How Hard Can It Be? Understanding Erectile Dysfunction

As part of my series on the Aging Male, Love and Medicine will tackle erectile dysfunction (ED) – failure of the penis to remain erect in order to reach sexual satisfaction. Most men have experienced this at one time in their lives.  Men are embarrassed, anxious and depressed when their penis isn’t working.  They report frustration because they can’t please their partner. For men in healthy relationships, their partner’s needs matter a lot.

I interned in a sleep lab in graduate school. Sleep studies were used to differentiate psychogenic ED from physiological ED. A normal man spends about two hours in a tumescent state while asleep, having three to four erections a night. A man with psychogenic ED would probably be not far from the norm; a man with physiological ED would remain soft. Diabetic men spent nights in the sleep lab while erections were recorded and it was there that the first correlation between ED and diabetes was discovered.

Continue Reading

Magic Dust & Artichokes

When my year of no shopping ended, like a prisoner released from captivity, I couldn’t wait to bust out and buy something. I fell right into the trap! What a sucker. You wouldn’t believe what my first purchase was: Dust. I did not know that Gwyneth Paltrow touted it in her painfully misguided bullshit celebrity retail outlet called Goop. I read about it on a blog I once respected, called Cup Of Jo. There was one line…

“Psst, my friend says this …really works,”

…with a handy hyperlink directly to the Nordstrom website. For $39 I was the proud owner of a tiny jar. My partner just heard me reading this aloud and mumbled, “That useless shit was $39”?

Continue Reading

Why We Need To talk About Sex

Love+Medicine Pillows

The Pelvic Health Collaborative invited me to present a lecture about the importance of talking about sex with patients. I passionately believe it should be an integral part of an evaluation of an individuals’ overall health and well-being. Any discussion with adult patients tends to be site/disease specific, i.e., after prostate surgery or heart attack. But what about patients with Crohn’s disease, arthritis, anxiety or obesity that are not considered directly related to sex? Are we asking these patients about their sex lives? We need to be. Because everything can affect sex and sex can affect everything.

An article was published in the New York Times entitled “When Did Porn Become Sex Ed?” Kids are not talking to their parents, their friends, or their doctors, so they turn to the Internet. The access is so easy and anonymous – straight from the smart phone. This is where they are learning how it is done. Is it any wonder performance anxiety is on the rise? What happens to expectations after watching internet porn? While some strides were made during the last administration in promoting comprehensive sex education, it was removed from the 2018 federal budget.

Continue Reading

Ask Dr. Annie K: Sex and Aging

My husband, who is 78, can’t climax. He has the desire but loses the urge after a short time. He has had ed for several years but could still finish up to the last year or so. Is this age related? Any hope?
– Anonymous

Love+Medicine

 

Thank you for this great question. I assure you that many of my readers are interested.

This is a condition called Delayed Ejaculation (DE) or Anorgasmia. The erection is there but no climax. The answer to your first question, whether it is age related is yes. About 1/3 of men your husband’s age have problems reaching climax.

Let’s take a look at the science behind the male sexual response to understand what is going on. It is a cascade of events originating in the brain but involving the entire body. One system relaxes the body allowing for blood flow to the penis (erection), the other follows up with contractions necessary for ejaculation. These processes are sweetly choreographed to reach the big O.

What can cause DE?

Drugs – It is well known that antidepressants cause sexual dysfunction. Here are some others:
Alcohol
Diphenhydramine (Benedryl)
H2 blockers (Tagamet, Zantac, Pepcid)
Hydrochlorothiazide
Atenolol
Opiates
Furosemide (Lasix)
Triamterine (Maxzide)
Estrogen
NSAIDs (Ibuprofen)
Pseudoephedrine (Sudafed)
Finasteride (Propecia, Proscar)
Lipid-lowering agents
Digoxin
Levodopa (Sinemet)

Heart Disease – The arteries of the penis are often the first to show atherosclerosis.

Weak Pelvic Floor – These muscles weaken as we age.

Infection – Urinary tract infections, STDs and prostatitis.

Endocrine Conditions – Diabetes, hypothyroidism, low testosterone levels.

Psychological and Spiritual Factors – Anxiety, depression, relationship issues.

Consultation with a primary care physician AND a urologist are recommended to rule out these and other medical conditions. They may provide treatment options as well. Studies are limited but there are promising reports of acupuncture as a treatment for DE.

Sex is different as we age – biology we have to accept. I like to describe it as a quieter sex. Just as hot but more simmering than full boil. Pleasure comes equally from giving and receiving. Orgasm may not be the goal every time. Going through the natural changes and seeing them as normal may bring you closer as a couple.

 This is advice for all my sexually active seniors:

  1. Get in shape.
  2. Make love early in the day, when testosterone levels are highest.
  3. Eat healthy – What is good for your heart is good for your penis.
  4. Maximize oral stimulation.
  5. Fantasize about sex.
  6. Do Kegel exercises.
  7. Use your imagination.

Age is not a disease. Do everything you can to OPTIMIZE the functioning of your body and mind. In answer to your second question, there is definitely hope!

Are You Due For A Tune-Up?

Dr. Annie K’s Spring Sex Tune-up

 

The human body is an absolute wonder. The way it bends and stretches, responds to pain and pleasure, protects us. It is upon us to take the time to honor and respect our bodies – by both daily words of gratitude and royal treatment. Like any intricate machine, our bodies require maintenance.

Here is my proposed sexual health checklist for men and women. My guess is that your doctor isn’t asking these questions (but should).

 

Continue Reading