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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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Breakfast: The Best Fuel For the Engine

Monday, June 29th, 2009

Run clean, run hard, run fast...with breakfast

Run clean, run hard, run fast...with breakfast

Most Americans wake up, rub the sleep out of their eyes, clean up and rush out the door. Breakfast is an afterthought. But soon after that, stomachs start to growl for some food energy. But by now it’s gotten a bit too late, and no oatmeal or egg will suffice. It’s time for doughnuts, or candy at the receptionist’s desk, or the potato chips in the vending machine.

There’s a good reason for this behavior. It’s called blood sugar. And blood sugar is at its lowest upon waking. Hypoglycemia is associated with slowness, dullness, sleepiness, crankiness, and it sparks feelings of hunger. For sugar. And once we have it, we feel sated and comfortable again, not to mention more awake, because sugar gives us a burst of adrenaline. Tasks are done with a flourish. Until about 10 o’clock in the morning. Then there’s another crash.

The high levels of sugar in our blood cause the pancreas to secrete insulin. With the help of insulin, sugar moves from the blood stream into the body’s cells to do work. This lowers blood sugar levels again, and the body goes back to feeling irritable and hungry. And so we make a midmorning beeline for the Jelly Bellies to receive another jolt, another spike in our blood sugar, and the vicious cycle continues. In the end, this cycle causes weight gain and fatigue, and affects overall and sexual health.

One thing can help with this, and that’s something called “breakfast.” Statistic after statistic tells us how important breakfast is, especially one that contains whole grains and protein. The Imperial College of London found that people who ate breakfast were far less likely to give in to fatty foods later in the day. Another study showed that drinking fat-free milk at breakfast helped people to feel fuller, more satisfied and to eat fewer calories at lunch. Yet another study reported that people who ate two eggs for breakfast lost 65% more weight and felt more energetic than people who ate bagels for breakfast. And the list goes on. Suffice it to say, starting the day with a good breakfast should help you to actually lose weight and improve your overall health and sex life. It is by far the most important meal of the day.

Eating a proper breakfast, before you get too hungry, makes it easier to resist sugar cravings and helps you make healthier choices at lunch and dinner. Stick to whole foods and grains as much as possible, and include protein in your breakfast. A well designed breakfast takes longer to digest and will cause less of a spike in your blood sugar. Apples or bananas paired with almond or peanut butter, for instance, could pass for breakfast. Whole grain toast with nut butter; yogurt and fruit with a handful of nuts; even a protein shake can make the grade. Opt out of the French toast and go for the scrambled eggs. Another trick is to make breakfast more convenient than a trip to Starbucks. Get it into your system before a croissant does. Trust me, the rest of the day will be a cakewalk.

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Pop Quiz on Men’s Sexual Health

Monday, June 22nd, 2009

Did the artist Roy Lichtenstein truly understand women?

Did the artist Roy Lichtenstein truly understand women?

Ok, you have been reading about men’s health on this blog for months. Now it’s time for a little quiz. Number two pencil’s out?

1. True or False: Real men don’t cry or express emotion.

False. Ever see Marlon Brando in Streetcar Named Desire, yelling Stella’s name in the streets? Too bad that men who cannot express their feelings are portrayed as monsters on film. Think of Arnold Schwarzenegger in the Terminator. Or Al Pacino in the Godfather (part two), where he has his brother killed with barely a trace of emotion. Simply not true. Real men feel but often they are not able to recognize and name the feelings. In any case, expressing feelings is as primitive and important as eating.

2. True or False: A healthy man always wants sex.

Tricky, but false. Testosterone influences a man’s libido, and men, on average, have a higher libido than women. When women state that “men always want to have sex,” it’s an exaggeration. According to the Kinsey Institute, 54% of men think about sex every day, or several times a day, but 46% think about it a few times per month, a few times per week, or less. Remember, stress also affects sexual desire. Men may not think about sex as much when they are older compared to when they were younger in part because of how much more complicated and stressful their lives have become.

3. True of False: A man who is good in bed should be able to keep it up for 45 minutes straight.

False. This would be fun it were true all the time. But actually, every man is different. In this case, it’s time to bury that competitive streak or any issues of inadequacy, because this expectation is a bit high. Although drug makers warn us on TV about erections lasting for several hours (which in fact can be painful), the average erection lasts 15 to 30 minutes. The average time to sexual climax in U.S. men is 7- 9 minutes, believe it or not.

4. True or False: I had five hours of sleep, worked a 9 hour day, then came home, helped with dinner, and worked on a pet project. Exhausted, I went to bed, and my lady love wanted sex. There must be something wrong with me if I don’t feel like it.

False. I wrote about this previously. Wanting to have sex is linked with stress and also sleeping well. This means between 6.5 and 7.5 hours of sleep each night. According to sleep researchers, the people that live the longest also sleep about that much. It’s well known that sleep deprivation has a direct impact on libido, and in some cases, on erectile function.

5. True or False: When I have sex with a woman, I need to attend to her needs before attending to mine.

True and False. It is gentlemanly and attentive to respond and pay attention to what a woman wants, but to tell the truth, women’s libido’s are a funny, wily thing. Only 26% of women in a committed relationship climax every time they have sex. Men often put themselves under undue pressure to give their partner an orgasm when it may cause more stress than satisfaction. Some advice: Take care of yourself and let her take care of herself.

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Testosterone, Steak and Eggs

Monday, June 15th, 2009

One strong arm does not a man make...

One strong arm does not a man make...

Testosterone is one misunderstood molecule. It has such great influence over the human body that it has gained a reputation, a mystique. Society associates testosterone with Arnold Schwarzenegger (circa 1980s), with strength, virility, aggression, violence, square jaws and six-pack abs. We also tend to blame it for certain male tendencies and traits in our society, as well as certain medical disorders, although there is little scientific basis for this reasoning.

Testosterone is the major sex steroid hormone in men, and its effects are wide-ranging and powerful. It will make a boy into a man, for one thing. It sparks the development of facial and pubic hair, Adam’s apples, deeper voices, bigger muscles, broader chests. In the adult male, testosterone is necessary for sexual desire, erection maintenance, and sperm production. It also affects other body functions not directly related to sex–important ones–such as maintaining a normal blood count, bone strength, muscle mass and mood.

Testosterone might explain the perpetual sexual desire of a sixteen year-old whose previously unannointed body is now seeing it for the first time, but it does not explain away acts of violence. One popular belief is that excessive testosterone can make one uncontrollably aggressive. However, men actually tend to feel moodier and more anxious with lower testosterone levels, and there are reports that testosterone treatment can disperse these negative feelings. Also, studies show that there is a higher correlation between acts of violence and a past history of violence, than between violence and testosterone levels.

It is also untrue that high testosterone levels cause male pattern baldness and prostate cancer. Baldness is not a sign of virility, and is not associated with high testosterone levels. It is associated with genetics, specifically from the mother’s side of the family (male pattern, crown centered baldness) or the father’s side (overall baldness). Prostate cancer, meanwhile, appears to be associated with low levels of testosterone, and not high ones. So, basically, despite being the cause of hairiness, sweatiness, smelliness, and horniness, testosterone is very good for men.

Does it deserve the bad rap it gets? Taken appropriately, as replacement for naturally low levels, testosterone is not dangerous, nor is it illegal. If taken as a supplement, things are different. Anabolic steroids are synthetically produced variants of natural testosterone. Some common street or slang names for anabolic steroids include arnolds, gym candy, pumpers, roids, stackers, weight trainers, and juice. There are about 100 different types of anabolic steroids circulating nowadays and you will get over 1 million hits on Google by entering “buy steroids,” if you’re interested. When anabolics are taken as a supplement to boost normal testosterone levels, they can lead to some interesting side effects: shooting blanks instead of having a normal sperm count, getting tender breasts when you really don’t want them, and acne like when you were fourteen. Here’s where the bad rap enters the picture. And with steroid abuse, all bets are off regarding the healthy benefits that normal testosterone balance has on cholesterol balance, liver and heart health, blood pressure and mood. So be just like the power hitter Jim Thome, who said: “The strongest thing I put into my body is steak and eggs.”

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You Are The Pill That You Eat

Tuesday, June 9th, 2009

Amber waves of grain, the stuff of our Neolithic ancestors

Amber waves of grain, the stuff of our Neolithic ancestors

At some point as we evolved, well after the Neolithic period, we started thinking that there must be a better way to get nutrients, something faster and more efficient, than through the food we have eaten for tens of thousands of years. Our fantasy of the future was encapsulated with TV shows like The Jetsons and Star Trek, where roast chickens and earl grey tea were produced by the touch of a button. Nowadays, grocery stores offer fruit smoothies, breakfast bars, energy drinks and microwave pizzas, so we can fuel up quickly and efficiently. Why sit down when you can eat while running? We take vitamins with the idea that we can rectify any potential deficiencies and even prevent illness, with the swallow of a pill. How simple, how easy, how efficient.

As a society, we are in love with “nutriceutical” supplements. About half of all adults take a multivitamin everyday and it is estimated that $75 billion worldwide is spent annually on nutriceuticals. And nonvitamin and nonmineral natural product use is so prevalent in the U.S. (40% of Americans) that the National Institutes of Health has even commissioned a new branch devoted entirely to the pursuit of complementary and alternative medicine research. This effort will undoubtedly unleash the true potential of alternative medicine. But let’s drill down on vitamins for a minute. What does the evidence really show? Well, it appears that taking vitamin supplements may not as beneficial as previously thought. Several major studies have now shown that vitamin supplements do little to prevent cancer and heart disease, while other studies report that vitamins and antioxidant supplements may actually increase cancer rates. One study concluded that folic acid supplements actually increased rates of precancerous colon polyps, and another study linked beta-carotene to higher lung cancer rates. Are vitamins then, failing us as supplements?

No one discounts the necessity of vitamins for our body’s function. Indeed, many diseases are associated with a deficiency in one or another vitamin. But we do place rather high expectations on vitamins. It’s rather narrow-minded of us to tout only a few particular nutrients in food and assign them letters of the alphabet, when many others may be just as essential to our primitive bodies, yet are unfamiliar to us intellectually. Vitamins do not exist in a void, but are part of a complex mixture of substances called food that is the real stuff of life. If anything, the fact that vitamins are getting an F in cancer prevention suggests that the way that they are absorbed in a pill is not the same as the way we extract them from whole foods that we eat.

My patients frequently ask me what supplements they should take to enhance their sexual health or fertility. The truth is that because sexual health is so thoroughly intertwined with overall health, I emphasize a whole-body approach. I don’t recommend a specific course of supplements, but antioxidants may have some value. If they wish to take a supplement, they may, but the important thing is that they get all nutrients necessary for their bodies to function optimally. The real solution to this is a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits, and vegetables. That said, I do realize how resistant many people can be to changing their diet. If a patient feels they must take a supplement to compensate for poor eating habits, I steer them towards whole food supplements that contain a larger and more complex spectrum of nutrients than that found in traditional multivitamins. In all honesty however, I firmly believe in carrots from the earth and apples from trees, just like our Neolithic ancestors did.

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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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Ramirez: A Lesson in Steroid Biology

Tuesday, May 12th, 2009

Build muscles naturally, like Joe Wieder in the 1970's.

Build muscles naturally, like Joe Wieder in the 1970's.

When a record-breaking athlete gets caught for doping, it’s not news anymore. It shouldn’t be. People have been taking drugs to increase physical prowess since ancient times. We’ve recently seen it with Barry Bonds, Jason Giambi, and now LA Dodger’s star Manny Ramirez, whose urine tested positive for a medication on MLB’s banned substance list.

The MLB was questioning the discovery of synthetic testosterone in Ramirez’s lab tests. Ramirez had been planning on waving that suspicion away by saying he had been using DHEA, a supplement made in the adrenal gland that is weaker than testosterone and that is currently not banned. What sealed the deal was his positive test for hCG (human chorionic gonadotropin). It occurs naturally in a woman’s body when she’s pregnant, and is a drug that is only federally approved for use as a fertility medication. In women, it is used to induce ovulation, the release of an egg from the ovary. For boys, it is used to induce natural testosterone production in the testicles to help with puberty. For men, the only medical reason a man might use it is to boost testosterone levels for fertility purposes. It is not commonly given for erectile dysfunction, as Viagra, Cialis or Levitra are more effective treatments and are less painful to administer. hCG can only be given by injection, while both Cialis and Viagra come in handy dandy pills.

So why hCG? Well, testosterone supplements are taken by athletes because they are anabolic: they increase muscle mass and performance. However, steroids effectively shut down a man’s own testosterone production. Because the body is being supplied with a steroid that serves testosterone’s purpose, the testicles see no need to continue to produce their own testosterone and cease production. Fertility is wiped out too while men are taking anabolic steroids. Because of these effects, the testicles actually shrink. HCG is commonly used by steroid users when coming off of anabolic steroids, to normalize the hormone signaling and prevent testicle shrinkage. It stimulates the testicles to start testosterone production again, after being told to turn it off. This makes the system able to respond to the next cycle of anabolic steroids. And on and on it goes, the process of steroid stacking and cycling.

So, the fact that hCG was found in Ramirez’s blood suggests that he was doing other things with other supplements as well. Another star now fallen off the pedestal…

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No Sex? Get Some Sleep!

Friday, May 1st, 2009

The Exquisite Woman Right Next to You..

The Exquisite Woman Right Next to You..

As a men’s health specialist, I get to hear a lot of things that men wouldn’t tell their best friends. And a very common occurrence is their confession that they have lost some of their sex drive. “My partner is great and I used to want sex ALL the time, now it barely enters my mind” is what I hear most.

The first thing to realize is that if you do not have the sex drive that you had when you were 18 years old, maybe its because you aren’t 18 anymore. Maybe the 10 to 20 years of aging that has occurred since then has taken a small toll. You are now older and wiser, having survived wars, financial distress and maybe even children, and you could be a bit less frisky as a result.

That reminds me of two memorable patients who represent different ends of this spectrum. Both in their late 30’s, one answered my survey question about how often they have sex by writing “twice daily, every day” and the other wrote “by appointment only.” This just goes to show that we are all built differently and we all age differently. Neither is really clinically out of the normal range. Blame comments in the locker room, Hollywood films, or Internet porn, but men often feel like their sex drive should not change with age. Tough for men to talk about and therefore tough for them to gauge. However, it is well understood by sex therapists that men aren’t always in the mood. Sometimes the History Channel looks way better.

It may not be for any lack of love or Barry White records. However, if it has been several weeks since you last took your wristwatch off, so to speak, then the real issue behind your lack of sex drive may be your level of sleeplessness and stress. If you aren’t well rested, you probably aren’t feeling too frisky. You’re probably cranky. Believe it or not, this is a very common reason why sex lives are compromised. Being anxious puts your nervous system, once part of the animal kingdom, into a primitive “fight-or-flight” response, and buries the sex drive. Relaxation though, stimulate several appetites, including degustory and sexual.

For a robust sex life, both of you need energy, relaxation, and time. The mind is the largest sexual organ, and turning off the amygdala, the portion of your brain that handles fear and worry, will allow that quiet, sensitive part of your brain that handles sex drive to kick into gear. Think seriously about turning off the TV or computer earlier in the evening, and swap out dozing in front of the TV for more restful sleep in bed. Think hard about improving how much quality rest you actually get, not necessarily to have more sex, but simply to sleep; the sex will follow. Make dates with your partner so you can focus solely on each other and forget the usual distractions. Take her to a funny movie, and laugh (or cry) together. But make the time, make it important, and catch some zzzs. Revving up your sex life can be as simple as that.

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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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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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