Embarrassing Questions About Impotence And Erectile Dysfunction

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Embarrassing Questions About Impotence And Erectile Dysfunction

Do women suffer from impotence and if so, how would you diagnose it?

Women do suffer from sexual health issues. Women probably have a very similar physical problem related to blood flow, and they diminish vaginal lubrication and increased time to vaginal arousal and diminished sensation and diminished orgasm. We're primarily treating women who are post-menopausal with a history of cigarette smoking and diabetes and high cholesterol, just like the men who suffer from circulation problems with their sexual dysfunctions. We intend to one day have ultrasound studies to record blood flow to the clitoris and vagina, which we are in development now. We will record things like pH of the vagina and other aspects of the physiology of the vagina. And right now, unless and until other drugs become available, our primary method of increasing the blood flow in these women who have dysfunction because of decreased blood flow will be the Viagra. And we've anecdotally utilized this in a series of women and actually have seen remarkable results. Pfizer has an on-going study in Europe at four cities in which women are given either placebo or different doses of Viagra. And these studies will be considered to be done in the United States starting the end of this year.

Men talk about getting Viagra so they can have better sex. If they don't already suffer from impotence will it really allow them to have better sex?

Is Viagra useful in men with normal erectile function? And the answer is it probably is not useful. You can't really get a better erection than a normal erection. However, there's a caveat here. Some people claim to have normal sexual activity and are having sexual activity, but with say a 50 percent erection, which really only allows two or three minutes. So whereas they're having sexual activity they may not be having normal erections during the sexual activity. And it gets a little confusing to listeners. So you may go to a party, and John may say, hey, I'm having intercourse three times a week, but you'll speak to the wife who will say, well, the intercourse is really not that great compared to what it once was. In that population who's sexually active with less than perfect erections, Viagra is very successful.

Can the sexual function be reinstated following a radical prostectomy. If so, how?

Prostate cancer is a very common problem in men, unfortunately. And like women with breast cancer, radical... or prostate cancer occurs in one in eight men. And one of the common treatment options for men with prostate cancer for a long term cure is a radical prostate. And unfortunately, the nerves and arteries that bring blood to the penis are often next to the prostate. And in removing the prostate during surgery, sometimes the plumbing and the nerves to the penis can be injured. We have had good success with Viagra, in radical prostate patients. But if the Viagra isn't successful, we've had very, very nice success with the pellet therapy, and the injection therapy, and we've even had wonderful success with implants. So if you have prostate cancer, get the treatment. If you're concerned that impotence is a consequence there are great therapies to reestablish sexual function after the prostate therapy.

Even with treatment to correct impotence, it can still be difficult to ejaculate or reach orgasm. Why is that? What would inhibit ejaculation and/or orgasm?

Those are, those are wonderful thoughts that we commonly hear about. People think that erection and ejaculation and orgasm are sort of all the same, and in fact, physiologically they're extremely different. Impotence is the inability to get an erection. Orgasm is a sensory phenomenon that occurs with stimulation to the skin of the penis, which passes to a portion of the brain. And ejaculation is the reflex from that sensory activity, which then results in fluid release from the end of the penis. In many reasons that you don't have orgasm, it can be from drugs. It can be from aging, sensation changes in the penis. You need to see a doctor for that one to find out which is the reason. In many cases, use of a vibrator will add so much increased sensation to the brain that it will result in ejaculation and orgasm. Sometimes the vagina simply doesn't provide the standard sensation for orgasm.

What about drug interactions with Viagra. For instance, is it compatible with Prozac?

There are very few reasons to not take Viagra that we presently know of. There's an eye problem called retinitis pigmentosa that means you should not be on Viagra. And it's a rare vision issue. And there's a pill that is called nitro-glycerin, or versions like nitro-glycerin. Nitro-glycerin would be a fast acting nitrate. There are medium acting and long acting nitrates. Short of those two conditions, it's reasonable to use Viagra. Now, should you use Viagra to overcome medication problems, Prozac being one of them, but actually the most common medication problem is cardiac medication or hypertension medication. But let's just say Prozac is the issue. Absolutely, use Viagra to overcome the adverse effects of other pills. If you have to be on any medication stay on that medication. If it has the side-effect of diminished erectile function use the Viagra or other therapies to restore that erectile function.

My erection has curved downward rather than upward to my embarrassment. I once told a urologist, but he said I didn't have a full erection. Since it was firm, I didn't believe him, but couldn't convince him he was wrong. Is this a common condition?

It's actually called congenital penile curvature. There are two ways to have penile curvature. One where you acquire it, and that's usually from an intercourse injury. And most commonly you get that with a partner in the superior position. You can also be born with curvature and that is essentially what this gentleman has. It makes intercourse difficult in certain positions, especially if it's significantly bending downward, and we've seen patients where the degree of bending is more than 90 degrees. And it's a congenital problem where the urinary system, the urethra, which is a part of the penis, is shorter than the erection chamber. So as the whole penis erects, of course you don't see that in the flaccid state, only when it erects, but it's like a tethering, as the erection generates, the urethra doesn't stretch like the erection chambers and the system is bent down. Surgical correction is actually not complicated, usually as an outpatient, and that would be the solution for many men.

I have heard of a topical cream being introduced. What do you know of this product?

Viagra being the example of a first line therapy for erections, which is a little more user friendly than say, pellets, or vacuum devices or injections or implants, there are a host of other things being developed. There are other pills being developed, and now we're in the era of topical creams. There are a series of companies generating topical cream data. Here at Boston University we're working on one. We actually have a little more than 100 people on the topical cream. And it looks like a very exciting alternative to oral pills. Not everybody is happy with an oral pill, and topical creams will fill their needs. Just a little caveat, topical creams will be widely used for treatment of the very first question we had, which was on female sexual dysfunction. I think women are a little more at ease using a topical substance to enhance blood flow delivery to the vagina and/or clitoris than perhaps an oral pill.

What treatments are effective for erectile dysfunction for diabetic men with circulatory problems and/or neuropathy

Unfortunately, diabetes is not a great disease to have in terms of the ability to get penile erections. It's extremely common to have erection problems with diabetes. And we advise you to have visits to a doctor and be managed in a way very similar to non-diabetics. You would undergo a history, physical examination, laboratory tests and probably managed by first-line therapies such as Viagra. Should these fail, then second line therapies, which would involve the pellet or the injection, or if those fail, third line therapies such as implant would be advised. We have had success with diabetics, with circulation problems, and nerve damage with Viagra.

Would consumption of alcohol cause a decrease in erection firmness?

It depends on the degree to which the alcohol is consumed. In the Massachusetts Male Aging Study, which was a large-scale, randomized, community-based sample of men who were assessed for what predicted erectile function, in addition to how often erectile function existed, which would be prevalence, ethanol use or alcohol use was actually not a statistical indicator of erectile dysfunction unless and until the alcohol consumption was fairly excessive. There are lots of reports that minor use of ethanol actually prevents vascular disease, which turns out to be probably the basic underlying dysfunction in the majority of men with erectile problems. So I guess the message is, you can drink minimally, but not excessively, and still maintain erectile function.

I have no problems achieving an erection, nor do I have problems sustaining it, but I do have trouble reaching an orgasm. Is this a sign of impotence?

Orgasm, ejaculation and erection are real separate sexual functions in men. Of course, another sexual function is drive, what we call libido. There are several reasons for men to have delayed orgasm, or diminished orgasm. And the most common, I would think, is just simply aging, changes in sensation. Since orgasm ultimately is a sensory event, sensation must reach a certain part of the brain in sufficient quantity as to then release what we call a propagating wave, which spreads in a portion of the brain resulting in the pleasure of orgasm. If you don't reach this ultimate sensation event in the brain, orgasm won't happen. Also medications prevent orgasm. Medications for example, such as things like Prozac, drugs that are for depression, we actually use for men who have premature ejaculation to slow down their orgasm ejaculation reflex. I would strongly encourage you to see a doctor. One of the best therapies we now have is vibration therapy, to enhance the amount of stimulation to the important part of the brain that orgasm is happening.

My husband has suffered from impotence for about six months He is not able to achieve and maintain an erection. However, he is able to achieve orgasm and ejaculate through masturbation, during which he still does not achieve an erection.

The fact that he has an erection problem that is consistent for six months meets the actual definition of impotence. We don't include men who have impotence with one night of activity. The second issue that this question addresses is the orgasm. Ejaculation clearly can happen normally in men without erections. You can actually have wonderful quality, well maybe not wonderful quality, but less forceful orgasm and ejaculation without good quality erections, but at least you can have them and get the sexual release. So they're not related. The young person aspect, that he's only 31, is a fascinating discussion in erectile activity, because by and large this is a disease of aging, and of aging blood vessels secondary to cigarette smoking and diabetes and high cholesterol. What we're finding more and more is that the young impotence is due to the same vascular damage, but that vascular damage is due to trauma. And I just wonder if we can ever speak to the other side of this. That this man is not a bicyclist or is a karate person, has been kicked in his crotch or has fallen on a fence post or fallen on a piece of concrete in his crotch, because that is likely the explanation if you think about it. I would strongly encourage this individual to see, in particular, a urologist, where specialized testing can be taken.

What role does frequent masturbation play in a man's inability to achieve erection later on in life?

There is no relationship between the frequency of masturbation and the onset of an erection problem. You could almost argue that frequent erections are good for erections. The sort of the opposite of "if you don't use it, you'll lose it" sort of syndrome. If you are experiencing erection problems and they're consistent and they're lasting six months, it is a reason to see a physician. There may be some other issue such as we just discussed earlier. Some trauma to the crotch region. Another obvious possibility is just simply slow down on the masturbation frequency and see if your erections restore themselves. But in a young man, having an erection problem is worth seeing a physician about, because it's not a good time to have an erection problem, when you're young.

If a 50 milligram Viagra pill has no effect, is it safe to try two pills, that would be 100 milligrams, without first checking with my doctor or urologist?

In general when you change the dosage of medications, you should consult your physician. If you're taking a 50 milligram tablet and not experiencing any of the side effects and also not getting the erection, it's not unreasonable to increase the dose because that would be what the doctor would tell you to do. But of course, again, with all medications it is wise to check with your physician.

What is the length in time of a normal erection? Also what is the length of a normal erect penis?

The duration of a normal erection should be related to the stimulation. If you have a partner that you find stimulating and you wish to have intercourse with that partner, and you wish to have intercourse for 30 minutes or 45 minutes, or an hour, and both are engaging in this relationship, you should be able to maintain the erection for that long. The average penile erect length is about 5 1/2 inches long in the United States of America. Now there are some fascinating things relating to penile length, and that's called penile anthropometry, which is the study of body part length. What's interesting about erect penile length is there are racial differences, there are differences in that you can predict erect penile length. The body part that predicts erect penile length is arm length, interestingly enough. And that if one smokes or has hypertension or cigarette smoking or diabetes or high cholesterol, you actually, compared to people who don't, you actually have a shorter penis. So those are some of the interesting observations, about erect penile length that we're now understanding.

My husband is 62, and he has a problem with his heart's electrical signals causing him to skip a beat, usually when he gets more active. At some point his cardiologist says he will need a pacemaker. Currently, he has impotence in terms of being able to sustain an erection for more than a few minutes. What effect or risks would a pacemaker have on the various treatment for impotence?

Unless a patient has angina, which means chest pain and relates that chest pain to blocked arteries and is treated by nitrates, and the most common example is nitroglycerin, there is no contraindication. So having a pacemaker would not be a contraindication if it was not associated with angina and treatment by nitrates or the example being nitroglycerine. If nitrates are used it is contraindicated. It should not be that you are taking Viagra.

I was told that impotence in my case was caused by the inability to retain blood in the penis because of a leaky valve. Is this a common occurrence? If so, which treatment is most likely to succeed?

Leaky valves are one of the most common physical reasons for men having erection problems. Just to explain quickly, like any hydraulic system and the penis, and a rigid erection is the equivalent of a hydraulic system, the physical requirements are that a pressurized source of fluid be delivered to the hydraulic structure, and in the case of a tire it's pressurized air, in the case of a penis, it's pressurized blood. And the pressurized fluid need to be contained within the hydraulic system. So in the tire it has a valve. In the penis there are in fact valves that keep the blood in the penis. The reasons for leaky valves are the same as atherosclerosis, hardening of the arteries, cigarette smoking, diabetes, hypertension. With men who have impotence, whether it's due to a leaky valve or not, they should start with first line therapies. And the first line therapy in this case would of course be Viagra. Second line therapies would be injections or pellets, and third line therapies would be implants. I would encourage you to use the Viagra and maybe join the Viagra with the vacuum device, even though you're having a few problems with it.

Does a childhood operation for undescended testicles put one at higher risk for impotence?

The surgical treatment for undescended testicles would not necessarily place you at risk for the development of impotence. If the problem is specifically erection problems there really should not be a relationship. If the problem is lack of interest, where the testicle may have been injured, and the hormone, the male hormone released may be diminished, that would be the relationship. A 46-year-old man who has specific erection problems is probably not related to the undescended testicle and may be due to some early vascular disease, such as cigarette smoking, diabetes, high cholesterol, or may be related to some bicycling type accident or injury or fall to the perineum.

When I have an erection only the left half of the penis seems to inflate. I am able to achieve orgasm, but there is discomfort in the penis on the side that is inflated, similar to too much pressure. Is there a reason and a solution?

Without seeing you, the left half inflates and the right side doesn't. The one thing that comes to my mind is a condition called Peyronie's Disease, and I'm surprised despite all these questions we've had today, I haven't heard from one patient who has had Peyronie's Disease. This condition involves thickening of the wall of the erection chamber. And of course, things that inflate and increase in volume require elastic or elastic properties of the wall. So if the wall is scarred and can't inflate then that would be a condition called Peyronie's Disease. Peyronie's Disease is also associated with pain and you described this pain. Peyronie's Disease is a condition which occurs generally from trauma during intercourse, primarily from partner superior intercourse. And one would need to see a doctor and discuss this with him for appropriate management.

What is the relationship to sexual dysfunction, if any, to protracted sexual inactivity or abstinence?

We use the word, Widower's Syndrome. And that is someone, for example, who is happily married and unfortunately, the partner passes on. And this man takes many years until he has enough energy to find a new partner and is essentially inactive for a protracted period of time. And we go back to the concept of, if you don't use it you will lose it. We have strong scientific beliefs in this statement that having an erection is good for an erection. For men who have impotence and believe that it's related to protracted inactivity, having Viagra would be a useful tool. But perhaps taking Viagra as a sleeping pill. We're going to look into it that way in the future. Taking it as a sleeping pill would enhance the nighttime erections, so these wouldn't be sexual erections. So the protracted inactivity could actually be generated or reversed, if you like, by taking the pill at night, and enhancing the duration of the natural erections that you get when you sleep. You get about three hours of erection if you sleep eight hours. It's about four or five or six episodes, each lasting about 30 minutes to 45 minutes. And Viagra has the capability of enhancing that. When you speak to men who take Viagra, one of the universal findings and statements by them is that they wake up with erections like they were 18 years of age again. And that's because it enhances the nighttime erections.

My wife has almost no sexual desire. She has had diabetes for 28 years and is on Prozac and Valium. What is the more likely cause of the sexual problem, the diabetes or the medications and what would be the best treatment?

At the present time where the research is a little scarce what my opinion would be in this case is that the diabetes is doing what it does in men. It's blocking blood vessels, injuring nerves and affecting tissues of the female genitals. Prozac, as it does in men, inhibits erectile function, would inhibit vaginal and clitoral function. In her, low desire may be reflective, possibly of diminished circulation to the vagina and/or clitoris during sexual activity. And we are now finding that Viagra can help in these cases. Now there's a caveat here. Viagra is not FDA-approved for the treatment of female sexual dysfunction at the present time. We are prescribing Viagra at Boston University for such women under controlled environment and controlled circumstances to assess the effect. Hopefully, in a short period of time, Viagra will be assessed by a large drug company, like Pfizer for the safe and effective treatment of female sexual disorders such as your wife.

The day after I take Viagra I feel hung over. I have a headache and feel slightly sick. I was left impotent as a result of surgery to remove a tumor from my rectum.

If you're having side effects from Viagra, my suggestion is, if you're using the 100 milligram tablet, cut back to the 50 milligram tablet, and you may not have your headache and feel sick. And you would still have the advantage of using an oral pill and not having the need to inject. The new drugs coming on the market are drugs that will be shown by the FDA one day, hopefully, to be safe and effective for the treatment of impotence. The next drug, which appears likely to be submitted to the FDA is a drug that blocks how stress affects the penis. Stress acts on the penis through specific receptors called alpha receptors, and these drugs are alpha blockers. There's also another drug which stimulates the erection center in the brain and you take that as a tablet underneath your tongue, what we call sublingual. They're not going to be available for at least a year, so we have to get something active in you right now. The first advice is to cut back on the dose of Viagra, and the second advice may be to go back to the injections. While it may not be appealing, it obviously did work in you and you may have to do that.

Does a vasectomy cause any of the symptoms of male impotence as one grows older?

For some reason we get people who always think that a vasectomy is related to impotence. There is no relationship that I can report from multiple studies studying thousands of men who under control situations didn't have a vasectomy, or under situations had a vasectomy and looking at things like erectile problems. People are also concerned of vasectomy in prostate cancer, and there's absolutely no relationship between vasectomy and prostate cancer. Having a reversal could happen, but if you are hoping it reverses your impotence, it won't. A 58-year-old male would most likely have erection problems from vascular disease, such as cigarette smoking or diabetes or high cholesterol. I would suggest you seek your doctor. And if you like, undergo testing. But specifically, you could simply try Viagra and see if it restores your potency, even though you have had a vasectomy.

My husband has had a problem with not being able to get as hard as he used to. He gets an erection but it is easily bendable and reduces my pleasure drastically. He also takes much longer to have an orgasm. He is 46 years old and this has been going on for a few years. Would Viagra be a good option for him?

Since you are sexually active and really he is at least hard enough to penetrate in you, some people may think that "he's normal." When obviously, as you state, he's not as hard. He has longer to achieve orgasm. There are sexual dysfunctions going on here. Yes, by all means, he would be an excellent candidate for Viagra. He is actually the ideal, in fact, candidate for Viagra. Since he's in his 40s and has erection problems, you might want to have him undergo testing to see if there are early vascular conditions. Because if there are, perhaps maybe he could get a cardiac stress test and see if other vascular conditions are abnormal such as the blood circulation to his heart, which would be very important to know.

What are the preventive actions to take against impotence?

The ones that are obvious are don't ride a bicycle. Don't smash your crotch in karate. Don't fall on fence posts. So preventing trauma and respecting the perineum. That would be my favorite. The most obvious, obviously, is to prevent the ravages of aging by taking control of your blood pressure. Keeping your weight down. Not having diabetes or at least if you have diabetes to get the maximum control you can. To avoid using drugs unless you have an obvious medical problem, because oftentimes drugs influence erectile performance. And the final answer, as it concerns preventative, is the concept of using Viagra to enhance the duration of nighttime erections. We have substantial evidence that would show that men who start becoming impotent start losing their night erections. That's one of the first things they see. We're hoping that if we get men at this early level where they're now starting to see just the beginnings of night erections that they used to get, easily and routinely, that they're now not getting, is to start taking drugs like Viagra or other ones as they become available, to enhance night erections.

Erection-Inducing Drugs - Medical Treatments For Erectile Dysfunction

Drugs which induce and strengthen erections can successfully treat Erectile Dysfunction and problems achieving and maintaining a strong erection. Erection inducing and erectile dysfunction drugs work for the majority of men who want stronger erections and can also help men with neurological and spinal problems.

Cialis : Works in the same way as Viagra, and is popular because the erection inducement effects last so long - often more than 12 hours. The Cialis erections are not blocked by food in the stomach.

Levitra : Works in same way as Viagra. Side-effects and interactions of Levitra are similar to those of Viagra. Levitra erections are not as long-lasting as Cialis.

Viagra : Widens the bloods vessels, so giving an erection provided the penis is rubbed. Viagra usually works within an hour. Effect lasts for about four hours. Easily blocked by food in the stomach. Commonest side-effects of Viagra are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. Viagra is very dangerous with certain heart drugs. Interacts with many medications. Do not drink grapefruit juice on day of use.

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