Mens Sexual Health

Age-Fighting Skin Treatments for Men

2008-09-23T11:14:00.000-07:00

Could a skin treatment that helps you look younger and more relaxed be right for you?

Maybe you've finally got the experience and confidence to be at the top of your career game. But if you're like many men over 50, you might feel like you're starting to lose some ground.

One reason: Younger men whose careers are also on the rise. And while they may have nothing on you in terms of knowledge, experience, or even energy, by Friday afternoon, you look like you need a vacation -- and they don't.

"A man's fear of being phased out of the marketplace because he doesn't look as young as his colleagues is very real. Today, more than ever, there is competition with the younger guys, and a lot of men are beginning to feel it," says dermatologic surgeon David Goldberg, MD, director of Skin Laser and Surgery Specialists of New York and New Jersey. "It's not about looking younger so much as it is about looking well-rested, like you have the energy to go the distance."

While diet and exercise can help put that bounce back in a man's step, you can also help level the playing field with skin treatments -- nonsurgical medical procedures designed to give your appearance that rested, relaxed look.

"For quite some time, cosmetic surgery generally has been thought of as a female-oriented area -- and while this may still be true to an extent, the percentages of male patients desiring cosmetic surgery now keeps pace with the increased numbers of procedures performed each year," says Joel Schlessinger, MD, president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

But unlike many women who want treatments that help them look as young as possible, Schlessinger says men typically want a look that is "rested, relaxed, and comfortable."

Goldberg agrees: "Men want to maintain their rugged looks -- they don't want to eliminate lines, just soften the look of aging and revitalize their skin."

And just how many men are seeking that "year-round vacation" look? According to the American Society of Plastic Surgeons, more than 1 million men sought skin treatments in 2005. There was a 44% increase in minimally invasive procedures alone between 2000 and 2005.

The American Society of Plastic Surgery, along with three top dermatologists, offered WebMD the following guide to the top five nonsurgical cosmetic facial treatments for men:

Skin Treatment 1: Botox Cosmetic

What It Is : Tiny amounts of the botulinum A toxin that are injected directly into the muscle that lies below a wrinkle.

What It Does: Temporarily paralyzes the muscle, allowing the wrinkle to relax so surface skin is smoother and younger-looking.

Skin Treatment Time: About 30 minutes

Downtime: None, in most people.

Cost: $350 to $500 per injection; more than one injection is sometimes necessary.

Lasting Effect : About six months

Doctor's Comments: "Men do this treatment mostly on the forehead," says Goldberg. "They don't want a totally smooth look like women do. They want some lines, but they just want them softened, and Botox does an excellent job."

Skin Treatment 2: Microdermabrasion

What It Is: In this procedure, a vacuum suction device is used in tandem with a mild chemical crystal formulation to remove the top layer of skin cells. This allows new, more evenly textured skin to come to the surface.

What It Does: Rejuvenate the complexion, help topical products penetrate more deeply, remove ultrafine lines, and give skin a more youthful "glow."

Skin Treatment Time: 30 minutes per treatment, though it does take multiple treatments and several weeks before full results become apparent.

Downtime: None. Skin may appear a little red for about an hour afterward.

Cost: $150 to $300 per treatment.

Lasting Effect: Several months, depending on age and condition of skin.

Doctor's Comments: "This is not suggested for serious lines or wrinkles, and it won't stop the skin from sagging. It is the quickest way to rejuvenate your skin in just one day," says Bruce Katz, MD, director of Juva Skin and Laser Center in New York.

Skin Treatment 3: Laser Hair Removal

What It Is: Relies on energy produced by a laser to pass through the skin, down to the hair follicle. The melanin pigment of the hair absorbs it, where it causes injury to the follicle. This makes the hair fall out -- and makes it difficult for the hair to grow back again.

What It Does: Removes hair from any area on the body.

Skin Treatment Time: As short as 10 minutes or as long as few hours, depending on how much hair needs to be removed. Because hair grows in cycles, between four and eight treatments are needed, usually four to eight weeks apart. Short, coarse dark hair responds best, but removal of all types of hair is possible.

Downtime: None.

Cost: $ 400 to $500 per treatment.

Lasting Effect: In some people, it can be permanent. In others, hair may grow back, but it is usually lighter and easier to remove. It's important to note, however, that the hair does not come out during the treatment. Instead, it falls out gradually in the days and weeks that follow.

Doctor's Comment: "Most men request hair removal on their backs and chest, and it is usually done for more social reasons than professional career reasons," says Goldberg.

Skin Treatment 4: Chemical Peel

What It Is: A topical treatment that uses various types of chemicals to "peel" away damaged layers of skin, and along with it, surface lines and wrinkles.

What It Does: Depending on the type of peel used, it can do anything from simply refreshing the skin (known as the "lunchtime peel," to, in the case of deeper peels, stimulate collagen production to firm skin, reduce wrinkling, improve skin texture, correct pigment problems, and reduce sun damage. All lead to a younger-looking complexion.

Skin Treatment Time: The "lunchtime peel" takes about 30 minutes; a medium peel 30 to 60 minutes, and a deep peel about two hours.

Down Time: Light peel -- no recovery or downtime; Medium peel -- four to seven day recovery; Deep peel -- two weeks healing time.

Cost: From several hundred dollars to more than a $1,000, depending on the procedure.

Lasting Effect: A light peel usually needs to be repeated for results to last several months; the results of a medium peel last about one year; a deep peel is permanent, though new wrinkles can form over time.

Doctor's Comment: "Most men tend to want the light chemical peel -- it does a very good job of rejuvenating the skin, softening the lines and making you look younger and more rested without any downtime to speak of. It's one of the most popular treatments among the men I treat," says Goldberg.

Skin Treatment 5: Laser/ Light Skin Rejuvenation

What It Is: A method of facial rejuvenation that uses either nonablative (noncutting) laser beams or other light-based devices to deliver short bursts of energy (called intense pulsed light) to the skin.

What It Does: Firms and tones skin by stimulating new collagen growth; improves texture and color; minimizes fine lines; gives skin a rested and refreshed look -- all without the use of any chemicals.

Skin Treatment Time: 15 to 30 minutes.

Downtime: Skin may be slightly red for about an hour after treatment.

Cost: $ 500 to $1,200 per treatment, depending on the size of treated area and your location. Generally, three to five sessions are required.

Lasting Effect: Several treatments are needed for maximum collagen production. Touch-up treatments are recommended every few months to keep collagen production stimulated.

Doctor's Comment: "Laser skin rejuvenation treatment is unlike any other skin resurfacing treatment because it uses no harsh chemicals and there is no intense aftercare required, so this really makes it an ideal procedure for men," says Goldberg.

Mistakes Men Make about SEX!!

2008-09-23T11:01:00.000-07:00

Hey guys, think you know everything there is to know about having sex with women? That erotic encyclopedia you carry around in your head may contain a lot of basic errors and omissions about women's sexuality -- errors that can lead to sex mistakes.

That's because -- after learning the facts of life -- most of us are left to figure out sex for ourselves. Guys tend to take a lot of cues from adult movies, and we all know how true-to-life those are. Experience may help, but many women can be shy when talking about what they like.

To help us with some sex tips, WebMD asked two acclaimed sex educators, Tristan Taormino and Lou Paget, to tell us what they think are the most common sex mistakes men make with women.

Taormino is a prolific author, lecturer, and video producer. Her latest project is the Expert Guide educational video series from Vivid Ed.

Paget is author of The Great Lover Playbook and other sex manuals, and she gives seminars nationwide.

Sex Mistake No.1: You Know What She Wants
Men often make assumptions about what a woman wants based upon what they've done with other women. But women aren't all the same.

"You develop a repertoire as you mature sexually, but you should never assume that what worked for the last person is going to work for this person," Taormino says.

That applies not only to sexual predilections, but also to relationships, she says. "There are women who can have no-strings-attached sex, and women who can get attached very easily, and then everyone in between."

Sex Mistake No. 2: You Have All She Needs
Some women can't have an orgasm with less than 3,000 rpm. No human tongue or fingers can generate that kind of vibration. But men typically think something is wrong if a woman needs a vibrator.

"If the only way that a woman can achieve orgasm is with a vibrator, she's not broken," Taormino says.

Think of a vibrator as your assistant, not your substitute. Many couples use vibrators together. "While you're doing one thing, or two things, the vibrator can be doing something else," Taormino says.

Sex Mistake No. 3: Sex Feels the Same for Men and Women
Paget says there tends to be a "huge disconnect" between men and women in the ways that sex feels good.

"When a man has intercourse with a woman, and his penis goes into her body, that sensation is so off the charts for most men, they cannot imagine that it isn't feeling the same way for her," Paget says. "It couldn't be further from the truth."

The inside of the vagina is probably less sensitive than the outer parts for most women. Also, deep thrusting may not feel so nice on the receiving end. If the penis is too long, "it feels like you're getting punched in the stomach," Paget says. "It makes you feel nauseous."

Sex Mistake No. 4: You Know Your Way Around a Woman's Anatomy
Most guys know generally what a clitoris is and where to find it. That's not to say that they really understand it.

More than 30 years ago, at the start of the "sexual revolution," a best-selling book called the Joy of Sex got Americans hip to the orgasmic importance of the clitoris. But the belief that women must be able to orgasm from vaginal penetration stubbornly persists.

"I still get letters from people who say things like, my wife can't [orgasm] from intercourse unless she has clitoral stimulation -- please help," Taormino says. "I want to write back and say, 'OK, what's the problem?'"

"For the majority of women, it's not going to happen that way," Paget says.

Men also lack information about how to touch it and how sensitive it is, Taormino says.

A touch that's bliss for one woman may feel like nothing special, or may even be painful for someone else. Some prefer indirect stimulation.

How can you find out how she likes to be touched? Try asking her.

Sex Mistake No. 5: Wet = Turned On
Guys sometimes get hung up if a woman doesn't get slippery enough for easy penetration. Don't worry about it.

"I think there's a myth that if you're turned on, you're wet," Taormino says. Not necessarily.

Some women tend to get wetter than others, and how much natural lubrication a woman has can change from day to day. It varies by the phase of her menstrual cycle, and it's subject to influences like stress and medications.

Sex Mistake No. 6: Silence Is Golden
A lot of guys think they should be silent during sex, but unless you speak up, your partner has to guess what's doing it for you and what isn't.

If you're respectful about it, a woman who wants to please you will probably appreciate some directions.

"I'm not saying push her head in your lap," Taormino says. "I think that, 'this is how I like it,' is a very useful conversation to have."

Treating erectile dysfunction...

2008-09-22T08:10:00.000-07:00

Sometimes the medical exam reveals a straightforward explanation for erectile dysfunction, such as a side effect of medication or of discord between the man and his partner. If the problem is a medication, sometimes the drug can be discontinued or a new one substituted. If there's emotional difficulty in a relationship with a partner, couples therapy may be helpful.

But for about three-fourths of men with erectile dysfunction, the cause is more complex. It may be vascular disease, neurological disease, or diabetes, or it may be the result of prostate surgery or radiation. If you are one of these men, chances are excellent that you can be helped by medication or another therapy. Counseling may help, too. Open communication with your partner is another important part of the treatment process.

Including your partner

First of all, talk. Talking with your spouse or sexual partner is essential. It can allow you to address any anxieties or inhibitions that may be causing or contributing to your erectile difficulties. And if you are seeking medical help, make sure to tell your partner and discuss the options and treatments together.

Many couples find it difficult to discuss their sexual relationship. But poor communication between partners often makes sexual dysfunction worse by leading to hurt feelings, anger, and withdrawal. Even if erectile impairment is initially caused by a medical problem such as diabetes, lack of communication can exacerbate the problem. For example, occasional trouble getting an erection becomes more frequent. Before long, performance anxiety sets in when you and your partner try to have sex. This can lead to depression, and the problem snowballs further. Discussing your erectile dysfunction frankly with your partner can help relieve the anxiety and improve your relationship both emotionally and sexually.

During these discussions, you may be surprised to discover that your partner has interpreted your difficulty as an insult — a sign that you no longer find your mate sexually attractive or that you have fallen out of love. Or you may discover that your partner has stopped initiating sexual contact for fear of embarrassing you. Some couples go for years with no physical contact beyond the occasional hug. Ultimately, this physical and emotional distancing causes the relationship to deteriorate. The following pattern is common among couples when sexual dysfunction becomes an issue:

Erectile dysfunction begins.

The couple experiences repeated, disappointing attempts at sexual intercourse.

The man withdraws emotionally from his partner.

The partner's self-esteem suffers because of an assumption that the man has lost interest.

The man stops initiating sex for fear that it will lead to yet another failure.

The couple becomes emotionally and physically estranged.

Fortunately, you can prevent this destructive pattern by talking honestly and openly with your partner. Even if you already recognize elements of this pattern taking hold in your relationship, you can reverse the damage by improving communication.

But how do you broach this subject when it's gone undiscussed for so long? First, if you plan to seek treatment for your problem, it's important to let your partner know this. If a couple isn't communicating, simply getting a prescription from a doctor and hoping for the best often fails. To begin, phrase your discussion in a way that doesn't accuse or alienate your partner.

Exactly what you say is highly personal, of course, but if you just don't know what to focus on first, you might start talking about your feelings: your understandable frustration, your sadness and regret that things have changed, and your hope for a solution. Make sure to discuss erectile dysfunction as an issue for both of you to resolve rather than as one person's problem.

If you're the partner of a man with erectile dysfunction, reassure him that his erection is not the most important part of lovemaking (see "Advice for partners"). Partners who explore other ways of making love — including massage and oral sex (which doesn't depend on erection) — often find that their sex lives become more passionate and fulfilling. Women may particularly appreciate this approach because it lengthens foreplay and often improves intimacy between couples.

Advice for partners
A man with erectile dysfunction isn't the only one who's affected by it; the impact extends to his partner as well. As his partner, you may want to help but not know how. You may feel ashamed and possibly even "abnormal" because of the sexual difficulties in your relationship. Meanwhile, the two of you drift apart in silence.

Here are suggestions of some ways you can help.

Discuss the issue. Good communication is the foundation of an enduring relationship. Confront any concerns you may have about erectile difficulties by discussing your feelings and telling your partner that you care. Keep the lines of communication open before, during, and after lovemaking.

Reassure your partner that he is not alone. Remind him (and yourself) that millions of men have erectile dysfunction and that it's a treatable medical condition.

Learn about the condition and treatment options. Information truly is empowering. The best treatment for erectile dysfunction is one that you both agree will fit most comfortably with your lovemaking.

Offer to go with your partner to his doctor's appointment. In general, couples who work together have the best chance of successful treatment. But if your partner prefers to see his doctor alone, respect his privacy. There are other ways you can support his treatment.

Help your partner help himself. Keep in mind that bad health habits, such as smoking and heavy drinking, can cause erectile dysfunction. In a supportive and nonjudgmental way, encourage your partner to break these habits. What's good for his overall health is good for your sexual relationship.

Express your love in many ways. Expand your repertoire of intimate expressions. Lovemaking can be satisfying even without an erection.

Men also need to understand that it's all right if their erections come and go. Many men achieve an erection only to have it dissipate and return later. This can make a man anxious, which, in turn, can further inhibit his ability to maintain an erection. Women need to know that it's possible for men to reach orgasm without an erect penis and that manual stimulation can bring a man to climax even without a full erection.

Above all, couples need to make lovemaking a priority, not something that may or may not happen at the end of a long, tiring day. Try lovemaking on a weekend morning rather than at night. Set a regular time when both of you are likely to be feeling awake and refreshed. Setting up a regular "date" to make love may not seem spontaneous, but if spontaneity means never getting around to it or making love as the last event in an exhausting day, then give yourselves permission to plan.

If you have not had intercourse for months or years because of erectile dysfunction, you may encounter some physical difficulties once you seek treatment and attempt to resume sexual relations. If your partner is a postmenopausal woman, she may find penetration painful. That's because after menopause, vaginal tissue can become thin or atrophied and thus more susceptible to tearing, particularly if a woman hasn't been having regular intercourse. Patience is key. You may need to use lubricated fingers or dilators to gradually stretch the vaginal tissues.

Erectile dysfunction and the single man
In addition to the psychological and medical issues facing all men with erectile dysfunction, men without long-term partners who wish to be sexually active face their own set of questions and concerns.

If you're in this situation, you may wonder how much to tell a new sexual partner. There is no right or wrong answer. It depends on how much you're comfortable revealing and, to some extent, on which therapy you're using. For example, if you're taking a pill, you don't have to reveal as much as you would if you're using one of the other treatments.

If treatment is successful, you may not have to say anything about your erectile dysfunction, even if you develop a steady relationship with someone. But if the problem recurs periodically, you may want to discuss it with your partner. The best time to do this is usually not when sexual intimacy is actively under way, but rather during a quiet, private time when you are feeling at ease with each other.

Tell your partner about your condition and what you know about its causes. Discuss the types of treatment, if any, that you are using. Answer any questions your partner has and, when the time for sexual intimacy arises, take it slowly. You may find that having discussed the subject improves your sexual experience.

Counseling
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If your erectile dysfunction is due partly or wholly to psychological factors or tensions with your partner, treatment with just a pill probably won't work. Even when there is a physical cause, strain can develop in your relationship. Or you may have performance anxiety that prevents you from initiating sexual contact. In such situations, counseling may be helpful.

You can find a qualified therapist in your area through the American Association of Sex Educators, Counselors, and Therapists, the leading organization that certifies sex therapists (see "Resources"). To be certified, a counselor must be a licensed or state-certified health care professional, such as a medical doctor, psychologist, or social worker.

Sex therapy can have several goals. It can educate you and your partner about the nature of sexual arousal, it can improve communication, and it can reduce the anxiety associated with sex. To meet these goals, therapists often suggest that couples initially try to reestablish intimacy with hugging and other nonsexual touching, and then — over a period of weeks or months — work up to more sensual interplay and, eventually, sexual intercourse. Sometimes relaxation techniques are also used to help overcome sex-associated anxiety.

Little is known about the effectiveness of psychotherapy for erectile dysfunction because few studies have been done on outcomes. But some reports are encouraging. In 1997, a study in the Archives of Sexual Behavior involving 37 couples reported that a brief period of sex and relationship therapy helped most of these couples attempt sex more often. The couples were also significantly more satisfied with their sex lives.

It has become increasingly common for counseling to be used along with Viagra and related drugs (Levitra and Cialis). These drugs seem to be most effective for erectile dysfunction that's psychological in nature. For example, Viagra's success rate in such cases is 84%, compared with about 70% among all men with erectile dysfunction. Doctors often prescribe these drugs to help men overcome performance anxiety in the short term, but they also recommend psychotherapy to help them work through the root of the problem. Once their confidence is restored, some men are able to have erections without taking medication. Whichever treatment or combination of treatments you use, the better the communication between you and your partner, the more successful you're likely to be.

Erectile dysfunction and depression
Erectile dysfunction and depression often go hand in hand. Erectile dysfunction is twice as common among men with depression as it is among those who are not depressed. In some cases, depression causes a loss of sexual desire and erectile dysfunction, but in others dysfunction comes first and leads to depression. If you experience at least four of the following symptoms, you may have depression and should see a doctor for help. If you have thoughts of suicide, see a doctor immediately.

a change in appetite that sometimes leads to weight loss or gain

insomnia or, less often, oversleeping

a slowdown in talking and performing tasks or, conversely, restlessness and an inability to sit still

loss of energy or feeling tired much of the time

feelings of worthlessness or excessive, inappropriate guilt

problems concentrating or making decisions

The PDE5 inhibitors: Viagra, Levitra, and Cialis
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Approved by the FDA in 1998, sildenafil (Viagra) revolutionized the way we think about — and treat — erectile dysfunction, largely because it is so easy to use and effective. In 2003, the FDA approved two closely related drugs, vardenafil (Levitra) and tadalafil (Cialis), but Viagra remains the best-known and most frequently prescribed oral medication for erectile dysfunction.

All three drugs work in a similar fashion, by affecting the normal physiology of the penis. In particular, they block PDE5, an enzyme that breaks down the erection-producing chemical cyclic guanosine monophosphate. This enables the penis to fill with blood and to stay erect long enough for intercourse. Of course, it's important to realize that none of these drugs is an aphrodisiac. You've got to feel sexually stimulated in order for them to work.

The main differences between the three drugs have to do with timing: how quickly they begin to work, and how long their effects last (see Table 4). Levitra may start working slightly faster than Viagra (within a half-hour instead of an hour) although the FDA says that like Viagra, it should be taken about an hour before sexual activity. Some studies suggest that Levitra may help some men who don't respond to Viagra. And while some doctors are skeptical about this claim, there's no harm in trying Levitra or Cialis if Viagra doesn't work for you.

Cialis stays active in the body much longer than the other drugs. Viagra and Levitra last about 4 to 5 hours (and sometimes up to 12 hours). But with Cialis, the window of opportunity ranges from 24 to 36 hours, which is why it's sometimes called "the weekend drug." Another minor difference is that while Viagra's action may be delayed or impaired when taken with food (especially high-fat foods), that's not the case with Levitra or Cialis.

Success rates
Because Viagra has been available the longest, there's more research available on this drug. Pooled data involving studies of 6,659 men have shown that Viagra helped 83% of men have intercourse at least once. On the other hand, Viagra is not a panacea. A 2001 study of its long-term effectiveness, in the Journal of Urology, reported a somewhat lower overall success rate (69%). The success rates for Cialis and Levitra are similar to those for Viagra (59% and 69%, respectively).

Viagra has proved beneficial for most men with erectile dysfunction resulting from spinal cord injuries. In one study, 83% of such men who took Viagra had improved erections. But for men with diabetes or advanced heart disease, the drug helps only about half of the time. The response is even lower — about 30% — for men who've had radical prostatectomy.

Side effects
So far, the risks and side effects of these three drugs seem to be roughly the same. They all work by relaxing smooth muscle cells, which widens blood vessels — primarily in the penis, but also in other parts of the body. The most common side effect is a headache, which occurs in about 16% of users (see Figure 6). Other reactions include flushing, upset stomach, nasal congestion, and urinary tract infections. But when the drugs are used properly, these side effects are relatively mild, and most disappear after a few hours. In rare cases, some men experience temporary, mild visual problems, mainly seeing a blue tinge, but also increased sensitivity to light and blurred vision. However, men with retinitis pigmentosa, a rare eye disease, should be very cautious about using these medications.

In 2005, reports linked Viagra use to another rare eye disease, nonarteric anterior ischemic optic neuropathy (NAION), which can lead to blindness. However, fewer than 50 possible cases were reported as of 2006, compared to the millions of men who have used erectile drugs without problems. Still, these reports serve as a reminder to men over 50 to get regular eye check-ups and to alert a physician to any unusual vision problems after taking a PDE5 inhibitor drug.

Drug interactions
Within several hours of taking PDE5 inhibitor drugs, blood pressure tends to drop slightly: The top (systolic) number dips 8–10 mm Hg, while the bottom (diastolic) number goes down by 5–6 mm Hg. So it's very important to avoid taking these drugs with medications that contain nitrates, which also lower blood pressure. Interactions between these two types of drugs can cause life-threatening drops in blood pressure. (The nitrates and nitrites found in food don't pose a problem.) Men who take long-acting nitrates, including isosorbide dinitrate (Isordil, Sorbitrate, and others) and isosorbide mononitrate (Imdur, Ismo, and others), or who use nitroglycerine patches or paste should not take PDE5 inhibitor drugs. And they should not use short-acting, under-the-tongue tablets or a spray form of nitroglycerine within 24 hours of taking either Viagra or Levitra. For Cialis, the ban extends to 48 hours.

Men who take medications known as alpha blockers should be cautious about taking PDE5 inhibitors. These drugs, which include doxazosin (Cardura), terazosin (Hytrin), and tamsulosin (Flomax), are used to treat BPH and high blood pressure. If you take an alpha blocker, ask your doctor before taking any PDE5 inhibitor. For example, Viagra shouldn't be taken within four hours of taking an alpha blocker.

Yet another common medication that interacts with PDE5 inhibitors is cimetidine (Tagamet), used to treat severe heartburn and stomach ulcers. Tagamet slows the breakdown of Viagra, which can effectively double the level of Viagra in the bloodstream. Because of this, men who take Tagamet should start with a lower dose of a PDE5 inhibitor. No adverse effects from taking the drugs together have been reported, but the risk of side effects such as headache or flushing may be higher.

Other considerations
Although the PDE5 inhibitors are expensive (about $10–$14 per pill), many health insurance plans (including Medicare) cover them, although most have a limit of four pills per month. Perhaps even more important considerations are the sometimes complicated and unexpected challenges that these medications may present to your sexual relationship. Some partners who've grown comfortable in a relationship without intercourse may need time to shift gears, so to speak, if the drug is successful. Use of these drugs may raise other issues for couples. Should you tell your partner before or after you've started taking it? Will this put pressure on your partner to have sex? Should you take the medication and just hope your partner will be in the mood? The best way to address these questions is to talk about them with your partner. Particularly if you're in an established relationship, your partner should know that you have a prescription for one of the drugs, and the two of you can decide together how and when to use it.

Cautions about alternative therapies
"Improve your sex life" — that's one of the most widespread promises made by makers of herbal remedies and nutritional supplements. But can they actually deliver on that promise? You may decide to try one of these remedies on the assumption that it can't hurt and might even help, but there are reasons to be cautious.

Alternative therapies that are purported to improve a man's sex life include vitamin E and zinc, ginseng, arginine, saw palmetto, muira puama, and ginkgo biloba, as well as two hormones, melatonin and DHEA. But because these substances have not been studied scientifically for erectile dysfunction, their effectiveness remains unproven. Also in question is their safety, especially if you take any of them in large doses or for weeks or months. L-arginine, a precursor of nitric oxide, a chemical messenger involved in the erection process, is sold in pill form as an alternative remedy for erectile dysfunction. However, a study of the possible benefits of L-arginine to treat heart attack survivors was stopped early when a peek at the early data showed six deaths among volunteers assigned to L-arginine, compared with none in the placebo group. So men — especially those at risk for heart disease — should avoid these supplements.

Many herbs are medically active substances, although the FDA does not regulate their use and dosage. That they are available over the counter doesn't mean they're harmless. For example, according to the National Institutes of Health, DHEA can increase the risk of cancer and lead to liver damage even when taken for short periods.

Aside from these issues, treating erectile dysfunction on your own can be dangerous because the problem may be a symptom of a serious illness, such as diabetes or heart disease. So even if an alternative remedy seems to help, you run the risk of delaying the diagnosis and treatment of a potentially life-threatening medical condition. If you do choose to try alternative therapies, tell your doctor so he or she can be alert to possible side effects or interactions with any other drugs you're taking.

Injections
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What if PDE5 inhibitors don't work for you? Many men who can't use these drugs or find them ineffective are able to get erections by injecting one or more prescription drugs into the side of the penis. The very idea may make you squeamish, and it's certainly not as easy as taking a pill. But the needle isn't very big (about half an inch long, the same size as those used to inject insulin), and drug injections can produce results.

Indeed, for men whose erectile dysfunction is caused by diabetes, injection therapy is more effective than Viagra. And it's the single most effective treatment available for men who experience the problem as a result of prostate surgery. Many men learn the technique quickly after a demonstration by a doctor or nurse in the doctor's office

There are several injectable drugs, all of which work by relaxing the smooth muscle tissue of the penis and allowing blood to flow into the corpora cavernosa. The only one specifically approved for erectile dysfunction is alprostadil (Caverject, Edex). However, a number of older drugs that were approved for other uses are also effective for erectile dysfunction. They are papaverine (Pavabid, Genabid, Pavatine, and others), phenoxybenzamine (Dibenzyline), and phentolamine methylate (Regitine).

An erection usually occurs within 5–20 minutes of an injection and lasts for 30–60 minutes. The effectiveness varies according to the drug used. For example, studies show that the response rate to papaverine is 65%, but for alprostadil, it's more than 80%. Doctors typically prescribe these drugs in some combination rather than singly; many men who don't respond to any of these drugs alone can get erections when they combine two or more. A preparation called Trimix contains a mixture of papaverine, phentolamine methylate, and prostaglandin. One study found Trimix aided 62% of men who did not otherwise respond to injection treatments.

The main side effects of the injections are mild to moderate pain, bruising, or scarring. Like Viagra, injectable drugs can also cause low blood pressure. Although rare, this side effect is most likely to occur if a man takes too large a dose or if he injects himself more than once in 24 hours.

Another rare complication is priapism, an erection that lasts too long. Any man who has an erection that lasts for more than three hours after an injection should go to an emergency room for an injection of a counteracting drug. An erection that lasts longer than six hours can cause scarring and complete loss of erectile function. Because of these potential side effects, doctors prescribe the lowest effective dose. A doctor or nurse usually gives a patient an injection in the office to establish what that dose is before writing a prescription.

If you're using injectable drugs, there are some things you can do to help the therapy feel more natural for you and your partner. One is to take a low dose and ask your partner for manual or oral stimulation to help achieve a full erection. That way, your partner will feel more involved. You might also suggest that your partner watch you inject yourself once or twice to help overcome any initial discomfort with the process. But if you're more comfortable doing this privately, that's fine, too. What's most important for the treatment's success — and for your emotional well-being — is that you and your partner feel at ease with it.

Yohimbine (Yocon)
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This plant-based remedy was the first impotence pill to be approved by the FDA, and until Viagra came on the market it was widely prescribed by doctors. It's a chemical extracted from the bark of the yohimbe tree, which is native to tropical West Africa. It's not known exactly how yohimbine works, but scientists surmise that it increases blood flow to the penis and prevents blood from leaving too quickly.

Studies of yohimbine show that as many as 40% of men taking it report improvement. Because of its relatively low success rate, yohimbine isn't recommended as a first-line therapy. However, many men have found that it becomes more effective after several weeks of use. Therefore, some doctors still think it's worth trying for men who can't take Viagra — including those who take medications containing nitrates to treat heart disease — as long as they stick to the standard dose of 5.4 milligrams (mg) three times a day. Yohimbine can cause side effects — mainly insomnia, but also increased heart rate and blood pressure, nervousness, irritability, and dizziness.

Surgical implants
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Surgical implants should be considered only after you've tried other, less invasive options. Penile implants date back to the 1930s, when a piece of human rib was surgically placed inside a man's penis. Since then, the process has been refined, and now there are two kinds of implants.

Silicone rods. One type of implant consists of two pencil-thin silicone rods that are placed in the penis above the urethra. The operation is done on an outpatient basis and takes about an hour. The penis remains permanently erect, although it can be pointed down along the thigh to conceal it under clothing.

Inflatable cylinders. Another kind of penile implant consists of two inflatable cylinders positioned in the corpora cavernosa, which produce an erection when filled with saline fluid (see Figure 10). The fluid is pumped from a reservoir implanted in the abdomen or the scrotum. Although an inflatable implant produces a more natural erection than a silicone rod, it's more prone to complications, like infections and malfunction. About 5% of men need a second operation to replace the implant

Vascular surgery
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Vascular surgery is used only for men whose erectile dysfunction results from specific blood vessel problems. There are two types of such operations, but neither has a high rate of success. The first — for men whose problem involves the leakage of blood from certain vessels during an erection — ties off those vessels so they retain blood.

The second type of vascular surgery is used when the problem is the blockage of isolated blood vessels. In such cases, the surgery entails bypassing the blocked vessels to allow more blood into the penis. Bypass operations are reserved mainly for patients whose blood flow problems result from injuries such as pelvic fractures. For each of these operations, the success rate in restoring normal erectile function is less than 30%.

Surgery for Peyronie's disease
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When treatments such as vitamin E and verapamil injections fail to correct Peyronie's disease, surgery can straighten the penis. In the simplest operation, the surgeon first cuts a notch on the outside curve of the penis and then stitches the ends together. Sometimes there's too much scar tissue to perform this operation without severely shortening the penis. In that case, the doctor might recommend a dermal graft operation, in which scar tissue is removed and then replaced with a graft of skin tissue.

However, this operation can actually cause erectile dysfunction by injuring the arteries that lie beneath the scar tissue. If you choose this operation, you can lower the risk by having a penile prosthesis inserted or by using a medication for erectile dysfunction, in the form of injections, MUSE, or a PDE5 inhibitor.

Hormone therapy
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Testosterone supplements are appropriate only if you have abnormally low levels of this hormone. The supplements can help boost your libido and improve your ability to have erections. These supplements are now nearly always given in gel form, which you apply daily to your shoulders. Other forms are less convenient (doctor-administered injections) or cause skin irritation (skin patches). The exact role that low testosterone plays in erectile dysfunction remains unclear. However, at least one study suggests that combination treatment with testosterone gel and Viagra may improve response for men with low to low-normal testosterone levels who did not respond to Viagra alone.

Warning about fraud
While health fraud certainly isn't rare, it's especially rampant among products for erectile dysfunction. These frauds can be hard to spot even by sophisticated people because they're often cloaked in scientific terms and promoted by supposed "medical" groups. The Federal Trade Commission offers these tips to help you evaluate claims made on the Internet, in health food stores, or in advertisements.

If the product is advertised as effective for treating impotence and no physician's prescription is necessary, don't buy it. All effective treatments for erectile dysfunction require a prescription.

If the product is advertised as a "breakthrough treatment," check with your doctor to see if it is legitimate.

If the product is promoted by what appears to be a medical organization, call your physician to check the organization's credentials. Phony "clinics" and sham "institutes" are used to tout bogus cures for impotence.

If the product says "scientifically proven" to reverse impotence in a high percentage of patients, check it out with your doctor. Some claims that clinical studies prove a product works are false.

If the product being pitched to cure impotence is "herbal" or "all natural," dismiss it. Other than yohimbine, no herbal substance has been shown to be effective in treating erectile dysfunction.

Diagnosing erectile dysfunction

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If you've been having difficulty getting or sustaining erections, talk about it with your doctor. Such a conversation is never easy, but thanks in part to greater publicity about this problem and its treatment, many obstacles have been toppled.

You may recall the TV commercials that showed self-assured men going to the doctor's office to discuss the problem and emerging relieved after having taken this important step. What's misleading is that such commercials leave the impression that there's not much to discuss — all you need is a prescription and your erections will come back. In reality, your doctor must diagnose the cause of your erectile dysfunction in order to recommend an effective treatment.

While therapy usually does involve medication, erectile dysfunction is sometimes a symptom of an underlying condition that requires its own treatment. Also, medication is more effective for some causes of erectile dysfunction than for others. For instance, if you've had prostate surgery, pills probably won't work as well as other treatments. And if a psychological condition is significantly involved, you may benefit from counseling with a mental health professional trained in sex therapy.

1.Diagnosing the problem
2.Possible cause of erectile dysfunction
3.What the doctor does

Vascular (circulatory system)
Takes your blood pressure and listens to your heart. Checks pulse in groin and feet. Checks your abdomen for aortic aneurysm.

Neurological (nervous system)
Tests reflexes of your knees and ankles, as well as anus. Checks for sensation in your legs and feet.

Hormonal (endocrine system)
Assesses testicular size and breast development. Checks your thyroid gland.

Local (reproductive system)
Examines your penis for Peyronie's disease. Checks your prostate.

Psychological (stress, anxiety, emotional)
Assesses the history of the problem, especially whether it started suddenly and if nocturnal erections are affected.

Causes of erectile dysfunction...

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In the past, it was thought that most cases of erectile dysfunction were psychological in origin, the result of such demons as performance anxiety or more generalized stress. While these factors can cause erectile dysfunction, doctors now think that 70% of the time the problem can be traced to a physical condition that restricts blood flow, hampers nerve functioning, or both. Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism.

But it would be misleading to regard this condition as either psychological or physical. Often the two go hand in hand. In fact, more than 80% of men who have erectile difficulties as a reaction to an underlying physical illness go on to develop psychological issues that further hamper erections. For example, a man may develop erectile dysfunction as a side effect of a drug, and then become so anxious about his sexual performance that he continues to have trouble with erections even after he stops using the drug. In such cases, a combination of medical treatment and counseling is often most effective. Counseling often involves the man's spouse or regular sexual partner.

Following are the main causes of erectile dysfunction. These may operate alone or in combination.

How an erection occurs...

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At its most basic level, an erection is a matter of hydraulics. Blood fills the penis, causing it to swell and become firm. But getting to that stage requires extraordinary orchestration of body mechanisms. Blood vessels, nerves, hormones, and, of course, the psyche must work together. Problems with any one of these elements can diminish the quality of an erection or prevent it from happening altogether.

In many cases, an erection really starts in a man's brain. A sight, a touch, a smell, or perhaps just a memory sparks intense activity in the hypothalamus, an area near the base of the brain. Electrical signals of sexual arousal travel from the brain down to an area in the lower part of the spinal cord. Nerves in this area signal nerves in the pelvis, which tell arteries to let blood into the penis and cause an erection.

Direct genital stimulation can also cause an erection, but different nerve pathways are involved. In this case, the sensation is carried by the pudendal nerve, which runs from the penis to the sacral nerves in the lower spine. The sacral nerves then send messages that cause the arteries in the penis to admit blood. During sexual activity, both of these nerve pathways are involved in producing an erection.

Nerves talk to each other by releasing nitric oxide and other chemical messengers. These messengers boost the production of other important chemicals, including cyclic guanosine monophosphate, prostaglandins, and vasoactive intestinal polypeptide. These chemicals initiate the erection by relaxing the smooth muscle cells lining the tiny arteries that lead to the corpora cavernosa, a pair of flexible cylinders that run the length of the penis.

As the arteries relax, the thousands of tiny caverns, or spaces, inside these cylinders fill with blood. Blood floods the penis through two central arteries, which run through the corpora cavernosa and branch off into smaller arteries. The amount of blood in the penis increases sixfold during an erection. The blood filling the corpora cavernosa compresses and then closes off the openings to the veins that normally drain blood away from the penis. In essence, the blood becomes trapped, maintaining the erection.

As most people know, testosterone is important to the erection process. Certainly, a man needs a normal level of this hormone to start and maintain an erection. But for all the talk about hormones and virility, doctors don't know exactly what role sex hormones play in normal libido or the ability to have erections.

Obviously, an erection isn't permanent. Some signal — usually an orgasm, but possibly a distraction, interruption, or even cold temperature — brings an erection to an end. This process, called detumescence, occurs when the chemical messengers that started and maintained the erection stop being produced, and other chemicals, such as the enzyme phosphodiesterase 5 (PDE5), destroy the remaining messengers. Blood seeps out of the passages in the corpora cavernosa. Once this happens, the veins in the penis begin to open up again and the blood drains out. The trickle becomes a gush, and the penis returns to its limp, or flaccid, state.

It's usually difficult for a man to get another erection right away. The length of the interval between erections varies, depending on a man's age, his health, and whether he is sexually active on a regular basis. A young, sexually active man in good health may be able to get an erection after just a few minutes, whereas a man in his 50s or older may have to wait 24 hours. One reason may be that nerve function slows with age.

Indeed, erections may work on a use-it-or-lose-it principle. Some research suggests that when the penis is flaccid for long periods of time — and therefore deprived of a lot of oxygen-rich blood — the low oxygen level causes some muscle cells to lose their flexibility and gradually change into something akin to scar tissue. This scar tissue seems to interfere with the penis's ability to expand when it's filled with blood.

Erectile Dysfuction

2008-09-22T07:48:00.000-07:00

What to do about erectile dysfunction

Until the late 1990s, people rarely spoke openly about erectile dysfunction (also called impotence). But all that changed in 1998 when sildenafil (Viagra), the "little blue pill," hit the market. The first safe, effective, and easy-to-use treatment for erectile dysfunction, Viagra brought the problem out of the bedroom and into the doctor's office.

Since then, more than 750,000 physicians have prescribed Viagra to more than 23 million men worldwide. The trend expanded further in 2003, when the FDA approved two closely related drugs, vardenafil (Levitra) and tadalafil (Cialis). Some have even dubbed this phenomenon a second sexual revolution, the first being the advent of birth control pills. Both medications fostered major changes in sexual behavior and the ways in which people think and talk about sexuality.

This isn't to say that talking about erectile dysfunction is easy. In fact, a 2003 study of men ages 50 and older who went to a urologist for other, unrelated problems found that 74% of those who later admitted to having erectile dysfunction were too embarrassed to discuss the problem with their physician.

If you are concerned about erectile function, it's important to understand what erectile dysfunction really is. Failing to have an erection one night after you've had several drinks — or even for a week or more during a time of intense emotional stress — is not erectile dysfunction. Nor is the inability to have another erection soon after an orgasm. Nearly every man occasionally has trouble getting an erection, and most partners understand that.

Erectile dysfunction is the inability to attain and maintain an erection sufficient for sexual intercourse at least 25% of the time. The penis doesn't get hard enough, or it gets hard but softens too soon. The problem often develops gradually. One night it may take longer or require more stimulation to get an erection. On another occasion, the erection may not be as firm as usual, or it may end before orgasm. When such difficulties occur regularly, it's time to talk to your doctor.

Erectile dysfunction can have many causes. Often, the culprit is clogged arteries (atherosclerosis), which can affect not only the heart but also other parts of the body. In fact, in up to 30% of men who see their doctors about erectile dysfunction, the condition is the first hint that they have heart disease.

Other possible causes of erectile dysfunction include medications and prostate surgery, as well as illnesses and accidents. Stress, relationship problems, or depression can also lead to erectile dysfunction.

Regardless of the cause, this problem can often be effectively addressed. For some men, simply losing weight may help. If medications aren't effective for you, a number of other options, including injections and vacuum devices, are available. The possibility of finding the right solution is now greater than ever.

How common is erectile dysfunction?

The American Urological Association estimates that erectile dysfunction affects 25 million American men. The Massachusetts Male Aging Study involved a random sample of more than 1,700 men between the ages of 40 and 70 living near Boston. Researchers found that about 43% of the men were classified as having some level of erectile dysfunction. Technically, erectile dysfunction can strike any man old enough to have an erection, but it becomes increasingly common with age. Nearly 5% of men in their 40s and 25% of men in their 60s have complete erectile dysfunction.

Still, these numbers don't mean that erectile dysfunction is something that a man simply has to live with as he gets older. It isn't. Although testosterone, a male sex hormone that's essential to sexual performance, tends to decline with age, it remains within normal limits in most men. And while other age-related factors can affect a man's ability to have an erection — tissues become less elastic, and nerve communication slows — even these factors don't explain many cases of erectile dysfunction.

Often erectile difficulties are the result of an illness that becomes more prevalent with age. Or it may reflect the treatment of such an illness — erectile difficulties are a potential side effect of many medications. But many of these illnesses, such as cardiovascular disease or diabetes, can be prevented through good health habits, such as following a healthy diet, exercising regularly, maintaining a normal weight, and not smoking.

Moreover, staying healthy often fosters good sexual functioning. In surveys, 50%–80% of healthy couples over age 70 say they have sex regularly, and half say they have intercourse once a week. And many men continue to have erections into their 80s and 90s.