SparkMD - Frequently Asked Questions about Erectile Dysfunction

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Frequently Asked Questions about: Erectile Dysfunction
More detailed discussion can be found in my book Sexual Health for Men: The Complete Guide- Published 2000-Perseus Press. Last Updated (4/23/01) Note: Information provided below is intended as a source of information and a guide. For specific details about your own health, speak to your doctor. 1. I am interested in having sex but whenever want I want to, I just can’t seem to get an erection. Can anything be done to help me? 2. I have no problem getting an erection but my penis goes soft and I cannot penetrate. Why is this and what can I do about it? 3. When I was younger I wanted to and did have sex 2-3 times a week, but now that I am 40-50-60-70(pick one age)-I just don’t have the same desire I did when I was in my 20-s and 30’s. Is there something wrong with me? What can I do to be like I was when I was 20? 4. My wife and I are about the same age and even though I love her very much sex is not the same as it was when we were younger. Do you think I would be better off with a younger woman? 5. I still enjoy sex but since my wife went through the menopause she no longer does. Is there anything that can be done to rekindle her sexual desire? 6. From age 55 on I have been taking Vitamin E and zinc tablets to keep myself young and sexy. Is there anything else I can take to improve my manliness? 7. I never had trouble having sex about 6 weeks ago when I could not get or hold on to my erection. I was mortified. From that point on every time I try to have sex I cannot. Why? Is there something that can be done to help me? 8. My major problem is premature ejaculation. Is there a treatment for that? 9. How does Viagra work? 10. Does Viagra work every time for every man? 11. I have heard that men who take Viagra die after they have sex. Is this true? Is taking Viagra risky? 12. My wife has no sexual desire. If I give her one of my Viagra pills will it get her interested in having sex again?
1. I am interested in having sex but whenever want I want to, I just can’t seem to get an erection. Can anything be done to help me?
Answer: Yes. But first your doctor has to find out exactly what is causing the problem. He/she will want to know if you have erections in the middle of the night, first thing in the morning or while masturbating. If the answer is YES then all you may need Viagra to restore your ability to have erections when you want to have sex. If the answer is NO then more studies will be done to find out if a medication you are taking or some other unrecognized problem like too many cigarettes or alcohol, too little testosterone levels, unrecognized high blood pressure or diabetes mellitus is responsible. Whatever the cause treatment is available. Do not suffer in silence. Speak to your doctor.
2. I have no problem getting an erection but my penis goes soft and I cannot penetrate. Why is this and what can I do about it?
Answer: When a man is sexually aroused blood rushes into specialized chambers in the penis called corporae cavernosae at such a high pressure and intensity that it chokes off the veins that would normally drain blood out of the penis to create a rigid erection. Anything -like high blood pressure or cigarette smoking-that stifles the flow of blood into or anxiety that accelerates the flow of blood out of these chambers will diminish the quality of a man’s erection. See pages 90-95 in my book Sexual Health for Men.
3. When I was younger I wanted to and did have sex 2-3 times a week, but now that I am 40-50-60-70(pick one age)-I just don’t have the same desire I did when I was in my 20-s and 30’s. Is there something wrong with me? What can I do to be like I was when I was 20?
Answer: For both men and women there is alas only one “first time” when sex was new and fresh and pursued with the an obsessive passion. With continued experience sex remains enjoyable and eagerly anticipated but with time the novelty of the experience dims a little. Also as we mature other demands from family and/or career claim more and more of our time and energy so there is less and less time for couples to get pleasure from sex. For most mature men and women sexual pleasure and satisfaction is vital to an improved quality of life.
4. My wife and I are about the same age and even though I love her very much sex is not the same as it was when we were younger. Do you think I would be better off with a younger woman?
Answer: I was speaking to a group of very successful middle- aged businessmen when one of them piped up with this question. To a man all in the audience turned to me perhaps expecting that I would provide them with a” medical release” for sanctioned adultery. I did not. The reality of life is that there will always be someone younger, slimmer and sexier for not just every man but for every woman as well. Men and women who feel that they need a fling to “recharge their sexual batteries” may be temporarily invigorated with the excitement attending the machinations and skulking required to maintain a clandestine relationship but more often than not end up either disappointed, plagued with guilt or both.
5. I still enjoy sex but since my wife went through the menopause she no longer does. Is there anything that can be done to rekindle her sexual desire?
Answer: Today we know more about male, than female sexuality. But this is rapidly changing. An intense effort is underway to probe the physiology of the female sexual response. For example we know that a common finding among women with diminished sexual desire is a low testosterone level. Surprisingly women’s ovaries make a small but significant amount of testosterone. In a woman as in a man testosterone is vital for normal sex drive. Women who have had their ovaries removed or are in menopause have two hormone problems-low estrogen levels as well as an inability to make a full ration of testosterone. Their low estrogen levels cause hot flashes and prevent their vaginas from lubricating normally during sexual foreplay. The lack of vaginal lubrication makes intercourse painful for these women. The low testosterone levels throttle their interest in sex. Supplying them with estrogen makes vaginal lubrication easier. A little testosterone often restores a woman’s sex drive. This is something a woman should discuss with her gynecologist.
6. From age 55 on I have been taking Vitamin E and zinc tablets to keep myself young and sexy. Is there anything else I can take to improve my manliness?
Answer: Vitamin E and zinc routinely used by men, more often on recommendation from other men than from doctors. Evidence of their long- term benefit is lacking but they tend to be harmless and may have some useful properties as anti-oxidants. Other purported male restoratives like “Andro” available as Androstenedione or marketed with egregious claims to be “ The Stud Pill for Men” as well as creatine have not been shown to be any more effective than placebos. For the 55-year-old man who is in good health can best improve his virile profile by commonsense health habits –stopping smoking, prudent diet, and a regular exercise program. See pages 280-281 in my book.
7. I never had trouble having sex about 6 weeks ago when I could not get or hold on to my erection. I was mortified. From that point on every time I try to have sex I cannot. Why? Is there something that can be done to help me?
Answer: When a man has a single failed sexual episode and then becomes more preoccupied with performance than pleasure he is said to develop a problem called “performance anxiety”. Instead of enjoying the sexual experience he becomes preoccupied with the ability of his penis to become erect. He is in a sense dissociated from the sensual act and finds himself a “spectator” focusing only on his penis worrying whether it will become erect, and if it does how long the erection will last. An interruption of the performance anxiety cycle with either a series of sensate focus exercises or a brief trial of Viagra may be all that is needed to restore a man’s sexual confidence and defuse his anxiety. See pages 226-229 in my book.
8. My major problem is premature ejaculation. Is there a treatment for that?
Answer: In Nature rapid ejaculation after coupling is a desirable trait for it allows animals to spend as little time in the posture of copulation where they are easy target for predators. Rapid ejaculation diminishes the pleasure men and women derive from sex. Two techniques the “start-stop” method described on page 230 of my book and on occasion the use of small doses of antidepressant medication p.204-205 of my book. Speak to your doctor and find out what treatment is best for you.
9 . How does Viagra work?
Answer: For a man to have an erection blood must flow into specialized spongy chambers of his penis called corpora cavernosae. Within the corpora cavernosae two chemicals one called cyclic GMP and the other PDE-5 determine whether a man’s penis will be erect or limp. When cyclic GMP levels are high a man’s penis is erect whereas when PDE-5 levels dominate- as they do after a man ejaculates- his penis becomes limp. Viagra blocks PDE-5 allowing cyclic GMP levels to remain high so that a man can have a more sustained rigid erection. See p. 103-115 in my book.
10. Does Viagra work every time for every man?
Answer: The Viagra success rate is between 50 and 80% with the highest percentage of responders among those with “psychogenic impotence” whereas the response rate i.e. the number of men who will be able to have successful sexual intercourse after taking Viagra is somewhat less in those with other physical problems contributing to their erectile dysfunction. Thus about 55% of those with diabetes mellitus and about 50% of men suffering from neurological problems respond well whereas for men who have had prostate cancer surgery and sustained more serious nerve damage the success rate is only about 28%. See pages 114-117 in my book.
11. I have heard that men who take Viagra die after they have sex. Is this true? Is taking Viagra risky?
Answer: Men known to have heart disease should not take Viagra especially if, they are using medication like nitroglycerin or Isordil as part of their treatment. Men being men occasionally want to “stretch the sexual envelope” and in the past some with heart disease eager to have sex ignored their doctors advice, took Viagra, had a sudden drop in blood pressure and died. However, when Viagra is used properly it has proven to both safe and effective. But men with heart disease especially those who use nitrates should not take Viagra. See pages 124-127 in my book.
12. My wife has no sexual desire. If I give her one of my Viagra pills will it get her interested in having sex again?
Answer: Viagra increases blood flow to a man’s penile erectile bodies the spongy corpora cavernosae as well as to a woman’s clitoris. It does not increase sexual desire in either men or women. Trials of Viagra in women have been disappointing. When this was explored it turned out that many women with diminished sexual desire had unusually low testosterone levels..Llow testosterone and mild depression are factors known to be responsible for low sexual desire in women as well as men.