-walled veins leading blood out of the penis are squeezed shut. The spongy tissue and the corpora cavernose actually beings to trap blood inside itself. To bring about real rigidity, we require one more anatomical component, the muscles located at the base of the penis. When the penis is stimulated during sexual activity, these muscles contract. They squeeze the corpora and raise the pressure inside to the point of rigidness.

What causes erection problems?

Even from that simple overview, you can see that for the penis to do its job, a lot must happen. We need the proper stimulation from the brain and nervous system. Male hormones must be secreted in the right way and in the correct amount. Most importantly, the heart must pump blood through the arteries to the penis and certain muscles and tissues must respond in very precise ways to make certain that blood does not escape too readily.

With all these physical factors at work, it may seem odd that until fairly recently, many doctors believed that impotence was all or mostly "in the mind." A popular home medical guide published in 1973 deals with impotence under "Emotional and Mental Illness" and mentions only "counseling or psychiatric help" as treatment.
Today we have a better understanding of the physiology involved. We find that although psychological factors often come into play, by far the most common causes of impotence are physical parts of our body are not working the way they should
be. Nowadays there are specialists, usually urologists, who can treat many of these conditions. The majority of patients can be restored to sexual potency. The type of treatment, of course, depends on the precise cause of the problem and on the motivation of the patient.

We have seen how an erection depends on the flow of blood. Consequently, it is easy to understand how any problems with the blood flow not enough blood entering the penis or blood flowing out too quickly can seriously affect our ability to achieve and sustain an erection.

Why do diabetics suffer from impotence?

Just one year after Sidney M. found out he was diabetic, he began having difficulties in sexual intercourse. At first, he noticed that his erections were less firm. Soon he could not maintain an erection long enough to satisfy himself or, for that matter, his wife June. Eventually, both husband and wife realized that Sidney had become impotent. At this point, they sought help from a urologist
specializing in sexual dysfunction. When the evaluation was completed, the doctor determined that the cause of Sidney's impotence was his diabetes.

Men with diabetes often have a malfunction of both the nerves and the blood vessels involved in the erection process. Not only may the signals that stimulate the penis not arrive properly, but the blood vessels bringing blood to the male sexual organs may be blocked. In addition, current research shows that the trapping mechanism which keeps the blood from leaving the penis too quickly is very sensitive to blood vessel damage of the type found among diabetics.

What drugs are available to treat impotence?

Papaverine is a medication commonly used by vascular surgeons to prevent spasm in tiny blood vessels. It has also become a common treatment for impotence. Papaverine increases blood flow in the penis and helps to trap blood inside the erection chambers. Self-injection therapy with this drug (and with Prostaglandin-caverject) has revolutionized the treatment of impotence for men with diabetes as well as a variety of other physical disorders.

This new form of treatment, Pharmacologic Erection Therapy, was selected by Sidney and his wife in consultation with the urologist. Just before having sex, Sidney injects himself with a dose of the medication directly into the penis. With sexual
stimulation, he is able to achieve a quite normal and satisfying erection, and he becomes capable of having intercourse. Sidney and June are often able to achieve a satisfying climax together because Sidney's erection lasts until the medication's effect wears off, usually up to a half hour. Since he had already learned to use insulin to treat his diabetes, Sidney was easily able to adapt a very similar technique to administering Papaverine. He and June now have intercourse on average once or twice weekly. In his words, "Sex has not been this satisfying for either of us in ten years!"

Sexual dysfunction in men may also be caused by cardiac and peripheral vascular disorders, high blood pressure and its treatment, hormone imbalances and emotional difficulties. These, in turn, may accompany diabetes.

Despite Sidney's success, not every man is a suitable candidate for self-injection therapy. The treatment demands motivation and careful attention to injection technique. There are potential side effects, which include infection, scarring of
the penile chambers, and even a painful prolonged erection. In addition, Pharmacologic Erection Therapy will not work in all cases. There are also many individuals and couples who feel that this technique is not spontaneous enough for their needs and desire a more permanent means of overcoming impotence. Medical
science is constantly exploring new treatments for impotence and your doctor may be aware of some of the medications which can be effective in treating this condition.
The bark of a tropical tree yields a drug called Yohimbine, which can also help certain men by increasing penile blood flow and improving the "venous trapping mechanism". Yohimbine tablets have improved sexual functioning in many men, usually in situations where the loss of sexual function is only partial.

In a few cases, hormone therapy may be advised. If blood tests show elevated levels of prolactin, there is medication to control this erection-inhibiting hormone. For those with low testosterone levels, supplemental injections may be considered.
However, the potential of harmful effects is considerable, so testosterone therapy is only rarely recommended.

Is there an external therapy for impotence?

One of the more recent and popular methods of dealing with an erection problem is with an External Vacuum Device. Quite simply, this is a plastic cylinder with a hand pump attached. The limp penis is placed inside the tube, then air is drawn out
through the pump. Creation of a vacuum outside the penis allows blood to rush in and fill the corpora cavernosa. A tension ring is placed around the base of the penis to maintain rigidity for up to 30 minutes.

Thousands of men have used external vacuum devices, and many with good success. But, they are not suitable for everyone. For example, this technique is not recommended for men who have had injuries to the penis, sickle cell disease, leukemia, pelvic
infections or blood clotting difficulties. Some men as well as their partners object to the limits it may place on foreplay and romance. Still, external vacuum devices are usually safe, relatively inexpensive and simple to use.

Are there permanent solutions to impotence?

Sometimes simple treatments are unsuccessful. At other times, men are dissatisfied with non-surgical solutions. In such cases, the best course is usually a Penile Implant. Also called a penile prosthesis, an implant is surgically placed into the corpora chambers of the penis. It provides enough firmness and substance to the penis so that a man can engage in satisfactory sexual intercourse. In general, the sensations surrounding sexual activity do not change after an implant, nor does
a man's ability to achieve climax and ejaculation. The erection resulting from an implant is very similar to a natural one, and the devices are not visible at all from the outside.

Most penile implant surgery is now done on an outpatient basis, though some may require a day or two in the hospital. The recovery period until a man can resume sexual relations is usually about six weeks. Currently available devices have been
found to be quite safe and reliable. Urologists who specialize in this form of therapy can provide guidance in choosing the type that will be best for a particular individual. More than a dozen different penile prosthetic devices are available, falling into four general types.

Fully Inflatable Implants have an action that most closely mimics normal sexual activity. They provide the best overall results and the greatest degree of patient satisfaction. However, they are slightly more complicated and more difficult to
install.

The surgeon places two balloon cylinders within the penis and a small pumping mechanism inside the scrotum. In addition, a fluid reservoir must be implanted, either in the abdomen or the scrotum, and these units must be connected by tubing.
To achieve an erection, the man squeezes the pump, which sends fluid from the reservoir into the balloon cylinders. The cylinders expand within the corpora, and the penis becomes erect. At the end of sexual activity, the pump is activated again and the fluid returns to the reservoir, returning the penis to its
limp state.

The Self-Contained Inflatable Implant works more or less the same way, except that all the parts are contained in one unit. One device is implanted into each corpora cavernosa. When the pump is squeezed, the unit becomes rigid. Pressing the release
valve returns the fluid to its reservoir and the penis once again becomes flaccid.
Unlike the fully inflatable implant, the self-contained unit will not expand the girth (width) of the penis. However, its rigidity is quite sufficient for effective intercourse. The surgery is slightly less extensive and patient satisfaction is
excellent. Finally, the most simple and least expensive prosthesis is the Semi-Rigid Implant. These devices are non-inflatable and non-expandable, and easiest to implant. They produce a satisfactory erection and most patients are very pleased with the result.

Implant therapy is usually covered by insurance plans and Medicare as long as an underlying physical cause of impotence can be demonstrated. The overall success rate for implants is well over 90 percent, and most men have no change in sensation, orgasm or ejaculation. Men are usually able to resume intercourse four to six weeks after surgery.

A newly developing area for treatment of impotence is Penile Vascular Surgery. In carefully selected individuals, it may be possible to actually increase the amount of blood flowing into the penis, bypassing obstructions in the arteries. In other
cases, the goal of surgery is to decrease the flow of blood leaving the penis by tying off certain veins. These two surgical procedures are the subject of much current research and may hold a good deal of hope for the future.

What can I do to make sex better?

Men who are even slightly impotent want to improve their sexual function. This can lead to fear of failure. Sometimes their partners' expectations create tension or anxiety. Depression, stress and marital problems all can affect our ability to perform sexually. While most impotence is caused by physical factors, psychological factors almost always come into play, sooner or later.

For that reason, whether or not we require medical treatment, we need to examine the way we approach sex and whether our lifestyles should be changed to improve our sex lives. Especially for men and women over 40, these are vital steps to achieving satisfying sex and improved relationships. Cut out smoking. Tobacco constricts blood vessels and the long-term affects of smoking affect all of the tiny blood vessels
in the body. An unusually high percentage of men seeking treatment for impotency are smokers.

Drink less alcohol. Heavy drinking is likely to produce impotence, sterility or loss of sexual desire in men. Alcohol does not improve an erection, it prevents one. With increasing age, it takes smaller amounts to affect us. Look into the prescription and non-prescription drugs you may be taking. Blood pressure medications are particularly prone to reducing our ability to have an erection. Antidepressants,
antihistamines and some ulcer medications also inhibit erections. In most cases, doctors can prescribe alternative medications that will improve your sexual functioning.

Relax and have fun with sex. Take a warm bath, maybe with your partner. Try different positions for sex and you'll find that some lead to better erections. Ask your wife or lover for more stimulation, something that older men naturally require for an erection. Avoid sex when you're tired or tense. Try different times (especially mornings) and places for sex. Get in the mood by combining relaxation and stimulation. Get regular exercise.

Urologists are all-too-often consulted by patients who feel despondent because they've been unable to have intercourse for years. They've been too embarrassed or afraid to discuss their impotence. But thanks to recent medical progress there are ways to treat almost every erection problem, no matter how long it's been present. With the wide range of treatments available to us now, it's almost a sure bet that a man's sexual function can be restored.

Management of Sexual Dysfunction Associated with Antidepressants: Drug Holidays

2008-11-02T08:56:00.000-08:00

KEY POINTS

o · Drug holidays in which the antidepressant is discontinued 2 to 3 days prior to sexual activity is more successful with drugs that have a short half-life.

o · Clinicians should ask specifically about sexual desire, sexual enjoyment, erectile problems, erections unrelated to sexual activity, capacity to reach orgasm, changes in capacity to reach
orgasm, and painful orgasm.

o · Antidepressants also have been used to treat some sexual dysfunctions, such as premature ejaculation.

Tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) have been used in psychiatry and other disciplines for almost 4 decades. Antidepressants were originally reserved for serious cases of depression. Selective serotonin reuptake inhibitors (SSRIs) were introduced into clinical psychiatry about 10 years ago. The use of SSRIs, along with advances in clinical
psychopharmacology research and the decrease in payments for psychotherapy by third-party payers, have to some extent revolutionized the field of clinical psychopharmacology. Since
these times, psychiatrists and primary care doctors have started to treat disorders that were once considered the domain of psychotherapy, such as dysthymia and some anxiety disorders, with antidepressants.

We have been treating patients mostly in the outpatient setting. The results of well-designed, long-term studies have helped to define the duration of treatment of an episode of depression.1,2

We now continue antidepressant treatment for about 6 months following remission, using the dosage that was effective in the acute phase. Clinical psychopharmacologists have also become more aware of various side effects, reasons for noncompliance, and quality-of -life issues during treatment with antidepressants. One such side effect is sexual dysfunction. Changes in sexual
functioning can occur with various mental disorders, such as depression, and can also result from antidepressant therapy (see Table 1).

The effects of psychotropic medication on sexual functioning have been the subject of various excellent reviews.3-6 Drugs used for treating depression have been implicated in sexual dysfunction with increasing frequency, and changes in sexual functioning havebeen reported with almost all the antidepressants (see Table 2). Estimates of the incidence of treatment-emergent sexualdysfunction with antidepressants vary from 1.9% (Physicians Desk Reference, for fluoxetine) to over 90% (see Table 3). This vast range is probably at least partially a reflection of the lack ofattention to sexual side effects in previous studies and the lack of thorough and uniform methodology in current studies focused on sexual dysfunction caused by antidepressant therapy. The majorityof studies have been nonsystematic. For example, some described sexual dysfunctions that were reported spontaneously, some described sexual dysfunction after patients were asked about it in a systematic way, and some studies used questionnaires.

Frequently, changes in sexual desire were not elicited. Serial questioning about sexual dysfunction during the course of pharmacotherapy has also not been used. Our understanding of the biology of normal sexual functioning and of mechanismsof action of antidepressant-induced sexual dysfunction is rather poor. Various neurotransmitter systems (adrenergic, dopaminergic, serotonergic, muscarinic) seem to be involved in the biology of normal sexual response and activity, centrally and peripherally.3,5 None of these systems should be solely implicated, and interactions on central and peripheral levels are likely. Some other neurotransmitters, such as acetylcholine, probably play a mediating role as well.5

Interestingly, a correlation between sexual dysfunction and the anticholinergic effects of antidepressants was not observed in one study.11 Sexual hormones and other substances (eg, vasoactive intestinal peptide) probably have at least a modulating role.

Administration of drugs influencing various neurotransmitter systems, such as antidepressants, could affect sexual functioning in different ways. Various sexual dysfunctions are the most frequently observed effects, but occasional improvement of sexual functioning with antidepressants14 or unusual sexual experiences15 have been reported. Antidepressants also have been used to treat some sexual dysfunctions, such as premature ejaculation.16 Obviously, antidepressants can cause various changes in sexual functioning (see Table 4).

Sexual dysfunction has been a frequently mentioned cause of noncompliance with antidepressant therapy, but this issue has not been systematically studied. Rabkin et al17 reported four cases of discontinuation of monoamine oxidase inhibitors (MAOIs), but only one case was solely due to sexual dysfunction, without any other major side effects. Other reports of noncompliance because of sexual dysfunction are anecdotal. Nevertheless, antidepressant-induced changes in sexual functioning pose a difficult and interesting clinical problem, in part because of the possibility of noncompliance.

Diagnosis of Sexual Dysfunction

The first two steps in the management of sexual dysfunction are (1) recognition or identification of the dysfunction, and (2) patient education. A baseline assessment of sexual functioning is absolutely necessary. Without this there is nothing with which to compare recent sexual functioning, and the clinician is unable to determine accurately if the dysfunction is a new or an old phenomenon.

As shown in Table 1, various factors can contribute to sexual dysfunction; therefore, sexual dysfunction should not always be attributed to medication. It may be a component of depressive
symptomatology (decreased libido); it may be due to concomitant medical illness (impaired erectile capacity may be the first symptom of diabetes mellitus); it may represent primary sexual dysfunction (sexual desire disorders, sexual arousal disorders, orgasmic disorders, sexual pain disorders); or it may be a side effect of medication. Ruling out all other causes before

attributing the dysfunction to medication seems to be a prudent, but not always practiced, approach. Given the multiple possible sources of sexual dysfunction, caution should be used when determining etiology.

Skilled clinicians should ask very specific questions. General questions such as "How is your sex life?" are not enough because they often lead to nonspecific answers such as "All right," "OK,"

"No problem." These answers will not provide adequate baseline information for the assessment of possible future dysfunction.

Clinicians should ask specifically about sexual desire, sexual enjoyment, erectile problems, erections unrelated to sexual activity, capacity to reach orgasm, changes in capacity to reach orgasm, and painful orgasm. It is known that asking about sexual dysfunction elicits twice the incidence found when no questions are asked. A good psychosexual history should be a part of every initial evaluation.

Identification of antidepressant-induced sexual dysfunction can be a diagnostic challenge. Is the problem a true sexual dysfunction or has the patient mislabeled it? What type of dysfunction is involved? Is it a single dysfunction or a combination of dysfunctions? If a combination, which dysfunction is primary? Is the problem generalized or situational? Is it the result of a combination of medications? What is the patient's reaction to the dysfunction? Were comorbid conditions, substance abuse, and relationship problems considered?

Occasionally, other diagnostic procedures, such as physiologic tests of erectile capacity (nocturnal penile tumescence, visual stimulation method), tests of penile vascular competence,neurologic evaluation, and hormonal assessment, must be used.

Patient education about possible sexual dysfunction can be problematic. A good physician-patient relationship plays a significant role. Some clinicians advocate either no discussion of possible sexual dysfunction or a discussion with little emphasis on dysfunctions and their severity, because they do not want to discourage patients. However, some patients may be informed about this topic because of increased attention by the media or because of aggressive marketing strategies used by the pharmaceutical companies. Oc-casionally, pharmacists may discuss various side effects of antidepressants, including sexual dysfunction, with patients, or other patients share their experiences. At least some discussion of these problems is better than no discussion. Clinicians should also mention that various management options for antidepressant-induced sexual dysfunctions are available.

Management

Once the diagnosis of sexual dysfunction induced by an antidepressant is established, the clinician should carefully consider management options (see Table 5) and discuss them with the patient.

Waiting for Spontaneous Remission of Sexual Dysfunction

This might be considered a questionable approach. As with many other side effects of antidepressants, spontaneous remission or decrease in severity to a tolerable level is possible. Cases of spontaneous remission have been reported for some antidepressants, such as sertraline and phenelzine.18 However, spontaneous remission may occur only after several weeks or months, which may be too long for the patient to wait. This approach requires a very good physician-patient relationship. Also, it has not been reported to be effective for tricyclic antidepressant-induced anorgasmia.5

Reduction to the Minimal Effective Dosage

This approach may occasionally help, but it is also risky. Balancing between the minimal effective dose and a subtherapeutic dose can be precarious. The dose at which the dysfunction appears is frequently the lowest that alleviates depression. Some authors 19 have suggested that there is a relationship between sexual dysfunction and the dosage of fluoxetine. They observed an improvement of sexual dysfunction and no recurrence of depression when they decreased the dosage of fluoxetine to 20 mg every other day, and in some cases to 20 mg a week. Sexual dysfunction associated with venlafaxine also showed a dose relation in one study.20 Despite the potential double-blind nature of dose reduction, it has been frequently recommended in erectile dysfunction.

Drug Holidays

A variant of dose reduction, the drug holiday approach requiresthat the antidepressant be discontinued 2 to 3 days prior to sexual activity. The success of this approach depends oncareful planning and a comfortable physician-patient relationship. It is probably more successful with drugs that have a short half-life, such as paroxetine and sertaline, and may be difficult with long half-life drugs, such as fluoxetine. Again, worsening of depressive symptomatology may complicate this practical alternative for management of sexual dysfunction associated with antidepressants.

Switching to Another Antidepressant

Several reports in the literature have described successful substitution of desipramine for imipramine or clomipramine, imipramine for amoxapine, and nortriptyline for imipramine or doxepin. This approach may take a long time and its success may be hindered by relapse of the depressive disorder.

Several studies report no sexual dysfunction with bupropion. In one study,21 24 of 28 patients who reported sexual dysfunction on various antidepressants reported resolution of their sexual dysfunctions when switched to bupropion. Another study reported significant improvement of fluoxetine-associated sexual dysfunction in patients who were switched to bupropion.22

However, caution is needed because one unpublished report has noted sexual dysfunctions in patients treated with the sustained-release form of bupropion.23 With nefazodone, the newest antidepressant available in the United States, there have been no reports of sexual dysfunction to date, and in some clinical trials, the incidence of sexual dysfunctions was found to be equivalent for nefazodone and placebo.

Using Secondary Pharmacologic Agents

Numerous pharmacologic agents have been successfully used in the "treatment" of sexual dysfunctions induced by antidepressants. These include bethanechol (30 mg, 1 to 2 hours before coitus),24 cyproheptadine (4 to 12 mg, 1 to 2 hours before coitus; caution patient that severe sedation or depression may occur),25, 26 yohimbine (5.4 mg tid or prn 2- to 4 hours before coitus; caution patient that yohimbine may induce anxiety),9,27 neostigmine (7.5 to 15 mg, 30 min before coitus), amantadine (100 mg one or twice daily up to 600 mg),28 bupropion (75 mg/day with fluoxetine),29 buspirone (30 mg/day or more with various SSRIs),30 dextroamphetamine (10 to 25 mg/day), and pemoline (18.75 mg/day).31 Other reportedly used agents include methylphenidate, trazodone, and bromocriptine.

Vacuum Erectile Devices

Use of vacuum erectile devices and injection of agents into the corpus cavernosum are specialized procedures that are best handled by urologists.

Matching Therapy to Type of Sexual Dysfunction

There are various treatment strategies for different types of drug-induced sexual dysfunction. In the case of decreased libido, drug holidays, the addition of neostigmine, or the substitutionof another drug such as bupropion or nefazodone may be effective.

For erectile problems, dose reduction, drug holidays, coadministration of bethanechol, or substitution of another drug may be tried. Orgasmic dysfunction may be resolved by waiting for spontaneous remission, or by drug holidays, coadministration of another drug, or substitution of another drug.

Two important additional points are the following:

1. Only tentative conclusions about the efficacy of the above treatments can be drawn because most of the literature in this area consists of case reports or series of cases.6

2. Priapism (abnormal, persistent, usually painful erection unrelated to sexual arousal) constitutes a urologic emergency. Priapism has been reported with trazodone and various other psychotropic drugs.

Positive Effects of Antidepressants on Sexual Function

Antidepressants do not necessarily adversely affect sexual functioning. A few cases of "improved" sexual functioning have been reported. Smith and Levitte reported a return of sexual potency in three elderly men treated with fluoxetine.14 Others32 described an elderly male who developed "orgasmic sensations" on fluoxetine. Orgasms associated with yawning in patients treated with clomipramine and fluoxetine have also been reported.

Trazodone has been used to treat impotence. Lal and colleagues33 described the case of a psychiatrist who successfully treated his own impotence with trazodone, 250 to 350 mg prior to coitus once a week for 4 years. Montorsi and colleagues34 reported that the combination of yohimbine (15 mg/day) and trazodone (50 mg/day) is a safe and effective first-line treatment for psychogenic impotence.

As already noted, one side effect of antidepressants p; delayed or inhibited ejaculation p; has been used for treatment of primary premature ejaculation. Some case reports have described improvement of premature ejaculation with selective serotonin reuptake inhibitors, such as sertraline35 and fluoxetine.36 Controlled studies have reported greater clinical improvement of premature ejaculation with clomipramine compared with placebo37 (25 or 50 mg/day; the higher dose produced a longer time toejaculation), and paroxetine compared with placebo.16

Conclusion

The effects of antidepressants on human sexuality are complex. The etiologic mechanisms of sexual dysfunctions are unclear and intricate. The diagnosis and management of sexual dysfunction induced by these agents is a challenging clinical issue requiring a good physician-patient relationship, keen and skillful observation, and a certain degree of creativity and patience.

Most effects of antidepressants on human sexuality are adverse, but some effects are beneficial p; for example, antidepressants can be used for the treatment of premature ejaculation.

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Glossary

Anorgasmia p; Inability to achieve orgasm, absence of orgasm. Drug holidays p; Regular periods during which the patient is not given medication.

Impaired erectile capacity p; Persistent or recurrent inability to attain or to maintain an adequate erection, until completion of the sexual activity.

Libido p; Sexual desire, drive, interest.

Priapism p; Persistent penile erection accompanied by severepain.

Primary sexual dysfunction p; Disturbance in sexual desire and in the psychophysiological changes that characterize the sexual response cycle causing marked distress. The term primarily refers to etiology.

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References:

1. Frank E, Kupfer DJ,Perel JM, Cornes C, Jarrett DB, Mallinger AG, Thase

ME, McEachran AB, Grochocinski VJ. Three-year outcomes for maintenance

therapies in recurrent depression. Arch Gen Psychiatry. 1990; 47:

1093-1099.

2. American Psychiatric Association. Practice guidelines for major

depressive disorder in adults. Am J Psychiatry. 1993; 150 (suppl): 1-26.

3. Segraves RT: Effects of psychotropic drugs on human erection and

ejaculation. Arch Gen Psychiatry 1989; 46: 275-284

4. Tone BK. Sexual dysfunction. In: Keshavan MS, Kennedy JS (Eds.).

Drug-induced dysfunction in psychiatry. Hemisphere Publishing Corp., New

York-Washington-Philadelphia-London. 1992; pp 273-280.

5. Segraves RT. Overview of sexual dysfunction complicating the treatment

of depression. J Clin Psychiatry Monograph Series. 1992 (53); 10:2:4-10.

6. Gitlin MJ. Psychotropic medications and their effect on sexual function:

Diagnosis, biology, and treatment approaches. J Clin Psychiatry. 1994; 55:

406-413.

7. Zajecka J, Fawcett J, Schaff M, Jeffriess H, Guy C. The role of

serotonin in sexual dysfunction: fluoxetine-associated orgasm dysfunction.

J Clin Psychiatry. 1991; 52: 66-68.

8. Herman JB, Brotman AW, Pollack MH, Falk WE, Biederman J, Rosenbaum JF.

Fluoxetine-induced sexual dysfunction. J Clin Psychiatry. 1990; 51: 25-27.

9. Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of

yohimbine. J Clin Psychiatry. 1992; 53: 119-122.

10. Harrison WM, Rabkin JG, Ehrhardt AA, Stewart J, McGrath P, Ross D,

Quitkin FM. Effects of antidepressant medication on sexual function: a

controlled study. J Clin Psychopharmacology. 1986; 6: 144-149.

11. Balon R, Yeragani VK, Pohl R, Ramesh C. Sexual dysfunction during

antidepressant therapy. J Clin Psychiatry. 1993; 54: 209-212.

12. Couper-Smartt JD, Rodham R. A technique for surveying side-effects of

tricyclic drugs with reference to reported sexual effects. J Int Med Res.

1973; 1: 473-476.

13. Monteiro WO, Noshirvani HF, Marks IM, Lelliott PT. Anorgasmia from

clomipramine in obsessive-compulsive disorder: a controlled trial. Br J

Psychiatry. 1987; 151: 107-112.

14. Smith DS, Levitte SS. Association of fluoxetine and return of sexual

potency in three elderly men. J Clin Psychiatry. 1993; 38: 317-319.

15. McLean JD, Forsythe RG, Kapkin IA. Unusual side effects of clomipramine

associated with yawning. Can J Psychiatry. 1983; 28: 569-570.

16. Waldinger MD, Hengeveld MW, Zwinderman AH. Paroxetine treatment of

premature ejaculation: a double-blind, randomized, placebo-controlled

study. Am J Psychiatry. 1994; 151: 1377-1379.

17. Rabkin JG, Quitkin FM, McGrath P, Harrison W, Tricamo E. Adverse

reactions to monoamine oxidase inhibitors. Part II. Treatment correlates

and clinical management, J Clin Psychopharmacology. 1985; 5: 2-9.

18. Nurnberg HG, Levine PE. Spontaneous remission of MAOI-induced

anorgasmia. Am J Psychiatry. 1987; 144: 805-807.

19. Benazzi F, Mazzoli M. Fluoxetine-induced sexual dysfunction: A

dose-dependent effect? Pharmacopsychiat. 1994; 27: 246.

20. Mendels J, Johnston R, Mattes J, Riesenberg R. Efficacy and safety of

b.i.d. doses of venlafaxine in a dose response study. Psychopharmacology

Bulletin. 1993; 29: 169-174.

21. Gardner EA, Johnston JA. Buproprion - an antidepressant without sexual

pathophysiological action. J Clin Psychopharmacology. 1985; 5: 24-29.

22. Walker PW, Cole JO, Gardner EA, Hughes AR, Johnston JA, Batey SR,

Lineberry CG. Improvement in fluoxetine-associated sexual dysfunction in

patients switched to buproprion. J Clin Psychiatry. 1993; 54: 459-465.

23. Fossey MD, Hammer MB. Male sexual dysfunction induced by buproprion

sustained release. Presented at the 147th Annual Meeting of the American

Psychiatric Association, Philadelphia, May 21-26, 1994.

24. Yager J. Bethanechol chloride can reverse erectile and ejaculatory

dysfunction induced by tricyclic antidepressants and mazindol: case report.

J Clin Psychiatry. 1986; 47: 210-211.

25. Steele TE, Howell EF. Cyproheptadine for imipramine-induced anorgasmia.

J Clin Psychopharmacology. 1986; 6: 326-327.

26. Arnott S, Nutt D. Successful treatment of fluvoxamine-induced

anorgasmia with cyproheptadine. Br J Psychiatry. 1994; 164: 838-839.

27. Hollander E, McCarley A. Yohimbine treatment of sexual side effects

induced by serotonin reuptake blockers. J Clin Psychiatry. 1992; 53:

207-209.

28. Shrivastava RK, Shrivastava S, Overweg N, Schmitt M. Amantadine in the

treatment of sexual dysfunction associated with selective serotonin

reuptake inhibitors. J Clin Psychopharmacology. 1995; 15: 83-84.

29. Labatte LA, Pollack MH. Treatment of fluoxetine-induced sexual

dysfunction with buproprion: A case report. Annals of Clinical Psychiatry.

1994; 6: 13-15.

30. Norden MJ. Buspirone treatment of sexual dysfunction associated with

selective serotonin re-uptake inhibitors. Depression. 1994; 2: 109-112.

31. Gitlin MJ. Treatment of sexual side effects with dopaminergic agents. J

Clin Psychiatry. 1995; 56: 124.

32. Garcia-Campayo J, Sanz-Carillo C, Lobo A. Orgasmic sexual experience as

a side effect of fluoxetine: a case report. Acta Psychiatrica Scandinavica.

1995; 91: 69-70.

33. Lal S, Rios O, Thavundayil JX. Treatment of impotence with trazodone: a

case report. J Urology. 1990; 143: 819-820.

34. Montorsi F, Strambi LF, Guazzoni G, Galli L, Barbieri L, Rigatti P,

Pizzini G, Miani A. Effect of yohimbine-trazodone on psychogenic impotence:

a randomized, double-blind, placebo-controlled study. Urology. 1994; 44:

732-736.

35. Wise TN. Sertraline as a treatment for premature ejaculation. J Clin

Psychiatry. 1994; 55: 417.

36. Forster P, King J. Fluoxetine for premature ejaculation. Am J

Psychiatry. 1994; 151: 1523.

37. Segraves RT, Saran A, Segraves K, Maguire E. Clomipramine versus

placebo in the treatment of premature ejaculation: A pilot study. J Sex &

Marital Therapy. 1993; 19: 198-200.

Understanding Prostate Changes: Evaluating Prostate Health

2008-10-23T21:36:00.000-07:00

Digital Rectal Examination (DRE)

The standard technique for evaluating the health of the prostate is by a physical examination called a digital rectal exam (DRE). Typically, a patient is asked to bend forward over a table while the doctor inserts a gloved and lubricated finger (called a digit in the medical community) into the patient's rectum. This allows the physician to feel the back portion of the prostate gland. In addition to gauging the gland's size, the doctor is able to evaluate its firmness and texture. The doctor looks for answers to some key questions: Has its usual rubbery feel changed? Are there any hard areas or lumps, which could signal a cancer? Has a growth spread beyond the prostate?

Prostate-Specific Antigen (PSA)

This is a substance produced by cells of the prostate gland. PSA circulates in the blood and can be deducted and measured with a relatively simple blood test. When the gland enlarges, PSA levels rise. PSA levels can also rise if cancer develops.

Generally, doctors consider readings below four nanograms per milliliter (ng/ml) to be normal, scores between four and 10 to be slightly elevated, scores between 10 and 20 to be moderately elevated and anything above that to be highly elevated. Most men with Benign Prostatic Hyperplasia (BPH) have levels of 10 ng/ml or below.

But many factors can influence PSA levels. Some prostate glands naturally produce more PSA than others. PSA scores also tend to increase with age. Another influence on PSA levels is race: PSA levels tend to be higher in African Americans, and lower among Japanese, than in white Americans.

A variety of conditions can raise PSA levels temporarily. These include prostatitis, prostate biopsy and transurethral prostate surgery.

Transrectal Ultrasound (TRUS)

This procedure uses a small probe that is inserted into the rectum. The probe emits and picks up high frequency sound waves. The sound waves bounce off the prostate, producing a pattern that is converted into a video image. Areas of cancer produce a different pattern than healthy tissue. The value of a TRUS is strongly influenced by the quality of the equipment and the skill of the person operating it.

While ultrasound does not provide enough specific information to make it a good screening toll by itself, doctors find it useful as a follow up to suspicious DRE or PSA. TRUS is also used to guide biopsies in sampling abnormal areas of the prostate, to estimate the volume of the prostate for calculating PSA density and to situate radiotherapy implants.

Self Test for BPH

To help patients and their physicians assess the severity of BPH symptoms, the American Urological Association has developed a seven questions index:

Over the past month how often have you:

1.) Had a sensation of not emptying your bladder completely after urinating?
2.) Had to urinate again less than two hours after urinating?
3.) Found you stopped and started again several times during urination?
4.) Found it difficult to postpone urination?
5.) Had a weak urinary system?
6.) Had to push or strain to begin urination?
7.) Had to get up several times to urinate from the time you went to bed at night until the time you got up in the morning?

How to score:

For the first six questions, give yourself a score of 1 for having problems less than one time in five, a score of 2 for having problems less than half the time, a score of 3 for having problems about half the time, a score of 4 for having problems more than half of the time, and a score of 5 for having problems almost all the time.

For the seventh question, give yourself 1 for each time you got up in the night. (If you had to get up five times or more, use 5 for scoring.)

Symptoms are classified as mild if your score totals 1 to 7, moderate from 8 to 19 and severe from 20 to 35.

Beer in Moderation May be as Heart-healthy as Wine

2008-10-23T21:31:00.001-07:00

Drinking moderate amounts of wine, especially red, may lower the risk of heart disease, studies have shown. But researchers have not determined whether it's the alcohol or something else in wine that protects the heart.

So Dr. Martin Bobak of the University College London in England and colleagues compared the drinking habits of 735 healthy men with 206 men who had recently suffered a heart attack, in a population-based case-control study. They were between 25- and 64-years-old, lived in the Czech Republic, and drank on average 148 grams of alcohol per week. Beer was their beverage of choice, as opposed to wine or spirits, almost exclusively.

The researchers grouped the men according to their average weekly intake of beer: non-drinkers and those who drank less than about 18 grams of alcohol; men who drank between 18 to 144 grams; those who drank 145 to 324 grams; and men who consumed over 325 grams.

The men least likely to have a heart attack drank daily or almost daily, consuming four to nine liters of beer per week, which is 145 to 324 grams of alcohol (or about 15 beers a week at 12 ounces each), the researchers write in a letter in the May 20 British Medical Journal. "This was true even when men with a history of heart disease, stroke, diabetes, or cancer were excluded from the analysis," the researchers report.

As other studies have shown, heavy drinkers didn't benefit from alcohol. Men who drank twice a day had the same risk of having a heart attack as non-drinkers, the researchers report.

"These results support the view that the protective effect of alcohol intake is due to ethanol rather than to specific substances present in different types of beverages," the team concludes. For example, wine contains molecules called flavanoids that are thought to be cardioprotective.

Could people who drink alcohol have something in common that protects them against heart disease, other than their consumption of ethanol? "It is unlikely," Dr. Bobak told HeartInfo/Mediconsult. For one, many studies have ruled out other factors, such as diet. Secondly, "there is good experimental evidence that alcohol influences blood lipids and
blood clotting, both of which influence heart disease," he said. Alcohol may raise levels of HDL ("good") cholesterol.

Bad news for non-drinkers: the chemical characteristics of ethanol can't be added to pills, he said.

Commenting on the study, Dr. Andrew P. Levy, Medical Advisor for HeartInfo, says " It is true that alcohol in moderation appears to protect against heart disease. This may be due to the effect on blood lipids. But alcohol also raises blood pressure significantly, which increases the risk of stroke, heart attack and kidney disease. People should not begin drinking in order to decrease their risk of heart disease."

Frequently Asked Questions Concerning Viagra

2008-10-23T21:20:00.000-07:00

This list of frequently asked questions and answers on Viagra has been developed by CDER's Drug Information Branch in response to the numerous telephone calls we have received. If you have other questions concerning Viagra or any other human drug products, please feel free to call Drug Information Branch (301) 827-4573.

1. What is Viagra for?

Viagra is approved for the treatment of men who have difficulty having and maintaining an erection (impotence).

2. When will Viagra be available to pharmacies?

It is our understanding that Viagra will be available to pharmacies in approximately one month. FDA has no control over when products are available in pharmacies after FDA approval for marketing. The decision of availability is completely up to the company marketing the product. For further information contact your pharmacist or Pfizer, Inc. directly.

3. How much will Viagra cost?

The FDA has no input into or legal control over the pricing of any drug product. At the present time, FDA is unaware of the price that Viagra will have when it is available in US pharmacies.

4. Will insurance cover the cost of Viagra?

The FDA has no input into or legal control over whether an insurance company does or does not cover the cost of drugs. Please call you insurance company if you have questions about whether your particular insurance provider will cover the cost of this product for you.

5. How does Viagra work?

An erection is the result of an increase in blood flow into certain internal areas of the penis. Viagra works by enhancing the effects of one of the chemicals the body normally releases into the penis during sexual arousal. This allows an increase of blood flow into the penis.

6. How do I take Viagra?

Viagra is taken orally as a once daily dose, one hour before sexual activity. For more detailed information consult with your health care provider.

7. How will Viagra be supplied?

Viagra will be available as oral tablets in 25mg, 50mg and 100mg strengths.

8. Will Viagra be prescription or OTC?

Viagra will be available by prescription only.

9. Are there any side effects with Viagra?

As with any drug products, there are side effects of the product in some people. The most commonly reported side effects in patients treated with Viagra during the testing of the product were: headache, flushing, stomach ache, and mild and temporary visual changes (color perception changes, light perception changes, and blurred vision).

10. Can Viagra be used with other treatment for impotence?

The safety and effectiveness of Viagra when used with other treatment for impotence has not been studied. The use of such treatments in combination with Viagra is not recommended at present.

11. What if I am taking other drugs?

Always discuss with your health care practitioner ALL of the medications you are taking (prescription and over-the-counter). In that way, you can receive the best advice for your own situation. At present, Viagra is not recommended for people taking nitroglycerin because the combination may lower blood pressure.

Is impotence your problem? Chances are it can be cured

2008-10-23T21:16:00.000-07:00

Although it occurs most often among older men, impotence-the inability to achieve or sustain an erection-is not an inevitable consequence of aging. Instead, the condition often reflects a physical problem. With proper care most cases can be cured or, at least, greatly improved.

Unfortunately, only 10 percent of the 30 million American men affected seek help. What's more, even men who do seek treatment typically wait an average of six to nine months. That's unfortunate because the sooner the problem is diagnosed and treated, the more likely it is that treatment will be successful.

And doctors have found that sexually active men who suddenly have trouble sustaining an erection need to be examined immediately, because the condition may signal that a heart attack or stroke is imminent.

One reason for the reluctance to come forward is embarrassment. Many men are afraid that erectile difficulties are due to psychological problems. In about 80 percent of cases, the causes are mainly in the body, not the mind.

The most common physical cause is damage to blood vessels which impairs blood flow to the penis (usually related to hardening of the arteries, high blood pressure, or diabetes). A reaction to some prescription medications can also cause erectile problems.

Other risk factors include smoking; excessive alcohol or cocaine use; a nerve or hormonal disorder; and nerve damage due to prostate, bladder or colon surgery. Emotional factors such as stress or guilt sometimes come into play, but usually in younger men.

Impotence Relief

The following treatments for impotence are currently available:

Caverject. Injected into the penis shortly before intercourse, this produces an erection within 5 to 20 minutes without interfering with sensation or ejaculation. The active ingredient is alprostadil, a synthetic hormone that works by relaxing smooth muscle tissue in the penis to improve blood flow.

MUSE (Medicated Urethral System for Erection). This also uses alprostadil. Instead of an injection, the drug is administered with a tiny plunger that drops a pellet of medication into the opening at the tip of the penis. Caution: Alprostadil should not be used by men who have sickle cell anemia; who have had bone marrow tumors, leukemia, prostate or breast cancer; or who have an abnormally formed penis or penile implants. Caverject is not recommended for use more than three times a week; do not use MUSE more than twice in 24 hours. MUSE should not be used with a partner who is pregnant except with a condom.

Testosterone replacement therapy. This is used to treat impotence problems related to a deficiency of the male hormone testosterone and is given by intramuscular injection or via adhesive patches that deliver the drug through the skin. The Androderm Testosterone Transdermal System, previously available in a 2.5 mg formulation, is now also available in a 5 mg. version, allowing users to apply a patch only once a day instead of twice.

For some men whose impotence stems from impaired circulation, pelvic-muscle exercises called Kegels can help.

The Rejoyn support sleeve, sold over-the-counter in pharmacies, fits over the penis and allows men who don't have natural erections to have intercourse.

Hand-powered pumps, like the ErecAid system, form a vacuum around the penis. As air is sucked from the tube, blood flows into the penis, creating an erection.

Inflatable or noninflatable penile implants.

Vascular surgery, to boost the blood supply to the penis, is usually effective only in younger men who can obtain an erection but not sustain one.

Reconstructive surgery may be used in the case of Peyronie's disease, where scar tissue forms on the penis. This causes pain and erectile difficulties and bends the penis to one side.

Impotence & Aging

About one in three men over 60 has erectile difficulties due to health problems that are more common among older men. If you're in this group, here's some helpful information from the National Institute on Aging:

Regular sexual activity helps maintain sexual ability, by bringing oxygen-rich blood to the penis. This keeps penile blood vessels and nerves healthy.

Over time, most men (and women) notice a slowing of sexual response. Men may find it takes longer to get an erection, that the erection may not be as firm or as large as in earlier years, or that ejaculation may occur more quickly. Some may find they need more manual stimulation. Using different positions, new techniques, or medical devices can help.

Most men can start having sex again 12 to 16 weeks after a heart attack. But many men lose potency because they fear that sex will cause another attack. The risk of this happening is very low. Follow a doctor's advice.

Q & A: Impotence, Causes, Treatment

2008-10-23T21:09:00.000-07:00

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Medical professionals often use the term "erectile dysfunction" to describe this disorder and to differentiate it from other problems that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This fact sheet focuses on impotence defined as erectile dysfunction.

Impotence can be a total inability to achieve erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. These variations make defining impotence and estimating its incidence difficult. Experts believe impotence affects between 10 and 15 million American men. In 1985, the National Ambulatory Medical Care Survey counted 525,000 doctor-office visits for erectile dysfunction.

Impotence usually has a physical cause, such as disease, injury, or drug side-effects. Any disorder that impairs blood flow in the penis has the potential to cause impotence. Incidence rises with age: about 5 percent of men at the age of 40 and between 15 and 25 percent of men at the age of 65 experience impotence. Yet, it is not an inevitable part of aging.

Impotence is treatable in all age groups, and awareness of this fact has been growing. More men have been seeking help and returning to near-normal sexual activity because of improved, successful treatments for impotence. Urologists, who specialize in problems of the urinary tract, have traditionally treated impotence--especially complications of impotence.

How Does an Erection Occur?

The penis contains two chambers, called the corpora cavernosa, which run the length of the organ (see figure 1). A spongy tissue fills the chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa.

What Causes Impotence?

Since an erection requires a sequence of events, impotence can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area of the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of impotence. Diseases--including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease--account for about 70 percent of cases of impotence. Between 35 and 50 percent of men with diabetes experience impotence.

Surgery (for example, prostate surgery) can injure nerves and arteries near the penis, causing impotence. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to impotence by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

Also, many common medicines produce impotence as a side effect. These include high blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug).

Experts believe that psychological factors cause 10 to 20 percent of cases of impotence. These factors include stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure. Such factors are broadly associated with more than 80 percent of cases of impotence, usually as secondary reactions to underlying physical causes.

Other possible causes of impotence are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as insufficient testosterone.

Erection begins with sensory and mental stimulation. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the open spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps to trap the blood in the corpora cavernosa, thereby sustaining erection. Erection is reversed when muscles in the penis contract, stopping the inflow of blood and opening outflow channels.

How Is Impotence Diagnosed?

Patient History

Medical and sexual histories help define the degree and nature of impotence. A medical history can disclose diseases that lead to impotence. A simple recounting of sexual activity might distinguish between problems with erection, ejaculation, orgasm, or sexual desire.

A history of using certain prescription drugs or illegal drugs can suggest a chemical cause. Drug effects account for 25 percent of cases of impotence. Cutting back on or substituting certain medications often can alleviate the problem.

Physical Examination

A physical examination can give clues for systemic problems. For example, if the penis does not respond as expected to certain touching, a problem in the nervous system may be a cause. Abnormal secondary sex characteristics, such as hair pattern, can point to hormonal problems, which would mean the endocrine system is involved. A circulatory problem might be indicated by, for example, an aneurysm in the abdomen. And unusual characteristics of the penis itself could suggest the root of the impotence--for example, bending of the penis during erection could be the result of Peyronie's disease.

Laboratory Tests

Several laboratory tests can help diagnose impotence. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. For cases of low sexual desire, measurement of testosterone in the blood can yield information about problems with the endocrine system.

Other Tests

Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of impotence. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then the cause of impotence is likely to be physical rather than psychological. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination

A psychosocial examination, using an interview and questionnaire, reveals psychological factors. The man's sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.

How Is Impotence Treated?

Most physicians suggest that treatments for impotence proceed along a path moving from least invasive to most invasive. This means cutting back on any harmful drugs is considered first. Psychotherapy and behavior modifications are considered next, followed by vacuum devices, oral drugs, locally injected drugs, and surgically implanted devices (and, in rare cases, surgery involving veins or arteries).

Psychotherapy

Experts often treat psychologically based impotence using techniques that decrease anxiety associated with intercourse. The patient's partner can help apply the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when physical impotence is being treated.

Drug Therapy

Drugs for treating impotence can be taken orally or injected directly into the penis. Oral testosterone can reduce impotence in some men with low levels of natural testosterone. Patients also have claimed effectiveness of other oral drugs, including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone--but no scientific studies have proved the effectiveness of these drugs in relieving impotence. Some observed improvements following their use may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men gain potency by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and prostaglandin E1 widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, sometimes can enhance erection when rubbed on the surface of the penis.

Research on drugs for treating impotence is expanding rapidly. Patients should ask their doctors about the latest advances.

Vacuum Devices

Mechanical vacuum devices cause erection by creating a partial vacuum around the penis, which draws blood into the penis, engorging it and expanding it. The devices have three components: a plastic cylinder, in which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis, to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body (see figure 2).

One variation of the vacuum device involves a semirigid rubber sheath that is placed on the penis and remains there after attaining erection and during intercourse.

Surgery

Surgery usually has one of three goals:

1. to implant a device that can cause the penis to become erect;

2. to reconstruct arteries to increase flow of blood to the penis;

3. to block off veins that allow blood to leak from the penile tissues.

Implanted devices, known as prostheses, can restore erection in many men with impotence. Possible problems with implants include mechanical breakdown and infection. Mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa, the twin chambers running the length of the penis. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and pump, which also are surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce impotence caused by obstructions that block the flow of blood to the penis. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch area or fracture of the pelvis. The procedure is less successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure--intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes rigidity of the penis during erection. However, experts have raised questions about this procedure's long-term effectiveness.

Points to Remember

Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse.
Impotence affects 10 to 15 million American men.
Impotence usually has a physical cause.
Impotence is treatable in all age groups.
Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

What Causes Erectile Dysfunction?

2008-10-23T21:06:00.000-07:00

Until recently, many people believed erectile dysfunction was purely psychological. Men were often told, "It's all in your head." But experts now agree that about 80 percent of men with erectile dysfunction have an underlying physical reason for the condition. In other words, a health problem or lifestyle practice makes it difficult to have an erection, no matter what a person's emotions are like. For the other 20 percent of men, emotions or 'psychological' reasons are thought to be the main cause of ED. This doesn't make the erectile dysfunction any less real, and psychological causes can still be treated. In some cases, both psychological and physical reasons can cause the condition.

Physical causes: Erectile dysfunction that slowly becomes more noticeable over time usually has a physical cause.

Physical causes can include:

blockage in the arteries going to the penis
a disease that affects tissue in the penis
injury or surgery in the pelvic area (between the hipbones)
a chronic disease, such as kidney or liver failure
health conditions that affect the nervous system
diabetes
unusual changes in hormones
side effects of some medications
alcoholism and/or drug abuse
heavy smoking

Psychological Causes: Men who notice a sudden change in their ability to have an erection often have a psychological reason for their condition. For example, just as thinking about sex may cause an erection, negative thoughts can stop one from happening. In fact, when erectile dysfunction is caused by psychological reasons only, a man may still have an erection during his sleep or when he wakes up in the morning.

Psychological causes of erectile dysfunction include:

stress or anxiety at work or at home
worry or fears about ability to "perform"
unresolved sexual orientation
problems in the marriage or relationship
depression

Whether erectile dysfunction is caused by physical factors, psychological factors, or both, the effect it has on a man and his partner can become a significant source of emotional and physical distress for both people.

Does Impotence and Depression Go Hand-in-Hand?

2008-10-23T21:02:00.002-07:00

As if impotence isn't depressing enough for many men, new research suggests that men with symptoms of depression are almost twice as likely to experience impotence as men who aren't depressed.

In the first study to scientifically examine the relationship between depression and impotence, researchers from the New England Research Institutes in Boston, Massachusetts, looked at data gathered from 1,265 men, ages 40 to 70, who had completed interviews for the Massachusetts Male Aging Study about their health and lifestyles, including questions about erectile dysfunction and depression.

Even after the scientists accounted for factors that are often associated with impotence, such as age and health status, men who had symptoms of clinical depression were almost twice as likely to report moderate to complete erectile dysfunction.

The researchers point out that they can't tell from this study whether impotence is contributing to depression or vice versa, because data was collected at one point in time. If impotence causes depression, then doctors should screen their male patients with erectile dysfunction for depression as well. On the other hand, if depression causes impotence, then they should screen their patients with depression for erectile dysfunction. Either way, it's important to be aware of the link between the two.

Meanwhile, researchers at the New England Research Institutes are carrying out new studies to sort out the "cause and effect" relationship between depression and impotence.

In a related study, doctors from the Max Planck Institute of Psychiatry in Munich, Germany, report that severe depression in men changes the way the body produces sex hormones. The researchers analyzed blood samples from 15 men with major depression and 22 men who were not depressed.

Over a 24-hour period, the depressed men's blood had significantly less testosterone and more cortisol than those who weren't depressed. Testosterone is one of the primary male sex hormones, and cortisol is the body's main stress hormone.

The researchers believe that depression causes a disruption of the body's ability to produce the various hormones in the correct balance. This disruption, they say, may be partly responsible for impaired sexual function, as well as putting the men at greater risk for heart attacks and osteoporosis.

Your Antidepressant May Be Causing Your Sexual Problems

2008-10-23T21:02:00.001-07:00

Depression is often accompanied by sexual dysfunction, such as decreased interest and impotence, but the cure for depression may cause even more problems in this area. What's more, most patients who are having sexual difficulties while taking antidepressants don't mention it to their doctors.

All of the most popular antidepressants can cause sexual difficulties in both men and women, particularly a group of drugs called selective serotonin uptake inhibitors (SSRIs). This includes fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Studies show that these drugs can cause delayed orgasm or ejaculation or inability to reach orgasm or ejaculate at all. They also may inhibit sexual or erection. One study estimates that more than 80 percent of patients taking these drugs suffer some form of sexual difficulty.

Scientists must be careful when studying this problem. First, they must separate problems caused by depression from those caused by antidepressant medication. Also, they need to ask patients about sexual side-effects, since many folks won't mention them on their own. Finally, they need to make sure that sexual difficulties aren't being caused by factors other than depression and antidepressants.

Researchers at the Robert Wood Johnson Medical School in New Jersey evaluated recent studies of sexual dysfunction among people taking SSRIs. Overall, it appears that more than half of patients taking these drugs experience sexual difficulty. The most common complaint is delay of orgasm or ejaculation, followed by inability to reach orgasm or ejaculate at all (anorgasmia). Most studies report that sexual difficulties get worse with higher doses of antidepressants.

So what can be done for patients suffering from these effects? One choice is to add another drug that will overcome them. A number of drugs have been reported to help, but no clinical studies have been done to affirm the effectiveness of these drugs.

Some clinical studies report success with changing to antidepressants that are not SSRIs. These include amineptine (used in France, Spain, and Italy), bupriopion (Wellbutrin), mirtazapine (Remeron), and nefazodone (Serzone). These drugs, however, may not be as effective as SSRIs in controlling depression, especially if the patient also has a concurrent obsessive-compulsive or anxiety disorder.

If you're taking antidepressants and have any kind of sexual difficulties, talk to your health-care provider. These problems may be caused by your medication, and if so, there are ways to improve your situation and quality-of-life significantly.

Short on Sex Drive? Low Testosterone Probably Isn't the Problem

2008-10-23T21:00:00.001-07:00

Physicians evaluating erectile dysfunction typically order blood tests to measure testosterone levels. Supposedly, a low level of this male hormone indicates a low sex drive. But recent research suggests that testosterone level is not a good predictor of sex drive.

Researchers at Bassett Healthcare in Cooperstown, New York, examined the records of 108 men (average age 59) who had gone to an erectile dysfunction clinic. The men completed a questionnaire, called the "Sexual Function Inventory," and had a blood test that measured total testosterone and "free" testosterone (which is not bound to other substances) levels.

Half of the men had low sex drive, 35 percent had medium sex drive, and 14 percent had high sex drive. There were no group differences, however, in the men's testosterone levels. Total testosterone was almost identical in each of the three groups. Of the 49 men with testosterone levels below normal, 29 had low sex drive, 15 medium, and five had a high sex drive.

The researchers noted that among men with erectile dysfunction, only about 6.6 percent have low testosterone levels. Although scientists do not know what role testosterone plays in either sex drive or erectile dysfunction, U.S. Medicare guidelines recommend measurement of testosterone in men with erectile dysfunction if they report a loss of sex drive. And, it is common practice for doctors to routinely order these tests when evaluating men with erectile dysfunction.

The average cost of measuring total testosterone in the blood is $52 and $58 for measuring free testosterone. The researchers estimate that if testosterone tests are ordered for every man who seeks medical treatment for erectile dysfunction, the total cost would be about $419 million.

Since testosterone doesn't seem to predict sex drive and the researchers also found that total and free testosterone levels are closely related, there doesn't seem to be any reason to routinely order even one of these tests, not to mention both.

The researchers suggest that more research is needed to determine what role testosterone may play in sex drive and erectile dysfunction, but until more is known, it is a waste of money to order these tests. This study was published in the September 1999 issue of "The Journal of Urology."

Korean Red Ginseng Shows Promise in Treating Erectile Dysfunction

2008-10-23T20:58:00.000-07:00

We hear all sorts of claims about the ability of various herbs to help men achieve and sustain erections, but not too many of these preparations have been clinically studied to determine their effectiveness. A recent study reports that Korean red ginseng, which has been used in Asian countries as a "men's tonic" and aphrodisiac for hundreds of years, seems to have a positive effect on erection in animals and may be helpful in humans too.

Researchers at Yonsei College of Medicine in Seoul, Korea, studied the effects of Korean red ginseng on rats and rabbits in the laboratory. They fed the animals 50 mg/kg of body weight daily for three months. Then they measured the animals' response when the nerve that goes to the to corpus cavernosum was stimulated. The corpus cavernosum is the spongy tissue in the penis that becomes engorged with blood during an erection.

None of the animals showed any side-effects from taking ginseng. Their blood pressure and body weight remained similar to that of control animals.

Compared to rats that had received placebo, those who took the ginseng had a significantly greater response to stimulation, with larger increases in pressure within the corpus cavernosum.

In addition to studying live animals, the researchers also compared the penile tissue of ginseng-treated rabbits and control rabbits in vitro. Compared to the tissues of control animals, tissues of rabbits that had been treated with ginseng were more responsive to the effects of acetylcholine, a brain chemical that stimulates the nerves in a process essential to erection.

"Ginseng has long been used in maintaining physical vitality throughout the Far East, including Korea and China, as a tonic and restorative," the researchers noted, adding that it's also been reported to have helpful effects in people with diabetes, atherosclerosis, high blood pressure, and cancer.

In this study, reported in the October issue of "The Journal of Urology," Korean red ginseng enhanced the erectile response in normal animals. Now that they've shown this, the authors plan to study the effects of the herb in animal models of erectile dysfunction, especially that caused by diseases such as diabetes.

What You Don't Know About Impotency Can Ruin Your Love Life

2008-10-23T20:57:00.001-07:00

Impotency—inability to achieve or sustain an erection—occurs most often in older men, but it isn't an inevitable consequence of aging. While psychological factors can cause impotence, at least 80 percent of all cases of sexual dysfunction are due to an underlying physiological problem that can be treated.

As men age, production of the male hormone testosterone declines, and the force and amount of semen ejaculated decreases, notes Gerald Brock, M.D., associate professor of Urology at McGill University in Montreal, Canada. "The good news is we seldom want to have children as we age, and the orgasms are still great! So in most cases it's only an academic finding without any significant consequences."

Studies have shown that testosterone is not essential for erection, but it definitely plays a role in sex drive, and erections are more frequent and rigid when a man has an adequate level of the hormone. Not only does testosterone affect libido, research has shown that it increases production of nitrous oxide in the erectile tissue of the penis (corpora cavernosa), which is important in regulating erectile function. That may be why it takes some older men longer to achieve an erection, or their erection may not be as firm or large as in the past.

Men who are impotent due to a low level of testosterone can be treated with hormone replacement therapy. However, impotence in older men is frequently the result of a medical condition or medication that interferes with erectile function. An erection requires a sequence of events, which involve nerve impulses in the brain, spinal column and penis, as well as response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa. Any disruption of this sequence of events can trigger impotence.

Therefore, the most common cause of impotence (70 percent) is disease that causes damage to arteries, smooth muscle and fibrous tissues, including diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, and vascular disease. Prostate, colon or bladder surgery--any surgery in the pelvic area--can cause impotence if nerves and arteries near the penis are injured. Smoking may also affect sexual performance, because it affects blood flow in veins and arteries. Medications that can affect erectile function includes high blood pressure drugs like lisinopril and atenolol, antihistamines, tranquilizers, appetite suppressants, and cimetidine (ulcer treatment). Additionally, antidepressant medications, especially serotonin uptake inhibitors (Luvox, Prozac, Paxil, Zoloft) may inhibit erection and delay or prevent ejaculation.

While one in three men over age 60 suffer from some form of sexual difficulty, only about 10 percent actually seek treatment. Possibly, many men suffer in silence because they're unaware of causes and treatments for impotency. In a survey, conducted by the Impotence World Association, less than five percent of respondents knew that erectile dysfunction is usually physiological, and less than 15 percent were aware of new impotency medications, such as Viagra.

Viagra® (sildenafil) and Uprima (apomorphine) are oral medications that improve a man's erection ability. However, men who become impotent following surgery may not respond to these drugs. "Viagra will only help those men who have preservation of some of the nerve fibers after the surgery. The good news is that if Viagra doesn't work, injection therapy with Caverject or other vasoactivator meds probably will help." Caverject and MUSE (Medicated Urethral System for Erection), another vasoactivator, involve self-administered injection of medication into the penis opening. However, men who don't respond to oral medications or injections may be helped with a penal implant or vacuum pump, which Dr. Brock notes is common in men with diabetes or very poor circulation. The pump, which is available without a prescription, forms a vacuum around the penis. As air is sucked out of the tube, blood flows into the penis, creating an erection.

Some studies indicate that Viagra presents a risk for men with cardiovascular diseases. However, Dr. Brock notes that the risk of heart attack depends on an individual's own risk factors, such as cholesterol level, age, and smoking among others. "People with diabetes, heart disease, and hypertension (high blood pressure) do develop heart attacks in the real world. When you have 1.5 million men, many of them with these problems, taking any medication, some will die from cardiac causes." Dr. Brock suggests that the risk for heart attack may not be higher with Viagra, but higher for the group of men likely to need Viagra. He stresses, however, that men who take nitroglycerine should not use Viagra, because it stops the body's ability to break down the chemicals in nitroglycerine.

While there is no known prevention for erection dysfunction, Dr. Brock suggests that exercise and eating a low-fat diet--the same strategies used to reduce the risk for heart disease--may be helpful, since erection is dependent on a healthy vascular system.

Q & A: Does regular sex keep you slim?

2008-07-09T11:55:00.002-07:00

Does regular sex keep you slim?

As fairly vigorous sex burns up about 7 calories a minute (for the man in the classic missionary position that is), you would think that regular sex would keep you slim.

However! Research shows that the average sex sessions lasts a fairly pathetic four minutes and would burn up only 28 calories - enough to burn off half an apple or one Ryvita. Should you definitely NOT be a four-minute man, and should you enjoy sex on a very regular basis, you could burn up a fair amount of calories in the process. Men tend to use up more calories having sex than women do, as women are often a lazy lot (or too exhausted after a day running the world and then doing the cooking, cleaning and child-minding) and tend to prefer the 'lie here and enjoy it' position most of the time, while men do all the hard work.

So let us assume that you have sex four times a week at 30 minutes a time (let's be generous!). Two hours of sex at 7 calories a minute (on average) comes to 840 calories burnt per week. That is about equivalent to a hungry male's evening meal, or four pints of beer, or a takeaway pizza.

So as long as you don't send out for the pizza after the sex, I suppose you could lose about 1lb a month (or not put ON 1lb a month) in weight with two hour's sex a week.

Is there any fat-burning exercise class that isn't aimed primarily at women?

A recent survey of exercise classes found that you are most likely to meet fellow males at boxercise classes (circuit training with boxing moves) or Ashtanga yoga classes. Boxercise is no surprise, although apparently 40% of devotees are female.
You may be amazed to learn that you can burn fat through yoga, but ashtanga is fast and furious and quite hard.

Is there a male menopause and if so is it the cause of my weight gain? I am 55.

Yes, it seems that there is a male menopause which could indeed have various side-effects including weight gain. Although the major symptom of the female menopause - loss of periods - is obviously not a factor for men, there is, according to studies presented at the British Endocrine Societies conference in 2001, a decrease in levels of the male hormone testosterone in midlife males.

Levels start to decline at a similar age to the female menopause - around 50 - and reduced testosterone can cause not only weight gain, loss of muscle mass and loss of energy, but also depression, mood swings, lowered sex drive, memory loss and irritability.

The explanation from one of the partner universities conducting the latest research is that low levels of testosterone seem to reduce the blood supply to the brain, which means, basically, a general shutdown or slowing of the metabolism - in other words, the factory that is the male brain is on go-slow and the menopausal symptoms described are a natural result of that.

As with women, menopausal symptoms vary from man to man and may be slight or severe. If you feel this may be your problem, do see your doctor. Work is underway in developing a male testosterone-replacement HRT. Such HRT for males may also include the female hormone oestrogen, which has been found to protect men against osteoporosis and may also protect them against mental decline and memory loss.

In the meantime, a programme of sensible eating and increasing the amount of both aerobic and resistance exercise that you do will help to minimise the symptoms. For although declining hormones can promote weight gain, that doesn't mean the situation isn't containable with a healthy lifestyle - as many post-menopausal women will confirm.

Staying in shape as you get older becomes harder, but is by no means impossible. The bonus is that with healthy diet and by taking more exercise you are also giving yourself natural protection against the diseases and infirmities of old age.

Q & A: Which is more fattening - beer, spirits or wine?

2008-07-09T11:55:00.001-07:00

Which is more fattening - beer, spirits or wine?

Each of these have roughly the same calorie content (about 90 - 100 calories): Half a pint of ordinary beer or lager, a double of spirits, or a small glass (about a fifth of a bottle) of wine. You will see then, that whichever tipple you prefer doesn't make a lot of difference, calorie-wise, unless you are likely to down significantly more of one than the other in the same length of time. For example, I would find it easier to down a glass of wine than a half pint of beer for the same calorie content - but you may be different.

And if you enjoy spirits, and could get by on a single with a low-calorie mixer (e.g. a Scotch and low-cal ginger) you could have two of those for the same calorie value as the glass of wine.

But when thinking about alcohol you also need to consider how many 'units' you're drinking (for your health's sake) and how many milligrams of alcohol you are putting in to your bloodstream (for your driving's sake - and may your driving license's sake).

Does beer drinking really cause a 'beer belly'?

A beer belly is a fat stomach by another name. Whether you take in too many calories via pints of beer or via too many takeaways or too much food on your plate too many times a day, and thus create a 'positive calorie balance' - you will eventually put weight on. It is just that a lot of men do get fat through too many 'beer' calories (e.g. five pints in an evening are around 1,000 calories, so if this is in addition to a normal adequate diet, the beer will put weight on fast).

The reason that in many men the extra pounds of fat seem to end up on your stomach rather than elsewhere is twofold. One, men are more prone to put weight on their midriff's than women are (men tend to be 'apples', women, 'pears'). And two, when anyone puts weight on, it tends to go first to the upper body (face, chest, belly) and last to the lower body. So when you are gaining weight around your middle you are in fact also gaining in on your face and maybe chest - but it is always the belly that you and other people notice. If you carry on gaining weight, you will also gain it in other areas of your body, but, being male, it is the belly that will stand out!

Can any man have a 'six pack'?

In theory, I suppose most men can. But in practice, not really. What is known as a 'six pack' is the outline of the divisions of the rectus abdominis muscle which run down either side of the centre of the stomach from rib cage to 'belly button' (in fact there are four 'divisions' on each side, so really it should be called an eight-pack).

All men have this muscle - but it can be seen in so few men because it is usually covered by a layer of fat, and is rarely exercised enough to be well-defined in any case. Those young men who work very hard and very regularly on their stomach muscles, have a low body fat percentage and who do achieve a 'six pack' can feel justifiably proud of themselves. For most males, the effort required to get that sought-after physique is just too much and there are more important things in life to do.

Men don't actually need to be that honed and toned in order to be healthy - you just need a reasonable waist circumference (CLICK HERE for more information) and an absence of obvious 'pot'.

If you do decide to 'go for it' - don't wait around too long. The older and flabbier your stomach gets, the harder it will be to convert!

Q & A: Difference between the type of a diet for a man and a woman?

2008-07-09T11:54:00.000-07:00

Is there any difference between the type of a diet a man and a woman should follow for weight loss?

The main difference is that the average man has a higher metabolic rate than the average women - because he is heavier, taller and with a higher percentage of lean tissue (muscle). Therefore he will need to eat more calories (food) on his reduced-calorie diet than she does, otherwise he will feel too hungry and he may lose weight too quickly. A man should generally have approximately 20% bigger portions than a woman.

Apart from that, men and women can follow the same ' healthy eating' type of reduced-fat diet, high in vegetables, starchy carbohydrates and containing enough lean protein, and essential fats from oily fish, nuts and seeds.

Some men may need a little extra protein - for example, men who do hard physical work all day, or men who are professional sportsmen. If that sounds like you, you could increase the protein element of the meal first (fish, chicken, lean meat, pulses, low fat dairy etc) and then, if you are losing weight too quickly, add on extra carbohydrate (bread, potatoes, pasta, rice, etc) too.

However I have a feeling that most men reading this question, who need to lose weight, will NOT be professional sportsmen or highly active. Most men (like most women) who need to diet have been taking too little physical activity long-term, and such men starting a moderate activity programme are unlikely to create a need for much extra protein, at least in the early months.

Should you turn into a bicep-bulging marathon-running person later on, you may need to take professional advice on your diet as you will be outside the scope of The Diet Bible.

I used to play football twice a week - one match and one training session - but I've given up. How much less do I need to eat so that I don't put on weight?

Assuming three hours a week of fairly vigorous exercise (though with football and other team sports it is hard to be precise about calories burnt because your physical involvement is so variable) this would work out at around 7 calories used a minute, which comes to 1,260 calories burnt in total for your training and match. That equals 180 calories a day, which in turn equals a pint of mild beer, or two slices of bread, or a 9-oz potato that you would have to decline every day in order not to put on weight.

But I think the real issue here is that, having given up three hours' worth of exercise a week in the form of football, it would be sensible of you to replace it with something else. If you've given up football because you are 'too old' or incapacitated, is there any form of exercise you could now take instead - a half hour walk or cycle session a day, or similar?

So many men as young as their late 20's, and certainly by the 30's and 40's, give up almost all exercise and then wonder why they get fat and start having health problems. So don't eat less - just get out and keep active. Even if you're still slim and fit at the moment - it only takes a small amount of overeating (like 180 calories a day) and a few months of inactivity for all kinds of negatives to begin happening to your body.

I'm a typical male - I love takeaway curries, Chinese, fish and chips and so on. Are there any wise choices now I'm trying to lose weight, or is everything bad news, health and calorie-wise?

There are some better choices amongst a host of not so good takeaways, and these better choices should fit in reasonably well with a varied diet, without putting weight on you or risking your cholesterol levels. For example, tandoori chicken or fish; plain vegetable or seafood pizza, plain burger (no cheese, small chips); doner kebabs.

But even so, I would still advise you to try to limit your forays to the takeouts to once or twice a week. If lack of time is your problem, you can incorporate a few 'ready meals' into your diet - all supermarkets sell single-portion ready meals and all contain a nutrition panel. Go for meals that contain no more than 5-600 calories for a complete main meal (assuming you eat three times a day) and try to ensure that they contain no more than 15 - 20g fat. Most supermarkets have their own 'healthy eating' range of ready meals. Adding a side salad (again, you can buy ready-prepared salads) with a low-calorie French dressing will make the meal more filling, and healthier still.

Herbs For Man: Help for Prostate Cancer?

2008-07-08T12:47:00.000-07:00

Soy, rich in estrogen-like isoflavones, was recently shown to inhibit prostate cancer in rats. A case study of a man suffering from moderately high-grade prostate cancer showed that these plant estrogens apparently caused some tumor regression.

In other news, a recent study of PC-SPES, a formula containing eight herbs, reported substantial estrogenic effects in eight patients suffering from prostate cancer. On the plus side, the phytoestrogenic activity of this herbal formula reduced serum testosterone and PSA (prostate-specific antigen, a "marker" for prostate cancer) concentrations in all eight men. The downside? All of the men experienced both breast tenderness and loss of libido, and one suffered a blood clot in a vein. The herbs included in this formula were chrysanthemum, isatis, licorice, reishi mushroom, Panax pseudoginseng, Rabdosia rubescens, saw palmetto, and skullcap. But researchers didn't identify the specific herb or herbs responsible for the effects seen in the study.

We need to wait for more research before we can recommend soy and other phytoestrogens for prostate cancer. Herbs with estrogenic activity may be useful in treating hormonally sensitive prostate cancer, but if used with conventional therapies may confound the results.

Saw palmetto extract is the best proven herbal remedy for this pesky condition. An extract of the fatty oils and steroids from the fruits of this plant is effective in a daily dose of 320 mg

Herbs For Man That Help Your Heart (Part II)

2008-07-08T12:45:00.000-07:00

Red Yeast (Monascus purpureus), cultivated on rice, contains several HMG-CoA reductase inhibitors related chemically to the popular statin prescription drugs. These protect by stimulating the formation of good (HDL) cholesterol and reducing the production of bad (LDL) cholesterol.

Clinical trials have shown that daily consumption of four 600-mg capsules of a standardized red yeast product (called Cholestin) produced significant reductions in serum levels of both cholesterol and triglycerides.

The Food and Drug Administration tried to ban over-the-counter Cholestin, because it felt Cholestin's active ingredients were too closely related to those in the statin prescription drugs. An appeals court rescinded the ban. As of now, you can still buy Cholestin, but its status could change if the ruling is reversed.

Guggul (Commiphora mukul) is an oleo gum resin derived from the trunk of a tree grown in India. There, a few studies have confirmed its ability to lower cholesterol and triglycerides in both small animals and humans. In one study, people were given 500 mg of gugulipid, one of the herb's active components, for 12 weeks. Cholesterol dropped by 24% and triglycerides dropped by 23% in 80% of the people studied. Guggul appears to be safe, though it may cause stomach upset. (Pregnant women should never take it because it tends to stimulate uterine contractions.)

Quick Tip: Take one 25-mg capsule of standardized guggulsterone three times a day until cholesterol levels normalize, then reduce dosage to one capsule daily.

Herbs for Men That Help Your Heart

2008-07-08T12:43:00.000-07:00

Great Herbs for Men

Several good-for-you herbs have been found to be valuable in helping treat certain life-threatening -- or life-altering -- conditions. Specifically, there are herbs for cardiovascular concerns, such as high blood pressure and atherosclerosis, and herbs for more singularly male problems, especially benign prostatic hyperplasia (BPH) and erectile difficulties that can result in impotence.

Here's the scoop on what's out there -- and what really works.

3 Herbs That Help Your Heart

Heart disease has often been portrayed as a disease for men only, but today we know differently: Studies show that, overall, it's the number one killer of both men and women in the US. But unlike premenopausal women, men lack heart-protective levels of estrogen. (Note: When women reach menopause -- around age 52 -- they stop producing estrogen and their risk of heart disease soars to eventually equal that of men.) Here are three herbs that can give men -- and women -- a weapon against heart disease.

Garlic has long been used to lower both blood pressure and blood lipids. Studies have shown that people who take garlic can reduce their systolic blood pressure by about 7%. Most of the clinical studies on garlic powder tablets, standardized to yield about 5 mg of allicin on a daily basis, show that you can reduce levels of serum cholesterol by about 11% and triglycerides by about 12%. These reductions are positive steps toward helping to lower your risk of heart attack and stroke.

But not all recent trials have yielded such favorable results, and these have raised questions regarding the herb's effectiveness.

Here's the good news. In spite of some conflicting findings, you can still have confidence in garlic's value, because recent clinical studies indicate that garlic helps to maintain the elasticity of the aorta in older men and women. Maintaining the flexibility of this largest artery is essential to healthy functioning of the entire circulatory system. In the long run, this activity alone may prove more essential to cardiovascular health than the actual cholesterol-lowering properties of garlic.

Rekindle Your Sexual Life With Cialis

2008-04-02T10:50:00.000-07:00

Does love happen when the moment is right or you desperately wait in vain to consummate passion play when a real moment turns into the right moment? If the second condition holds true for you, you may be experiencing erectile dysfunction. It is a condition when a man cannot get, or keep, a hard erect penis suitable for sexual activity. There are many underlying physical and psychological causes of erectile dysfunction. The most common physical causes are reduced blood flow to the penis and nerve damage. Other causes associated with erectile dysfunction include vascular disease, diabetes, drugs, hormone disorders, surgery, radiation therapy, and psychological conditions.

Before finding a treatment for erectile dysfunction, you need to understand the specific steps that take place to produce and sustain an erection. The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts. The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection. If something affects any of these factors or the delicate balance among them, erectile dysfunction can result.

Damage to the nerves that control erections can cause erectile dysfunction. It may result from an injury to the pelvic area or spinal cord. Surgery to treat bladder, rectal or prostate cancer also can result in erectile dysfunction. Prolonged bicycle riding also can cause a temporary problem. A wide range of drugs — including antidepressants, antihistamines and medications to treat high blood pressure, pain and prostate cancer - can cause erectile dysfunction by interfering with nerve impulses or blood flow to the penis. Tranquilizers and sleeping aids also may pose a problem.

Chronic use of alcohol, marijuana or other drugs often causes erectile dysfunction and decreased sexual drive. Excessive tobacco use can also damage penile arteries. Psychological conditions, such as depression, guilt, worry, stress, and anxiety all contribute to loss of libido and erectile dysfunction. If a man experiences loss of erection, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to chronic problems during sex. If the cycle is inescapable, it can result in impotence.

In today’s world it is possible to treat erectile dysfunction with the wonder pill, Cialis. It is the only erectile dysfunction pill that can work as soon as after 16 minutes and remains effective for up to 36 hours. You can buy Cialis from reliable suppliers who offer cheap Cialis along with free Cialis prescriptions. In addition, you can shop for Cialis at various online pharmacies.

Overshadow Impotence with Cialis

2008-04-02T10:46:00.000-07:00

So lovers who profess they spirits taste,
Feed yet on grosser meat;
I know they boast thy souls to souls convey,
However they meet, body is the way.
-- No Platonic Love

These lines by William Cartwright emphasize the importance of physical union in love. To Cartwright love is incomplete without bodily union. Everyone desires of an awesome, rocking love as well as sexual life but, how many of them really achieve it? probably just a handful of them. There occur many hindrances in this wish fulfillment. In some cases lack of a willing partner ends the entire fun or excitement. Whereas, in others in others the sex drive is present but the physical health of one of the partners doesn’t allow a satisfying endeavor.

The reasons for this physical weakness can further be so many and the most commonly occurring problem is E.D in case of males. Erectile dysfunction or E.D, is more commonly known as impotence. A man is impotent if he cannot achieve or sustain an erect penis for sexual activity. In E.D a similar thing happens but not because of impotence but mainly because of physical health.

There have been a lot of factors that have been involved in being a barrier to the Sex-Life; like age, hormonal imbalances, society, money and many other things. The causes of it may be many for e.g. psychological, hormonal, arterial or muscular. The diseases associated with it are Diabetes Mellitus, Major Depression, certain thrombotic disorders, etc.

Men have been in search of some miraculous thing which would help them just not sustain erection for sufficient time but also helping him regain his vigor and vitality. Yoga, Medicinal herbs and meditation have helped him in one way or the other but there has always been a search for that extra punch to help men in his erectile dysfunction in nearly all cases with having minimum of the side effects. This search for the punch ended with CIALIS.

Cialis acts by inhibiting an enzyme called phosphodiesterase which releases Nitric Oxide from nerve endings and endothelium causing relaxation of smooth muscle and hence penile erection.

Life is once and if you missed such a vital pleasure of your life due to a minor disorder it's really a matter of shame. What are you thinking, go for Cheap Cialis and make the special moments even more special.

Will I Get Prostate Cancer?

2008-02-11T12:50:00.000-08:00

They say that if you're a male and you live long enough, you'll develop prostate cancer. But it probably won't be the cause of death. They'll just find it at autopsy. (Worldwide, 30% of men older than 50 have 'latent' prostate cancer.) You're much more likely to have died of heart disease. Not too comforting a thought, is it? You'd prefer to die of 'very old age' without either heart disease or cancer.

No one wants to develop heart disease, but it's a much less frightening concept than prostate 'cancer.' Too many men you know are having 'prostate problems' these days. It's frightening to think that the changes in bladder function might be a bothersome condition called BPH, an anatomical problem that develops when the prostate (a walnut sized gland at the base of the bladder) enlarges. In the process, BPH impedes urine flow, resulting in an inability to completely empty the bladder, frequent and/or painful urination, and even incontinence. Or it might be cancer of the prostate.

Environment (e.g., drugs, chemicals) and diet both play a role in the development of prostate cancer. Epidemiological studies provide clear evidence of this, thereby providing insight into how the incidence can be reduced. For instance, there are approximately 75,000 cases of prostate cancer in the United States each year - representing 18% of all new cancers. This rate of clinically evident prostate cancer is 120 times higher than found in China, even though men in both countries exhibit the same 30% rate of latent cancer found at autopsy.

What causes this transformation from abnormal cells to life-threatening disease? And what does this tell us about how we should live? It tells us a lot about the impact of our diet upon our health, in this case the effect it appears to have on the progression of prostate cancer. And on its prevention.

There are two ways to reduce your risk of prostate cancer: One, alter the type and amount of fat intake in your diet. Two, increase your consumption of foods and botanicals that have been shown to protect the prostate gland against cellular injury. These are important steps to take, and can be valuable even if you already have prostate involvement. At the same time, you should also be taking advantage of medical screening and diagnosis, such as yearly PSA (prostate specific antigen) blood tests to monitor the health of your prostate.

I. Alter The Type and Amount of Fat In Your Diet

The results of two major epidemiological studies, one in Hawaii and one on US health professionals, both implicated dietary fat as a major risk factor for prostate cancer. The recommendations from both studies are to reduce the total amount of fat in your diet. Currently in the US, 37% of our calories are obtained from fat. To reduce the risk of prostate cancer (and perhaps other cancers, as well), it is important to reduce that percentage to less than 20%. The data are not conclusive about whether the best percent is 20% vs. 15% vs 10%. But at least it can be said that men in the US consuming an average diet must cut their fat at least in half (from 37% to 20%) to reduce their risk.

These two studies, as have many other, implicated animal fats as being particularly important in the development of prostate cancer. The saturated fats in beef and milk caused substantial increases in relative risk of developing prostate cancer. It would be wise, therefore, for men to alter their intake of high-animal fat foods as well. Substituting fish and fowl for high fat meats appears to make a big difference in risk. (Read the article "How Much Meat Can I Eat?" for some good ideas.)

It has also been reported that a particular type of fat (alpha-linolenic acid) can increase risk of prostate cancer. This fat is found in vegetable sources as well, such as soy and rapeseed oils. Further research is required on this point, however, since soy has also been shown to have beneficial anti-cancer effects for other organs.

How can fat in the diet affect the risk of developing prostate cancer - or any cancer, for that matter? Because of their biochemical effects, which is true for all nutrients and botanicals. For instance, reducing total fat in the diet - and in particular the type of fat consumed, will reduce the amount of sex steroid hormone produced. This in turn reduces the amount of stimulation to the prostate gland, decreasing the risk of overstimulation. Reducing the amount and type of fat also leads to a reduced synthesis of biochemical compounds called 'eicosanoids.' These compounds can lead to inflammation of the prostate, in essence setting up a pattern of constant irritation - and increased likelihood of transformation to cancer.

II. Use Foods and Botanicals For Protection

Certain foods and botanical supplements have been shown to protect against the adverse biochemical effects that chemicals, fats and hormones can have on sensitive cells - such as the prostate. These include anti-oxidants (e.g., Vitamin C, Vitamin E, selenium) and the active compounds in natural substances such as Saw Palmetto and Nettle.

Just as there is a mechanism of injury by which fats and chemicals have their negative effects, there is also a preventive mechanism by which these nutrients and botanicals provide protection. For instance, Vitamin C and selenium protect against the effects of free radicals, parts of the fat molecule that break away and injure adjacent tissue. Saw Palmetto inhibits the enzyme (5-alpha reductase) that produces dihidrotestosterone in the gland, a hormonal stimulant of the prostate. Nettle is thought to work in a similar way, to inhibit the level of testosterone stimulation to the prostate, preventing its enlargement.

Prudence dictates a change in the way men eat, so they can reduce their risk of prostate cancer. It's also smart to use nature's resources - such as the botanicals - to further reduce the risk. Living a long and healthy life should be the goal. Watching your fat intake isn't too big a price to pay, is it?

Holistic and Alternative Therapies for Hair Loss in Men?

2008-02-06T22:22:00.000-08:00

Many men are familiar with the thinning (or absence) of hair at the hairline or on top of the head, also known as alopecia. And most men can blame it on their genes: 95 percent of cases of hair loss are genetic in origin. While there are several conventional treatment options, including Rogaine, which is available over the counter, and Propecia, available by prescription, these medications require on-going use for maintained success, as well as regular visits to the doctor to watch for side effects. Surgery, such as a hair transplant, is another conventional option but an expensive route.

Since this condition is fundamentally a cosmetic one, any treatments must be weighed against potential side effects and costs. While numerous complementary and alternative treatments exist, their success has been limited. Still, as less expensive alternatives, you may find them worth a try. As always, be sure to let your doctor know of any complementary or alternative therapies you pursue.

Nutrition

Reduce the amounts of saturated fats, dairy products, and other animal products in your diet. Increase your intake of fresh vegetables, whole grains, and protein from non-animal sources like nuts and beans. These changes in your diet will help insure that the essential nutrients for normal hair growth are available.
Biotin (300 mcg per day) and trace minerals, such as those found in blue-green algae (2 to 6 tablets per day), may help hair growth.
Vitamin B6 (50 to 100 mg per day), zinc (30 mg per day), and gamma linolenic acid (1,000 mg twice a day) can help to stop the chemical process that leads to hair loss.

Herbal Medicine

Combine the following in equal parts and take as an herbal tea (2 to 3 cups per day) or tincture (20 to 30 drops two to three times per day): ginkgo, rosemary, prickly ash bark, black cohosh, yarrow, and horsetail.
Take green tea (2 cups per day) in addition to saw palmetto (100 mg twice per day).

Massage

Therapeutic massage increases circulation and decreases stress. Scalp massage using essential oils of rosemary, lavender, sage, thyme, and cedarwood may help to increase circulation. Add 3 to 6 drops of essential oil to 1 tablespoon of jojoba or grapeseed oil. Massage into scalp daily.

Male Pattern Baldness

2008-02-06T08:39:00.001-08:00

Many men experience some signs of balding as they age. In fact by the age of 30 about 1 out of every 3 men will be missing a little up top. Many men are comfortable with their new streamlined look, but some will try anything to reverse the process. The good news for those that care is that there are two FDA approved treatments currently available that really do help. They may not be perfect and they certainly won?t give you that Fabio look you?ve always wanted, but for some they are worth it.

The treatments are Minoxidil (Rogaine and others) which are available over the counter and Propecia (finasteride) which is prescription only.

Minoxidil (Rogaine and others)
Originally Minoxidil was used as a medication in the form of a pill to treat high blood pressure. One of the side effects was that people began to grow back hair they had lost. So the topical cream was developed to specifically treat hair loss. Users must apply the cream twice a day and there are two strengths currently available: 2% and 5%.

Minoxidil acts to stimulate new hair growth and works in about 60% of all men. The hair that grows back may be so called "baby hair," or may be more natural looking. In order to determine if it?s going to work you need to take it for at least a year which brings us to the major downside — the cost — about $30 per month for the extra strength (5%) treatment. Other side effects can include some itching and irritation of the skin.

The Minoxidil treatments work best for men who have started losing their hair in the last 5 years and so are commonly in the 20-40 age range.

Finasteride (Propecia)
Finasteride is available by prescription only under the name Propecia. This treatment works differently to Minoxidil and in most men acts to slow or prevent you from losing hair in the first place, but will also grow back some hair in almost two thirds of men. Propecia is taken in pill form once a day and is also expensive, about $45-50 per month. Once again you are going to have to give it at least 6 months to a year to see if it?s working for you. The side effects can include impotence in about 1% of men and reduced sexual drive in about 2%.

Cautions
These treatments are for male pattern baldness only (known as androgenic alopecia). If you start to lose your hair in patches or in large amounts, you should consult with your doctor as there may be a different cause.

Summary
Both these treatments can help fight against baldness, but once you stop taking them you are likely to lose all that hair back again within only a few months. They seem to work better for men who are losing their hair from the tops of their heads and not so well for those with receding hairlines. So if you think it?s worth the money and it?s important to you, you might consider them. Talk to your doctor to see which treatment is right for you.

Men's Interest in Cosmetic Surgery Grows

2008-02-06T08:33:00.000-08:00

Christopher Reitano was 44 and people were always asking "Do you have a cold? How are your allergies?"

Reitano was getting self-conscious.

"Basically, my eyes were baggy, especially on the upper eyelids. It was starting to get aggravating," says Reitano, a Voorhees, N.J., resident who is an international service manager for a global electronics firm. "I decided to do something about it."

Reitano did what many men are doing these days: He headed for the plastic surgeon where he had an operation on his upper and lower eyelids to reduce the puffiness.

"I look better, but more than that, I feel more self-confident," says Reitano. "I used to look down a lot, just so people wouldn't see. Now I give a better appearance in business and that is very important to me."

Making the cut
Women still account for the bulk of cosmetic surgery—91%, according to the American Society of Plastic Surgeons (ASPS). But plastic surgery has become more popular among men in the United States. ASPS-member surgeons performed 15,564 eyelid operations on men in 1998, nearly double the number in 1992. Eyelids are the second most popular procedure for men.

Number one is liposuction—the removal of excess fat from the thighs, abdomen, neck or other area of the body. In 1998, 19,789 liposuctions were performed on men by ASPS surgeons, more than triple the number in 1992.

"Women have always wanted to look younger and now men do too." says James W. Slavin, M.D., who is on the board of directors of the American Society for Aesthetic Plastic Surgery. "If a man is 55 and his 53-year-old wife gets a face-lift, he doesn't want to look like her father."

Increasingly, though, it is not just for social reasons that men are undergoing plastic surgery.

"With career pressures what they are, people, especially in their mid-40s, want to compete with younger people for good jobs," says Richard Dolsky, M.D., the plastic surgeon who operated on Reitano's eyelids.

One kind of plastic surgery men seem not to be getting is rhinoplasty, the traditional nose job. Dr. Dolsky says that men don't perceive a nose job as making them look younger, or even handsomer.

Cosmetic surgery is rarely covered by medical insurance. ASPS estimates that surgeon fees for a male face-lift run an average $5,540; liposuction, $2,281; eyelid surgery, $3,234, and a tummy tuck, $4,418. There are wide regional variations in cost.

No miracles
Plastic surgeons offer this caveat to anyone considering a cosmetic procedure: Don't expect too much.

"There are unrealistic expectations some of the time. We can help, but we aren't in the miracle business," says Dr. Slavin. "If a man comes to me and says his nose is bothering him or he looks a little too heavy and that is why he isn't getting promoted, I wonder if he realizes that he might not get promoted no matter what I do. Sometimes if you have a patient like that, you might recommend psychological help."

But Christopher Reitano says his plastic surgery has given him such a psychological lift that he's started a trend among his friends. "Some of my friends have now had more drastic stuff than I did—liposuction and the like." he says.

Men shopping for a surgeon should pick wisely, Reitano says. "I would never want to go to someone who says, 'Oh, great, we're going to make you look wonderful.' You've got to have realistic expectations. It can help your life, not change it drastically."

The American Society of Plastic Surgeons recommends choosing a plastic surgeon who is board certified by the American Board of Plastic Surgery. Here are other questions ASPS recommends you ask before deciding on a plastic surgeon:

Do you have hospital privileges? At which hospital? (Even if your surgery will be performed in your doctor's own surgical facility, he or she should have hospital privileges. It means the surgeon is subject to approval by his or her peers. Call the hospital to make sure.)
Where will you perform my surgery?
What are the risks involved?
How many procedures of this type have you performed?
Would it be possible to contact any of your former patients who have had this procedure?
How long of a recovery period can I expect?

What is impotence? How is it diagnosed? How is it treated?

2007-11-18T13:24:00.000-08:00

What is impotence?

Impotence is the inability to achieve and keep enough stiffness of the penis to enter the vagina and have intercourse.

It is normal for most men to have an occasional instance of impotence when tired or nervous. When impotence becomes a pattern or a long-lasting problem, however, it can profoundly affect the emotional lives of men and their sexual partners.

Impotence affects older men more than younger men. Midlife and the later years bring changes in circulation that may affect the sexual organs. Couples need to be more open and understanding with each other about sexual problems such as impotence.

Fortunately, impotence can often be cured.

How does it occur?

An erection is caused when there is increased blood flow into the penis and the penile veins clamp down to make sure the blood is trapped there, causing stiffness. Nerves in the penis provide the sensations of pleasure and help maintain the erection until ejaculation.

There are many possible physical and nonphysical causes of impotence, including:

disturbance of blood circulation to the penis
overeating and drinking, which diverts blood to the gastrointestinal organs
extreme fatigue and jet lag
fear of failure at intercourse and loss of interest in sex
depression, stress, or anxiety
diabetes
neurological diseases or injuries, such as paraplegia and multiple sclerosis
alcohol and drug abuse
low levels of male hormone (testosterone)
side effects of medications for heart disease, high blood pressure, and nervous disorders (tranquilizers)
complications after radical surgery for cancer of the prostate.

How is it diagnosed?

If impotence lasts longer than 2 months or is a recurring problem, you will want to have a physical exam by your doctor or ask him or her to refer you to a doctor who specializes in erectile problems.

The exam will include urine and blood sugar studies so that the doctor can rule out diabetes. In addition, the doctor may want to measure the male hormone level in your blood.

The doctor may want to test penile blood flow and pressure and may also want to measure the nighttime stiffness of the penis by the stamp test or snap gauge test. In the snap gauge test, a band is placed around the penis before you go to sleep. If there is an erection, the snap gauge will break.

For the stamp test, you take a strip of stamps (such as Easter Seals) and make a ring around the nonerect shaft of the penis, moistening and sealing the stamp overlap before going to sleep. (Do not use postage stamps because the glue is too strong.) If an erection occurs during sleep, the stamp ring will break, waking you, and allowing you to feel the degree of erection. Awakening the next morning with the ring intact means you did not have an erection while you were sleeping. Repeat the test the next two nights. If you have the same negative result three times, you probably have impaired circulation in your penis.

If the doctor has ruled out physical problems as a cause of your impotence, he or she will probably refer you and your partner to a psychotherapist or family counselor.

Psychological problems causing impotence are varied, but most can be helped. Therapy often leads to improved function in other areas of life as well as in sexual function. Psychotherapists often like to work with both partners. Therapy, like other treatments, can be uncomfortable although worthwhile. If you have concerns about your referral, ask to discuss them with your primary doctor.

How is it treated?

If you have low blood pressure to your penis or have a problem with blood flow to it, you may have several options.

Drug Treatment

If a man's level of male hormone (testosterone) is low, he can take monthly injections (in the arm) of testosterone.

Drugs may also be used to get more blood to enter the penis through the arteries, producing or enhancing an erection. Drugs can be injected directly into the penis to produce an erection. The new drug Viagra (sildenafil) can be taken as a pill rather than injected into the penis.

Viagra can help men have and keep an erection. It should be taken about an hour before sexual activity. Viagra should not be used by men who are taking nitrates because the combination could make the blood pressure too low. Erythromycin and some antifungal medicines can interact with Viagra, too, so a lower dose of Viagra is prescribed for men taking these medicines. Viagra can cause some mild side effects, including flushing, headache, and less commonly, indigestion.

Individualized combinations and dosages of other drugs can be self-injected into the penis when an erection is desired.

An occasional problem with injections has been priapism (painful and prolonged erections), requiring emergency treatment. Therefore, the injections must be done only with a doctor's prescription. A man will usually become erect in 3 minutes or less. Men with hormonal or nerve problems will usually respond in 5 minutes. Erections occurring from injections usually last as long as an hour.

External Mechanical Devices

There are mechanical devices that trap blood in the penis to cause an erection. They come with a vacuum chamber, a pump, connecting tubing, and elastic bands. The system requires time and dedication on the part of the couple to become comfortable with it. There are a number of such devices on the market. They may be covered by Medicare when the problem is vascular and the device is prescribed by a physician.

You insert the soft penis into the vacuum chamber tube connected to a pump by a piece of tubing. You then apply suction by using the small hand pump. Negative pressure or suction pulls blood into the penis producing an erection. The blood is held in the penis by placing a tight band, similar to a rubber band, around the base of the erect penis. You should not keep the band in place longer than 30 minutes or fall asleep with it on.

Advantages of these devices include:

Initial positive results increase the desire to remain sexually active.
They may help to reestablish penile blood flow by creating stiffness.

Surgery

Men who have defects of penile arteries or veins may choose surgery to correct the defects.

Invasive Mechanical Devices or Implants

These are mechanical devices actually placed inside the body.

Invasive devices are used only when:

There is nerve and vascular damage.
There has been no improvement with mechanical devices used outside the body, hormonal replacement therapy, or medical treatment of the cause.

Treatment involves inserting a mechanical device or prosthesis into the spaces where the blood normally collects to stiffen the penis.

Although the overall success rate of the penile prosthesis is greater than 95%, many urologists urge couples to consider simpler, less expensive alternatives before surgery.

The urologist or doctor will discuss the advantages and disadvantages of each type of device and help the couple select the appropriate one. The implant has rods or cylinders that can be inflated or deflated at will. Most prostheses can be inserted during a one-day surgery requiring no overnight hospital stay.

Semi-rigid or rigid implants:

Advantages of a semi-rigid or rigid implant are:

It is inexpensive.
It is simple to insert.
It can be inserted under local anesthesia.
It is always ready for use once it is in place.
It has a 20-year successful history.

Disadvantages of a semi-rigid or rigid implant are:

It is always at its full size.
It may be hard to conceal. A malleable semi-rigid implant can be bent to hide it and brought into position when desired.

Inflatable Implants:

Advantages of an inflatable implant are:

It can be easily hidden. It uses a pump tucked in the scrotum above the left testicle and a fluid reservoir behind the pubic bone. The hollow cylinders that replace the erectile tissues are connected to the reservoir and can be inflated or deflated at will. The penis returns to a resting state when the fluid is returned to the reservoir from the cylinders by reversing the flow with the pump.

Disadvantages of an inflatable implant are:

It is more expensive.
Its insertion requires a hospital stay of 24 to 48 hours.
Since it is more complex, there are more ways in which the device could stop working.

For More Information

Information and support are available through Impotence Anonymous (IA) and Impotence Institute of America (IIA). The hotline for both is: 1-800-669-1603.

You may want to write the IIA at:

The Impotence Institute of America
119 South Ruth
St. Maryville, TN 37801-5746

Impotence treatments: Implants, Vascular Re-constructive Surgery, External Vacuum Therapy

2007-10-29T12:03:00.000-07:00

The purpose of this site is to provide comprehensive information on
impotence, and objective information on all currently acceptable medical
treatments. However, readers should understand that like most publications
distributed by a medical supplier, this one has a bias for the treatment
therapy and products it is most familiar with, in this case external vacuum
devices and Osbon ErecAid® System.

For more information on external vacuum devices, a list of the published
clinical studies on ErecAid® System, or referral to a physician in your
area who is familiar with vacuum therapy, please call Medic Drug's Impotence Information Center at 1-800-686-8886, ask for Bill at Ext. 118.

Forward:

Until a few years ago, men had few choices for erectile dysfunction. This
is not the case today. Thanks to a large amount of creative work
accomplished recently, virtually every impotent man can now be treated
successfully. The choices range from oral medications to injections, from
psychological therapy to surgery, and from external devices to internal
ones.

Most of these treatments are found in the urology area, where they have
been for 15 years. But this is starting to change. General practitioners
have discovered that they can safely prescribe many of the treatments
available. This is important because erectile dysfunction is often the
first overt symptom of serious conditions like diabetes, high blood
pressure and vascular disease.

Ten to fifteen percent of all men have some degree of impotence; this
statistic includes one out of every three men over age 60. Most of these
men visit a family doctor on occasion which means that if the physician is
alert and inquisitive about sexual function a golden opportunity exists to
discover the impotence, determine its underlying cause and offer successful
treatment.

Because of the availability of many good treatments, no man has to live
with impotence any longer. By investing one hour of your time to read this
guide, you will learn about treatments that could dramatically change your
life.

The choice is up to you. The information contained in this booklet is
presented in layman's language for easy understanding. Good luck with
whatever treatment you select.

Table of Contents:

1. Admitting Impotence to Yourself
2. Three Tough Questions
3. Understanding the Erectile Process
4. What Causes Impotence?
5. Choosing Your Doctor
6. What Happens at the Doctor's Office?
7. Current Treatments for Impotence

o Yohimbine Tablets
o Hormone Medication
o External Vacuum Therapy
o Injection Therapy
o Types of Implants
+ Rods
+ Multi-Component
+ Self-Contained
o Vascular Surgery
o Sex Counseling and Therapy

8. Choosing Your Treatment
9. Health Insurance and HMO's
10. Medicare Coverage

Admitting Impotence to Yourself
A lot of men become sexually impotent, but never admit it to themselves.
Sadly, this denial prevents them from enjoying sexual activity on a regular
basis again. A man who behaves this way has a lot of company. Up to 30
million American men are impotent, but fewer than 5 percent have ever been
treated.

Ignoring the problem was normal behavior years ago, but today sexual
wellness is often viewed as an indicator of total health. As more men are
living longer, they have an interest in treating impotence. The pride
factor does not inhibit treatment as it once did. Today, there are many
effective treatments to choose from, both surgical and non-surgical. But
the first step is admitting the problem.

We begin by defining what impotence is:
Impotence is the inability to have an erection that is rigid enough and to
maintain it long enough to complete sexual intercourse.

If your erections do not become firm enough to allow vaginal penetration,
you are impotent. If your erections have the necessary rigidity, but are
only firm briefly, you may have an impotence problem. If your erection
loses its strength upon penetration, you probably have the problem. If any
of these scenarios fit you, it may be time to admit it and take the first
step toward a treatment that can change your life.

Ask Yourself Three Tough Questions

The answers to these three questions may determine whether you should
seriously seek impotence treatment.

1. What is your degree of motivation? After long periods without sexual
activity, men and women fall out of the habit of having sex. Mere
curiosity about a particular treatment is not enough. To stand a
better chance for success, you should define yourself as eager or
extremely eager to resume sexual activity on a regular basis.

2.
3. What is your willingness to learn new techniques? In order to
successfully use any of the treatments discussed here, a man must take
some physical action to make the erections happen. If you learn how to
perform this action, you should get a consistent erection every time.
Your willingness to perform this action and to work your way through
the learning curve is vital. If you resist using new methods to
achieve an erection, you will probably not be successful with these
treatments.

4.

5. What is the degree of your partner's support? Asked more directly, the
question is, "Does your partner also want to become sexually active
again?" Is she willing to help you decide which treatment to use? Is
she willing to have sex with you using the treatment you both
selected?

Conviction, strong emotion and basic masculine motivation are needed to
resolve sexual dysfunction problems. If your three answers are negative,
you should lower your expectations of success with any of the impotence
treatments.

How Do Erections Occur in a Potent Man?
[Image]Successful erections require the coordinated actions of a healthy
brain, pliable blood vessels, fully functional nerves, and certain
hormones. Erotic stimulation, triggered by the five senses or by memory,
begins the erectile process. The nervous system responds by sending
chemical messages to and from the pelvic area.

These messages cause the smooth muscle tissue inside the penis to relax.
The blood vessels dilate, allowing more blood to flow into the corpora
cavernosa, the two erectile bodies within the penis. Like sponges, they
capture more blood, swelling and lengthening the penis. When all of the
spaces are occupied with blood, the organ becomes rigid. The enlarged
corpora cavernosa take up so much space inside the penis that strong
pressure is exerted against the penile veins, greatly reducing their
outflow of blood.

At this point, the erect penis contains eight times more blood than the
same flaccid or non-erect penis. As long as the sexual stimulation is
continued, an erect stage can be maintained until orgasm and ejaculation.

What Causes Impotence?
Impotence is not a disease, but a secondary condition brought on by other,
primary causes. It is a side effect, a symptom of something else. Thirty
years ago, when men went to their doctors asking for help for erectile
problems, they were told that there was no treatment because it was caused
by aging, or it was all in their heads (psychological). A generation of
research has been conducted in the intervening years. With more knowledge
now, doctors divide this very common disorder into four general causes:

1. Psychological
2. Physical (Organic impotence)
3. Mixed origin-both psychological and physical
4. Unknown origin

About 85% of this problem is due to a physical (organic) cause. Slightly
more than 10% is totally psychological, or "all in your head." The other 5%
is unknown. The 85% figure includes a mixture of physical impotence with
psychological involvement. Once a man fails to become erect a few times, he
places more stress on himself to have an erection by sheer will power. When
this too fails, he often begins to have a psychological problem.

The main point here is this: 85% of all impotent men are that way because
something within the body, other than the penis, is malfunctioning.
Psychological Impotence describes the problem when physical causes cannot
be found. Pure psychological impotence usually comes on suddenly. It can be
caused by job stress, a troubled marriage, or financial worries. Any
nagging everyday situation which occupies conscious and subconscious
thoughts can cause impotence. Depression or concern over poor sexual
performance can cause it.

It should be noted that every man experiences temporary periods of
impotence at one time or another during his life. That's entirely normal,
and you don't need treatment unless the problem is persistent.

Physical Impotence develops gradually and is characterized by any of these
three basic functional problems:

1. Failure to initiate results from impaired release of the chemical
messages sent by the nervous system. The inability to develop an
erection is common in cases of hormonal insufficiency, spinal cord
injury, radical pelvic surgery, multiple sclerosis and Parkinson's
disease.

2.
3. Failure to fill results from poor blood flow into the penis. The
inability to develop an erection rigid enough for intercourse is
caused by blockage in the arteries, common in cases of pelvic trauma,
hypertension, smoking, diabetes and high cholesterol.

4.
5. Failure to store results from venous leakage when blood escapes too
quickly from the penis, leaking back into the body. This inability to
maintain an erection rigid enough for intercourse is common in cases
of hypertension, smoking, diabetes, high cholesterol and pelvic
trauma.

6.

7.
The consensus of most authorities is that the table below represents an
accurate distribution of the various causes of physical impotence.

* The important thing to remember is that most causes of impotence are
physical and often beyond your control. While it is not good to have these
physical problems (diabetes, high blood pressure, stroke or prostate
disease, etc.), they are conditions you can probably accept and feel
comfortable about trying to correct.

* Diseases of the blood vessels (vascular disease) is the leading cause of
impotence. Vascular disorders include arteriosclerosis (hardening of the
arteries), hypertension, high cholesterol and other conditions which
interfere with blood flow. If poor blood flow occurs in the heart, or
coronary vessels, it causes heart attacks; when it occurs in the brain it
causes strokes; and when it occurs in the penis, it causes impotence.

* Another problem, "venous leakage," occurs when the penile veins are
unable to close off (constrict) properly during an erection. Constriction
of the veins holds the blood in the penis to maintain the erection. When
the veins "leak," blood escapes too quickly back into the body, and the
erection fails.

* Diabetes is a very common cause of impotence. This disease can damage
both blood vessels and nerves. When nerves are affected, the brain cannot
properly transmit the sexual stimulus that creates an erection. About 50%
of all diabetic men experience impotence after the age of 55.

* Radical pelvic surgery may also result in impotence. Surgical procedures
involving the prostate gland the bladder or colon may sever the nerves
involved in erectile response. Radiation treatment in this area can also
affect the erectile process.

* Neurologic (nerve) disease is another cause of impotence. Neurologic
disorders affect the nervous system and include multiple sclerosis,
Parkinson's disease and spinal cord injury with paralysis.

* Deficiencies of the endocrine system are another source of erectile
dysfunction. For example, low levels of testosterone or thyroid hormone
often cause poor quality erections. Excessive production of prolactin by
the pituitary gland may contribute to a low testosterone level and lack of
desire. Diabetes is also considered an endocrine disease.

* Prescription drugs often cause Impotence as a side effect, and over 200
medications fall in to this category. Never change a dosage or stop taking
a prescribed drug without the advice of your doctor.

* Substance abuse affects erectile function as well. Illegal drugs and the
excessive use of alcohol or cigarettes can seriously damage the blood
vessels and nerves involved in a normal erection.

* The Logic to Use in Choosing A Doctor
Where do you go? What type of doctor diagnoses and treats impotence? How do
you get the best answer? Almost all erectile dysfunction in the USA is
treated by the six types of professionals listed below:

1. Family Practitioners
2. Urologists
3. Internists
4. Endocrinologists
5. Psychiatrists
6. Psychologists

Family practitioners, internists, and endocrinologists are primary care
physicians most likely to be your family doctor or principal physician.
This is the doctor you consult first about impotence. He or she knows the
most about your medical history and current condition. If he chooses not to
treat you, he may refer you to another physician who treats impotence
regularly. Many family doctors, however, are now treating this problem
using non-surgical treatments.

As surgical specialists of the genito-urinary system, urologists are
closely identified with impotence. Of about 10,000 urologists in the USA,
some 3,500 of them actively treat impotence.

Psychiatrists and psychologists may be consulted if your doctor cannot find
a physical cause for your problem. In many cases, a psychological aspect
develops after impotence has been present for a while.

Your doctor's job is to help determine, through simple tests, the cause of
your impotence, and to help you choose the simplest, safest and most
effective treatment.

What Happens at the Doctor's Office?
The purpose of your visit to the doctor is to answer two questions:

1. Why am I impotent?
2. What can I do about it?

The second question assumes that you will be able to select from a number
of treatments. You could also choose abstinence. Though each doctor may
approach diagnosis and treatment differently, your physician will help you
understand the cause of your impotence and your options for dealing with
it. Remember it is your doctor's job to help you determine which treatment
option is best for you.

All physicians will first record your medical history, including
psychological and sexual aspects. They may ask about stress and fatigue and
about the relationship between you and your partner. Some questions may be
very person al, but your doctor needs to know about your present sexual
functioning in order to treat your impotence.

One sure question is, "Do you wake up in the morning with an erection?" If
you always wake up with an erection, your physical system works, and the
impotence may be psycho-logical. If you never wake up with an erection, it
suggests a physical problem with blood vessels or nerves.

Whether you start treatment with your family doctor or a urologist, the
initial approach will probably be conservative. Conservative, non-surgical
treatments for impotence have proven very successful, and most patients
find surgical treatment unnecessary.

In diagnosing your impotence, your doctor will first look for obvious
contributing factors. For instance, diabetes, alcohol abuse or prostate
surgery can cause impotence. "Short cut" diagnosing may be appropriate when
your medical history strongly points the way.

The Family Doctor
After recording your medical history, a family doctor may do a complete
physical exam, including a rectal exam to check your prostate. He will also
check your genitals for abnormalities that could interfere with effective
treatment. For example, some men have Peyronie's disease, a curvature of
the penis caused by plaque formation. Certain treatments cannot be used if
the curvature is severe.

Of particular interest when diagnosing the cause of impotence are various
blood pressure readings, the results of blood tests, and an update on the
medicines you take.

The Urologist
If your family doctor is not comfortable with treating impotence, he or she
may refer you to a urologist, who may prescribe any of the known treatments
for impotence. He or she may also do all the examining and testing already
mentioned, if not done by your family doctor. The urologist will conduct
additional, more sophisticated tests if you are thinking about a surgical
correction for your impotence.

The Current Treatments for Impotence
A panel of experts met in Washington, D.C. in December 1992 to define the
state of the art in the diagnosis and treatment of impotence. In treatment,
they recommended that "as a general rule, the least invasive procedures
should be tried first." Their statement then listed current treatments in
this order:

1. Psychotherapy or counseling, if appropriate
2. External vacuum devices (such as ErecAid® System)
3. Penile injection therapy
4. Penile implant surgery
5. Vascular surgery

A few men may be helped by taking an oral drug like yohimbine, but
undesirable side effects may occur, and results are usually weeks away. A
few may also benefit from taking hormone medications, but unless the
hormone deficiency is severe, this treatment may not help.

Vacuum therapy with ErecAid® System, the original external vacuum device,
is probably the most widely recognized first-step treatment since it works
for all types of impotence and has minimal side effects. Even if other
non-invasive treatments, like yohimbine or counseling, are tried first,
vacuum treatment can be applied concurrently to get immediate results.

Penile injections have been used for over a decade with about a 70% success
rate, but many men express disdain for this treatment when they learn that
it involves a needle stuck into the penis. However, there are many
impotence clinics which specialize in this therapy.

Implanted devices, of course, involve surgery. Experts now believe that
this treatment, once considered as the "gold standard" therapy, should only
be done as a last resort, when the lesser invasive treatments have failed.
The placement of an implant permanently alters the interior of the penis.
If a pill is finally invented which cures impotence, it will surely require
healthy corpora cavernosa in order to work. An implant prevents this part
of the penis from being useful again.

The bar graph below shows the estimated percentages of men on various
impotence treatments at this time.

Yohimbine Tablets
This natural aphrodisiac from the bark of the yohimbehe tree is sometimes
prescribed by doctors for men with intermittent erectile dysfunction. In
most of these cases, the physician suspects a psychological problem, but
cannot prove it. The drug is used to stimulate desire and improve the
quality of the erection. Dispensed in tablet form, yohimbine is taken three
times a day for 4-6 weeks to test its effect. Costs are about $40 a month.
Even if the tablets work, which they do in 15-20% of patients, stopping the
tablets may return the patient to his former state of impotence. Side
effects may include headaches, sweaty palms, dizziness, and nausea. Men
with ulcers or hypertension probably should not take this drug.

Hormone Medication
A severe deficiency of the male hormone, testosterone, can cause impotence.
The nature of the treatment is to give the man either oral testosterone or
an injection in the arm or buttocks to raise the hormone to acceptable
levels. In these cases, the treatment can be an effective one. Only about
4% of the male population, however, have the problem and can benefit from
the treatment. Side effects of testosterone replacement therapy can be
serious, and patients with a medical history that includes liver disease,
heart disease, kidney problems, or prostate cancer should probably avoid
supplemental testosterone. This chemical can lead to the retention of
fluids, enlargement of the prostate, and damage to the liver.

External Vacuum Therapy
This treatment is a simple, non-surgical method of producing a quality
erection. The external vacuum device was created by Geddings Osbon, in the
early 1960s, to solve his own impotence problem. He created the ErecAid®
System, based on negative pressure and tension rings, to produce and
maintain a naturally engorged erection every time one was needed.

The vacuum System (two versions are depicted) consists of a clear plastic
cylinder, a hand pump or battery pump, and a special tension ring. The user
stretches the tension ring around the open end of the cylinder, then
inserts his penis into that end. Holding the device firmly against his body
to form an air seal, he uses the pump to remove air from inside the
cylinder. This creates a partial vacuum around the penis, causing the
body's blood to enter the corpora cavernosa. This engorges the penis in a
way similar to a natural erection.

To maintain the erection, it is necessary to reduce the outflow of blood
from the penis. Therefore, while the penis is still under vacuum pressure,
the tension ring is pushed from the cylinder on to the base of the penis.
This breaks the seal of the vacuum, allowing the cylinder and pump to be
removed and laid aside. The user can maintain an erection for up to 30
minutes, wearing only the tension ring. This procedure, which takes about
two minutes, is used whenever an erection is needed.

The ErecAid® System has been effective for over 90% of men who have used
it. Men who have had their prostates removed are successful with it. Men
who have had penile implants installed and later removed can often use this
system successfully, as can men with blood vessel blockages. Psychological
patients are successful with it, as well as diabetics.

The manufacturer of the System polls new owners to determine the
effectiveness of the product. Over 200,000 men have been surveyed. When
questioned about the 6-month period just prior to acquiring the vacuum
System, 76% of the men reported that they had had no sexual intercourse or
very irregular sexual activity. After using the System for 90 days, 80%
said they were having sexual intercourse at least twice a month. Initially,
it takes practice to use the System. 42% of patients learn to use it in one
day, and 90% master it in two weeks. 69% can create a usable erection
within two minutes.

An unexpected statistic which emerged from the survey pertained to the
occasional restoration of natural erections. About one in four (26%)
reported that after using the System for a number of months, they were
sometimes able to have intercourse without using the device. This means
that the use of a vacuum device to force blood into the penis may have the
effect of bringing back some sexual power, some of the time. This was also
noted in a Case Western Reserve University Medical School study (Cleveland,
Ohio) in 1989-1990.

The most significant advantage of the ErecAid® System is that it works
without requiring surgery or a healing period. As such, it is non-invasive.
It is used on the body (not in the body), and can stay in a dresser drawer
or on a shelf when not in use.

Another advantage is cost. The hand-pump ErecAid® costs the patient $395,
and the battery model, $455. Most other impotence treatments are far more
expensive. The major components of both Systems have lifetime guarantees,
and medical insurance coverage is available in many cases.

A significant advantage is that the erections are of high quality, lasting
longer than natural ones, and they do not usually disappear after an
orgasm. Also, once the erection technique has been learned, the patient can
achieve reliable, consistent erections each time. The erection stops when
the tension ring is removed, recommended to be no longer than 30 minutes.

With some men, minor side effects can occur, such as petechiae and
ecchymosis. Petechiae are caused by placing the penis under negative
pressure too rapidly. Reddish pinpoint-size dots appear on the surface of
the penis. The penis may need to be reconditioned slowly after a prolonged
period of inactivity.

Ecchymosis is a bruise caused by the penis being held under vacuum pressure
too long. Neither condition is painful nor serious and does not need
treatment. They stop happening after a few uses. A final side effect is a
temperature drop of 1-2(deg)in the penis, caused by the tension ring. No
major injuries have ever been reported concerning the ErecAid® System.

This device may not be an appropriate treatment for men who have sickle
cell anemia, leukemia, or blood clotting problems. Proper use of it
requires some manual dexterity and average hand strength. All criticism of
these devices centers around the use of tension rings, and the loss of
spontaneity in lovemaking. Many men believe, however, that they are far
better sexual partners with the device.

Penile Injection Therapy
[Image]Physicians learned in the early 1980s that some medications injected
directly into the corpora cavernosa would produce an erection within a few
minutes. Urologists now routinely use this method to treat men by teaching
them self-injection techniques to use at home.

Currently, three medications are used for this purpose. Papaverine was the
first one used. Phentolamine, an alpha blocker, was used second, initially
as an additive to papaverine, and later to prostaglandin El, the third
drug.

Papaverine and prostaglandin both act on smooth muscle tissue in the
corpora cavernosa, while phentolamine is more effective in the tiny penile
arteries to prolong the erection. Most doctors mix all three drugs
together.

Diabetic needles (27 or 28 gauge, a half-inch long) are used for these
injections. The patient must learn to inject the base of the penis using
less than 1 cc. Either corpus cavernosum may be injected but not the
urethra. Hand pressure is applied afterward for 2-3 minutes to prevent
bleeding. Ideally, erections will last 30-60 minutes and will become more
rigid if stimulation occurs.

With injection treatment, high quality erections are available on demand,
and they last longer than natural ones. The erection does not always
disappear at orgasm or ejaculation. Injections work in about 70% of all
cases. The 30% failure is often due to poor blood flow or venous leakage.

There are concerns with injections. The key ones are priapism, pain,
dropout rate, and cost. Priapism is the word to describe an unwanted,
prolonged erection. Injecting too much of the drug may cause an erection
which lasts much longer than intended. After four hours, men should seek
medical help for reversal of the erection. This is done by injecting an
adrenaline-like drug into the penis.

The pain from injecting is primarily from the needle puncture. Many men are
frightened to think of injecting the penis with a needle. This apprehension
may account for the high dropout rate for men on injections. A 1990 study
(University of Chicago) showed that 51% of the group dropped out after
receiving only a test injection. The average patient stayed in the study
group for seven months before leaving it. Other men, however, inject
successfully for years.

Depending on the exact mix of the drugs, an injection costs $5 to $15. If a
man is sexually active twice a week, the annual cost will range from $520
to $1560. Third-party insurers, especially Medicare, do not usually pay for
these treatments because the FDA has not approved the drugs for impotence
treatment, and is still considering using them for impotence treatment to
be experimental.

Introduction to Implants
In 1972-73, physicians began doing penile implants to help with lost
potency. Over the years since then, three distinct types of implants have
been used. Today, surgeons implant about 20,000 of these devices per year
into American men who choose this treatment. Semi-rigid rods account for
about 35%; multi-component inflatable implants are thought to be 45% of the
total; and self-contained devices make up the last 20%. In all cases, two
synthetic cylinders are surgically placed inside the corpora cavernosa of
the penis. After 4-6 weeks, a man is ready to engage in sexual intercourse.

These devices are either mechanical, inflatable, or hydraulic. Their
implementation permanently alters the corpora cavernosa, ending all hope of
the return of natural erections, so this treatment should be considered a
final step, not an early one. There is also the usual risk of infection
with surgical procedures, and eventual malfunction or deterioration of the
device may require other surgeries.

Semi-Rigid Rods
[Image]Two bendable rods have an outer coating of silicone and inner,
parallel, silver or stainless steel wires or interlocking plastic joints
held together by a cable. With this rod, the penis is always erect, but can
be bent down. To prepare for intercourse, the man simply bends the penis to
a "ready" angle.

The rate of complication is low and many of these rods are inserted as an
outpatient procedure with a local anesthetic. The surgeon's skill is
important since he has to properly "size" the implant to your penis. Cost
is approximately $6,000-$10,000, including the surgery.

Disadvantages are these: Because the penis is always erect, it is difficult
to hide under a swimsuit or tight-fitting clothes; the erection is due to
metal and silicone, not the flow of blood into the penis; and, finally, the
surgery is not reversible.

Multi-Component Inflatable Implants
[Image]This implant has two or three components. Inflatable cylinders are
placed in the corpora, a fluid reservoir goes into the abdomen (or scrotum)
and the pump is placed in the scrotum. A squeeze of the pump moves fluid
from the reservoir to the cylinders, causing rigidity. Another pump squeeze
reverses this process.

A skilled urologist, using general anesthesia, implants this device for a
total cost of $12,000-$15,000. After 4-6 weeks of healing, the patient may
begin to use it. Mechanical failure or patient infection are the two most
common complications. Both can cause a need for more surgery. Key factors
are (1) the surgical procedure is not reversible, and (2) the erection
stems from saline solution, not the bloodstream.

Self-Contained (Inflatable) Implants
[Image]Two cylinders are placed inside the penis. Each one contains a pump,
fluid, and release valve. A squeeze of the head of the penis forces a fluid
transfer to the forward chamber, causing rigidity. A certain bend of the
penis causes fluid to flow back into the storage area, ending the erection.

Using general anesthesia, a urologist implants the device for a total cost
of $10,000 - $12,000. After 4-6 weeks, sexual activity starts.
Complications: Device failure and infection. Important factors are (1) this
is not reversible, and (2) the erection is from saline solution and plastic
parts.

Vascular Re constructive Surgery
Penile surgery of this type is like heart bypass surgery, which reroutes
the blood supply around blockages. Fewer than 1% of impotent men are
candidates for this procedure, and the failure rate is very high.

Venous ligation is a penile surgical procedure in which the surgeon
attempts to repair the veins causing venous leak. This procedure was
popular until physicians began to realize that it offered only a temporary
solution. Many patients required another operation within a few years.

These procedures cost about $15,000 and should only be done by surgeons
experienced with the procedures, preferably in an investigational setting.
Complications may include: permanent numbness near the incision and scar
tissue which may shorten or "torque" the penis. Also, the surgery may need
to be repeated.

Sex Counseling and Sex Therapy
Sex counseling refers to consultations with a qualified counselor who helps
the couple to identify, understand, and cope with their sexual concerns.
Sex therapy is more structured in that it uses counseling, but also
includes a time element and specific exercises for the couple. Exercises
are meant to remove stress from areas of the relationship that influence
sexual function. They may include sexual touching and other sexual
exploration.

When the cause of impotence has a strong psychological involvement, sex
counseling or therapy can be very effective. Couples should seek this
therapy only from a trained professional with a good reputation.

Which Treatment Should I Choose?
Several factors must be considered in selecting a treatment. A few of them
have been outlined below.

Partner's opinion. Ask her to go through this booklet with you. Ask her to
visit the doctor with you. Does she lean toward one treatment more than the
others? If you are young with no partner, you may be happier with implants
and injections.

Frequency of sexual activity. Will sex be performed twice a week, twice a
month, or twice a year? Select a therapy which is consistent with the
estimated amount of use.

Must you change the way you live? A permanently erect penis (semi-rigid
rods) may keep you out of a swimming pool forever. Ask your doctor about
any compromises you may have to make.

Treatment sequence. The best way to look at impotence therapy is that the
simple, inexpensive, reversible treatments should be tried first, while the
more complex, expensive, non-reversible treatments should be attempted
later. The ErecAid® System, yohimbine tablets, and sex therapy might be
tried earliest since all are relatively inexpensive and reversible. Last on
the list are injections, vascular surgery, and implants. All of these are
invasive therapies which cause internal changes in the penis. If some new
treatment appears in the future which requires the corpora cavernosa to be
healthy, you probably will miss out on it if you have permanently altered
the erectile bodies.

What are the odds of re-operation? Ask your physician about the odds of
having repeat surgeries. Ask about the failure rate of the implant he is
recommending. Ask about the failure rate of the various vascular surgeries.
Injections may only be temporary. The majority of men choosing injections
have switched to another treatment within one year. Ask your doctor why.
Ask about "fibrosis" caused by the frequent needle punctures. Make sure you
know about "priapism" and how it is reversed. Learn about how the body can
develop a tolerance to the drugs, making you use larger and larger doses.

ErecAid® System in a backup role? A large number of patients select the
ErecAid® System as their primary treatment. But it should be noted that
some men use the System along with injections. Why? By using a tension
ring, it is possible to inject less drug to get a good result; also, the
two treatments can be alternated so that the weekly limit of two sexual
encounters can be exceeded. An ErecAid® System is also sometimes used to
enhance the rigidity of an implant. This is a safe practice for rod
implants, but becomes riskier with the inflatable models.

Financial considerations. What is the out-of-pocket cost of the treatment
selected? How much will health insurance pay for? What are the guarantees
or warranties of the treatment chosen?

Maintenance costs. Ongoing costs for treatment must be identified. For
example, yohimbine tablets have an ongoing cost, as do penile injections.

Safe and effective treatment? Has the chosen therapy received FDA marketing
approval? Have clinical studies been performed for this treatment? Is the
treatment backed up by a reputable provider, with liability insurance?

Physician, heal thyself? A medical publication asked urologists, in 1990,
how they would treat themselves if they became impotent. The question was:

If you or a close family member suffered from erectile dysfunction, which
treatment would you choose/recommend as the first step?

The answers came back as follows:

Health Insurance and Impotence
Insurance companies will generally pay for impotence treatment when the
cause is physical. Your physician must specify on the claim form the
physical cause of your impotence and that your treatment is "medically
necessary."

If your physician diagnoses a psychological cause, many insurance companies
will deny the claim, unless state law mandates limited coverage. Some group
policies exclude coverage for impotence of any type.

Health Maintenance Organizations (HMOs)

Most HMOs consider sexual health to be an integral part of an individual's
total health, so they will generally provide treatment unless there is an
exclusionary clause in the patient's contract.

HMO physicians generally try to guide patients to the most effective
treatment at the lowest cost. For this reason, external vacuum devices are
usually favored because of the high success and relatively low cost.

Penile injections and implants are used less often. The initial costs for
penile injections are relatively low, but costs accumulate as long as the
patient is sexually active. Penile implants, with higher initial cost and
higher risk of complications may be considered for payment by the HMO only
after the patient has tried more conservative treatments.

Medicare and Impotence
Medicare coverage is divided into Medicare "A," which covers surgeries,
hospital stays and the more costly medical services; and Medicare "B,"
which covers doctors' office visits, medical devices and the less costly
items and services.

If you have FICA taxes deducted from your paycheck, you will be covered by
Medicare A at no charge when you reach 65. Medicare B costs about $30 a
month and may be deducted from your Social Security check.

Surgical treatments for impotence are usually covered by Medicare A in most
states, as long as your doctor verifies a physical cause of the impotence
and states that the treatment is "medically necessary." Vacuum devices are
covered under Medicare B. Penile injection therapy is not covered since the
drugs used for injection have not yet been approved by the FDA as a
treatment for erectile dysfunction.

As of late 1993/early 1994, Medicare is reimbursing for external vacuum
devices under Medicare B. With a valid prescription, you may obtain a
vacuum device from Medic Drug, a medical
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suffering from impotence.

Impotence is the inability to achieve or to sustain an erection
adequate for sexual intercourse. It's a common, treatable condition,
yet over 90% of affected men never receive treatment. This is because
often they're reluctant to discuss the subject with their doctor.

Until recently, many health care professionals believed impotence was
psychological. Patients were often told, "It's all in your head."
Today, experts have learned that up to 75% of impotence cases aren't
psychological in nature. Impotence is often a symptom of an underlying
physical condition and can be medically treated.

Most men experience occasional impotence at some time, usually as a
result of fatigue, temporary stress, or excessive alcohol consumption.
Temporary impotence is not something to worry about. However, if the
condition persists or interferes with your normal sexual activity, you
should consider seeing a doctor who specializes in treating impotence,
typically a urologist.

Impotence can now be managed effectively with CAVERJECT which is
indicated both for the treatment of impotence due to neurogenic,
vasculogenic, psychogenic, or mixed origin and as an adjunct in the
diagnosis of impotence. CAVERJECT contains alprostadil, the naturally
occurring form of prostaglandin E (PGE), and normally induces an
erection within 5 to 20 minutes, once the optimum dose has been
established. The dose must be individualized for each patient by
careful titration under physician supervision. (See DOSAGE AND
ADMINISTRATION section of the prescribing information.)

The activity of CAVERJECT is localized to the penis. Mild to moderate
penile pain, generally well tolerated, is the most frequently reported
side effect of injection, occurring in approximately one third of
patients. *CAVERJECT is contraindicated in men with a known
hypersensitivity to the drug or conditions that might predispose them
to priapism, and in men with penile implants or anatomical deformities
of the penis.

I hope this information has been helpful to you. Please feel free to
contact us with any questions.

*Among patients reporting pain, not every injection was associated
with it. Of 21,490 injections studied, 11% were pain related.

Complications of penile lengthening and augmentation seen at one referral centre.

2007-10-23T21:22:00.000-07:00

Glossary:

Scrotalization: One possible result of a penile lengthening operation, in which the skin that had once been just behind the penis advances down the shaft. This pubic hair-bearing skin is bunched up around the shaft, resembling a scrotum that extends above as well as below the base of the penis. It is useless for intercourse, and comparatively devoid of sensation.

Peyronie's disease: A disease of unknown cause in which the corpus cavernosum is surrounded by dense fibrous tissue, causing deformity and painful erection.

Epispadias: A malformation in which the urethra's opening is located on the dorsal (upper) side of the penis.

Penile lengthening is widely accepted as a necessary treatment for men with very short penises who suffer from Peyronie's disease, epispadias, or penile retraction following spinal injury. Only recently has it been adopted as a cosmetic technique for healthy men. The normal approach is to cut the suspensory ligament, which connects the base of the upper side of the penis to the pubic area. With this released, the penis can theoretically hang lower when flaccid. The operation is known as inverted V-Y plasty, after the shape of the incisions made. All 12 of the patients looked at here had undergone V-Y plasty.

Penile girth augmentation, which involves injecting fat from other parts of the body, is a purely cosmetic treatment. If the experiences of the 10 Californian patients who tried it are any guide, it can only be described as a remarkably unsuccessful procedure. In fact, it is practically guaranteed to fail in the long term, because such fat transplants lose 55% to 90% of their volume after one year. Moreover, such deposits as there are tend to be very unevenly spread, giving the penis a bulbous and misshapen look. Two of these patients had attempted to have this problem rectified with further injections into the narrow areas, but without success. In another patient the fat had migrated immediately after the operation to the underside of the penis, giving it an appearance quite different from that desired. Such fat deposits can be removed by resection, but there is a risk of losing erectile function by cutting the blood flow to the overlying skin.

Scarring, scrotalization and wound infection were common results of V-Y plasty in these patients. Four of the 12 patients required hospitalization for infections. Two suffered skin breakdown which required scar revision -- unfortunately these repair attempts failed. Six of the 12 had already undergone secondary operations in an effort to correct cosmetic deficiencies before they turned to the authors for help. Two patients had raised scarring at the base of the penis bad enough to cause pain during sex, one to such an extent that he no longer had intercourse. Four patients suffered scrotalization, a deformity that was fortunately reparable by reversal of the V-Y plasty. One patient was afflicted with severe ventral penile deflection -- in other words, his penis pointed straight down even when erect -- as a result of the severing of his suspensory ligament. He had to be warned that he would be unlikely to maintain penetration.

Four other patients exhibited sexual dysfunction of one sort or another. One had already been impotent due to diabetes; another had reduced libido, a third had poor erections, and one found penetration difficult because of excess fat deposits on the shaft. Several patients showed signs of neurological injury to the penis. All patients reported feelings of guilt, shame, and intense embarrassment, which could contribute psychosomatically to sexual dysfunction.

All of these problems were compounded by the very poor cosmetic results, and the failure of the V-Y plasty operations to achieve their main aim -- lengthening of the penis. Only one of the twelve patients said his penis was longer than before the operation, while nine reported no change and two said their penises were actually shorter.

This was not a planned survey of success rates in penis augmentation. There are no figures telling what proportion of these operations end in failure, either in this paper or anywhere else. Obviously, satisfied customers are unlikely to present themselves at a urological unit, so there were no controls. Two patients were found in the university's sexual dysfunction clinic who had undergone augmentation and declared themselves not dissatisfied with the result. One had been impotent already, while the other had Peyronie's disease. In both cases, the doctors who had performed the augmentation had failed to treat their primary condition.

The Society for the Study of Impotence has decreed that in view of the total lack of reliable evidence for the efficacy of augmentation, it should be regarded as an unproven experimental procedure. The authors of this paper, it seems, are strongly inclined to agree.

Questions for Dr. Wessells:

1. Could V-Y plasty theoretically lengthen the erect penis as well as the flaccid one?

Release of the suspensory ligament of the penis theoretically increases penile length. V-Y plasty changes the configuration of the skin which would otherwise prevent the penis from assuming a lower position in relation to the pubic bone. No published data exists regarding the effectiveness of penile lengthening in normal men. In a study of cadaver dissections, division of the suspensory ligament and V-Y plasty resulted in only a 1.6 cm increase in flaccid length and a 1.6 cm increase in erect length. Honest surgeons performing penile lengthening have suggested that a man can expect to gain one inch in flaccid length from the procedure, with minimal change in erect length.

2. Did you see any cases of urinary incontinence or similar problems?

We didn't see any urinary problems due to penile augmentation. The nerves which supply the bladder are far from the surgical site of penile augmentation. Problems with penetration can occur due to ventral deflection or excessive fat placed around the shaft of the penis.

3. What reasons did your patients give for attempting augmentation, especially those who were already impotent?

The impotent men were led to believe that the penile lengthening would solve all their sexual problems. It is unlikely that any preoperative evaluation of their sexual dysfunction was carried out.

Most of the other men responded to advertisements touting the procedure. Many were told that the procedure could be performed without complications and that their penises would be larger. The logic was: "Who wouldn't want a larger penis if there were no drawbacks?" Several of the men faced mid-life concerns about their masculinity and saw the procedure as a way to rejuvenate their lives. Popular culture is filled with jokes and references to penile size, and penile augmentation plays on fears of having a small penis.

4. What sort of doctor is carrying out this surgery? Is there any redress for disfigured patients?

Urologists and plastic surgeons perform most penile augmentations. No sanctioned training exists in this field in America, and no national organisation or board certification process can monitor the procedure. An article in the Wall Street Journal on June 6th of this year suggested that penile augmentation was a new source of income for doctors feeling the pressures of managed care. A few surgeons performed the majority of operations on the patients we saw, and other more scrupulous doctors continue to carry out penile enlargements.

Disfigured patients can write to their state medical board to obtain the necessary papers to lodge a formal complaint against their surgeon. There are also reports in the lay press regarding patients who have brought suit against their surgeon.

Very few patients actually have penises small enough to warrant augmentation. Since the procedure has not been proven to increase penile size, normal men should be very wary of penile augmentation, and demand objective documentation of their surgeon's previous results with this technique.

Complications of penile lengthening and augmentation seen at one referral centre.

Hunter Wessells, Tom F. Lue and Jack W. McAninch.

Purpose: Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed.

Materials and methods: During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection.

Results: The chief complaint was poor cosmetic appearance (irregular residual fat nodules in seven men, skin deformity and scarring in four and scrotalization in four). Reoperation was necessary in six patients, wound complications occurred in six and sexual dysfunction was reported by four. Only one patient reported a subjective increase in penile length.

Conclusions: Although a verifiable complication rate may never be available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.

Most Men Say They're Happy with Their Penile Prostheses

2007-10-23T21:01:00.000-07:00

The surgical insertion of a penile prosthesis is usually the last resort for men for whom other impotence treatments haven't worked. In this surgery, a small pump device about the size of a walnut is implanted in one side of the scrotum, and two tubes extend up either side of the penis. In the newer inflatable devices, which are the most popular today, manually pumping the device forces fluid into the tubes and creates an erection. The tubes are easily emptied using hand pressure.

Unfortunately, the devices destroy the tissue inside the penis that allows erection. So once a man has a prosthesis, other treatments for impotence will no longer work. Therefore, effectiveness and customer satisfaction are big issues!

Researchers attending the annual meeting of the American Urological Association reported, however, that most men with penile prostheses are quite satisfied with them.

In a follow-up study, led by researchers at the University of North Carolina Medical School, records of 372 men, who had received one of the most popular devices (AMS 700CX) at one of seven different U.S. medical centers, were evaluated for reliability of the prosthesis. Later, 207 men were interviewed about their experience with the device.

The prostheses were functioning properly in 92 percent of recipients after three years, and in 86 percent after five years. When interviewed, 86 percent of the men expressed satisfaction with the device, and 88 percent said they would recommend it to other patients.

These results agree with a study reported last year by the Health Technology Assessment Agency of the Spanish Ministry of Health. These researchers reviewed more than 40 articles from medical journals to evaluate effectiveness of these devices and patient satisfaction with them.

Looking at a variety of brands and designs, the Spanish team estimated that the devices were, on the average, about 80 percent effective, with the newer inflatable devices up to 100 percent effective. Surgical complications and infections were low. Sexual satisfaction for patients with the devices ranged from 72 to 96 percent; again, with the newer inflatables getting the highest ratings.

In the United States alone, about 20,000 penile prostheses are implanted each year. It's good to know that for most men, they work!

Impotence Among Men with Diabetes

2006-11-02T10:51:00.000-08:00

Impotence is a common complaint among men with diabetes. In order to
understand it, first we have to see what is involved in a normal
erection. I'll try to explain what it takes to have a normal erection.
Remember here the differences between impotence and lack of libido (sex
drive). In true impotence, the libido is normal but there is no
erection and therefore no performance. In decreased libido, there is
decreased interest in sex (so there are usually no erections), but the
person is not concerned about it.

The majority of erections appear when one is sexually aroused, but
erections are also common during sleep. For that reason, it is not
uncommon for a man to wake up with an "unprovoked" erection two or
three times a week. This is a good sign that helps us to know if the
pathways of an erection are functioning well or not.

To have an erection, several ingredients are required:

- A normal brain, the most important sexual organ
- Normal hormones
- Normal circulation to the pelvic and genital areas
- Normal nerve terminals

A "normal brain" means that, emotionally, one should feel very good
about himself. The most common causes of impotence are psychogenic
("psychogenic impotence") and are due to stress, too much work, not
enough sleep, and, particularly, depression. Less common are phobias
and long-term psychological trauma. In cases of psychogenic impotence,
the onset of impotence is usually sudden, and these persons have normal
erections when they first get up in the morning two-three times a week.

Normal hormones. You need to have normal function of the pituitary
gland and the testes to maintain a good level of circulating
testosterone (the "macho" hormone). An excessive amount of female
hormones may also have an effect similar to low testosterone. Male
hormones are necessary, but they are NOT a sine qua non for erections.
There are persons with low testosterone who are able to have erections,
although at a decreased frequency, because very often low testosterone
is associated with low libido. Treatment with testosterone injections
restores this function. On the other hand, to give testosterone
injections in any other form of impotence is not justified, and it's
even contraindicated because it may increase libido without increasing
performance.

Normal circulation. Erections are a "hydraulic" phenomenon that occurs
involuntarily. Nobody can will an erection! Blood supply to the area
increases by a factor of 15 - 20 because of dilatation of the arteries.
At the same time, the veins close, and this pools the blood in the
organ, increasing the pressure and causing the hardness. If there are
blockages (atherosclerosis of pelvic arteries), blood flow does not
increase, and therefore the hydraulic pressure inside of the penis does
not raise and there is less or no hardness.

Normal nerve terminals. If there is blockage of the "electrical"
connections between the brain and the penis because the "wires"
(nerves) are not normal, the orders to cause an erection do not reach
the area, and these hydraulic changes do not occur. The messages from
the brain do not arrive to the area. It may happen at times with
lesions in the spinal cord, such as in persons with multiple sclerosis,
or more commonly with abnormalities in the peripheral nerves
(neuropathy) like it's seen in diabetes.

Blood pressure medications. All the medications that lower blood
pressure tend to cause impotence because an erection is basically a
hydraulic phenomenon. The blood supply increases to the corpora
carvenosa, which dilate, and the veins close so that there is pooling of
blood with pressure. If you lower the blood pressure, there is less
pressure to send more blood into the penis. Of all the blood pressure
medications, ACE inhibitors are amongst the ones that cause less
impotence because they do not seem to decrease blood flow as much.

Finally, it's not uncommon that impotence is due to several factors
acting together (decreased circulation and abnormal nerves).

Remember that every person is different. You have to analyze with your
doctor the reasons for this problem. Do not be afraid to bring it up.
At times, doctors are afraid to talk about it, but then they feel much
better if you tell them about it.

The treatments vary according to the cause. If it is psychogenic, the
treatment is mostly psychiatric. In cases of permanent and organic
impotence, several modalities of treatment may be considered:

a) Vacuum pumps. They consist of a tube placed outside the penis that
creates a vacuum and increases the blood flow. Once the blood is pooled,
a rubber band is applied to the base of the organ to maintain the blood
and the erection. These devices are inexpensive and work for some, but
they tend to be anticlimactic because you have to stop and get the pump,
then pump, then get the rubber band, and so on.

b) Injections in the penis. There are two different products. The
newest, by Upjohn, is a prostaglandin. Using an insulin syringe, the
medication is applied, and this causes an erection for about 2 to 4
hours. Side effects are rare (plaques of scar-fibrosis if you use them
too much; prolonged, painful erections - this is called priapism).

c) Surgery. A rigid, plastic prosthesis is inserted inside of the penis,
permanently giving the organ enough rigidity to be used at any time. I
prefer the implants because they are simple and effective, and they are
usually covered by insurance. You forget you have the problem, and you
can use it any time you want without having to make any stops.

Dealing With Male Impotence

2006-11-02T10:27:00.000-08:00

WARNING: The information presented in this document is not
intended to serve as a clinical diagnosis or treatment of male
impotence. The information contained in this paper should be
considered only as anecdotal and informational in nature. The
author does not endorse any specific brands of described items.

"I was first diagnosed as being diabetic in 1987. One of the
problems men with diabetes must face, besides the life-long need
to control their diabetic condition, is male impotence. This was
not a problem until I began regular injections of insulin
in 1992.

I discussed the problem of impotence with my endocrinologist.
First, he recommended a serum testosterone test. The results
showed I was thirty-five percent deficient for a 43 year old
male. I began Depo-testosterone (testosterone cypionate)
injections. The results, in my case, were remarkable!

As a result of the testosterone injections, I was able to
maintain a full erection for as long as forty-five minutes!
Also, I gained the endurance to exercise on a treadmill, at three
miles per hour, thirty minutes per day! For the first time in my
life I had the stamina and endurance to exercise on a daily
basis! My glyco-hemoglobin test results improved (from 11.7 in
1992 to 6.00 in 1994). And I required less insulin.

Since secondary male impotence (the kind I have) is often
controllable, I researched other things that would maintain and
enhance male sexual performance. Here is what I found:

ADDENDUM: A recent Discovery Network television show "Assault on
the Male" indicated that phenol based products tends to feminize
(de-masculinize) males. The need for avoidance of refined and
processed foods (yes, even the lining of canned foods) becomes
important in that phenol based products invade every facet of our
male lives (cologne, foods, cosmetic products, etc.). Phenol-
based products mimic estrogen (the female hormone) and readily
bond to estrogen receptors in the nucleus of both male and female
tissue cells. The end result is that males may possess male
appendages (a penis) but may, due to estrogenic activity of
phenol based products and others, exhibit female characteristics
and tenancies. I shall let the reader further explore and
interpret the obvious repercussions of this information.

Prescription Drugs

-Testosterone Cypionate. This is a class three (C3) regulated
drug (Anabolic Steroids Control Act). You need a prescription.
Also, you need a three cubic centimeter (3CC) syringe and a one
and one-half inch long needle (needless to say, another
prescription). There is no such thing as a normal dose of
testosterone. I started at 100 milligrams (.5 CC) and progressed
Prescription Drugs (continued)

to 500 milligrams (2.5 CCs) twice per month before my serum
testosterone "normalized" for my "male" age of 43 years.

Administration: This is a deep gluteal (hip) upper/outer
quadrant injection. Once you get over the initial shock of that
1.5 inch long cannula (needle) poised over your hip and give
yourself that first injection, it gets easier. I self-inject
twice a month. If you do take this drug, make sure you read and
understand the pharmacological description that comes with it.
There is a "patch" on the market but it requires daily
application to your "dry shaved" scrotum (forget-it!).

Benefits: If it works for you like it works for me (evidently,
men respond differently to the treatment): An achievable and
maintainable full erection and increased physical endurance and
stamina.

Side effects: In my case, acne and profuse night sweats. There
are other side effects, too. According to the literature these
injections cause the same symptoms as going through puberty.
They minimize as the body becomes acclimated to the dosage.

-Prozac (antidepressant). This is a controversial prescription
drug. Some antidepressants delay sexual orgasm (in both males
and females) and they are sometimes used to control premature
ejaculation. Read all the literature on Prozac before you decide
to take it. The reason I am taking Prozac is due to a clinical
diagnosis of mild depression (diabetics tend toward a depressive
state). I personally find Prozac to be beneficial in not only
controlling depression but in maintaining mental alertness.
Also, it helps control ejaculation for as long as forty-five
minutes, even during direct physical stimulation.

Administration: Orally, once per day.

Benefits: Already described.

Side effects: Read the literature on Prozac. I personally have
not experienced any negative side effects.

Non Prescription Drugs

-Exercise! Just Do It! Do at least twenty minutes per day of
vigorous exercise or one hour of non-vigorous exercise.
Remember: Sexual performance is diminished if you are
overweight!

-Excessive use of tobacco and alcohol. These are probably the
two primary causes of temporary male impotence. Enough said!

-Pumpkin Seed Oil. This is a standard treatment for prostate
disorders in Europe. Most of the claims about pumpkin seed oil
Non Prescription Drugs (continued)

I have read about are anecdotal. I take it because as a diabetic
I am on a low/no fat diet and some essential fatty acid (EFA)
foods are needed by the prostate for maintenance. Other EFA
sources are olive oil, fish oil, and evening primrose oil.
Remember! One out of eleven men will develop prostate cancer.
Take care of you prostate and it will take care of you!

-Water. Drink eight to ten eight ounce glasses of water each
day. Again, Just Do It! I do it because I have already had two
kidney stones removed (no fun at all!).

-Vitamin and Mineral supplements: Vitamin C, E, and zinc are
needed by the prostate for proper maintenance and for the
formation of seminal fluid. Also, I take B vitamins and
magnesium.

-Homeopathic Remedies. There is not enough room in this paper to
fully describe homeopathic remedies. Buy a book or go to the
library if you don't know what these are. There are several
remedies for male sexual problems (including impotence) described
in homeopathic literature. I am taking these remedies with
positive results.

-Herbal Remedies. One herbal remedy I use is yohimbe bark (the
unrefined bark of the yohimbe tree). There are pharmacologically
pure preparations of yohimbe but they can cause a lot of side
effects (you should not take refined yohimbe hydrochloride if you
are taking antidepressants). You can buy the bark preparation
from companies that sell health supplements.

What it does: The bottom line is that yohimbe reportedly
increases the flow of blood to the penis, and decreases the
outflow from an erect penis. Also, retromission (the time after
orgasm to gain another full erection) is reduced. The literature
I have read states that yohimbe may act as an aphrodisiac.
Enough said!

The only other herbal I use is panax ginseng (specifically
Manchurian Ginsing). This herbal can give you a real power boost
if you take it prior to a workout. I have read that too much
ginseng can cause headaches and skin problems. The primary
effect of ginseng, as an adaptogen, is on the adrenal gland. You
can buy this preparation from companies that sell health
supplements.

-Raw testicular concentrate. Again, the claims about glandular
therapy I have read are anecdotal rather than clinical.
Evidently, the raw glandular tissue formulation has an affinity
for similar living tissue. One of the components of the raw
testicular concentrate, testosterone, acts to boost the level of
serum testosterone. How much you need to take will vary. Based
on the literature I have read, the half-life of testosterone is
short (somewhere between 10 and 100 minutes). It is rapidly
metabolized and 90% of an oral dose doesn't even make it through
the digestive system. You can buy this preparation from
companies that sell health supplements.

Final Note

These things work for me. You may want to consider some or all
of the above if an active sex life, and physical strength and
endurance, are important to you as a male. If you are a male
diabetic you are probably already familiar with the problem of
impotence: Anything that helps to diminish impotence is
welcomed!"

-- Submitted by John

What Every Man Should Know About Feminist Issues: Rape Women as property

2006-11-02T10:02:00.000-08:00

One bad idea pop-feminists promote is that men's abhorrence of rape begins with property ownership: "The essence of rape was theft of or damage to another man's property, be it the father or the husband. As a result, rape was originally connected to property, the seizing and devaluing of a possession." (Women on Rape, Jane Dowdeswell, p 43)

This ignores the historical dynamics between women and men. In the past, to be eligible for marriage, men often had to prove themselves able to provide a wife with food and shelter. In a sense, a woman didn't marry a man, but his livelihood. In every essential respect, he was as much her property as she was his.

It also demeans modern men. Historically, rape may have been about property. But that does not dictate what is presently true. Do most mothers consider their children chattel? Are kids no more than property to moms? Would torturing a woman's children be, to her, nothing more than vandalizing her property?

Of course not. Nor is the rape of a man's wife mere "defilement" of a valued possession. The conduit of his love may be occluded by his anguished I-should- have-been-there-to-defend-her shame, but no matter what reasons individual men may have for wishing no harm for their wives, one thing very clear is that most men feel almost as much concern for the safety of most women as they do for their own mothers, wives and sisters. When pop-feminists disparage this genuine concern, they do more than harm men, they hurt women, too.

When the bonds of love are severed by cut-throat commentators, what's left? For men today, it's quickly becoming a matter of self-preservation. No where is this so evident as in the discussions over date rape and responsibility.

What if your date tells you she wants to have sex with you, then when you're in bed about to "do it," she says, "no." If you keep going, is it rape? What if you're already humping away and she says, "I've changed my mind, stop" seconds before you orgasm, if you orgasm, is it rape? The best answer in every case is: Assume it is, get the hell out of there, warn all of your friends she's a rape waiting to happen, and never have anything to do with her again. Always take no for an answer. The less you have to do with women who play such games, the better.

Isn't this being paranoid? Yes, and men have good reason to be paranoid. Pop- feminists are teaching most women, and college students in particular, that even reluctant sex is rape. (Time, June 3, 1991, p 53)

Even though most accusations of rape are dropped, a false charge can destroy a man's career, ruin his reputation, and leave his life in shambles. What do pop- feminists have to say about that? A woman who levels false charges of rape has her "reasons." (Time, June 3, 1991, p 51)

When is it rape, and when is it something else? Susan Brownmiller argues that rape is "a crime of violence and power over women" rather than a sex crime: "It is nothing more or less than a conscious process of intimidation, by which all men keep all women in a state of fear." (Against Our Will, Susan Brownmiller, p 5)

We should welcome such a broad definition since it allows us to look beyond the limited idea of rape as a crime committed only by men against women. Realistically, rape is an obsolete term that should be replaced with a non-gender specific term, such as Sexual Violence. Indirectly, pop-feminists even admit the whole concept of rape has as much to do with subjective social attitudes as with any objective characteristics of the crime:

Men can never be raped by a woman in the same way a woman can be raped by a man -- or a man can be by another man -- since cultural symbols do not allow female sexual aggression to be humiliating to a man. -- The Hite Report on Male Sexuality, Ballantine Books Edition, Sixth Printing, 1989, Shere Hite, p 794

If rape wholly depends upon what kinds of sexual aggression cultural symbols cause to be humiliating, then women are raping men at breakneck speed. By their own logic, every woman who has ever sneered at and spurned a "nerd's" request for a dance or a date is guilty of rape. Everytime a woman fakes orgasm, she rapes. And every woman who has ever scorned a man's sexual performance has raped, because most men find these forms of female sexual cruelty both hurtful and humiliating.

Despite this, pop-feminists cling to their anachronistic concept like Crusaders of olde swashing their bucklers because, without the means to deny by definition that men can be sexually victimized by women, they would lose the primary basis upon which they persecute men. Consequently, they cannot accept that rape sometimes results from an over-excited libido.

Rape, or sexual violence, is not always about sex. But women who assert it's never about sex just don't get it.

But when rape isn't about sex, it can be, as Brownmiller argues, "a deliberate, hostile, violent act of degradation and possession on the part of a would-be conqueror, designed to intimidate and inspire fear ..." (Against Our Will, Susan Brownmiller, p 439) So, if it's not about sex, but power and control, then clearly millions of women are guilty of raping men. This is a crime pop-feminists encourage and perpetuate.

They are successfully using rape and many other "feminist" issues, for example, as a "conscious process of intimidation, by which all (women) are putting all (men) in a state of fear" by terrorizing men with the threat of being accused of rape, sex discrimination, a sexual thought, or sexual harassment for any act that the "victim" may believe or say occurred: "Men, too, should be aware that if walking behind a woman, she may assume she is being followed. They should cross over or take a different route." (Women on Rape, Jane Dowdeswell, p 53)

By pop-feminist definition, men are guilty, period. "All men are rapists, that's all they are," pop-feminists say. The corollary to this, which most rightly ridicule, is "all women want to be raped."

Presuming a universal perversity among men is acceptable to many, but Brownmiller asserts our adherence to this absurd notion of human sexuality is in men's best interest: "There is good reason for men to hold tenaciously to the notion that 'All women want to be raped.' Because rape is an act that men do in the name of their masculinity, it is in their best interest to believe that women also want rape done, in the name of femininity." (Against Our Will, Susan Brownmiller, p 346) The problem with this is, the two go hand in hand. If "all men are rapists," then "all women
want to be raped." They are inseparable propositions, each lending life and
logic to the other.

Every time a pop-feminist denounces all men as rapists, or as potential rapists, she also brands women as real or potential masochistic matrons of perfidiousness. They do try, however, to obscure the connection by assiduously asserting the former while vehemently denying the latter: It is in their best interests to sell the idea all men are potential rapists.

Until recently, rape was defined as a crime no woman could commit: "rape is the only crime in which by law the victim is female and the offender is male." (Against Our Will, Susan Brownmiller, p 413) This ignores that women can be guilty of statutory rape. Have sex with anyone too young and, male or female, the act is, by law, rape. In this context, women can be rapists, too. But are they likely to be charged with rape? Rarely, because "our society mistakenly believes that 'girls get raped and hate it, but boys are seduced and love it.'" (Abused Boys, Mic Hunter, pp 25 - 26)

Why is a girl a "victim" but a boy is "lucky"? Because, no less than the men whom they accuse of sexism, women objectify themselves as sex-objects. Thinking in terms of supply and demand, they see themselves as suppliers of sex and men as consumers. Thus, a boy who is "given" sex to "consume" is lucky, while a girl who "gives" of her "supply" is, by sexist logic, a victim of theft. Objectified by her own gender, her pleasure is made a commodity she must hang onto and exchange for power over men.

For this reason, as "suppliers of sex" all women are subject to victimization, while all men, as "consumers of sex," are like thieves in the night whom pop-feminists prejudge guilty by virtue of being men.

This is particularly evident in Brownmiller's assessment of the predicament of groupies, who find themselves "coerced" into giving away their sex: "(T)he glamour attached to cultural heroes, such as a movie star, sports figure, rock singer or respected-man-in-the-community, provides a psychologic edge that lessens the need for physical coercion until it is too late for the victim to recognize her predicament." (Against Our Will, Susan Brownmiller, p 283) Personifying men as success objects, these frequently young women pursue the attentions of rich, powerful, sometimes famous walking wallets with a fervor matched only by some young men's pursuit of sexually objectified women.

Recognizing the sexual power these men have, Brownmiller labels them "rapists" who "operate within an emotional setting or within a dependent relationship that provides a hierarchical, authoritarian structure of its own that weakens a victim's resistance, distorts her perspective and confounds her will." (Against Our Will, Susan Brownmiller, p 283) As most men can confirm, an attractive woman has an almost identical effect on men. Does that mean all attractive women are rapists? If a man's career success makes him a rapist because it gives him a sexual "edge," then shouldn't the same be true of a woman whose carnal success gives her a competitive edge of her own? Just who are the real victims, here?

Pop-feminists assert most women are victims of rape. That it is both common and under-reported. In Great Britain, the 1984 Women's Safety Survey concluded one in six women had been raped. (Women on Rape, Jane Dowdeswell, p 16) In the U.S., Brownmiller asserts "one in five (female) rapes, or possibly one in twenty, may actually be reported." (Against Our Will, Susan Brownmiller, p 190) Their numbers may be true. But ignoring how women victimize men, they are certainly biased.

Do women sexually violate men as often as men sexually violate women? Not according to police statistics. But do those numbers accurately portray reality?

Probably not: Most cases of reported spouse battering, for example, involve a man attacking a woman. Yet surveys conducted independently of reported cases (i.e., police records), show that, in 1975, five husbands were battered for every four battered wives. Ten years later, that increased to more than seven battered husbands for every four battered wives. (Handbook of Family Violence, Susan K. Steinmetz and Joseph S. Lucca, p 237)

Despite this, police statistics show between twelve and fourteen cases of wife battering are reported for every case of husband battering. In other words, only one case out of between seventeen and twenty occurrences of husband battering is reported. If this ratio holds true with rape, then it's possible that, in 1985, perhaps one in three men were raped, but only one in 29 were reported.

This is not as far-fetched as it may sound: Statutory rapes of male victims are seldom reported. What's more, the 1991 study suggesting a new category of rape defined by reluctant consent, found that more male than female college students said they had engaged in sexual intercourse when they really didn't want to. (Time, June 3, 1991, p 53) If reluctant consent sex is rape, then the rape of men may be the most under-reported crime of all. But, all of this begs the question if men cannot, by definition, be victims of rape.

Treatment For Erectile Dysfunction

2006-11-02T09:15:00.000-08:00

Treatment Options
Successful erections require the coordinated actions of a healthy brain, pliable blood vessels, fully functional nerves and certain hormones. Erotic or manual stimulation, triggered by the five senses or by memory, begins the erectile process. The nervous system responds by sending chemical messages to and from the pelvic area.

These messages cause the smooth muscle tissue inside the penis to relax. The blood vessels dilate, allowing more blood to flow into the corpora cavernosa, the two erectile bodies within the penis.

Like sponges, they capture more blood, swelling and lengthening the penis. When all of the spaces are occupied with blood, the organ becomes rigid. The enlarged corpora cavernosa take up so much space inside the penis that strong pressure is exerted against the penile veins, greatly reducing the outflow of blood, which allows the penis to stay rigid.

At this point, the erect penis contains seven to eight times more blood than the same flaccid, or non-erect, penis. As long as the sexual stimulation is continued, an erect stage can be maintained until orgasm and ejaculation.

Some patients can achieve an erection naturally, but cannot maintain it long enough for normal sexual activity. This situation is sometimes referred to as "venous leak." A non-invasive, prescription product called StayErec may be able to help with venous leak.

It is your doctor's job to help you determine what is causing your problem and which treatment option is best for you. All physicians will first record your medical history, including psychological and sexual aspects. They may ask about stress and fatigue and about the relationship between you and your partner. Some questions may be very personal, but your doctor needs to know about your present sexual functioning in order to treat your impotence. So, be honest with your answers.

One common question is, "Do you wake up in the morning with an erection?" If you always wake up with an erection, your physical system works, and the impotence may be psychological. If you never wake up with an erection, it suggests a physical problem with blood vessels or nerves.

A new impotence screening device called Inform(TM) is a simple, inexpensive, at-home erection test. Inform provides an easy, cost-effective method of determining whether your impotence is physical or psychological. Your doctor may use the information provided by Inform to decide on further testing with a more sophisticated testing device, the RigiScan monitor. For more information on ordering the Inform nighttime erection test, see our on-line Inform order form or call Osbon Medical Systems’ Customer Service department at 1-800-438-8592.

Whether you start treatment with your family doctor or a urologist, the initial approach will probably be conservative. Conservative, non-surgical treatments for impotence have proven very successful, and most patients find surgical treatment unnecessary.

If your family doctor is not comfortable with treating impotence, he or she may refer you to a urologist, who may prescribe any of the known treatments for impotence. He or she may also do all the examining and testing already mentioned, if not done by your family doctor. The urologist will conduct additional, more sophisticated tests if you are thinking about a surgical correction for your impotence.

A panel of experts met in Washington, D.C. in December 1992 to assess current knowledge of the diagnosis and treatment of impotence. They recommended that "as a general rule, the least invasive treatments should be tried first." The statement of the National Institutes of Health (NIH) Consensus Panel suggested the staging of treatments from the least to most invasive in a sequence such as the following:

External vacuum devices (ErecAid® System)
Penile injection therapy (InjecAid System)
Penile implant surgery (Dura-II)
Vascular surgery

Sexual therapy or counseling - In November of 1996, the American Urological Association (AUA) issued the first official guidelines for the treatment of erectile dysfunction. The guidelines confirm and reinforce the NIH recommendations on the staging of impotence treatment, adding that the three safe and effective treatments today are external vacuum therapy, penile injection therapy and implant surgery. The guidelines further declare that vacuum therapy is almost always helpful as an adjunct therapy and may be used concurrently with any treatment.

Some men may be helped by taking an oral drug like yohimbine, but its effects have been determined to be largely placebo effects and any results are usually weeks away. A small percentage may also benefit from taking hormone medications, but unless the hormone deficiency is severe, this treatment may not help.

Vacuum therapy with ErecAid® System, the original external vacuum device, is probably the most widely recognized first-step treatment since it works for all types of impotence and has minimal side effects. Even if other non-invasive treatments like yohimbine or counseling are tried first, vacuum treatment can be applied concurrently to get immediate results. Vacuum therapy is widely prescribed, safe and 90% effective.

Penile injections have been used for over a decade with about a 70% success rate, but many men reject this treatment when they learn that it involves putting a needle into the penis. However, many impotence clinics specialize in this common, effective therapy. More recently developed is a method of delivering a drug through insertion of a pellet into the urethra

Implanted devices, of course, involve surgery. Experts now believe that this treatment, once considered the "gold standard" therapy, should only be done as a last resort, if and when less invasive treatments have failed. The placement of an implant permanently alters the interior structure of the penis and precludes successful use of other therapies or the return of natural function. Consider that when a pill is finally discovered to restore potency, it will surely require healthy corpora cavernosa in order to work.

External Vacuum Therapy - This treatment is a simple, non-invasive method of producing a quality erection. The external vacuum device was created by Geddings Osbon in the early 1960s to solve his own impotence problem. He created the ErecAid® System, based on negative pressure and tension, to achieve and maintain a near-natural erection any time one was desired.

ErecAid® System consists of a clear plastic cylinder, a manual pump or battery pump and a patented pressure-point tension ring. The user loads the tension ring around the open end of the cylinder, then inserts his penis into that end. Holding the device firmly against his body to form an airtight seal, he uses the pump to remove air from inside the cylinder. This creates a partial vacuum around the penis, causing the body’s blood to enter the corpora cavernosa. This fills the penis with blood in a way similar to a natural erection.

To maintain the erection, it is necessary to reduce the outflow of blood from the penis. Therefore, while the penis is still under vacuum pressure, the tension ring is moved from the cylinder onto the base of the penis. The cylinder and pump are then removed and laid aside. The user can maintain an erection for up to 30 minutes wearing only the tension ring. This method of creating an erection takes about two minutes and may be used as often as desired.

ErecAid® System has consistently proven effective for over 90% of its 450,000 users, regardless of the cause or origin of their impotence. It is often prescribed following prostate surgery and has even been successfully used by men who have had a penile implant removed. Also, because of its non-invasive nature, ErecAid® System may be used as an adjunct to other therapies.

One of the most significant advantages of the ErecAid® System is that it works immediately, without requiring surgery or a healing period. The erections are of high quality, last longer than natural ones and do not usually disappear after orgasm. Though it is recommended that the ring be removed within 30 minutes. Also, once the Osbon Technique has been learned, the patient can achieve reliable, consistent erections whenever he wishes.

Another advantage is cost. The ErecAid® System has a one time cost of $400 to $500. Most other impotence treatments have a continuing cost for duration of use. Medicare and most private insurers cover the cost of ErecAid® System. To further protect you, the major components of ErecAid® System have lifetime replacement guarantees.

Side effects of vacuum therapy are minor and rarely require treatment. Some men experience petechiae and ecchymosis. Reddish pinpoint-size dots (petechiae) may appear on the surface of the penis. They are often caused by placing the penis under negative pressure too rapidly. Ecchymosis is a bruise caused by the penis being held under vacuum pressure too long. Neither condition is painful or serious and does not need treatment. They stop happening after a few uses. No major injuries have ever been reported by users of the ErecAid® System, and side effects rarely require treatment.

This device may not be an appropriate treatment for men who have sickle cell anemia or a history of spontaneous priapism (extended erections). It has been determined that men on blood thinners like coumadin may safely use the device by pumping more slowly. Proper use of ErecAid® System requires some manual dexterity and hand strength though the newer battery powered model minimizes that requirement.

Some of the drawbacks mentioned by users involve the initial minor discomfort of the tension ring or a perceived loss of spontaneity in lovemaking. Both of these concerns appear to resolve with regular use of the device. Becoming comfortable with ErecAid® System is comparable to becoming comfortable with eyeglasses or a hearing aid during the first few weeks of use. Most couples believe that the learning period is well worth the effort for the return of a fuller, happier life. For more information on the ErecAid® System, please call or e-mail the Osbon Medical Systems’ Customer Service department at 1-800-435-6780.

Penile Injection Therapy - Self injection should be done near the base of the penis and at a specific angle. Physicians learned in the early 1980s that some medications injected directly into the corpora cavernosa would produce an erection within a few minutes. Urologists now routinely use this method to treat men by teaching them self-injection techniques to use at home.

Currently three medications are used for penile injection, though only one - Prostaglandin E¹ (alprostadil) - has received permission to market under FDA guidelines. The first injections were typically of papaverine alone; the alpha blocker phenlatahine was sometimes added to papaverine as well as prostaglandin E¹.

Diabetic needles (27 or 28 gauge, a half-inch long) are used for these injections. The patient must learn to inject the base of the penis at a specific angle, usually using less than 1 cc. Either corpus cavernosum may be injected but not the urethra. Hand pressure is applied afterward to the injection site for 2-3 minutes to prevent bleeding. Ideally, erections will last 30-60 minutes and will become more rigid if stimulation occurs.

With injection treatment, high quality erections are available on demand, and they last longer than natural ones. The erection does not always disappear at orgasm or ejaculation. Injections work in about 70% of all cases. The 30% failure is often due to poor blood flow, venous leakage or severe scarring of the penile tissues.

There are concerns with injections. The key ones are priapism, pain, dropout rate, and cost. "Priapism" is an unwanted, prolonged erection. Injecting too much of the drug may cause an erection which lasts much longer than intended. After four hours, men should seek medical help for reversal of the erection. This is done by injecting an adrenaline-like drug into the penis.

Any pain from injecting is primarily from the needle puncture. Many men are frightened to think of injecting the penis with a needle, though the needless are a very fine gauge and many report the injection to be painless. This apprehension may account for the high dropout rate for men on injections. A 1990 study (University of Chicago) showed that 51% of the group dropped out after receiving only a test injection. The average patient stayed in the study group for seven months before leaving it. Other men, however, have injected successfully for years.

Depending on the exact mix of the drugs, one injection will cost from about $5 to $32. If a man is sexually active twice a week, the annual cost will range from $520 to $2080. Reimbursement is available for prostaglandin drugs only.

Implant Therapy - In 1972-73, physicians began doing penile implants to help with lost potency. Today, surgeons implant about 20,000 of these devices per year into American men who choose this treatment. Semi-rigid rods account for about 30%; multi-component inflatable implants are thought to be 50% of the total; and self-contained devices make up the last 20%. In all cases, two synthetic cylinders are surgically placed inside the corpus cavernosum of the penis. After a 4-6 week healing period, a man is usually ready to engage in sexual intercourse.

These devices are either mechanical, inflatable, or hydraulic. Their implementation permanently alters the corpora cavernosa, ending the possibility of the return of natural erections, so this treatment should be considered a final step, not an early one. All surgery carries a risk of infection and eventual malfunction or deterioration of the device may require other surgeries.

Semi-Rigid Rods (Penile Prosthesis or Dura-II) - A pair of semi-rigid rods implanted in the penis is bendable. Two bendable rods have an outer coating of silicone and inner, parallel, silver or stainless steel wires or interlocking plastic joints held together by a cable. With this rod, the penis is always erect, but can be bent down. To prepare for intercourse, the man simply bends the penis to a "ready" angle.

The rate of complication is low and many of these rods are inserted as an outpatient procedure with a local anesthetic. The surgeon’s skill is important since he has to properly "size" the implant to your penis. Cost is approximately $6,000-$10,000, including the surgery.

Disadvantages are: Because the penis is always erect, it is difficult to hide under a swimsuit or tight-fitting clothes; the erection is due to metal and silicone, not the flow of blood into the penis; and, finally, the surgery is not reversible.

Multi-Component Inflatable Implants - This implant has two or three components. Inflatable cylinders are placed in the corpora, a fluid reservoir goes into the abdomen (or scrotum) and the pump is placed in the scrotum. Squeezing on the pump moves fluid from reservoir to cylinders, causing rigidity. A squeeze of the pump release valve reverses this process.

Self-Contained Inflatable Implants - Two cylinders are placed inside the penis. Each one contains a pump, fluid, and release valve. A squeeze of the head of the penis forces a fluid transfer to the forward chamber, causing rigidity. A simple bend of the penis causes fluid to flow back into the storage area, ending the erection.

Vascular Reconstructive Surgery - Penile surgery of this type is similar to heart bypass surgery, which reroutes the blood supply around blockages. Fewer than 1% of impotent men are candidates for this procedure, which is still considered experimental. The failure rate is high.

Venous ligation is a penile surgical procedure in which the surgeon attempts to repair the veins causing venous leak. This procedure was popular until physicians began to realize that it offered only a temporary solution, as many patients required another operation within a few years.

These surgeries cost about $15,000-$20,000 and should only be performed by surgeons experienced with the procedures, preferably in an investigations setting. Complications may include permanent numbness near the incision and scar tissue which may shorten or "torque" the penis. Also, the surgery may need to be repeated.

What are the odds of re-operation?
Ask your physician about the odds of having repeat surgeries. Ask about the failure rate of the implant he is recommending. Ask about the failure rate of the various vascular surgeries.

Hormone Medication - A serious deficiency of the male hormone, testosterone, can cause impotence. In these situations, treatment with hormone replacement can be effective. Only about 3-4% of the male population, however, has this problem and can benefit from the treatment.

The nature of the treatment is to administer an injection of testosterone into the arm or buttocks to raise the hormone to acceptable levels. Side effects of testosterone replacement therapy can be serious, and patients with a medical history that includes liver disease, heart disease, kidney problems or, especially, prostate cancer should avoid supplemental testosterone.

Yohimbine Tablets - This natural aphrodisiac from the bark of the yohimbehe tree is sometimes prescribed by doctors for men with intermittent erectile dysfunction. In most of these cases, the physician suspects a psychological problem, but cannot prove it. The drug is used to stimulate desire and improve the quality of the erection. Dispensed in tablet form and available only by prescription, yohimbine is taken three times a day for 4-6 weeks to test its effect. Costs are
about $40 a month. Even if the tablets work (which they do in 15-20% of patients) stopping the tablets may return the patient to his former state of impotence. Side effects may include headaches, sweaty palms, dizziness, and nausea. Men with ulcers or hypertension should take this drug with caution. The American Urology Association has determined that the benefit is largely a placebo effect.

Sex Counseling and Sex Therapy - Sex counseling refers to consultations with a qualified counselor who helps the couple to identify, understand and cope with their sexual concerns. Sex therapy is more structured in that it uses counseling, but also includes a time element and specific exercises for the couple. Exercises are meant to remove stress from areas of the relationship that influence sexual function. They may include sexual touching and other sexual exploration.

When the cause of impotence has a strong psychological involvement, sex counseling or therapy can be very effective. Many people feel that counseling can enhance the effects of other treatments as well. Couples should seek this therapy only from a trained professional with a good reputation. Best results occur when there is good partner cooperation and both patient and partner attend the counseling session.

Which Treatment Should I Choose?
You and your partner should thoroughly discuss the options and your habits. Go through this booklet together and visit the doctor together. Does your partner lean toward one treatment more than the others? Do you? Start with the simplest treatment that has the highest potential for success.

Treatment Sequence.
The best way to look at impotence therapy is that the simple, inexpensive, reversible treatments should be tried first, while the more complex, expensive, non-reversible treatments should be attempted later. ErecAid® System, yohimbine tablets, and sex therapy might be tried earliest since all are relatively inexpensive and reversible. Injections are next on the list, followed by implant surgery. The surgical procedures are the most invasive therapies and cause internal changes in the penis. If some new treatment appears in the future which requires the corpora cavernosa to be healthy, you may miss out on it if you have permanently altered the erectile bodies.

Financial considerations.
What is the out-of-pocket cost of the treatment selected? How much will health insurance pay for? What are the guarantees or warranties of the treatment chosen?

Maintenance costs. Ongoing costs for treatment must be identified. For example, yohimbine tablets have an ongoing cost, as do penile injections.

Safety and effectiveness.
Has the chosen therapy received FDA marketing approval? Have clinical studies been performed for this treatment? Is the treatment backed up by a reputable provider, with liability insurance?

Treatment Alert!
Unfortunately, perhaps due to the private nature of impotence, unethical advertising of sexual help products and miracle "cures" abounds. Many men do not seek medical treatment, but attempt instead to treat themselves with non-medical devices or unproved remedies. These so-called "cures" seldom work and can be potentially harmful.

Also, because impotence is often a symptom of more serious physical problems such as vascular disease or diabetes, it is extremely important for anyone experiencing impotence to see a qualified physician. Only after careful examination can a doctor determine the cause of impotence and recommend appropriate treatment.

Lastly, be wary of clinics that promote unnecessary and/or expensive testing when trying to determine the cause of impotence. Usually a detailed medical and sexual history will reveal a patient's predisposition to common, primary causes of impotence, such as diabetes.

Insurance Coverage - Insurance companies will generally pay for impotence treatment when the cause is physical. Your physician must specify on the claim form the physical cause of your impotence and that your treatment is "medically necessary."

Medicare coverage is divided into Medicare A, which covers surgeries, hospital stays and the more costly medical services; and Medicare B, which covers doctors’ office visits, medical devices and the less costly items and services. If you have Medicare, the person who sold you the System is required to file the claim for you. This may be your doctor, your pharmacist, medical supplier or Osbon Medical Systems. However, you are responsible for furnishing your Medicare number, date of birth, medical diagnosis, prescription and payment before a claim can be filed.

If you have FICA taxes deducted from your paycheck, you will be covered by Medicare A at no charge when you reach 65. Medicare B costs about $30 a month and may be deducted from your Social Security check.

Surgical treatments for impotence are covered by Medicare A in most states, as long as your doctor verifies a physical cause of the impotence and states that the treatment is "medically necessary." Vacuum devices are covered under Medicare B. Penile injection therapy is not covered by Medicare at this time.

With a valid prescription, you may obtain an ErecAid® System from your doctor, a pharmacy, a medical supplier or directly from Osbon Medical Systems

Impotence Common After Kidney Transplant

2006-10-23T20:55:00.000-07:00

Sexual difficulties are among the 10 symptoms most frequently reported by men with kidney failure. These are caused by a combination of fatigue, hormonal changes, nerve damage and arterial disease. Of all the symptoms experienced before transplant, sexual difficulties are the only ones that don't improve afterwards.

A recent study in France reports that erectile dysfunction is surprisingly common in men who have had kidney transplants. Researchers gave a well-established questionnaire called the International Index of Erectile Function, or IIEF, to 271 men who had had kidney transplants and were sexually active. The men answered questions about five areas of their sexuality: erectile function, orgasm, sexual desire, satisfaction with intercourse, and overall satisfaction with their sex life. The researchers then compared this group of men with those that had been studied when the questionnaire was developed.

"A significant decrease in erectile function and intercourse satisfaction was observed in male kidney transplant recipients compared to the controls. The prevalence of erectile dysfunction after renal transplantation was surprisingly high," according to Dr. Lionel Rostag of Hospital Rangueil in Toulouse, France, and colleagues, in the May issue of Transplantation. "Erectile dysfunction affected approximately every other sexually active patient (55.7 percent)." They note that among the general population, impotence affects only about one in 10 men.

The two aspects of sexuality that differed significantly between the transplant patients and the control group were the ability to achieve and sustain an erection and overall satisfaction with intercourse. The groups did not differ on interest in sex, ability to achieve orgasm or overall satisfaction with their sex life.

"Orgasmic function and most interestingly, overall satisfaction scorings were not affected," noted the researchers. They noted that while interest in sex is usually impaired in patients with kidney failure, the transplants restore patients' hormonal balance and this problem usually disappears.

Previous research had found that sexual dysfunction in both male and female patients was the only symptom that didn't improve significantly after kidney transplant, explained the researchers. However, they did not expect to find that over half of the men in their study reported difficulties, especially since the average age of this group as a whole (age 48) was younger than the control group (average age 55).

In the current study, the factors most closely related to sexual dysfunction in the transplant recipients were age, the amount of time they'd spent on dialysis before their transplants, and whether they'd had more than one transplant. Men who reported sexual difficulties were significantly older than those who didn't and had spent an average of almost eight years on dialysis -- compared to six years for those without difficulties. Twenty-one percent of those with sexual problems had had more than one transplant compared to just eight percent of those without problems.

Several factors could contribute to the sexual difficulties experienced by these men, Rostag and colleagues explained. In particular, kidney failure and dialysis both damage the blood vessels that lead to the penis as well as the tissues of the penis itself. The best way to avoid this damage, they concluded, is to do kidney transplants as soon as possible and reduce the amount of time on dialysis.

"Swift access to transplantation is widely recommended because it is more effective and less costly than dialysis," the researchers stated. "Another reason should be to preserve an intimate but very significant aspect of quality of life, i.e., sexuality."

In addition, specialists who work with kidney transplant patients should be aware of potential problems, evaluate them and be ready to help treat them, concluded the researchers.

"In view of the recent development of effective oral therapies for erectile dysfunction, nephrologists [kidney specialists] and transplant surgeons alike should be aware of the magnitude of patients' unexpressed expectations and of the means available for male patients to disclose these. In this respect, [the IIEF] could be used routinely for diagnosis and treatment evaluation."

Study Suggests Viagra Safe for Men Not Taking Nitrates

2006-10-23T20:53:00.000-07:00

Taking a single dose of the popular impotence drug Viagra (sildenafil) caused no cardiovascular problems in 14 men who had severely clogged arteries, researchers report in the June 1, 2000, New England Journal of Medicine. Instead, Viagra decreased blood pressure slightly and boosted blood flow in coronary arteries, which is good for the heart.

"Viagra should be safe for many cardiovascular patients who are not on nitrates and who are capable of moderate activity," Dr. Howard C. Herrmann of the University of Pennsylvania in Philadelphia told HeartInfo/Mediconsult. Patients may want a stress test to make sure their heart can handle the exertion of intercourse, he said. Nitrates, a common heart medication taken for chest pain, are dangerous if used in combination with Viagra, studies have shown.

During the past couple of years, the Food and Drug Administration has raised concerns about Viagra by reporting that a significant number of men had heart attacks and cardiac arrests soon after taking the drug and before having intercourse. Researchers wondered if this was because many impotent men also have heart disease or if Viagra was dangerous to the heart.

Viagra works by inhibiting a type of enzyme in the penis, and similar enzymes are also found in the heart muscle. Researchers wondered if inhibiting the enzyme posed a cardiac risk, Dr. Herrmann explained.

As part of the open-label, non-blinded study, he and his colleagues gave 100 milligrams of the drug to 14 heart patients and then monitored their lung and heart function. All were
in their 50s and 60s and had at least one artery that was more than 70 percent blocked.

The men were on a variety of medications, but none were on nitrates. Almost half of the group had hypertension or diabetes, or were smokers. Before and 45 minutes after taking Viagra, the participants had their blood pressure, heart rate, and blood flow measured. The men did not have intercourse during the study, so it was not a test of the effects of Viagra on the heart during exertion.

On most measures of blood pressure and blood flow, Viagra did not appear to have any significant effect, the researchers report, "and it had no effect on pulmonary-capillary wedge pressure, right atrial pressure, heart rate, or cardiac output." There were no adverse effects on coronary blood flow. And none of the men in the study experienced any serious side effects, like low blood pressure or chest pain, that could be linked to Viagra, according to the authors.

"Our data support the consensus position of the American College of Cardiology and the American Heart Association that sildenafil is safe for patients with stable coronary artery disease who are not taking medications containing nitrates," the authors conclude.

Pfizer Inc, which makes Viagra, funded the study.

The American College of Cardiology and the American Heart Association recommend that patients with stable coronary disease who are not taking nitrates should consult their physician about the risks and benefits of taking Viagra. Those taking a combination of blood pressure-lowering drugs may be at increased risk for drug interactions, they note.

In addition, Dr. Andrew P. Levy, Medical Advisor for HeartInfo, cautions that "It is difficult to make many conclusions from such a small study. Men with heart disease should consult their doctor before taking Viagra. We don't yet understand why the drug may cause death, and this study is not definitive."

Erectile dysfunction affects up to 30 million men in the United States, and shares certain risk factors with heart disease, including age, diabetes, hypertension, hypercholesterolemia, and smoking.