Posts Tagged ‘sex drive’

Freud’s Vasectomy

Sunday, July 25th, 2010
A man looking for his mojo.

A man looking for his mojo.

Do you know why Sigmund Freud, esteemed psychoanalyst, had a vasectomy when he was 67 years old? How about William Butler Yeats, the famed writer, having his vasectomy at 69 years of age. Were they that sexually active and worried about conceiving? God bless them if this is true!

Hardly. Believe it or not, vasectomies were done in the roaring twenties and thirties in Austria by an endocrinologist named Steinach for physical and mental rejuvenation. “It revived my creative power,” wrote Yeats in 1937. This may be true as Yeats wrote a crop of poems during this period that rank with his best work. At that time, a vasectomy was considered the “holy grail” of perpetual youth. Steinach felt that by blocking sperm flow, male hormone production in the testis would improve.

The idea of hormonal rejuvenation really started in earnest with an acclaimed endocrinologist named Brown-Sequard who in 1889 injected himself with testicular extracts from rats and dogs. This led to the trend of “organotherapy” in which all sorts of animal organs were injected for every conceivable human illness. Sound familiar at all? It also led to serious and productive experimental research on the function of glands in the body.

The rejuvenating vasectomy was not an isolated claim to fame by Eugen Steinach from Vienna. He was nominated for a Nobel Prize six times for innovative studies that showed that male or female development depended almost entirely on the sex glands and their secretions. Give this theory a pinch of salt to incorporate modern genetics and is it true enough today.

What went wrong with Steinbach’s vasectomy idea was that he believed that narrow biologic principles could be used to treat the wide and complex condition of human sexuality. The funny thing is, almost 100 years later, we are still trying to figure out how to stay young forever.

For the Good of the Hood

Sunday, January 31st, 2010
Do you agree with the Ancients on the good of the hood?

Do you agree with the Ancients on the good of the hood?

To circumcise or not. A loaded subject to be sure. The practice of male circumcision is ancient, likely far older than the biblical account of Abraham in Genesis. The Jewish faith, but not that of the Greeks or Romans, routinely recommended circumcision of newborn males. In the past century, it became “medicalized” as a preventative procedure only to be debunked in the last decade. Well, it may be now a procedure on the rise once again.

Circumcision is the removal of some or all of the foreskin or prepuce from the penis. The august American Academy of Pediatrics continues to recommend that circumcision is medically unnecessary, that it lacks any proven benefit, and that it should not be performed routinely in neonates. Maybe that is why the incidence of neonatal circumcision in the U.S. has continued to decline, from 80% in the 1960’s to 60% in 1996, to 55% of boys in 2001.

Why should circumcision be avoided? Issues of neonatal pain, behavioral changes and the potential for loss of sexual sensitivity from removal of the prepuce are age-old arguments for its discontinuation. However, a military study showing that there is a higher rate of urinary tract infections (UTIs) in non-circumcised boys and the fact that penile cancer tends to occur almost exclusively in uncircumcised men has kept the procedure alive and well.

In a somewhat radical departure from earlier recommendations, public health officials are now arguing that circumcision of men is a key weapon in the fight against human immunodeficiency virus (HIV) in Africa. Three recent, large, controlled studies have shown that circumcision reduces infection rates by 50 to 60% among heterosexual African. These studies stem from 3 different parts of the continent: South Africa, Uganda, and Kenya. In fact, two of the three clinical trials were stopped early because of overwhelmingly positive results. Experts now estimate that more than 3 million lives could be saved in sub-Saharan Africa alone if the procedure becomes widely used. And there is more recent data showing that the incidence of Herpes virus and HPV (Human Papilloma Virus) may also be reduced in circumcised men.

How circumcision prevents HIV transmission is not completely understood, but it is believed that the foreskin acts as a reservoir for HIV-containing secretions, increasing the contact time between the virus and target cells in the foreskin.

The problem with HIV and circumcision is that it is much more than a simple “behavior-based” intervention and this may ultimately be its biggest obstacle to wide acceptance. Changing social mores and behavior is one thing, but the “cold, hard steel” aspect of this public health initiative may not survive in the long run. If you don’t live in Africa, a clean penis and a clean life may be all that’s needed to replace the knife.

Getting There Early or On Time: Which is Better?

Sunday, January 24th, 2010
Is faster better? Not always.

Is faster better? Not always.

What is the most common sexual health problem affecting men? That’s easy, it’s erectile dysfunction, right? Nope. Try premature ejaculation. Hands down more common than erection issues, affecting 25-40% of men in the U.S.

Variably called early ejaculation, or early or rapid climax, it is defined as male ejaculation earlier than the subject or his partner desires. It used to be defined as ejaculation within 2 minutes of sexual intercourse, until it was realized that 75% of men ejaculate within 2 minutes in over half of their sexual encounters. What the definition really implies is that is some element of poor control over ejaculation that is stressful and may result in interpersonal difficulty.

Is this a medical disorder? In some cases, yes. Think of ejaculation as a reflex, like sneezing. There is a point of no return and this is what comes too soon in men with early ejaculation. The problem has two forms: lifelong and recent. The former is believed to result from low levels of the neurotransmitter serotonin (5HT) that normally modulates the ejaculation reflex. The recent form does not have as clear a biological basis, but may occur from psychological stress or from the need to overcome an erection problem.

The good news is that there are treatments available, and more treatments being reviewed by the FDA. Currently, the most effective treatments are pills called SSRIs, which elevate 5-HT levels and include anti-depressants such as Prozac, Zoloft, Celexa, and Lexapro. A newer form of SSRI drug, called Priligy, is now available in nine countries but has still not been FDA approved in the states. Also, a metered-dose aerosol spray has been developed to increase time to ejaculation by numbing the skin on the penis and decreasing sensation. Maybe this will help. Unfortunately, with all drug treatments for this condition, when the drugs are stopped, the issue generally returns.

What I find interesting is that companies are vigorously trying to drum up sympathy and attention for premature ejaculation as a widespread medical disorder, when in many cases it may be only an occasional annoyance that does not need constant treatment. Treatment might be perfect for a few men with debilitating disease, but it appears that they are trying to create and market a whole new category of disease. Good idea: create a “huge unmet need,” an epidemic that is perfect for a blockbuster, quality of life drug. Well what about a pill for shyness, or talking too fast? Where does it end? The larger issue here might be the “medicalization” of our daily lives in which there is a healthy and wide variation of normal.

Do I believe that some men have debilitating early ejaculation? You bet, and I see them every day. Do I think that a pill will treat this issue? Sure, for many, but only while you take it. Will blockbuster pills be the cure-all for early ejaculation? No way. The cure will come with more holistic treatment, by empowering men through behavioral changes that teach them to control and “own” the problem. Works superbly for my patients, pill or no pill.

Weighing Your Options

Sunday, January 10th, 2010
Bacchus is no longer a role model...

Bacchus is no longer a role model...

What you weigh affects how your sperm play. And your fertility. Overweight men tend to have lower semen volumes, less sperm and more oddly shaped sperm. The same is also true for men who are too thin. So, along with the many other health hazards associated with obesity, add poor semen quality to the list.

Obesity in both sexes is known to be associated with heart disease, diabetes, hypertension, and metabolic syndrome among other nasty conditions that can shorten your life. Typically, obesity is measured with BMI or body mass index, which looks at weight in relation to height. Not a perfect measure, but reasonably accurate. Using this tool, the ideal BMI for men (and women) is considered to be 20-25. A Danish study of 1600 men showed that overweight men with a BMI > 25 had a 22% lower sperm concentration compared with healthy weight men. Interestingly, a BMI of <20 was also associated with poor semen quality. For optimal sperm production, then, it helps to be not too fat and not too thin.

But what about fertility? Is it also affected by obesity? Yup. Another recent study showed that for every 20-pound increase in a man’s weight, there is a 10% increase in the chance of infertility. And this remained true when other factors that might influence the results were accounted for, including obesity status of the women, the man’s age, cigarette smoking, alcohol intake, and solvent and pesticide exposure. In addition, obesity was associated with infertility in both older and younger men.

So what is it about weight that influences men’s sperm production and fertility? One theory is that sex hormone metabolism is altered by changes in weight. Sex hormones are the “fuel” for the engine (testis) to make sperm. Obesity increases fat stores and fat converts male hormones (testosterone) into female hormones (estrogens). Too much estrogen in men is bad for sperm production. Another theory posits that normal 2-degree difference in testis temperature relative to the body is lost with obesity, as excessive fat provides too much insulation and results in overheating. On the other hand, when a man is too thin, he may take on a “catabolic” metabolic state. With a body in “starvation mode,” fertility is not the first thing on its mind and sperm production and fertility suffer.

So, is the epidemic of obesity the reason why sperm counts have been falling in Western countries over the last 50 years? Maybe. But this problem is unique in that it is utterly and entirely preventable. Eat well and in moderation, sleep well and treat your body like a temple. You used to it for your own health; now do it for the health of your future family.

What Comes After the Pill?

Sunday, November 15th, 2009
Making the world a better place with modern technology.

Making the world a better place with modern technology.

In this forum, I’ve already talked about how erections occur and also about pills used to treat erectile dysfunction in men. But what if they don’t help? What comes after the pill?

There are about 30 million men in the U.S. affected by erectile dysfunction. For 20% or more of men, common prescription therapies – Viagra, Levitra or Cialis – are not effective. For these men, we have many things “up our sleeves” to help. Before reviewing this cornucopia of cures, I really need to emphasize again the idea that erectile dysfunction may be a message that your body is not perfectly healthy. Think of it as a loud noise coming from under the hood of the car. It may run fine if you keep going, but you never know. Similarly, medical conditions such as high blood pressure, heart disease, high cholesterol, diabetes and low testosterone are important “loud sounds” that are associated with erectile dysfunction; they should be treated first and foremost. Often, by treating these illnesses, not only will erections improve, but you might live better and longer too.

Ok, so your cholesterol is fine. How then can erections be improved? Well the answer may be to “go local.” Local therapies attempt to improve erections by going to the source to treat the problem: the penis itself. Help the big guy out without involving the rest of the body. Penile salves, creams and urethral pills are available in many forms and are often compounded by pharmacies. One of these is a pill (MUSE) that is inserted just inside the urethra (the urine tube within the penis) and is absorbed by the penis to stimulate an erection. A little unconventional, but very effective in some men.

Although more difficult to imagine, local therapy can also involve injecting the side of the penis with highly active erectogenic agents such as papaverine, phentolamine and prostaglandins. Not the most palatable way to get an erection, but highly effective for the vast majority of men who fail to respond to pills. A more inviting alternative is based on recent developments in transdermal technology and involves delivering the same three medications in a clear gel into the urethra (TriMix Gel). Rub it in for a minute or two and you are up and running.

Available for 30 years now, penile vacuum pumps will also work in the majority of men. By creating 6 atmospheres of negative suction pressure around the penis, these mechanical devices draw blood directly into the penis. Once filled, a rubber ring is placed around the base of the penis to keep the blood in and away you go. But please don’t keep the ring on too long (more than 45 minutes) as bad things could happen…

In the most resistant cases, surgical implants may be needed to resurrect the erection.  Reliable and realistic, implants are the most invasive kind of local therapy and are effective in virtually all men. They can be rigid but bendable, inflatable, antibiotic coated and can have other neat widgets and gadgets. But they do require surgery, which distinguishes them from other treatments. They are also irreversible in the sense that they permanently alter penile anatomy, rendering ineffective most other treatments discussed here. So, let it be known that “vee have vays” of getting those erections back in case the pill doesn’t work.

The Agents of Erection

Monday, August 24th, 2009
The biochemistry is complex; the result is simple.

The biochemistry is complex; the result is simple.

Subtle, efficient, and powerful, Viagra is a first-line agent of erection, along with its accomplices, Cialis and Levitra. True, there are other agents out there, such as penile implants and injections, but these three, the triumvirate of pills, are the go-to agents, because they work so well for so many people.

Viagra wasn’t so much invented as happened upon. Its ability to restore erections was discovered as a side effect of a clinical trial targeted towards treating heart disease. Viagra was supposed to reduce anginal chest pain by increasing blood flow to the heart. It turned out that Viagra did increase blood flow, but to a different organ. After the trial, when the company asked the test subjects to return the extra pills, the patients refused because their erections were so much better. And so the agents of erection were born.

Viagra, Cialis, and Levitra all work the same way–sort of like coffee for the penis. Similar to coffee, which works by preventing the breakdown of the energy molecule ATP, thus increasing metabolic energy, these agents inhibit an enzyme that breaks down a different energy molecule (cGMP) that is found in the penis. This energy molecule causes the arteries of the penis to dilate which is how erections begin. Because cGMP is not being broken down, more cGMP is available, and for a longer period of time. More cGMP equals more blood to the penis. Cue the Love Boat theme.

These medications, as a class called PDE5 inhibitors, are not aphrodisiacs and are no replacement for sexual stimulation. In other words, the traditional rules of engagement still apply. They can take up to one hour to start working, during which time foreplay and intimacy is important for a good experience. All three medications work equally well, with Cialis having the longest effect. Aside from the usual side effects from most pills that include headaches and upset stomach, the major concern with these medications is that they can have dire consequences if one is also taking certain heart or blood pressure medications, namely nitrate-containing medications and alpha-blockers. Dangerously low drops in blood pressure can result, leading to strokes and heart attacks.

These first-line agents of erection are intended for mild to moderate cases of erectile dysfunction. Because this disease is frequently a harbinger of other medical problems such as diabetes and heart disease that you should really know about, a thorough evaluation by a doctor should be performed before it is prescribed. So for health’s sake, please resist the temptation to purchase them from your email spam folder and see a doctor; although embarrassing at first, you’ll be happier in the long run.

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.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

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.

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.