Archive for the ‘sexual health’ Category

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Music to Our Ears

Sunday, November 8th, 2009

 

Miles and Microsurgery: it doesn't get any better.

Miles and Microsurgery: it doesn't get any better.

For as long we have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting and consoling their spirits, inducing calm and tranquility, or the trance of dance. I have listened to the sounds of classical jazz during microsurgery operations throughout my professional career as a surgeon. Coltrane, Miles, Evans, Djavan, Caetano Veloso and all the greats sweetly waft in the operating suite and overcome the din of devices within the room. Does music in the operating room lead to less wasted and more fluid surgical motion, and therefore faster procedures and better patient outcomes? Who knows. But as the background makes the painting, the music may make the maestro.

 

A recent study suggests that listening to music in surgery may also benefit patients. Maybe this is why oral surgeons and dentists offer earphones and video glasses to their patients. Anything is better than listening to the whine of the drill during a root canal. The effect of music on cortical, limbic or higher brain centers has previously been studied in patients undergoing brain surgery. These centers control feeling, thoughts and memory. In this recent research, a neurosurgeon studied the effect of different kinds of music on deeper portions of the brain, located in the thalamus. This region is responsible for sensation, motor function, consciousness, sleep and alertness. This study of music and Parkinson’s patients is quite different from what Oliver Sacks describes in his book Musicophilia, in which music therapy is used to increase the mobility and responsiveness of Parkinson’s patients.

According to this new study in awake patients undergoing surgery for Parkinson disease, music slowed the neuronal firings deep within the brain. As a consequence, patients became physically more relaxed, calm and even slept during their surgery. And pure melodic music appeared to be the most soothing to most patients.

So music in the operating room may make more sense than we think. In addition to helping the surgeon with his surgery, it may reduce patient anxiety. This in turn, could shorten operative times, reduce the need for anesthetic medication, and lead to quicker patient recovery and shorter hospital stays. In a word, more music, less pills.

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Are We Replacing Ourselves?

Tuesday, September 8th, 2009
Where are you? Green means high and red means low.

Where are you? Green means high and red means low.

When a couple decides to have children, they rarely, if ever, contemplate the effect this has on the nation. But population scientists do. The effect that birth rates have on society is critical—as basic as knowing whether a nation is sustaining their population or not. But, trying to figure out if birth rates are going up or down is also complex, not unlike taking our temperature by feeling our foreheads.

A good barometer of birth rate assesses the average number of births per woman, and is generally noted by country. For a country to sustain its population in the future, the replacement rate is 2.1, or 2.1 births to every woman. What has occupied the minds of population scientists over the past 20 years is the fact that birth rates have dropped around the world, especially in Europe, but also in China and Japan. Interestingly, many countries in Africa do not have this problem, with birth rates well above 4. 

Also notable is the fact that in the past 20 years, the population of the world has dropped, falling an average of 1% per year. You can imagine how much this issue has occupied the minds of population scientists who seek to explain the phenomenon. Contributing factors include changing attitudes about family size, the cost of raising a child and the wider availability of contraceptives. The birth rate may also be dropping because child mortality on the whole has dropped. Or, because women who choose to have children later create a temporary lull in the birth rate. One concern with population drops is that countries whose populations become too small may not be able to afford to support its infrastructure, causing economic decline. So, on the one hand, it’s expensive to raise a child. On the other, it’s also expensive not to.

A recent study however, does show a change in these trends. Fertility rates now show a recent increase in developed nations. For years it has been thought that for some reason, developed nations, including most of Europe, have steadily dwindling populations. But this may not actually be the case. For example, in the 1970s, the US fertility rate was at a low of 1.74; lately it’s been relatively stable at 2.05. It appears that children are still wanted in a modernized world.

It’s quite hard to see these trends in my daily medical practice, as I perform as many vasectomies as I do vasectomy reversals. It’s even harder to render an opinion when the information is so diffuse and generational. So, to population scientist, I am a professionally “neutral contributor” to fertility rates. Like to think I do more good than that though…

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The Anatomy of an Erection

Monday, August 10th, 2009

Impressive natural rock formations in Cappadocia, Turkey

Impressive natural rock formations in Cappadocia, Turkey

There is a bit of mystery that surrounds the average erection: Where did it come from? How long will it last? Will it be good enough?  They happen when you least expect it (whilst asleep, or in math class). And they happen when you do expect it–hopefully. Biologically, men have less control then they think regarding when or how long they occur. In fact, normal men have at least 3 erections lasting 1 hour every night, while they are asleep, deep asleep. This is the penis “sighing” and relaxing, as it takes more energy to keep a penis flaccid than erect. Believe it or not.

 

The key to an erection lies within the male brain, through visual, auditory, or imagined stimuli, or through manual stimulation. Upon stimulation, the arteries within the penis relax, and blood flows into the penis at more than 20 times the normal rate.  The spongy areas of the penis become firm and engorged with blood, much like filling up a balloon with air. So now that the penis is holding more blood, the veins, which usually drain the penis of blood, are compressed tightly enough that blood cannot exit the penis, in effect tying a knot in the balloon. And now the balloon is ready to go. 

 

Erections last, on average, between fifteen and thirty minutes, and can cause the penis to rise to a fairly stiff angle. They can also curve upward or downward, to the right or to the left. This is why upscale clothiers in London ask men who are ordering custom tailored suits: “To what side do you dress, sir?” Right before ejaculation, a reflex is triggered (bulbocavernosus) which causes the muscles that surround the penis to forcefully compress the penis, such that the blood pressure within the penis reaches levels far higher than normal blood pressure. The penis falls when there are no more energy molecules available, in effect “running out of gas”. Viagra and other erectile drugs work by supplying more “gas” to the penis. Erections also fall from nervous system discharge during ejaculation. This discharge results in a latency period or “down time” during which it is difficult to achieve another erection. Once the nervous system has recovered, then an erection is again possible.

 

One can see what might cause the balloon to wilt (erectile dysfunction). There could be a problem with circulation (not enough pressure), a problem with venous leakage (the balloon has a hole in it) or nerve damage or hormonal issues (no one is blowing up the balloon) which could inhibit penile filling or emptying or the ability to feel sexual stimulation. Drugs, toxins, and conditions such as heart disease and diabetes are all culprits. This is why good health is so important for a healthy sex life.

You may never have ultimate control over something so willful as an erection, but it may be helpful to understand how it occurs. Because, with a finer understanding, hopefully, comes finer appreciation and enjoyment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Pulling Out is In

Thursday, July 30th, 2009
Barrier contraception faces stiff competition...

Barrier contraception faces stiff competition...

Hold on now. Wait a minute. Don’t get too excited. If you thought “pulling out” was a feeble and ineffective method of contraception for the reckless and unprepared, well it is. At least at first glance. But given that at least 38 million couples use it worldwide, coitus interruptus warrants a second look. 

Coitus interruptus, with its ancient yet undistinguished history, is very easily dismissed as an effective contraceptive because of the widely accepted belief that the pre-ejaculate contains sperm. There is actually no conclusive evidence that this is the case. No one has actually found sperm in pre-ejaculatory fluid. In addition, it is all-natural, organic, hormone- and side effect-free, and affordable. It needs no tool that nature hasn’t already given us, except rigorous and unerring self-control. Well, in fact this is the big downside. Who has rigorous and unerring self-control? We are men, not robots. Pulling out doesn’t protect you from sexually transmitted diseases, either.

That said, a recently published study has shown for the first time in the modern era that withdrawal is more effective a contraceptive than one might think. Maybe we should look at the pull-out with a little more respect. The withdrawal method, when used with perfect technique, has a 4% failure rate. This falls behind vasectomy (0.1%), birth control pills (0.3%), IUDs (0.6%), and condoms (2%), but not by much. The actual (real life) failure rate is likely somewhere between 15-25%, which is really not far behind the actual failure rate of condoms, at 10-18%.  So withdrawal is not that bad after all, only a little less effective than condoms. Perhaps men deserve a pat on the back for this. Well done. 

However, if this were a contraceptive pill, a 15% failure rate would send its inventors back to the drawing board. For coitus interruptus is inherently flawed, and women who seek more control over whether or not they become pregnant are more likely to reject this method over the long term. One study revealed that women of higher economic status and education are more likely to insist upon a more surefire method of contraception. It appears that women simply don’t trust men’s timing, their control, and perhaps even the male sense of responsibility when it comes to contraception. They want more control in the matter. What does this mean for a male contraceptive pill? More on that next week.

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Sexual Health Pop Quiz #2

Monday, July 20th, 2009
Remember computer test bubble sheets? Get out the #2 pencils...

Remember computer test bubble sheets? Get out the #2 pencils...

You may call me a stern and demanding taskmaster, but because the last one was so much fun, it’s time for another pop quiz on men’s sexual health. This one is based on real-life, case-based questions.

1. In anticipation of a romantic encounter with his partner, and to help him be the best that he can be, a man takes Viagra. His next move should be:

A. Watch Law and Order, a stirring drama to stir the loins.
B. Go to the post office and renew his passport.
C. Eat tacos and drink beer.
D. Play strip poker with his romantic encounter.

Answer: D. Viagra and the other erection pills do not provide an instantaneous erection. They may take from 20-60 minutes to work. In addition, they won’t give you an erection unless you want it to occur. Engaging in stimulation and foreplay is an excellent way to spend your time waiting for the pill to kick in.

2. Good sex ALWAYS involves:

A. Multiple orgasms from your partner.
B. Whatever looks really freaky in the last pornographic film you saw.
C. Kinky stuff.
D. Leather of one sort or another
E. None of the above.

Answer: E. In our society, exceptions to any rule fascinate us. Here, extreme sex performance acts, characteristic of pornography, are the exception. Sex was designed by Mother Nature to be satisfying when undertaken in many different ways, and takes many different forms, all of which can be intimate and pleasurable without having to go to extremes.

3. The problem with porn on the Internet is that:

A. There is no problem! It’s good fun and free!
B. The video is fuzzy and far too pixilated.
C. I can’t watch it at work without getting caught.
D. I can get too used to it, and sex with my own partner could become unsatisfying.

Answer: D. With the increasing availability of porn, a serious problem is arising. Men who are without partners become accustomed to that kind of sexual stimulation and then end up needing that same kind of stimulation to become aroused with a partner. So, when they find themselves face to face with an honest-to-goodness, flesh-and-blood woman, they may have trouble performing. This is an increasingly common issue for sex therapists.

4. TRUE or FALSE: You and your partner have a night in together. You turn off the television, go upstairs, and tenderly give each other long, leisurely massages with body oil in a room lit only by candles. You have a great time. This constitutes a satisfying sexual experience.

Answer: True. “Sex” does not have to involve sexual intercourse and climax and orgasm. The point is to feel satisfaction and closeness with your partner. Of course sex can involve pure carnal pleasure, but that definition should be broadened to include other emotional and physical intimacy.

5. TRUE or FALSE: Since the advent of free love, we’ve become liberated from the sexual taboos of our mothers and  fathers.

Answer: Profoundly False. Although we’d like to think so, sex therapists still see tales of embarrassment and lack of communication between couples, now more than ever. Being able to express our needs, both emotional and physical, without embarrassment or shame, is a problem of the ages.

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The Prostate: All You Ever Wanted to Know

Monday, June 1st, 2009

One famous fountain: the mannequin pis in Belgium

One famous fountain: the mannequin pis in Belgium

As a man ages, he is more likely to look at travel experiences as a series of restroom stops. He might begin navigating his way to the grocery store, the gas station or to a friend’s house for poker based on whether or not there’s a restroom conveniently located nearby. This may sound like the end of the world, but it’s not. It may be the end of long road trips. It is also the start of the realization that, similar to needing reading glasses, he is not immortal but actually a simple human being.

The prostate is a gland the size of a walnut at the base of the penis. It wraps around the urethra (the tube that urine comes from). A prostate is essential for normal male fertility, as it is responsible for making fluid that protects and nourishes sperm. Everything is shipshape until a man gets older, when two problems can arise. One is benign prostatic hypertrophy (BPH), which is a fancy way of saying enlargement of the prostate. This occurs in about half of all men in their sixties. For reasons still unclear, the prostate continues to grow as a man gets older. It is usually symptomatic – men have urinary urgency, dribbling, weak stream and may have to get up at night to urinate. The other problem is prostate cancer. Most commonly, cancer has no symptoms.

BPH is not preventable, but prostate cancer may be. Following a heart-healthy, low-fat, low carbohydrate diet is key to the prevention strategy, as are exercise, weight management and stress reduction. Concentrate on fruits and vegetables, which are high in antioxidants that protect the cells of your body from becoming cancerous. Soy and green tea may also protect the prostate. Sugar intake should also be limited, as it often ends up stored in your body as fat, and obesity is linked to prostate cancer.

That said it may surprise you to know that prostate cancer doesn’t always kill. Cancer is no one’s friend, but prostate cancer is not as deadly as lung cancer, colon cancer or breast cancer. It is much more slow-growing than these other cancers, doubling in size every 2-3 years instead of every 4-6 months. As such, a man is eight to ten times more likely to die of heart disease than prostate cancer. Even more interesting, some believe that prostate cancer is really a disease of age in men, as the likelihood of having small amounts of cancer in the prostate goes up with age. That means that about 80% of 90 year old men will have prostate cancer, and may never know it. They will likely die of unrelated causes. It also means that there are many prostate cancers occurring in men that are “clinically insignificant,” a rare term in cancer medicine. So, many prostate “cancers” actually don’t act as such.

Although diseases of the prostate are rarely lethal, they can affect your quality of life…and your road trips. Men over forty should start to have the prostate checked regularly, although most men would rather spend quality time with the dentist’s drill than go in for that exam. Blood tests for a substance called PSA, can also help detect cancer. The symptoms of prostatic enlargement can treated with pills; if these don’t work, various, safe but indescribable procedures can remove the symptom-causing prostatic tissue. Some of the FDA approved pills to treat BPH also prevent prostate cancer. Now that’s a pill that men might want to swallow. So, for all kinds of reasons, don’t ignore the prostate. Try to attend to it before it disrupts the flow of your daily life.

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Stem Cells, Snake Oil and You

Monday, May 18th, 2009

Stem cells are past the snake oil stage of medical treatment

Stem cells are past the snake oil stage of medical treatment

We’re way past bottled snake venom now. The new miracle medical cure lies deep within us, in our stem cells, if we can only figure out how to tap into them. 100 days into President Obama’s term, and it seems that the scientific community here in the U.S. might just be getting the fuel it needs to make major headway. The ban on using federal research money for stem cell research has partially been lifted, and I imagine that more funding is to come. A wise investment, I say. The potential for stem cells in medical care is simply enormous. I say this without hint of idealism, or romance, since I myself have seen what stem cells can do in my research with Stanford.

True stem cells are “pluripotent.” That is, they have the ability to become all of the different types of cells in the body. They could be used to rebuild or replace damaged tissue that is difficult or impossible for our own bodies to repair. Take nerves for example. If nerve cells degenerate, as occurs say with multiple sclerosis, one could apply stem cells to replace those degenerated nerve cells. These same stem cells could also replace damaged tissue associated with lung cancer, or Parkinson’s disease, or diabetes. Many conditions, including these, can currently be medically controlled, and made easier to live with, but they can’t be cured. Stem cells may change all that. For example, if eyesight has been lost due to corneal damage, we may be able to use stem cells to grow a new cornea, and restore lost vision.

There are many hurdles to overcome, some of them highly technical problems dealing with how to get from point A to point B. And cells that come from someone else can potentially be rejected. Even still, there are questions that may never be satisfactorily answered, ethical and cultural questions. Truly pluripotent stem cells are currently taken from embryos. When embryos get older, we call them fetuses, and when they are born, we call them children. The meaning of taking basically the seedling of a human being to treat another isn’t easy for some people to swallow. For others, the idea of cell-based therapy goes against deeply rooted notions of what is natural on this good earth. How you feel about this reaches into the most sacrosanct places in the heart and mind.

But there are other possibilities besides taking stem cells from embryos. “Adult” stem cells are stem cells made not from embryos, but from the tissues of fully grown adults. Bone marrow is a good example. Within bone marrow, special cells exist that can create all the cells within your blood. It could be that almost every tissue in the adult body has some kind of adult stem cell within it. Such cells might be able to be harvested from the same patient who needs treatment. Manipulated in a dish, they could be coaxed into other tissues, just like embryonic stem cells. This would avoid the issue of rejection discussed earlier, as well as the ethical questions raised from using embryonic stem cells. Currently, this coaxing is only possible with the help of viruses that introduce specific pluripotency genes into the adult cells and transform them into embryonic like cells. But who knows what tomorrow will bring? As I said, I have seen the potential already in a petri dish. More on that in my next posting.

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Posted in male infertility, sexual health, testosterone | 1 Comment »

Spring, Bicycling, Sex and You

Monday, April 13th, 2009

The beauty of a Campagnolo derailleur

The beauty of a Campagnolo derailleur

The warm breath of spring is here, and on it rides the cyclists. I join their ranks, happily. As a teenager in Connecticut, I spent my summers at a bicycle shop working on European models that gleamed amongst the dust motes. I joined a cycling club, wrote stories about races, and deified the movie Breaking Away, a coming-of-age film filled with dreamy Italian bicycles. With the extra money I earned mowing lawns, I bought a beautiful Raleigh racing bike with gorgeous Italian gears and toured rural New England, feeling like I was one of the scrappy townies in the movie. And so my love affair with bicycles began.

It took a while before the honeymoon was over. About twelve years ago, Dr. Irwin Goldstein reported the first case of erectile dysfunction (ED) in an avid cyclist. Other reports followed, and an “epidemic” ensued, despite very few verified cases of bicycling-induced erectile dysfunction. The current understanding is that the saddle (bicycle seat to you laymen), compresses the blood vessels and nerves in the perineum, the area between the scrotum and anus. This cuts off circulation in the penis, and decreases sensitivity. It has been reported that the pressure on the perineum when a man sits on a bicycle is sevenfold that of sitting in chairs. Currently, it is believed that adult men who ride a road bike for more than three hours a week have a seventy percent increased risk of getting ED, and five percent of cyclists will develop bicycle seat impotence. However, the exact risk factors (besides seat time) that predispose men to this problem are not understood.

So now we have a public health paradox. While bicycling is great exercise for your cardiovascular system, it may be detrimental to men’s sexual health. What is good to know is that the Feds are now involved with this issue, specifically the National Institute of Occupational Safety and Health (NIOSH). This is a good thing, as it means that more studies will be forthcoming that will focus on preventing bicycle seat impotence. From what we know now, the safest saddles appear to be those that force men to sit back, keeping the pressure off of the perineum. Noseless saddles may be better too. Gel saddles may be better than foam ones, and split rail or cutout saddles, which have a depression or gap down the middle of the seat, are probably safer. For now, if any pelvic numbness occurs while bicycling, change the saddle so it doesn’t occur anymore. Keeping your pelvis happy may also keep your sex life going.

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Posted in Uncategorized, sexual health | 5 Comments »

Men, Oysters and Sex

Tuesday, April 7th, 2009

The Miraculous Oyster

The Miraculous Oyster

The eating of an oyster is a tale of seduction. Crack open its rocklike shell at its most fragile point and it gives easily, revealing the delicate tissue at its heart. Eat it raw and it tastes of the soul of the ocean that made it. To many, it’s food pornography. An aphrodisiac.

But oysters don’t make you a sex machine. It’s a just a myth. There is simply no scientific evidence that these tender sea dumplings help maintain erections, improve stamina, or enhance arousal. They may make you think about sex. Which is as good an aphrodisiac as any.

Despite the sexual innuendo inherent in these mollusks, there is a lack of scientific support that oysters are sexual performance boosters. Oysters do support a healthy body, and so a healthy sex drive. Along with being a protein source, they are rich in zinc, a deficiency of which can cause impotence. Zinc is also a necessary building block for testosterone, so it supports a healthy libido and sperm production. But zinc is common enough in other foods, such as chicken and turkey, and no one considers poultry an aphrodisiac. In rat studies, oyster extracts lower cholesterol levels and blood pressure, but changes in mating patterns have not been investigated. And at least one human clinical trial reports an improvement in cholesterol in healthy men with an oyster-rich diet. However, like in the rat study, sexual activity and performance were not examined.

That said, oysters contain something that can’t be scientifically quantified. Romance. And that’s a vitamin for the soul as well as the body.

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Posted in male infertility, sexual health, testosterone | 6 Comments »

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