Category: Health Concerns

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Sexual Health Is Mental Health

— Comprehensive sex ed is key to supporting youth mental health development.

Marchers with Bans off my Body signs during the Pride March in New York City in March 2022.

BY

May is Mental Health Awareness Month—a time to share knowledge and bust stigma around mental health issues and empower our communities to take greater care of themselves and each other. As a youth sexuality educator, I have seen firsthand how comprehensive sex education that teaches young people healthy sexuality and communication, boundary-setting and consent is key to youth mental health and development.

I first got involved with Planned Parenthood as a volunteer for their Community Action team in Nashville. After working as a sex educator at Vanderbilt University, I joined Planned Parenthood’s Sex Education Training series in a state known for being difficult when it comes to amplifying sexual and reproductive health and education. After being exposed to all the possibilities that sex education can create for people, it didn’t take me long to realize that Planned Parenthood has its finger in the pulse when it comes to advancing the reproductive and sexual justice movement. I wanted to get involved in whichever capacity I could, so I asked to work with Planned Parenthood of Greater New York.

Today, I get to give workshops and interact with teenagers about interpersonal relationships, reproductive health, safe sex, STI prevention, consent and even relationship management strategies. I have gotten to see the way sexual health competency influences the mental, emotional and physical health of young people specifically. Evidence-based research shows how a better understanding of their bodies and sexuality can have profound positive effects on a young person’s mental health, but even though we have the data, there is so much work that still needs to be done.

Young people who receive comprehensive sex education are better at maintaining a balanced sexual and mental health.

In my everyday work, it’s very common for me to hear young people talk about the first time they experience jealousy, shame, excitement or even love. In those moments of openness, I can teach young people healthy strategies to respond to these very human emotions, and how their response can set healthy relationships and a safer experience for everyone.

Because age-appropriate, comprehensive sex education for our youth is not a requirement in our current education system, most teenagers—especially those in disenfranchised communities of color—still hold on to deeply troubling, outdated ideas about what is happening in their bodies. They believe that their development is not normal or shouldn’t be happening at all.

For those of us in the sex education field, it is common to have a holistic approach to our practice. In the classroom, we don’t just quiz young people on STIs. We go deeper, asking how they would feel if someone they knew was diagnosed with HIV, or how they would approach talking about a diagnosis with a partner. We explore the difficulties around discussing safe sex, and the reasons why it can make someone feel anxious or avoidant.

According to a study by the Guttmacher institute, the feeling-while-learning strategy improves confidence, teaches teenagers interpersonal relationship skills, coping strategies, to speak up when violence or abuse might be happening, how to advocate for themselves and others, how to manage problematic partnerships, and how to reduce shame, stigma and general feelings of discomfort around sex. The research shows that young people who receive comprehensive sex education are better at maintaining a balanced sexual and mental health.

By talking about sex with young people, we not only create a trust-based system that allows us to better guide them when making decisions, but we empower them with the tools and knowledge that could have life-altering outcomes for their futures. By receiving age-appropriate sex and emotional education, young people gain a wealth of knowledge, attitudes, skills and values to make healthier choices in their sexual and reproductive lives, which can help them gain an increased awareness of an already universal human experience and in exchange, have a happier life.

I’m still here today because I believe the educational work I get to do daily could have profound consequences for the betterment of all our communities. But I can’t continue to do my job the best way possible until comprehensive, age-appropriate sex education is expanded, protected and codified into law. Sexual health is mental health, and the only way we can stop the epidemic of youth self-harm and deteriorating mental health that has invaded the lives of our young people is by giving them the kind of education and resources they deserve.

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How Does Chemotherapy Affect Your Sexual Health?

— Chemo is a powerful cancer treatment, but there are side effects you should be looking out for.

Chemo is a powerful cancer treatment, but there are side effects you should be looking out for.

By Jennifer Sizeland

Chemotherapy is the chemical treatment of cancer using drugs. The primary purpose of chemo is to kill cancer cells, shrink tumors, relieve symptoms of untreatable cancer and prevent it from returning.ƒhealth

It can be administered in several different ways but is usually given through a needle or tube inserted into a vein or orally—by mouth in capsule, liquid or tablet form—over a period of time. This treatment can be used in conjunction with other therapies, such as radiation therapy, immunotherapy and surgery. Progress is monitored by an oncologist, a cancer specialist who will perform various tests to see how the cancer responds to chemotherapy.

While chemotherapy has come a long way, it still has side effects that can influence all areas of your life.

How does chemotherapy affect general health?

Aside from the symptoms and problems caused by the cancer itself, chemotherapy can have myriad side effects.

“One of the most common side effects of chemotherapy is myelosuppression, or lowering the blood counts,” said Mohamad Cherry, M.D., the medical director of hematology at Atlantic Medical Group Hematology Oncology in Morristown, New Jersey.

He noted that this treatment can impact the body in the following ways:

  • Lowering platelets can cause bleeding.
  • Lowering the red blood cells can cause anemia and lead to fatigue.
  • Lowering the white blood cells can affect the immune system and increase the risk of infections.

Different chemotherapeutic agents create different side effects. These can vary depending on the type and stage of cancer, he added.

Some of the other common side effects of chemotherapy include the following:

  • Appetite loss
  • Bleeding
  • Bruising
  • Constipation
  • Hair loss
  • Mouth soreness
  • Nausea
  • Vomiting

Cherry recommended talking with your doctor about the best way to treat the symptoms of chemotherapy, as there are medications and other tools to help manage these side effects. Methods like cooling caps can help prevent hair loss, and antiemetic medication can reduce vomiting and nausea.

It is important to look after your mental health, he added, as this is an aspect of cancer treatment that is often ignored. Some cancer sufferers find that speaking to a therapist is helpful.

How does chemotherapy affect sexual health?

“Chemotherapy can, unfortunately, impact sexual health in many ways, although not everyone has these symptoms,” said Anne Peled, M.D., a breast cancer surgeon and the co-director of the Breast Care Center of Excellence at Sutter Health California Pacific Medical Center in San Francisco.

She explained that women can experience the following sexual side effects as a result of chemo:

Men can experience:

“Chemotherapy can also impact future fertility, which is unfortunately not always discussed before treatment when options like sperm and egg harvest are potentially available,” Peled added. 

If you would like to have children, this is something you can discuss with your doctor before chemotherapy starts.

Whitney McSparran, L.P.C.C., a counselor who specializes in relationships, stress, grief, anxiety and self-esteem at Thriveworks in Cleveland, Ohio, explained that there are other forms of intimacy partners can share that don’t involve intercourse.

“Exploring non-sexual forms of physical intimacy like massage, cuddling and hand-holding can be helpful in maintaining a sense of intimacy when sexual activity isn’t on the table,” she said.

Complications and related conditions

The powerful nature of chemotherapy means it can cause serious complications.

“Certain chemotherapeutic agents can affect the heart, causing congestive heart failure or arrhythmias, and others can affect the lungs, causing shortness of breath,” Cherry said.

Chemotherapy drugs can especially affect the kidneys and liver, he added, which can result in increased liver enzymes or a decrease in kidney function. These organs will be closely monitored throughout treatment.

If any severe complications arise as a result of chemotherapy, your doctor will adjust your schedule or prescribe supportive medication to help your body to better cope or recover.

Living with chemotherapy

While undergoing chemotherapy, it’s important to build a support network of friends and family to go along with a healthcare team. Cherry recommends asking for social worker support as well.

It is important to be open and honest about your cancer and treatment, even when you feel uncomfortable talking, in order to maintain those relationships, McSparran said.

“Many healthcare systems may have social workers or nurse navigators that can answer questions or help facilitate these difficult discussions,” she said.

Many people find that they can live relatively normal lives while on chemotherapy and even continue their day-to-day responsibilities.

Dating and relationships with chemotherapy

“Transparency, boundary setting and communication are important in all dating relationships but are especially important when navigating dating and chemotherapy,” McSparran said.

Her advice for managing romantic relationships while undergoing chemo includes:

  • Accept that your priorities or values may change.
  • Be aware that your relationship may change as a result of cancer and cancer treatment.
  • Be clear on your expectations of the relationship.
  • Be clear about the time and energy you have to commit.
  • Be open to talking about what is and isn’t working.
  • Explore possible solutions to your feelings and problems.

Practicing safe sex is very important during chemo, as these drugs can severely harm a pregnancy in the first trimester.

It may help partners to join a support group where they can speak to others whose relationships have been impacted by cancer.

Supporting someone and aftercare

“Don’t rely on the person going through chemo to tell you what they want or need. Know the type of support you can provide and be consistent,” McSparran said.

She stressed the importance of looking after yourself, as being someone’s support during cancer treatment can take its toll.

McSparran recommended these strategies as the most important so that you look after yourself while you’re caring for someone on chemo:

  • Find a professional to talk with if you need to.
  • Lean on your own support network.
  • Practice self-care.

Chemotherapy and cancer can have unexpected impacts, so it is vital to keep checking in with yourself as well as the person you’re caring for.

Whatever you’re going through, there is likely someone else who has been through a similar experience. Charities, groups and online resources can provide emotional, financial and practical help during your time of need.

Resources for patients and caregivers

Here are some great resources to start learning more about chemotherapy and its potential effects:

Complete Article ↪HERE↩!

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What You Should Do if a Condom Breaks

— Turn to emergency birth control and STI tests

Nothing ruins the post-sex glow like realizing the condom broke. Now what?

“You’re probably anxious about what to do next. It’s natural to jump to worst-case scenarios,” says sexual health specialist Henry Ng, MD, MPH. “But don’t let your fears get the best of you. Take a breath.”

Don’t panic but do get prompt medical care. Dr. Ng explains what to do next and what to expect.

What to do if a condom breaks

If the condom broke while you were having sex, you may be worried about:

“Seek care right away,” Dr. Ng advises. “If you have a primary care provider, that’s a good place to start.” When you contact your healthcare provider, say you have an urgent concern. You may be able to get a same-day appointment.

If you don’t have a primary care provider, your options for quick care include:

  • Community clinics and health centers.
  • Express care or urgent care clinics.
  • Reproductive and sexual health clinics, such as Planned Parenthood.

“Go where you think you’ll feel most comfortable talking openly about sex and your needs,” encourages Dr. Ng. “When you call for an appointment, check that the clinic provides emergency contraception and STI testing, depending on your concerns.”

Dr. Ng also advises against going to the emergency room unless you have a true medical emergency. Trips to the ER can be very costly, and it’s better not to tie up emergency services unless you need them.

How to prevent pregnancy after unprotected sex

If you’re worried about potential unwanted pregnancy, get emergency contraception as soon as possible after unprotected sex. Dr. Ng explains your options.

Plan B One-Step (levonorgestrel)

Known as a “morning-after pill,” Plan B One-Step® and its generics (My Choice®, My Way®, Preventeza®, Take Action®) are available over the counter. It’s best to take it within 72 hours (three days) of unprotected sex, but you can take it up to five days after.

“The longer you wait, the less effective Plan B is for preventing pregnancy,” says Dr. Ng. “So, it’s really important to get it within that three-day window.”

Plan B One-Step and the generic versions contain levonorgestrel, a synthetic hormone used in some birth control pills. But the dose is different than regular birth control pills. You take Plan B One-Step in one dose.

ella® (ulipristal acetate)

Another morning-after pill option is ella®, but it’s only available with a prescription. It’s a single-dose pill, and you can take it up to five days after unprotected sex. But like Plan B, ella is most effective if you take it within the first 72 hours.

Can you take multiple birth control pills after unprotected sex?

“We typically don’t recommend taking multiple birth control pills for emergency contraception,” says Dr. Ng. “The pills you have on hand may not be the right type of drug or the right dose to prevent pregnancy.”

He says the most effective options are Plan B One-Step (or its generics) and ella, which are approved by the U.S. Food and Drug Administration (FDA) for emergency birth control.

What to do about potential STIs when the condom breaks

Potential STI exposure can be scary to think about. And even if your partner doesn’t show symptoms of an STI, they could still have one.

If possible, ask your partner about their STI status. If they currently have an STI, you know you need to get tested. If you’re unsure if your partner exposed you to an STI, you may still want to get tested.

STIs to be aware of

STIs are widespread and on the rise in the U.S. According to the Centers for Disease Control and Prevention (CDC), about 1 in 5 people have an STI. Some people have an STI but don’t have any symptoms.

Bacterial STIs

Dr. Ng says the most common STIs are gonorrhea and chlamydia, both bacterial infections. Syphilis is also a bacterial STI. If you’ve been exposed, the bacteria will show up on a test right away. Tests are typically done by taking a pee (urine) sample or swabbing your genital area.

“When you get tested, talk to your provider about how you express yourself sexually — the type of sexual activity you engage in,” Dr. Ng says. “A urine test and genital swab may miss a gonorrhea or chlamydia infection if you engaged in oral sex, for example.” Be sure to ask for an oral or rectal swab if you had oral or anal sex.

Antibiotics can treat gonorrhea and chlamydia. Dr. Ng urges that you seek out treatment quickly for these conditions, so you can avoid complications like pelvic inflammatory disease (PID), urethritis or infertility.

Viral STIs

STIs that are viruses include:

These viral STIs won’t show up on a blood test right away. It takes time for your body to make antibodies to the virus, which are the signs (markers) that show up on a test. But it’s still important to get tested, especially if you think you were exposed. Your care provider will guide you on the testing windows for viral STIs.

If you know you were exposed to HIV, get medical care right away. Preventive treatments, called post-exposure prophylaxis (PEP), can protect you, but you must begin taking PEP within 72 hours of exposure to HIV.

“Also consider talking to your care provider about going on pre-exposure prophylaxis for HIV,” suggests Dr. Ng. This medication, often called PrEP, is for people who don’t have HIV but are at risk of getting the virus. You take it every day, and it can lower your risk of sexually transmitted HIV by up to 99%.

Condoms are still great protection

There’s no such thing as perfect protection during sex. Even though condoms can fail, it happens rarely, and they’re still your best defense against STIs. Condoms (and there are many different types) are effective birth control when used consistently and correctly.

If your main concern is preventing pregnancy, many birth control options work even better than condoms. Just remember, other birth control methods don’t protect you from STIs, but condoms do.

Complete Article ↪HERE↩!

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Your Guide To Buying Condoms Because Prioritizing Your Sexual Health Is A Flex

By Frances Dean

Taking care of your sexual health pleasure is actually a huge flex, but society doesn’t make it easy to feel empowered while buying birth control. Condoms — the easiest kind of birth control to obtain and the kind with the least amount of side effects — are marketed almost exclusively to cisgender men, in everything from packaging design to description. “The products and shopping journey remains geared towards men and there is still a stigma attached to a woman buying and having her own condoms,” Cécile Gasnault, brand director at SmileMakers, explained to Cosmopolitan UK.

The market continues to grow and change, and in recent years there’s been an influx of startups and brands marketing condoms to women and femme people. However, it’s still far from the norm. So, until femme-forward condoms become ubiquitous and the patriarchy ceases to exist, you’ll likely have to make do with a pharmacy full of male-forward brands. To make the process easier, we break down everything you need to know about buying condoms so that you can be in complete control of your sexual health.

Know your options

When talking about condoms, people usually mean two different things. They are either talking about female condoms or male condoms. Female condoms are much less popular, due in part to the fact that they’ve only been around since the 1990s. A female condom is basically the opposite of a male condom. A female condom goes inside the vagina, and a male condom fits around the outside of the penis or phallic-shaped toys. Another key difference is the levels of effectiveness. Male condoms are roughly 82% effective at preventing pregnancy if used ideally, while studies have shown female condoms to be closer to 79% effective.

Condoms of both varieties, unlike many other forms of birth control, are a good option because they are highly effective and available without a prescription. Most importantly, out of all types of birth control, condoms (both male and female) are the best at preventing STDs. “Condoms act as a barrier which doesn’t allow mixing of bodily fluids and decreases exposure of one partner’s fluids from another,” Dr. Randy S. Gelow told Banner Health. “Remember, between 50% to 80% of STIs have ZERO symptoms, so even if a partner states they have no symptoms or don’t show any symptoms, this doesn’t mean that they don’t have an STI.” Some scientists even think that female condoms might be slightly more effective than their male counterparts. Translation: unless you and your partner have just been tested, use a condom.

Protect yourself

Woman with condom in pocket

There are about a million different brands of condoms out there, and it can feel a little overwhelming when you’re facing an entire aisle of them at the pharmacy. If you opt for external condoms (i.e. male condoms), experts recommend checking the ingredients of the brands before spending your money. A small percentage of people are allergic to latex. If you fall into this category, opt for lambskin or a different material. Even if you don’t have a latex allergy, some ingredients in condoms can be toxic no matter your gender, so it’s best to opt for something natural if you can.

“Chemicals, dyes, additives, sugar alcohols, preservatives, local anesthetics, spermicides, and other potentially carcinogenic ingredients are often included in standard condoms,” Sherry Ross, MD, OB-GYN, a women’s health expert, and author told Healthline. “Standard brands are not usually concerned about whether their ingredients are organic or natural.” As our bodies absorb everything we put in them, using condoms with carcinogenic ingredients can be dangerous. Don’t be nervous to try something non-name brand for the sake of safer ingredients. Organic options are just as effective as traditional brands and can be safer for you and your partner.

While condom manufacturers are unfortunately not required to list all the ingredients in their products, there are a few to look out for. Avoid condoms with nitrosamine (a known carcinogen), as well as glycerin and condoms with added spermicides — two ingredients that studies suggest do damage the vagina.

Your pleasure is paramount

The sheer variety of birth control methods can feel overwhelming, but sex isn’t supposed to feel like a chore; It’s supposed to be fun! When it comes to hitting the condom aisle, sex therapists recommend looking for two things: ribbed and lubricated. The texture of ribbed condoms (or the less common “dotted”) can provide some of the sensations that using a condom may take out of penetration. “A textured condom can stimulate the nerves that are present in the vagina better than a nontextured condom does, which may enhance pleasure,” Goody Howard, a sex educator, explained to Healthline.

Besides texture, a lubricated condom can be the difference between a great and a very uncomfortable sexual encounter. Lubrication — something the body tends to create itself — is a sign of arousal and a helpful aid for sex. However, a regular latex condom can sometimes feel too dry. To combat this, opt for a brand that factors lubrication into their product. “Any kind of condom with lubrication is always great, just because we can always use a little extra help. Why not?” said Jenni Skylar, a certified sex therapist, when speaking to Women’s Health.

A lubed condom (or adding lube when using a regular condom) makes sex feel better and safer. “If you use a condom-friendly lube (i.e., water-based lube),” Angie Rowntree, founder of a sex-positive and ethical porn site, told Mind Body Green. “It can help prevent breakage and make condom use feel more pleasurable.”

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For cancer survivors, sexual intimacy can pose unexpected issues

— ‘I feel as if my body has betrayed me,’ one survivor says

Brenna Gatimu and her husband, Nimmo Kariuki, tend to their youngest son, Kylian, in Casper, Wyo. Gatimu was diagnosed with Stage 3 breast cancer in 2020.

By Netana H. Markovitz

Brenna Gatimu, 34, of Casper, Wyo., was diagnosed with Stage 3 breast cancer in 2020. She quickly had chemoradiation, and both her breasts and ovaries were removed. She now takes a medication that suppresses any remaining estrogen in her body.

“I feel as if my body has betrayed me, like all the things that make me biologically a woman — the estrogen, the progesterone, my ovaries and my breasts — everything had to be removed and stopped,” Gatimu said.

Gatimu’s experience is not uncommon. As cancer survival rates in the United States improve, many survivors are left with permanent changes to their body — outwardly and functionally. Some feel particularly unprepared for persistent changes in their sexual functioning.

“Sexuality is a very big issue, and unfortunately, the avenues to get help are often limited because people are concentrating on helping [patients] live through cancer, and really concentrating on quality of life but devoid of sexuality,” said Don Dizon, a professor of medicine and surgery at Brown University and the founder of the Sexual Health First Responders Clinic at the Lifespan Cancer Institute.

Sexual health and quality of life

In 2022, approximately 18 million people with a history of cancer were living in the United States. The number is expected to increase over time.

“As people live long lives after cancer … these questions on the permanent, long-term side effects of treatment are something we have to address,” said Sharon Bober, founding director of the sexual health program at the Dana-Farber Cancer Institute and an associate psychiatry professor at Harvard Medical School.

“I feel as if my body has betrayed me, like all the things that make me biologically a woman — the estrogen, the progesterone, my ovaries and my breasts — everything had to be removed and stopped,” Gatimu says.

“We are looking not just at what people do functionally, but we’re also thinking about people’s experiences of themselves being whole, having a sense of integrity in their body — even after things change,” Bober said. “We’re talking about an experience of how people relate to a partner, we’re talking about dating, we’re talking about emotional and sexual relationships that undergo changes themselves.”

“We’re also thinking about people’s experiences of themselves being whole, having a sense of integrity in their body — even after things change.” — Sharon Bober, founding director of the sexual health program at the Dana-Farber Cancer Institute

Some cancer centers have created programs dedicated exclusively to sexual health for patients with cancer — such as Massachusetts General Hospital and Memorial Sloan Kettering in Manhattan. These centers are still relatively rare, but their numbers are increasing.

Those without access to a comprehensive center should consider seeking out “specific practitioners who have relevant expertise, such as certified menopause specialists, urologists or urogynecologists who specialize in sexual medicine, pelvic floor physical therapists or certified sex therapists in the community,” Bober said in an email.

Gatimu holds some of the medications she takes while Kylian asks if he can have the pills, too.
A family portrait on Gatimu’s wall shows husband Nimmo Kariuki, stepdaughter Paisley Grundhoffer, and sons Malcolm, James and Kylian. The family had the photo taken the day Gatimu completed chemotherapy.

Patients can also access a growing body of information.

“There are really more resources now than there ever have been and there are a lot of organizations that now have really good information and education on their websites,” Bober said. “I would just say people should feel free to access the growing amount of supports that are out there. And that’s the case both for patients and providers.”

For example, the Scientific Network on Female Sexual Health and Cancer has a host of resources, including webinars, a page with links to several online resources and a “find a provider” page to search for help by location. The American Cancer Society also has a fairly comprehensive overview of navigating sex and cancer.

Jacob Lowy in his living room in New York.

Even before intimate encounters, body image can be an issue. Jacob Lowy, 31, a fourth-year medical student at the University of Michigan, was diagnosed with metastatic sarcoma in 2021. Since then, he has had to deal with dating.

“It definitely messed with my psyche a lot to talk to people because it feels like you’re hiding something at first,” Lowy said. “But there’s no real advice for how to do it properly.”

Besides fatigue and surgical complications from his two abdominal surgeries, he has experienced decreased libido and erectile dysfunction.

“I went from feeling … invincible and very strong to my body feels like a wreck on the inside,” Lowy said.

Physicians often don’t discuss sexuality with patients for many reasons, Dizon said. “Partly it’s because I don’t think oncologists are trained in talking about sexuality,” he said.

Lowy spends time with friends on the Lower East Side in New York on March 4.

When sexuality is discussed, much of the talk often focuses on what’s safe — for example, when it is safe to have sex during chemotherapy. Bober said “potential sexual side effects and sexual rehabilitation really is not routinely incorporated into care. So a lot of people struggle on the other side of treatment and feel pretty isolated.”

“I went from feeling … invincible and very strong to my body feels like a wreck on the inside.” — Jacob Lowy

But when the topic is broached, doctors often have treatment recommendations.

Sarah E.A. Tevis, an assistant professor of surgery at the University of Colorado, recently started asking her patients about sex after a patient questionnaire she distributed flagged the issue.

“This wasn’t a common thing I talked to all of my patients about, and ever since I’ve started bringing it up, I feel like almost every single patient I talk to is having some problem that we can probably help with,” Tevis said.

Ask for help or a referral

Even if your oncologist does not know how to help, someone is probably out there who can.

“This is something that people should be empowered about — that as with other aspects of our health, if you’re having issues, give it voice, ask for specific assistance,” Dizon said. “And if your doctor doesn’t know or doesn’t want to discuss it, then ask for a referral.”

For Gatimu, she has done her best to adapt to a new normal but still struggles.

Since treatment, she has experienced vaginal dryness, difficulty achieving orgasm and lack of libido. She also has no sensation in her reconstructed breasts. Gatimu has sought advice through a combination of doctors and friends who are cancer survivors.

Gatimu helps Kylian wake up to get ready for day care on March 1.
Gatimu’s son Malcolm walks past a photo wall his mom and dad put together of past family moments, photos and sayings as he gets ready for school on March 1.

“I still have times where I really struggle with the comparison or the wishful thinking of ‘Oh my gosh, if only this didn’t happen and I didn’t have to live through this, where would [I] be?’ On the positive side, I have gained such a self-awareness and such a self-confidence within myself,” Gatimu said.

One 44-year-old man who was diagnosed with Stage 3 rectal cancer in 2018 underwent chemotherapy and radiation before having surgery that resulted in an ostomy pouch, a bag that collects stool outside the body.

“It’s tough for me not to view my body as … broken,” said the man, who asked not to be named for privacy reasons.

For him, sex with his partner now involves going to the bathroom to empty out the ostomy pouch and ensuring that it is as flat as possible so it does not get in the way. He also takes Viagra for the erectile dysfunction he has had since treatment.

A photo of Gatimu and Kariuki attending an adult prom in Casper, Wyo., that raises money for childhood cancer research.

“I am very fortunate that I have a loving partner who loves me for who I am and we’ve adjusted, but now sex is really tough to have spontaneously,” said the man, who lives in Chapel Hill, N.C.

A common misconception is that only certain cancers affect sex.

“We tend to think of sexual health as an issue [only] for people treated for sex-related cancer,” Dizon said. “But that’s actually not true. There’s a growing literature that even people treated for, say, colon cancer and lung cancer — they actually have issues related to sexuality.”

He points out, for example, that chemotherapy itself can affect the vaginal mucosa, which can cause pain with sex.

Unfortunately, many cancer patients feel alone in their struggles.

No one mentioned sexuality to the Chapel Hill resident, except for a brief, awkward conversation with his radiation oncologist regarding the possibility of infertility after treatment.

“People often will equate sexuality and fertility, but those are very different conversations,” Dizon said.

Lowy organizes his pills for the week.

“Their goal is to save a life.” the Chapel Hill resident said. “And they were very good at doing that. I willingly put my life in their hands, but sex was an afterthought.”

Once he got the courage to broach the subject, he was prescribed Viagra, which has been working well.

“I think the biggest advice I would give is, do not be afraid to ask questions,” he said. “If something isn’t right, talk to the doctors about it.”

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A silent crisis in men’s health gets worse

— Across the life span — from infancy to the teen years, midlife and old age — boys and men are more likely to die than girls and women

By and

A silent crisis in men’s health is shortening the life spans of fathers, husbands, brothers and sons.

For years, the conventional wisdom has been that a lack of sex-specific health research mainly hurts women and gender minorities. While those concerns are real, a closer look at longevity data tells a more complicated story.

Across the life span — from infancy to the teen years, midlife and old age — the risk of death at every age is higher for boys and men than for girls and women.

The result is a growing longevity gap between men and women. In the United States, life expectancy in 2021 was 79.1 years for women and 73.2 years for men. That 5.9-year difference is the largest gap in a quarter-century. (The data aren’t parsed to include differences among nonbinary and trans people.)

“Men are advantaged in every aspect of our society, yet we have worse health outcomes for most of the things that will kill you,” said Derek Griffith, director of Georgetown University’s Center for Men’s Health Equity in the Racial Justice Institute.“We tend not to prioritize men’s health, but it needs unique attention, and it has implications for the rest of the family. It means other members of the family, including women and children, also suffer.”

The longevity gap between men and women is a global phenomenon, although sex differences and data on the ages of greatest risk vary around the world and are influenced by cultural norms, record keeping and geopolitical factors such as war, climate change and poverty.

But data looking at health risks for boys and men in the United States paint a stark picture.

  • Men are at a greater risk of dying from covid-19 than women, a gap that cannot be explained by rates of infection or preexisting conditions. The age-adjusted death rate for covid was 140 deaths per 100,000 for males and 87.7 per 100,000 for females.
  • More men die of diabetes than women. The death rates for men are 31.2 per 100,000 people vs. 19.5 per 100,000 for women.
  • The cancer mortality rate is higher among men — 189.5 per 100,000 — compared with 135.7 per 100,000 for women. Black men have the highest cancer death rate at 227.3 per 100,000. Among Black women, the cancer mortality rate is 149 per 100,000.
  • Death rates for boys and teens ages 10 to 19 (44.5 per 100,000) far outpace that for girls (21.3 per 100,000). Even among infants, the mortality rate is higher for boys (5.87 per 1,000 live births) vs. girls (4.95 per 1,000).
  • Men die by suicide nearly four times more often than women, based on 2020 data from the Centers for Disease Control and Prevention. The rate of suicide is highest in middle-aged White men, but teen boys also face a high risk.
  • In 2020, 72 percent of all motor vehicle crash death victims were male. Men also accounted for 71 percent of pedestrian deaths, 87 percent of bicyclist deaths and 92 percent of motorcyclist deaths.

Advocates for more research into men’s health say the goal isn’t to steal resources from women, girls and gender minorities.

“Some people think health care is a zero sum gain and one dollar to men’s health is taking something away from women,” said Ronald Henry, president and co-founder of the Men’s Health Network, an advocacy group. “That’s wrong. We are fully supportive of women’s health efforts and improving quality of life for women.”

But by viewing men as the privileged default, health experts are ignoring important sex differences that could illuminate health issues across gender and minority groups.

For instance, for years the widely held belief in medical circles was that women used too many health-care resources compared to men. As a result, men were viewed as the standard for seeking health care, while women were often dismissed as hysterical or “anxious” when they sought care.

“We used to think women were overutilizing health care, and men were doing it correctly,” Griffith said. “What we realized was that women were doing it better, mostly for preventive care, and men were actually underutilizing health care.”

Explaining the longevity gap

The reasons behind the longevity gap aren’t fully understood, but the global nature of the disparity suggests that biology probably plays a strong role.

For instance, high levels of testosterone, which can weaken the immune response, may be a factor in why men, and male mammals in general, are more vulnerable to parasitic infections. Estrogen may explain why women have lower rates of heart disease throughout life — and why the gap narrows after women reach menopause. (Even though estrogen appears to be protective in women, studies in the 1970s showed that when estrogen was given to men, instead of being protective, it caused double the rate of heart attacks as those in a placebo group.)

Cultural biases around masculinity that teach boys and men to hide their feelings and not complain also can influence men’s health.

“Depression in men is quite deceptive,” said Marianne J. Legato, a physician and founder of the Foundation for Gender-Specific Medicine in New York. “Men are socially programmed to not complain. Suicide is often unexpected as an early end to a man’s life compared to that of a woman.”

Cultural expectations to remain stoic can also delay men’s care. For instance, although diseases such as diabetes, heart disease and hypertension are common in men and women, men often wait longer to seek care and the illnesses are diagnosed at later stages, leading to more damage and poorer outcomes.

“It’s an interesting conundrum and in many ways it’s not well understood,” said cardiologist Steven Nissen, chief academic officer for the Cleveland Clinic. “Men need to pay close attention to cardiovascular risk factors. Treating risk factors early can mitigate a lot of the risk.”

Men also are known to engage in more risky behaviors, such as drug and alcohol use, smoking and reckless driving. While the reasons behind these trends aren’t fully understood, behavioral risks are also a reason men’s health doesn’t get studied, Griffith said.

“It’s hard to convince people that men’s health is an issue if we think it’s just because men don’t do what they’re supposed to do,” he said.

Fewer doctor visits

An oft-cited concern is that men are also less likely to visit the doctor. Although boys and girls visit the pediatrician at the same rate, the trend changes in adulthood and medical visits by men decline. CDC data show that the physician visit rate in 2018 among females was almost 40 percent higher — 3.08 visits per woman vs. 2.24 per man.

One reason is that women regularly visit the gynecologist in their reproductive years. “There is no similar pathway for men,” Nissen said.

But even when visits for pregnancy are excluded, research suggests that women still are twice as likely as men to schedule regular annual exams and use preventive services.

Doctors say that men are most likely to visit the doctor because of a sports injury or for the “Viagra” visit — when they seek treatment for erectile dysfunction. As a result, sports medicine physicians and urologists are encouraged to use those visits to check blood pressure, cholesterol and other indicators of overall health.

“Stamina and sexual health are two of the top things that men think about,” said Howard LeWine, an internal medicine physician at Brigham and Women’s Hospital in Boston and chief medical editor at Harvard Health Publishing. “When you’re 20, 30 and a man, you really don’t think about health. The idea of going to a doctor to prevent cancer or heart disease — I don’t think it’s in the mind of many men until something has happened to them.”

The irony is that men for years have been overrepresented in medical research, often at the expense of women, according to a seminal 1985 report that prompted more government investment in women’s health research.

“Men who were overrepresented in medical studies before are still underrepresented in terms of clinical care,” said Harvey Simon, an internal medicine physician and founder of Harvard Men’s Health Watch, a newsletter devoted to men’s health.

Lack of support

Men’s health advocates say one of the biggest factors is a lack of infrastructure to support research specifically focused on men’s health.

For years, the Men’s Health Network has lobbied for the creation of an Office of Men’s Health, similar to the Office of Women’s Health in Health and Human Services Department. Proposed legislation, however, has consistently failed to win support.

While some health systems claim to have departments focused on men’s health, the care is often focused on urologic and prostate health rather than cardiac care, mental health or other issues that afflict men at high rates.

The topic of men’s health simply hasn’t caught on as something that advocates, corporate sponsors and politicians want to get behind. While the pink-ribbon has been elevated to iconic status to signal breast cancer awareness, nothing in men’s health has achieved the same level of attention.

“There is an empathy gap,” Henry said. “There are people who shrug and say, ‘Yes, men die younger. That’s the way the world is.’ It doesn’t need to be that way. If we devote attention and resources, we can change the outcomes for men.”

Complete Article ↪HERE↩!

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Sex after menopause doesn’t need to hurt

— Comprehensive review offers roadmap for doctors to evaluate, treat overlooked condition

  • Between 13% and 84% of postmenopausal women experience vaginal pain during sex
  • Causes of pain other than vaginal dryness are often undiagnosed and untreated
  • Pain during sex can harm relationships, self-esteem and contribute to depression, anxiety
  • Safe, effective therapies exist but condition is rarely evaluated or treated

Between 13% and 84% of postmenopausal women experience dyspareunia—vaginal pain during sex—but the condition is rarely evaluated or treated despite the availability of safe and effective therapies. With life expectancy increasing and the functional health of older adults improving, the identification and treatment of painful penetrative sex represents a great unmet need.

A new Northwestern University Feinberg School of Medicine comprehensive review of medical studies involving painful sex in post-menopausal women provides a roadmap for doctors to evaluate and treat the typically overlooked condition.

It is the only comprehensive review of its kind because it examines multiple reasons for the condition beyond just vaginal dryness due to lack of estrogen, such as post-hysterectomy problems, arthritis, cancer treatments and more.

“Post-menopausal women shouldn’t accept painful sex as their new norm,” said Dr. Lauren Streicher, clinical professor of obstetrics and gynecology at Feinberg. “Many women try over-the-counter lubricants but continue to have pain. They, and sometimes their health care professionals, are unaware that there are other, more effective treatments.

“In addition, women are increasingly treated by telemedicine and not examined. The cause of pain with penetration is assumed to be due to vaginal dryness when they may have another condition that has been undetected.”

The review was published last week in Menopause: The Journal of The North American Menopause Society.

Aside from the obvious negative aspects of enduring pain and the inability to have penetrative sex, the consequences of dyspareunia include negatively impacting relationships and self-esteem and can contribute to depression and anxiety. In addition, other sexual dysfunctions such as hypoactive desire disorder and orgasmic dysfunction are often consequences of pain with penetrative sex.

Causes of vaginal pain during sex

Post-menopausal vaginal pain is often specifically due to lack of estrogen, but there are other, usually undetected and untreated causes for inability to have penetrative sex, Streicher said. These include post-hysterectomy problems; cancer treatments (chemotherapy, radiation, surgery); lichen sclerosus (patchy, discolored, thin skin) and other vulvar conditions; pelvic-floor tension; arthritis and other musculoskeletal problems; pelvic organ prolapse; and sexually transmitted infections.

More than 30% of women over the age of 50 are single and potentially will have a new sexual partner, Streicher added.

“Sexuality in women after the age of 50 years is marginalized, and gynecologic care is not prioritized, valued or even recommended,” Streicher said.

Why aren’t women being evaluated, treated for the condition?

Despite available treatments, dyspareunia often goes undetected for a variety of reasons. First, most American women no longer see a gynecologist after going through menopause, Streicher said. Secondly, women often don’t discuss painful sex with their primary health care clinicians, and, when they do, most clinicians are not equipped to treat these problems because they haven’t been trained to properly evaluate or treat dyspareunia in this population. Third, sexual function is often a low priority in women with other serious medical problems.

In a 2004 survey of more than 1,000 midlife women, 98% had at least one sexual concern, but only 18% of physicians broached the topic. This is particularly true in postmenopausal women who are unaware that solutions are available and rarely seek care for this complaint.

It’s also difficult to pinpoint the exact prevalence of dyspareunia in post-menopausal women because studies on dyspareunia require women to have at least one sexual encounter the month before enrollment, and women with dyspareunia avoid sexual activity because of pain.

What can be done?

Doctors should broach the topic of dyspareunia with their patients using oral or written questionnaires, Streicher said. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening and vaginitis testing.

Some of the treatments discussed in the review include silicone lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol and fractional CO2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists.

Complete Article ↪HERE↩!

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Why Are STI Cases Soaring?

— We Asked the Experts

Newly-released data shows infections for certain sexually transmitted infections have jumped tremendously.

By Korin Miller

  • Several sexually transmitted infections have increased in the U.S., according to new data from the CDC.
  • The 7% increase continues an upward trajectory in certain STIs.
  • Doctors say there are a lot of reasons why this is happening in the U.S.

Sexually transmitted infections continue to climb in the U.S., with syphilis cases in particular skyrocketing in 2021—the most recent year data is available.

The data was shared as part of a report from the Centers for Disease Control and Prevention (CDC) released this week. The report breaks down cases of a range of STIs, including chlamydia, gonorrhea, and syphilis.

The data show that there were 1,644,416 new chlamydia cases diagnosed in 2021—a 4% increase over 2020. There were also 710,151 new cases of gonorrhea diagnosed, an illness that’s been steadily increasing 28% since at least 2017, when 555,608 cases were diagnosed.

But while syphilis cases made up a fraction of overall STI cases, they’re on a sharp upward trajectory: 176,713 new cases were diagnosed in 2021, a significant increase from the 133,954 cases diagnosed in 2020 and 129,818 cases diagnosed in 2019.

Cases of congenital syphilis (which is what happens when the disease is passed from a mom to her baby during pregnancy) also jumped up—from 2,157 in 2020 to 2,855 in 2021.

The CDC notes that case numbers were undercounted in 2020 due to the pandemic and “likely continued in 2021,” but that the impact was the most severe in 2020. “The annual report shows infections continued to forge ahead, compromising the nation’s health,” Leandro Mena, M.D., M.P.H., director of the CDC’s Division of STD Prevention, said in a statement.

Those are a lot of numbers to wade through, but the overall takeaway is this: STIs, which have already been recorded at high numbers across the country, continue to jump up. Here’s what’s going on.

Why are STIs increasing across the country?

The report didn’t specify why these STIs in particular are jumping up—it simply crunched the numbers. However, the CDC noted that certain racial, ethnic, and sexual minority groups are disproportionately impacted by STIs.

Black or African-American people made up a third of chlamydia, gonorrhea, and syphilis cases, but only make up 12% of the U.S. population, the report points out. Nearly 1/3 of all gonorrhea cases were in gay and bisexual men. Congenital syphilis rates increased for most racial and ethnic groups, but the highest rate was in babies born to American Indian and Alaska Native people, the report noted.

“While tried-and-true prevention strategies are key, social inequities often leads to health inequities and, ultimately, manifest as health disparities,” the report says. “We must work collaboratively to address social, cultural, and economic conditions to make it easier for people to stay healthy.”

But…what’s behind all this? “A lot,” says Thomas Russo, M.D., an infectious disease expert at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. “Here’s the thing: 2021 was our breakout year where the COVID-19 vaccine became available and people started playing a lot of social catch-up,” he says. “As a result, there was a whole bunch of interactions, some of which involved sexual activity.”

STI rates “reflect how well our public health infrastructure is,” Dr. Russo says, noting that there was a big shift in resources during the height of the pandemic. “It was all about COVID,” he says. “STI public health clinics and even interactions with physicians probably took a backseat.”

Infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security, agrees. “COVID disrupted STI work dramatically,” he says. “Health departments do the bulk of STI work and they were under-resourced to do STIs and COVID.”

The opioid crisis may also play a role, Dr. Russo says. “There’s a lot of activity that occurs to get drugs for sex,” he says. “That usually involves multiple partners and unprotected sexual activity.”

There was also a lack of widespread testing for STIs during the height of the pandemic in 2020, and that may have led to less people getting screened and diagnosed—increasing the odds they spread STIs to others, says women’s health expert Jennifer Wider, M.D. “A drop in screening and testing for all sorts of diseases and conditions [in 2020] has resulted in a jump in diagnoses for many people, particularly in groups with poor access to healthcare to begin with,” Dr. Wider says.

here is also inconsistent and “inadequate sex education” in the U.S., which lowers the odds that someone will know prevention strategies for STIs and recognize symptoms, if they happen to develop them, Dr. Wider says.

Why are syphilis cases jumping up so quickly?

Syphilis cases hit “historic lows” in the early 2000s, the report says, but they’ve since surged, increasing a jaw-dropping 781% since 2001. Some states—California, Texas, Arizona, Florida, and Louisiana—have been disproportionately impacted, making up 58% of reported cases of congenital syphilis. The larger syphilis epidemic was also mostly concentrated to within 100 counties—they made up 60% of all reported cases in 2021.

A lot of the reasons why chlamydia and gonorrhea are spreading in the U.S. applies to syphilis as well, Dr. Russo says. But he also points out that syphilis “spreads reasonably well” through oral sex. “People often think that oral sex is relatively safe when it comes to STIs but, with syphilis, that’s not the case,” he says. “That’s one of the factors that can drive it.”

The CDC stressed in the report that syphilis is “completely preventable and treatable,” adding that “timely screening, diagnosis, and treatment can save lives, but if left untreated, the infection can cause serious health problems and increase the risk of getting an HIV infection.”

How to lower your risk of getting an STI

You’ve likely heard all of this before, but it never hurts to do a refresher. The CDC offers the following advice to lower your risk of getting an STI:

  • Practice abstinence. The CDC points out that the most reliable way to avoid STIs is to avoid having anal, vaginal, or oral sex.
  • Get vaccinated against HPV and hepatitis B. The vaccines won’t protect against everything, but the HPV vaccine in particular can help lower the risk of contracting certain strains of HPV that are linked to the development of cancer.
  • Reduce your number of sex partners. Less sex partners means a lowered risk, the CDC says. However, the agency still recommends that both you and your partner get tested and share your results with each other.
  • Be mutually monogamous. That means both you and your partner only have sex with each other.
  • Use condoms. The CDC recommends that you use a male latex condom every time you have anal, vaginal, or oral sex. Non-latex condoms can be use, the agency says, but they have higher breakage rates than latex condoms.

The CDC also stresses the importance of using STI testing and treatment, noting that there some pharmacy and retail health clinics allow people to get tested on-site.

Unfortunately, Dr. Russo expects things to get worse before they get better, given the state of reproductive care in the U.S. and lack of access to sexual health clinics for people in some states. “We need to do better and make a commitment to this important area,” he says.

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The Life-Changing Magic of a Urologist

— Here are three issues you may want to address with a professional.

By Jancee Dunn< Urologists often deal with health problems that arise from two very intimate functions: peeing and sex. Because of this, “most urologists tend to have a lot of brevity and a bit of humor, because we know these are hard topics for our patients,” said Maria Uloko, a urologist at UC San Diego Health and assistant professor of urology at the University of California, San Diego School of Medicine.

In my experience (as both a patient and a health journalist), urologists will happily discuss the subjects that some of us laypeople tend to avoid: erectile problems, peeing too much, peeing too little, painful sex, dwindling or nonexistent orgasms, urinary tract infections and the list goes on.

Rachel Rubin, a urologist and sexual health specialist based outside Washington, D.C., said many people don’t share these issues with their doctor even if they are ongoing; they simply learn to live with discomfort. “They’ll tell themselves, ‘Well, that’s just aging. Suck it up,’” Dr. Rubin said. But, “if it bothers you and it matters to you, then it’s a medical problem with medical solutions.”

There are two parts of a urologist’s job. “There’s the serious illness stuff, like cancers,” said Nelson Bennett, a professor of urology at Northwestern University Feinberg School of Medicine, who specializes in male sexual function. “But there’s a big chunk of our practice that is basically quality of life. I tell my patients that no one dies of not having an erection, but they’re still suffering.” All of this may be why people who have seen a urologist (present company included) sometimes say the results are life altering.

Here are three issues you may want to address with a professional.

Erection problems

If you have erectile dysfunction, Dr. Rubin said: “Don’t be embarrassed. So do your friends.” Erectile dysfunction affects as many as 30 million men in the United States, according to the American Urological Association.

There are treatment options for almost every erectile problem, including oral medications, injectable medications, surgery and cognitive behavioral therapy, Dr. Bennett said.

Although it can be tempting to furtively order medications such as Viagra on direct-to-consumer websites, a practice that Dr. Bennett found, in a 2021 study, is dramatically increasing, he said there are several reasons to see a specialist instead. “We can actually begin to figure out why you’re having the problem, as opposed to just taking medication to cover it up,” he said. Some medications can also affect erections, such as antidepressants, which can cause orgasms to be delayed, or vanish altogether. And a urologist can screen for those, he said.

What’s more, erection problems can be a sign of heart problems down the road. Penis arteries, which are one millimeter in diameter, are very small, compared with heart arteries, which are 3 millimeters. “So if you’re clogging your small pipes first, you may have erectile dysfunction before you have your first heart attack,” Dr. Rubin said.

“Those are the guys you need to start looking at,” said Dr. Bennett, “because we know that erectile issues will predate cardiovascular issues by about 10 years.”

Painful sex

For older women, painful sex is a leading sign of genitourinary syndrome of menopause, or G.S.M., a term that in 2014 replaced the dispiriting phrase “vulvovaginal atrophy.” During perimenopause and beyond, as estrogen leaves a woman’s body, the tissues in the vulva, vagina and urinary tract become dryer, less supple and more sensitive. This process can cause recurrent urinary tract infections and incontinence, and sex can become excruciating, which takes many women by surprise, Dr. Rubin said. G.S.M. may affect up to half of postmenopausal women, according to a 2019 review, and is “unlikely to improve without treatment.”

What has been shown to work for conditions like G.S.M., Dr. Rubin said, are treatments like inserts with DHEA, a steroid that mimics hormones, lubricants and moisturizers; ospemifene, an oral medication that is approved by the Federal Drug Administration to treat G.S.M.; vaginal dilators; and low-dose topical vaginal estrogen.

“There’s not a cocktail party or children’s birthday party where I don’t recommend vaginal hormones,” Dr. Rubin said. (It is important, however, that you discuss any of these treatments with your own doctor first.)

Pelvic floor therapy is another option, Dr. Rubin added. “Pelvic floor therapists rehab your muscles, just like you would do rehab after a knee replacement.” And you don’t have to do it forever, she added. “Physical therapists are there to optimize your pelvis and send you out the door.”

Then there’s the D.I.Y. approach: a 2023 review found that vibrators were considered “an accepted modality” to treat vulvar pain. “I think doctors should be prescribing vibrators, which are health aids, just like eyeglasses or hearing aids,” Dr. Rubin added. “The more we normalize them and educate patients in exam rooms about them, the better.”

Bladder issues

You may know that bladder control loss afflicts women at various hormonal stages in their lives — pregnancy, after giving birth and during menopause — but “men are plagued by urinary incontinence, too,” Dr. Bennett said. A quarter to a third of Americans have incontinence, according to the American Urological Association.

There are two main types: “stress incontinence,” which means sudden leaking brought on by activities like coughing, sneezing or exercise, and “urgency incontinence,” a strong and immediate urge to pee, which sends you on a mad dash to the bathroom.

Some male patients will visit the bathroom 10 times a night because of a prostate issue, which leads to sleep deprivation, Dr. Bennett said.

Some treatments for urinary incontinence include medication, and for women, vaginal estrogen, but urologists also teach patients Kegel exercises, use electrical stimulation and employ pelvic floor physical therapy. (Men have a pelvic floor, too.)

Urologists, Dr. Uloko said, “are really glorified plumbers. We know how to fix the leaks.”

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Walk Your Way to Better Erections

— Taking a stroll for as little as 30 minutes a day can improve sexual health.

By Lauren Dodd

Seeking to improve your sex life as the new year kicks into gear? This one isn’t all that difficult. Resolve to walk your way to better erections.

Men who experience erectile dysfunction (ED), the consistent inability to get or maintain an erection satisfactory for sexual intercourse, may benefit from incorporating more heart-pumping physical activity—as little as a 30-minute walk—into their 2023 routine.

More than 30 million men in the United States experience ED, which can lead to higher rates of depression and anxiety. ED is generally seen as a growing public health concern. But a portion of ED sufferers may be able to improve their condition by simply adding extra steps to their daily life.

Medical conditions such as cardiovascular disease, the leading cause of death in men, produce changes to the penis’s blood flow and are common causes of ED, as blood flow is necessary to achieve and sustain an erection. Without the need of a doctor or a prescription, better sexual health may literally be around the corner for men who resolve to lace up their sneakers and head outdoors.

Better erections could be just a few steps away

Walking, one of the most popular forms of exercise in the world, is also one of the cheapest. No gym membership required.

Increasing your daily steps can be as easy as parking farther away from entrances or opting to take the stairs rather than the elevator. As little as 40 minutes of moderate to vigorous exercise four days a week—a grand total of 160 minutes—sustained over the course of six months can improve ED caused by physical inactivity, obesity, hypertension, metabolic syndrome and/or cardiovascular disease, according to a 2018 systematic review that looked at a decade of erectile dysfunction research.

Moderate exercise can be achieved by walking briskly at a pace of 4 mph or bicycling at a pace of 10 to 12 mph, according to Harvard research. Another Harvard study found walking 30 minutes a day was linked with a 41 percent decline in risk for ED.

Considering the leading causes of ED are atherosclerosis (hardening of the arteries) and diabetes, additional physical activity may improve more than just erectile function.

People who took 12,000 steps a day had a 65 percent lower risk of dying over the course of 10 years compared with those who took 4,000 steps a day, one 2020 study found.

“Higher step counts were also associated with lower rates of death from heart disease and cancer,” the study stated.

Quitting smoking or vaping and reducing alcohol consumption in the new year may also lead to better performance in the bedroom. Heavy smokers, even younger ones, are twice as likely to develop ED than their nonsmoking peers.

Heavy drinking doesn’t help, either. One study found men’s “episodic erectile failure” occurred at “significantly higher” rates in those consuming more than three standard units of alcohol a day. (One standard unit is any drink that contains 14 grams of alcohol, according to the National Institute on Alcohol Abuse and Alcoholism.)

Maintaining a healthy weight is essential

The risk of developing ED and losing sexual function increases along with a man’s waistline, according to Harvard research. A man with a 42-inch waist is 50 percent more likely to have ED than one with a 32-inch waist.

Regular physical activity such as walking can aid vascular health. It helps arteries by boosting nitric oxide production, thereby increasing blood flow to the penis and making it easier to get an erection.

One of the first suggestions Susan MacDonald M.D., a urology specialist at Penn State Health in Hershey, Pennsylvania, offers her male patients is to lose a little weight.

“There is an obesity epidemic in America, so odds are most of your readers have five to 10 pounds to lose,” MacDonald said. “If they were to start walking, that would help.”

Quitting smoking is another one of her top recommendations for men experiencing ED.

“If we’re making New Year’s resolutions here, stopping smoking is a huge one,” MacDonald explained. “I think if you’re smoking, you’re paying double, because you’re paying for the cigarettes and you’re paying for [medication] to fix the erectile dysfunction it’s causing.”

Symptoms of erectile dysfunction should be taken seriously because a man’s penile dysfunction may be the first red flag of other illnesses and disorders, she said.

“In most cases, it’s the disease process leading to the ED,” MacDonald said. “In cardiovascular disease, we see the ED before we see the heart attack.”

Walking can curb more than erectile dysfunction

Walking has been proved to lower blood pressure, ease joint pain, curb sweet-tooth cravings and improve sleep. It can also help ward off breast cancer, heart disease, stroke, and early onset Alzheimer’s disease and dementia.

During peak flu and cold seasons, walking is another way to boost your immune system to fend off germs. It can increase bone health and bone density in osteoporosis patients and improve a person’s balance.

In addition to physical benefits, walking can offer mental health perks, such as improving feelings of sadness, anxiety, anger and depression.

But as with anything, the trick to picking up a new exercise habit is to do so safely.

Anyone taking to the streets should map out a path in advance, use sidewalks when possible, choose a well-lit area, be aware of major changes in the weather, stay hydrated and wear bright, reflective clothing. If sidewalks are unavailable, public school tracks and indoor shopping malls can be additional areas to squeeze in a little extra physical activity.

Be sure to consult a primary doctor before making changes to your diet and exercise routine.

If lifestyle and diet changes improve your overall health but erectile dysfunction persists, even intermittently, a wearable device free of the negative side effects of medication may help restore sexual function. Eddie® is an FDA-registered Class II medical device designed to treat erectile dysfunction and improve male sexual performance. Its specific shape optimizes blood flow as it puts pressure on the veins of the penis but not the arteries.

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Blue Balls

— A Cause of Testicular Pain

Anyone who has ever experienced “blue balls” can tell you that it is a painful and frustrating consequence of sexual arousal. Of the many causes of pain in the testicles and scrotum, blue balls are the most benign. It is not a serious medical condition, but that does not make it any less tolerable. Here is what you need to know about blue balls and what you can do to relieve the pain.

By Kristopher Bunting, MD

  • Blue balls (epididymal hypertension) is a real condition that causes pain and tenderness in the testicles and scrotum after prolonged sexual arousal without ejaculation or orgasm.
  • Blue balls is temporary, usually lasting no more than a few hours, but can be relieved through sexual release, a cold shower or cold compress, or the Valsalva maneuver.
  • Severe, persistent, or worsening scrotal or testicular pain may indicate a medical emergency, not blue balls.

What are blue balls?

Blue balls also called “lover’s nuts” or epididymal hypertension is a condition that causes scrotal and testicular pain. Epididymal hypertension can occur after prolonged sexual stimulation without sexual release. In other words, being sexually excited by foreplay or other sexually arousing activities that do not end in ejaculation or orgasm can lead to tender and painful testicles.

Medically speaking, the condition known as blue balls is poorly understood. There is little to no research into the causes and treatments of epididymal hypertension and there is only one known case report present in the current medical literature. This lack of published research is because epididymal hypertension is not a medical emergency and has no long-term negative effects on health. It is a real condition, but it is nothing to be alarmed about.

What are the symptoms of blue balls?

The primary symptoms of blue balls are pain and tenderness in the scrotum and testicles. The skin of the scrotum can also develop a slightly bluish tint. The experience varies between individuals but can be described as aching, heaviness, or fullness of the testicles. The discomfort may also be felt in the groin and lower abdomen. Blue balls do not cause swelling, bleeding, discharge, or fever. The pain subsides within a few hours (or less) without requiring treatment.

What causes blue balls?

While epididymal hypertension is not well understood, it is believed that a buildup of excess blood in the testicles after sexual arousal causes blue balls. Blood flows into the penis and testicles during sexual arousal and normally leaves the genitals after achieving orgasm. However, when the blood does not leave the testicles it can lead to pain.

Treating blue balls

There are several ways to relieve the pain of blue balls:

Give it time: blue balls typically only lasts for a few hours at most before resolving on its own.

Sexual release: ejaculating or having an orgasm through intercourse or masturbation can relieve blue balls quickly.

Cool it down: taking a cold shower or applying a cool compress (such as a towel soaked in cold water) may help relieve the pain of blue balls.

Try the Valsalva maneuver: the Valsalva maneuver can help relax blood vessels, allowing blood to leave the testicles.

Other recommendations for relieving the pain include distracting yourself to take your mind off of sexual arousal or exercising to increase blood flow out of the groin.

Other causes of testicular pain

Having blue balls can be a very unpleasant experience, but it is not a serious medical issue. However, many other conditions can cause pain in the testicles and scrotum, including some serious medical emergencies. Pain in the testicles and/or scrotum that is severe or is associated with bleeding, discharge, nausea, vomiting, fever, or swelling can indicate a serious medical condition. If you have symptoms other than mild to moderate pain or discomfort that lasts for up to a few hours, you should seek medical help immediately.

Testicular torsion is a medical emergency that can cause intense scrotal and testicular pain that usually comes on suddenly. Epididymitis or orchitis causes painful inflammation of the testes due to an infection that requires medical treatment. Testicular varicoceles can also cause testicular or scrotal pain. Varicoceles are caused by enlarged veins in the scrotum, similar to varicose veins, that can feel like a ”bag of worms”. While this is not an emergency, it may affect fertility.

Sexual arousal without sexual release can lead to blue balls, a real medical condition that causes pain in the scrotum and testicles. It is a temporary condition that resolves on its own and does not require treatment, but there are steps you can take to relieve the pain. Sexual release is the fastest way to relieve pain from blue balls, but this should never be used as an excuse to pressure anyone into sex.

While blue balls are not a serious condition, pain in the scrotum or testicles should always be a cause for concern. Seek immediate medical attention for severe or persistent pain in the testicles lasting more than a few hours.

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Staying Healthy While Staying Open

— The Polyamory Dilemma

By Jenna Fletcher

Angie Ebba, 42, of Portland, OR, has two local girlfriends, one long-distance partner, and a platonic life partner.

Ebba is polyamorous, having multiple intimate romantic relationships at the same time. Her partners know about each other and have consented to the arrangement, she says.

Polyamory is becoming more common in the United States. In 2021, one in nine Americans said they’d been in polyamorous relationships, and one in six said they wanted to try it, according to a study by researchers at the Kinsey Institute.

While a high level of transparency is required to make polyamory work, those who practice it don’t always feel comfortable sharing their relationship status with health care professionals. The fear of disclosure is not unfounded. Of the those in the Kinsey study who said they weren’t and had never been interested in polyamory, fewer than 15% said they respect people who engage in the practice.

“I hear all the time from patients who have sexual questions and issues but are uncomfortable talking to their doctors or even other therapists,” says Ian Kerner, PhD, a psychotherapist and sex therapist in New York City. “As polyamorous systems are still on the outskirts of the mainstream, some doctors may have implicit biases or explicit judgments, especially if they are lacking in experience.”

Roadblocks to Care

People who practice polyamory face unique health issues. These include a potentially higher risk of sexually transmitted infections (STIs) from having multiple sexual partners, and anxiety or depression stemming from managing multiple relationships.

“It is of particular importance in OB/GYN given the risk of STI transmission, and its consequences such as infertility, vaginal discharge, and systemic illness,” says Cheruba Prabakar, MD, the CEO of Lamorinda Gynecology and Surgery in Lafayette, CA. “Disclosing information will allow the provider to think about the patient more holistically.”

Ebba does not tell her doctors about her personal life. She knows other people in these relationships who have felt judged in clinical encounters, and she avoids disclosure unless absolutely necessary.

“Primarily, I don’t let my providers know because I’ve already in the past faced discrimination and awkwardness for being queer; I don’t want that for being poly as well,” she says. “If I can avoid it, I will.

A study from 2019 of 20 people in consensual non-monogamous relationships – which can include polyamory – found most of them reported challenges in addressing their health care needs related to lack of provider knowledge, not enough preventive screenings, and stigmas that impacted their health and trust in the medical system.

“Polyamorous people often have trouble seeking out health care because they fear being judged by their doctor or other clinicians who don’t understand or respect their lifestyle choices,” says Akos Antwi, a psychiatric mental health nurse practitioner and co-owner of Revive Therapeutic Services in Rhode Island and Massachusetts. “They may also be reluctant to share information about their relationships with providers who aren’t familiar with the complexities of polyamory.” Sharon Flicker, PhD, a clinical psychologist and assistant professor of psychology at California State University-Sacramento, says she understands why people are worried about discussing the topic of multiple relationships with their health provider.

“Health care providers’ interactions with patients are often shaped by their mono-normative assumptions, that monogamy is ideal and deviations from that ideal is pathological,” she says. “Non-disclosure presents a barrier to sensitive care that meets the individualized needs of the patient.”

Flicker says health care professionals can seek training to reduce their biases, and to better understand and address the unique needs of people involved in consensually non-monogamous relationships. In addition, offering to answer any questions that a doctor might have after disclosure can open the door to dialogue, according to Prabakar.

“They may be simply embarrassed to ask, as many may not be familiar with” polyamory, Prabakar says.People in polyamorous relationships also can look for affirming language on the websites of health providers, which may mention welcoming patients of all sexual orientations or gender identities. A first appointment can serve as an interview to find out what kind of terms a provider uses when referring to non-monogamy.

Safely Navigating Sexy Time With Multiple Partners

Prabakar says sexual health and safety is at the forefront for her patients in polyamorous relationships because they are engaging with multiple partners.

She recommends anyone who has multiple partners use condoms and dental dams for the prevention of STIs, like herpes and gonorrhea, in addition to receiving regular screening tests for the diseases.

Tikva Wolf, from Asheville, NC, says she’s been in polyamorous relationships for 20 years. She says she has strict boundaries for engaging in new romantic relationships to protect her sexual health: She has sex only with people who know their current STI status, are clear communicators, and use protection.

“If the conversation feels awkward, or they don’t seem to know what they’ve been tested for, I don’t engage in sex with them,” she says. “I don’t start romantic partnerships with people unless they’re on the same page about relationships, and I don’t have casual sex.” Wolf says her actions toward transparency mirror the greater community of people who engage in polyamorous relationships.

Monogamy is the default setting, so there’s a tendency to be more transparent about specific preferences upfront in any relationship that doesn’t quite fit into that standard box,” she says.

Some research backs up Wolf’s hypothesis. A 2015 study in The Journal of Sexual Medicine found that polyamorous people reported more lifetime sexual partners than people in monogamous relationships, but were more likely to report using condoms and be tested for STIs. About one-quarter of monogamous partners reported having sex outside of their primary relationship but not informing their primary partner.

Kerner explains that each partner in a polyamorous relationship may have different ideas about sexual activity; some partners may be interested in casual sex, while others are interested in maintaining steady primary and secondary relationships.

“These systems are always different, and without clear boundaries, honesty, and communication – for example around the use of protection – the potential to contract an STI within the system increases,” and the potential for the polyamorous relationship to not work increases, he says.

Taking Care of Mental Health

Not only does a polyamorous lifestyle require talking about sexual health and romantic boundaries, it demands an openness with feelings as they come up.

“Couples in a polyamorous relationship don’t fully anticipate the emotional response they might have to their partner being with another person,” says David Helfand, PsyD, a therapist in St. Johnsbury, VT, who has worked with many polyamorous couples.

People may have feelings of insecurity or jealousy, which can lead to anxiety in navigating the complexity of multiple relationships.

“The first time your spouse goes on a date with another person, or you hear them in the bedroom with someone else, it can create an intense emotion that you might not know how to process or have been prepared for,” Helfand says.

Seeing a therapist can help with processing emotions raised by dating multiple people. Ebba says she sees a therapist regularly, in part for help setting boundaries on how much time to spend with different partners. “Poly relationships can be great because you have more support people in your life,” she says. “But you’re also giving more of your time and energy away too.”

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Maintaining Your Sex Life After Prostate Cancer

Sex may be different after prostate cancer treatment, but it can still be enjoyable

If you have prostate cancer and your healthcare provider recommends treatment, you might be wondering how your sex life may or may not be affected. You’re not alone if you have questions about this, as this is a common concern.

“Treating prostate cancer is about treating the whole person,” says urologist Raevti Bole, MD. “We have many effective therapies to help you resume intercourse if that’s your goal. But we want you to feel like you can talk to your provider and partner about your issues or concerns.”

Dr. Bole explains how your sex life may evolve after treatment and answers some commonly asked questions.

Can you have sex after prostate cancer?

Sexual and urinary side effects are common after prostate cancer treatment. “But yes, we can help most people get back to a satisfying sexual experience, though this may look different after treatment,” says Dr. Bole.

There are two gold-standard treatments for prostate cancer:

  • Radical prostatectomy removes your prostate gland and the two small glands at the base of your prostate called seminal vesicles. Pelvic lymph nodes may also be removed as part of this operation.
  • Radiation therapy delivers radiation to your entire prostate to destroy cancer-specific cells, and often the pelvic lymph nodes as well. If you opt for radiation therapy, you may receive androgen deprivation therapy to reduce testosterone in your body. This combined approach provides improved overall treatment.

New treatment options, such as high-intensity focused ultrasound therapy and cryotherapy, are being investigated for the potential to treat focused areas of the prostate gland and potentially lessen sexual side effects. But these treatments are typically only an option for certain types of prostate cancer, and you may eventually need a prostatectomy or radiation therapy down the line. Consultation with a urologist who specializes in prostate cancer is the best way to determine if you’re a candidate for any type of focal therapy.

Sex after prostate biopsy

To confirm a diagnosis of prostate cancer, you need to have a biopsy. During this test, your healthcare provider collects a sample of prostate tissue to look for cancer. They can do this in one of two ways:

  • Transrectal biopsy: This biopsy occurs by inserting an ultrasound probe into your rectum and then using a needle to pass through that probe to get the sample cells from your prostate.
  • Transperineal biopsy: This biopsy is taken by inserting a needle into the skin of your perineum (the area of skin between your genitals and your anus) to remove sample tissue cells from your prostate.

Though you may be sore for a couple of days, there aren’t any restrictions on sexual activity after having a biopsy. It’s common to notice old blood in your ejaculate for up to a month or two. This typically goes away on its own as you heal and isn’t associated with pain. Infection is a risk after a biopsy, though the risk is much lower when it’s taken through your perineum.

“For the vast majority of men undergoing an uncomplicated biopsy (either transrectal or transperineal), long-term sexual function should not be affected,” reassures Dr. Bole.

In most cases, if you’re feeling well, you should be able to ejaculate or have sex again when you feel ready. If you participate in receptive anal sex, you should wait for two weeks or until you’re fully healed, especially if you had a transrectal biopsy. But if you experience any blood, pain or swelling, you should refrain from sexual activity until you meet with your healthcare provider.

Sex after prostatectomy and radiation therapy

Once your provider confirms a diagnosis, they’ll discuss your treatment plan with you. Both prostatectomy and radiation therapy can affect your sexual performance in the following ways:

Anal sex safety

Your anus doesn’t create its own lubricant, so the tissue inside of your anus is delicate and susceptible to tearing. Luckily, that tissue heals relatively quickly. If you have anal sex, it’s important to let your surgeon know before you have your prostate removed. Your surgeon will help you determine when it’s safe to insert anything anally. In most cases, it’s OK to participate in anal sex after six weeks.

“Know your body and take your time,” advises Dr. Bole. “If you’ve waited to heal after prostate removal, but you have anal intercourse and notice pain or blood, talk to your surgeon who may advise you to wait longer.”

In some cases, having your prostate removed may affect your ability to enjoy receptive anal sex.

Erectile dysfunction after prostate cancer treatment

For some people, undergoing prostate cancer treatment can result in some difficulty getting or maintaining an erection. This erectile dysfunction (ED) occurs because the nerve bundles that help control erections sit behind your prostate.

Surgeons make every effort to leave these nerve bundles intact, but the nerves may become damaged. If the tumor has grown into your nerve bundles, your surgeon may remove the nerves entirely.

“Erectile dysfunction is not uncommon after prostate cancer surgery, but the level of effect is variable in the short and long term,” explains Dr. Bole. “Your prognosis depends on your erectile function before treatment, your age and whether your nerves were spared. Erectile function can improve for up to two years after surgery, but it’s possible that it does not return to normal. This is also affected by natural aging and any other health conditions you have.”

Radiation therapy can also affect the nerves around your prostate depending on the type of radiation, your age and health conditions. According to Dr. Bole, in general, five years after radiation therapy, about half of people have some level of erectile dysfunction.

Orgasm after prostate cancer treatment

You can orgasm after prostate cancer treatment, but it usually results in a dry orgasm. With a dry orgasm, no fluid comes out of your urethra when you climax. But you can still feel the pleasurable sensation of climax.

Why do you have a dry orgasm? If you had a prostatectomy, the procedure removes the seminal vesicles (which produce and hold your semen) and cuts the vas deferens, so there isn’t any semen to come out. And radiation therapy causes the tissues in and around your prostate, including your ejaculatory ducts, to become fibrous, or stiff and dense. Although there isn’t a reliable treatment to improve a dry orgasm, it’s a common condition where up to 90% of people who receive radiation therapy can develop dry orgasms over time.

Climacturia after prostatectomy

Climacturia is when you leak any drops of urine during an orgasm. Though this number can vary, on average, climacturia can occur in about 25% of people after prostate removal. Studies have found that of these people, only half of them have enough climacturia to be bothersome.

Lack of interest in sex after prostate cancer treatment

Androgen deprivation therapy often accompanies radiation therapy and reduces testosterone production in your body. When you have low testosterone, you could experience a decrease in your sex drive (libido). “The general stress and anxiety of treatment may also affect your desire to have intercourse,” notes Dr. Bole.

Infertility after prostate cancer treatment

If you’ve had your prostate removed, you can’t get someone pregnant through intercourse. After surgery, you no longer produce semen, which carries sperm when you ejaculate. Radiation therapy also reduces semen production and affects your ability to make sperm.

If you’re considering having children, talk to your healthcare provider before prostate cancer treatment. There are several options for preserving fertility before cancer treatment or retrieving sperm (if you have them) after treatment.

Treatment options for ED after prostate cancer treatment

Sex is often different after prostate cancer treatment, but it can still be enjoyable. “Treatments for ED are often focused on penetrative intercourse,” says Dr. Bole. “But the sexual experience is often not just about penetration. We work with you to discuss your goals for sexual health or intimacy with a partner.”

Treatments for ED include:

Erectile dysfunction medications

There are many medications to treat ED, including Viagra® and Cialis®. “These medications are often the first treatment we recommend,” says Dr. Bole. “They are inexpensive, and if you don’t like them, or they don’t work well for you, you can stop taking them at any point.”

Penile rehabilitation

The goal of penile rehabilitation is to reduce the risk of permanent ED before you have treatment. It focuses on increasing oxygenation and preserving the structures of the erectile tissues to prevent long-term damage. The theory is that helping people regain erections earlier than later after treatment could prevent long-term damage. Think of it as a “use it or lose it” approach.

This is an active area of research and there’s no standard protocol that’s been proven best for every person, says Dr. Bole. Your oncology team may recommend their preferred protocol, such as oral medication, to promote the early return of erectile function and, hopefully, longer-term recovery.

Penile injections

Medication you inject into the base of your penis, called intracavernous injections, can improve your ability to stay erect. Your healthcare provider can teach you how to inject the medication for times when you want an erection.

“The medication takes about 10 or 15 minutes to take effect and may not be the best option if you have a fear of needles,” notes Dr. Bole. “But if you’re looking for a better erection after prostate treatment, and the oral medications are not working, injections can be very effective.”  

Vacuum constriction device

A vacuum erectile device (also known as a penis pump) draws blood into your penis to help you get an erection. Usually, it comes with a rubber ring you slip down over the base of your penis to hold the blood in. It can be a good option if medications aren’t working well or you don’t want surgery.

Surgery

There are several types of penile implants to improve erections, including:

  • Malleable prosthesis, a noninflatable implant that’s always semirigid and you bend it up or down.
  • Inflatable implant, a device placed in your penis that inflates using a pump in your scrotum.

Climacturia treatment

If you have climacturia, pelvic floor muscle therapy can help you improve urinary control. This noninvasive treatment involves simple exercises to strengthen the muscles that help regulate urination.

Surgery is another option. Your healthcare provider can insert a sling made from synthetic mesh-like surgical tape around the area of your urethra to reposition it. The pressure caused by the sling often helps prevent leakage.

People with climacturia may also experience erectile dysfunction. “In the instance you experience both, we can do a combined surgery to put in a penile prosthesis and a sling to address both problems,” says Dr. Bole.

Therapy for you and your partner

Sex therapy, couples therapy and support groups are important resources for people who’ve undergone prostate cancer treatment and their partners. Sex can often be an uncomfortable topic, especially if you or your partner are experiencing changes in sexual behavior and are unsure of how to communicate your feelings. If you’re experiencing shame or embarrassment, or feel like you’re inadequate, please know that these side effects of prostate cancer treatment are common and (in most cases) treatable with the right tools and therapies.

Some therapeutic options that can be beneficial after your treatment include:

  • Couples therapy centers around your relationship with your partner. It can help resolve conflicts and find ways to communicate better about things that are upsetting to you and your partner. A couples therapist can help you discuss these issues, so they don’t interfere with your relationship.
  • Sex therapy focuses on sexual intimacy and helping couples show affection with and without penetration. That may include the use of sex toys or other activities you may not have considered before. Some sex therapists even specialize in working with people who have or who’ve had cancer.
  • Support groups connect you with others going through the same experience as you. They can help you understand what to expect and how others have handled specific challenges. Many people find support groups as a source of hope and comfort, and your healthcare provider can help connect you to these resources should you need them.

“Our goal is to make sure you live the longest, healthiest and most fulfilling life possible,” says Dr. Bole. “We treat cancer to protect your life, then we help get back your quality of life. If intimacy and intercourse are important to you, we can help you get back to experiencing those again safely.”

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The Most Effective Erectile Dysfunction Treatments for Older Adults

By James Roland

Erectile dysfunction (ED) is very common. Although it can affect men of all ages, it occurs more often in older adults and those with certain medical conditions, like diabetes.

Older research estimates that about 70 percent of men ages 70 and older report being “sometimes able” or “never able” to achieve an erection adequate for satisfactory intercourse, compared with just 30 percent of older men who report being “usually able” or “always or almost always able.”

Though it isn’t inevitable for everyone, ED is considered a normal part of aging as its risk factors include conditions common among older adults, such as:

  • cardiovascular disease
  • diabetes
  • reduced levels of testosterone
  • use of medications that treat conditions including:
    • high blood pressure
    • chronic pain
    • prostate disorders
    • depression
  • long-term, heavy substance use, including alcohol and tobacco
  • psychological conditions, including stress, anxiety, and depression
  • overweight or obesity

Sometimes treating an underlying condition can cure or reverse ED. However, most ED treatments are designed for temporary symptom relief, so an erection can be achieved that’s satisfactory for both the person with ED and their partner.

Best ED treatment for 70s and over

A variety of ED treatments are currently available. Researchers continue to develop new medications and other therapies.
For older adults, treating ED may require a two-prong approach:

  1. treat underlying conditions that contribute to ED, such as cardiovascular disease and diabetes
  2. address ED symptoms with oral medications or other alternatives

Medications

The most commonly used ED medications among older adults are from a class of drugs called phosphodiesterase-5 (PDE5) inhibitors.

PDE5 inhibitors block the activity of an enzyme in the walls of blood vessels. As a result, blood vessels are able to relax. In the penis this means more blood can fill the blood vessels, producing an erection.

The main PDE5 inhibitors available with a prescription are:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)

Except for avanafil, all of those medications are available in both brand-name and generic versions. (As of 2020, avanafil is still only sold as the brand-name drug Stendra.)

More ED medications are in the testing and approval process. In the United States, PDE5 inhibitors require a prescription. None are available over the counter.

Side effects from these medications are usually temporary and minor. More serious reactions such as priapism (a painful, prolonged erection) may occur in some cases.

Typical side effects include:

  • headache
  • flushing
  • congestion
  • stomach and back pain

ResearchTrusted Source indicates that PDE5 inhibitors are appropriate for most older adults.

Each medication works a little differently. For example, vardenafil usually works faster than the other medications, while tadalafil’s effects last longer.

Tadalafil is often a good choice for older adults who also have an enlarged prostate because it can be prescribed for daily dosing.

Sildenafil should be taken on an empty stomach and may require dose adjustments to get it right.

Talk with your doctor to find the right ED medication for you and your lifestyle.

Who shouldn’t take these meds

People who have certain health conditions, including heart disease, shouldn’t take these medications.

People who take certain medications to manage another health condition shouldn’t take PDE5 inhibitors either. This includes nitrates and alpha-blockers.

Older men are more likely to have heart disease or take nitrates for blood pressure.

Your doctor will take into consideration your overall health and lifestyle when prescribing an ED medication.

Injections

For older adults who find that PDE5 inhibitors don’t produce the results they want or who don’t like their side effects, self-administered penile injections may be a preferred option.

The three most widely used medications for penile injection therapy include:

  • papaverine
  • phentolamine
  • prostaglandin E1 (PGE1) or alprostadil (Caverject, Edex, MUSE)

To use these, you inject the medication into the penis with a syringe before intercourse. While this approach often results in some minor, temporary pain, research shows that about 90 percentTrusted Source of men who used alprostadil were satisfied with the results.

These medications are often used in combination with other treatments and require dosing adjustments. Your first injection should be done in your doctor’s office so they can make sure you do it correctly and safely.

Who shouldn’t use these

Older adults who feel they or their partner can’t carefully administer an injection should consider other options, whether due to lack of dexterity or other reasons.

Taking blood thinner medications is another reason to avoid injectables.

Inflatable prosthesis

If oral or injected medications can’t be used or don’t provide desired results, another ED treatment is an inflatable prosthesis surgically implanted in the penis.

In a 2012 studyTrusted Source of men ages 71 to 86, researchers found that an inflatable penile prosthesis was well tolerated and largely effective in treating ED.

Because it’s a surgical procedure, it carries the slight risks of infection or other complications. It’s important to go over all the risks and benefits of this treatment approach with your doctor. Together you can decide whether your overall health makes you a good candidate for the procedure.

It’s also important to note that an implant is permanent. It would only be removed under certain circumstances, such as infection or malfunction.

Once you have a penile implant, it permanently alters the penile anatomy. This means other treatments can’t be used after it’s placed.

Lifestyle changes

While not a specific treatment, making some changes in your day to day can make a noticeable difference in erectile function. Some helpful strategies include:

  • quitting smoking
  • limiting or avoiding alcohol or substance use
  • maintaining a moderate weight
  • exercising more often than not
  • following a healthy diet that supports cardiovascular health, such as the Mediterranean diet

Why these treatments?

PDE5 inhibitors are widely used among older adults because they’re generally safe, effective, and convenient.
Because ED medications are taken on an “as needed” basis, there isn’t the same concern about missing a dose that there may be with potentially lifesaving drugs, such as high blood pressure medications or blood thinners.

Older adults who find the side effects of PDE5 inhibitors too uncomfortable may prefer injections. Those who are used to self-administering medications, such as people who give themselves insulin shots to treat diabetes, may be more comfortable with penile injections.

Penile implants avoid the concerns about side effects altogether. And since the body’s response to medications can change over time, an implanted prosthesis also means not having to worry about changing medications or dosages.

How effective is it?

ED treatments vary in how long each one is effective, as well as side effects. Regardless of which kind of treatment you choose, there are some important facts to keep in mind:

  • ED medications typically take 30 to 60 minutes to become effective. Medications such as sildenafil usually wear off in about 4 hours or so, while tadalafil’s effects can linger for nearly 36 hours. Your general health and other factors will affect these time estimates.
  • If you don’t get the results you want from one PDE5 inhibitor, a different one may be a better match.
  • ED medications don’t cause erections. Sexual stimulation is still required to become aroused.
  • As you get older, you may require more stimulation to become aroused than you did when you were younger.
  • An erection triggered by a penile injection may occur within 15 minutes, though sexual stimulation may still be required for the medication to work.
  • Recovery from inflatable penile prosthesis surgery can take 4 to 6 weeks. This means no sexual activity or great physical exertion should take place during that time. Once you’re free to engage in intercourse, the prosthesis takes only minutes to be inflated.
  • Lifestyle changes, such as strategies that boost cardiovascular health and weight management, have also been proven to be effectiveTrusted Source.

Is it safe?

ED medications can be taken safely with most other medications, though they shouldn’t be used if you take nitrates or alpha-blockers.

The combination of PDE5 inhibitors and these medications could causeTrusted Source a dangerous drop in blood pressure.

People with heart disease or kidney disease should discuss the use of PDE5 inhibitors with their doctor. They may prescribe a lower dose, which may or may not help you achieve the results you want.

Injections pose different risks than oral medications as it may be possible to hit a blood vessel or nerve with the syringe. Also, scarring is possible. It’s best to make the injections in different places each time to reduce scarring.

Implant surgery is generally safe, and the technology is constantly improving. It’s important to find a surgeon who has ample experience with this procedure.

When to see a doctor

You can often chalk up occasional episodes of ED to stress, fatigue, relationship conflicts, or other temporary conditions. They don’t necessarily indicate a problem that needs medical attention.

But frequent problems with ED can point to the need for medical attention, especially if the ED is affecting relationships, self-esteem, and quality of life. Talk with your doctor or a urologist if this is the case for you.

Having that conversation is also important because ED can sometimes be an early symptom of diabetes or cardiovascular disease. Your doctor may want to order blood tests and other screenings to check for these underlying conditions.

The bottom line

ED at any age can be a troubling condition. Among older adults, it may be more expected, but it’s nevertheless still a concern.

ED medications and other treatments have a track record of effectively and safely treating ED symptoms in older adults.

Proper treatment starts with a frank conversation with your doctor. Don’t be embarrassed to have this conversation. Rest assured your doctor has the same talk with many other people, year in and year out.

It’s also important to talk openly and honestly with your partner. ED is simply a health condition. It should be approached thoughtfully in a straightforward manner, in the same way you would address any other condition, like arthritis or high blood pressure.

Counseling may also be helpful for both you and your partner while you seek the right medical care for this common concern.

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France to Make Condoms Free for Young People

— The new policy, which will take effect in January, is part of an effort to counter an increase in sexually transmitted diseases in recent years.

French health authorities say that sexually transmitted infections have been on the rise as a result of a decline in the use of prevention methods.

By Constant Méheut

France will begin offering free condoms in pharmacies for people up to age 25 starting Jan. 1, in a bid to reduce the spread of sexually transmitted diseases, President Emmanuel Macron said on Friday.

“It’s a small revolution for prevention,” Mr. Macron said as he announced the news in a video message posted on Twitter.

The move comes as health authorities have observed an increase in sexually transmitted infections, such as chlamydia and gonorrhea, in recent years. But it is also part of a broader public health campaign that has led France to expand free access to contraception and screening for sexually transmitted diseases.

Mr. Macron said that “regarding sexual health” of young people, “we have a real issue,” according to reports from French news outlets present at the debate. And he acknowledged that, when it comes to sex education, “We’re not good on this topic.”

The French president had initially announced on Thursday, during a health debate with young people, that the measure would only apply to people ages 18 to 25. But on Friday — after several people and activists called him out on the fact that minors, too, were at risk of contracting sexually transmitted diseases — Mr. Macron announced that he was extending the policy to underage people.

“Let’s do it!” Mr. Macron, who by the evening had traveled to Alicante, Spain, for a European summit, said in the video message.

Since 2018, people have been able to get the cost of condoms reimbursed by the national health system if they were purchased in a pharmacy with a prescription. But the measure is not well known to young French people. And more than a quarter of them say they “never” or “not always” use condoms during sexual intercourse with a new partner, according to a study released last year by HEYME, a student health insurance company.

“Condom use is very low, especially among young people,” said Catherine Fohet, a gynecologist and top member of the National Federation of Institutes of Medical Gynecology. She said the price of condoms can be prohibitive but also pointed to their “bad image” as devices that reduce tactile sensation.

French health authorities say that sexually transmitted infections, or S.T.I.s, have been on the rise in recent years, especially among young people, as a result of a decline in the use of prevention methods.

Recently released figures show that the number of people infected with chlamydia rose last year by 15 percent compared with 2020, and more than doubled compared with 2014, based on data from screenings at private health centers.

Meanwhile, gonorrhea infections have been growing since 2016, and H.I.V. infections, which condom use had helped curb in the 1980s and 1990s, have stagnated around 5,000 from 2020 to 2021.

“There’s an explosion of S.T.I.s,” said Jérôme André, the director of HF Prévention, an association that organizes screenings among university students. He added that in some universities of the Paris region, the rate of S.T.I.s reached 40 to 60 percent of those tested.

“We end up testing tons of people who should not be infected,” Mr. André said.

Mr. Macron said in a message posted on Twitter following his announcement that other health measures would be implemented as part of a recently passed health care law. They include free emergency contraception for all women in pharmacies and free testing for sexually transmitted infections without a prescription, except H.I.V., for people under 26.

Ms. Fohet welcomed Thursday’s announcement, but she said free condoms “won’t solve everything.” She added that “education and information” were key to convincing people to use protection during sexual intercourse.

Mr. Macron acknowledged on Thursday that France needed “to train our teachers much better on this topic, we need to raise awareness.”

Earlier this year, the French government made contraception free for all women up to age 25. The move was welcomed by the country’s National Council of the Order of Midwives, which said in a statement that it should be accompanied by better sexual education for all teenagers ages 15 to 18.

“Handing out condoms is good,” Mr. André said. “But when people are already infected, it’s too late.”

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