Why Viagra has been linked with better brain health

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Viagra can be a wonder drug for men with erectile dysfunction, helping them maintain their sex lives as they age. Now new research suggests the little blue pill may also be beneficial to aging brains.

The findings are based on a massive study of nearly 270,000 middle-aged men in Britain. Researchers at University College London used electronic medical records to track the health of the men, who were all 40 or older and had been diagnosed with erectile dysfunction between 2000 and 2017. Each man’s health and prescriptions were tracked for at least a year, although the median follow-up time was 5.1 years.

During the study, 1,119 men in the cohort were diagnosed with Alzheimer’s disease.

The researchers noticed a distinctive pattern. The men who were prescribed Viagra or a similar drug had an 18 percent lower risk of developing Alzheimer’s disease, compared with men who weren’t given the medication.

The researchers also found an even larger difference in men who appeared to use Viagra more often. Among the highest users, based on total prescriptions, the risk of being diagnosed with Alzheimer’s was 44 percent lower. (Men with erectile dysfunction are instructed to only take Viagra before sex, and no more than once a day.)

“I’m excited by the findings but more excited because I feel this could lead to further, high-quality studies in a disease area that needs more work,” said Ruth Brauer, a lecturer in pharmacoepidemiology at the University College London School of Pharmacy and the principal investigator of the study.

There’s a limit to how much we can conclude from the study results. The findings show an association between lower Alzheimer’s risk and Viagra use, but don’t prove cause and effect. For instance, it may be that Viagra use is a marker for better overall health, and that men who have more sex also are more physically active as well. Physical activity is independently associated with a lower risk of Alzheimer’s disease, Brauer said.

Why Viagra may be linked with a lower risk of dementia

Sildenafil, the generic name for Viagra, was never supposed to be a sex drug. Pfizer had developed the drug as a cardiovascular medication to treat hypertension and chest pain called angina. The company had been conducting clinical trials using sildenafil as a heart medication when some patients reported an unexpected side-effect — erections.

Viagra is part of a class of drugs known as phosphodiesterase Type 5 Inhibitors, or PDE-5 drugs. The drugs work by dilating blood vessels and increasing blood flow throughout the body, including to the penis. Since its discovery as an erectile dysfunction treatment, sildenafil also has been used to treat pulmonary arterial hypertension for both men and women.

The link between heart health and sexual health is strong. Erectile dysfunction can be an early warning sign of coronary artery disease. And an unhealthy vascular system is one of the reasons men start having problems with erections.

Vascular risk factors have also been linked to certain types of dementia, including Alzheimer’s disease, so researchers have been intrigued about whether erectile dysfunction treatments can affect brain health as well.

Animal studies of PDE-5 inhibitors have shown the drug may help prevent cognitive impairment by, in part, increasing blood flow in the brain, but researchers who conducted a review of the available research say the efficacy of the class of drugs “remains unclear.” And Brauer said the findings in animals are only “possible mechanisms” in humans.

“There is an idea that if we can help with improving blood flow in the brain, maybe we can also reduce the risk for Alzheimer’s disease,” said Sevil Yasar, an associate professor of medicine at Johns Hopkins University and the co-author of an editorial that accompanied the study in Neurology.

Other reasons for the effect

Stanton Honig, a professor of urology at Yale School of Medicine, said the newest study is far from definitive. “You can’t draw any conclusions” from the study because “there are so many other factors” at play besides whether a man takes a pill for erectile dysfunction.

“Someone who is more likely to take a pill like that at 70, they’re probably more active, they’re more likely involved with their partners, things like that,” Honig said. “There’s too many confounding variables to make a definitive statement that it’s the pills or it’s the patients that are taking the pills that are less likely to be neurologically impaired.”

Brauer said the average “pack” per prescription is four tablets. But it’s not clear if the men took all the tablets prescribed and, if so, how often.

“We do not know if people used the prescribed drugs as intended nor could we measure sexual activity or physical activity levels,” Brauer said. “We need further studies to show if our results would hold up in a group of men without erectile dysfunction and — even better — it would be better to run our study in a group of men and women.”

Previous studies on different populations have come to somewhat contradictory conclusions. A Cleveland Clinic study found a significantly reduced risk of Alzheimer’s disease among those using sildenafil, said Feixiong Cheng, the director of the Cleveland Clinic Genome Center and the principal investigator of the study. But a study by researchers at Harvard Medical School and the National Institute on Aging found “no association” between the use of sildenafil, or other PDE-5 inhibitors, and the risk of Alzheimer’s disease, said Rishi Desai, an associate professor at Harvard Medical School.

More study is needed

Rebecca Edelmayer, the senior director of scientific engagement for the Alzheimer’s Association, said in an email that it remains unclear whether Viagra and similar drugs have an effect on Alzheimer’s risk. “Further research and specifically designed, randomized clinical trials are a necessary step,” she said.

For now, the findings don’t suggest that men should start taking Viagra if they don’t need it. But we do know that Viagra is an effective treatment for erectile dysfunction, and men who are experiencing the problem should see a doctor and discuss both their sexual health and cardiovascular health.

“You should not take Viagra to reduce your risk,” Yasar said. “You should eat healthy. You should exercise. There’s plenty of evidence for that.”

Complete Article HERE!

How to keep your sex life thriving after prostate cancer

— Poor sexual function is the most common consequence of prostate cancer treatment, but support through the NHS is patchy and many men suffer in silence.

By Laura Milne

When BBC presenter Gabby Logan and her husband Kenny, the former Scotland rugby union winger, experienced difficulties with their sex life after he had his prostate removed last year, rather than keep it under wraps, they decided to make a podcast about it.

The couple, who have been married for 22 years, discussed their issues in an interview about Kenny’s prostate cancer diagnosis and subsequent erectile dysfunction on Gabby’s podcast The Mid Point.

Kenny, 51, who won 70 international caps representing Scotland, said his wife, 50, had expected the passion in their relationship to be reignited “immediately” after his operation and when he was unable to perform, it knocked his confidence badly.

He said: “When we first tried to have sex after the operation, Gabby said, ‘Oh, it’s not working, that’s it, it’s not working’. You didn’t even give me a chance. What actually happened from that was my confidence went rock bottom.

Gabby and Kenny’s experience is far from unusual. In the UK, prostate cancer is the most commonly diagnosed cancer in men and more than 395,000 were living with it, or had been successfully treated for it, in 2018.

According to the Life After Prostate Cancer Diagnosis (LAPCD) study of 35,000 men in the UK, funded by men’s health charity Movember, poor sexual function is the most common consequence of prostate cancer treatment (79 percent with prostate cancer compared with 48per cent of men in the general population).

Unfortunately, the problem remains one that is either not addressed routinely or at all in prostate cancer care.

The LAPCD study found that 56 per cent of men were not offered any help with sexual dysfunction following their treatment.

Problems with sex can lead to stress, anxiety, anger and even shame.

Some men don’t like to talk about vulnerable feelings because they think they should be “strong and silent”. Others avoid talking because they’re overwhelmed or trying not to burden their partner.

But learning how to face these challenges and work through them can strengthen your sexual wellbeing, explains Dr Karen Robb, Implementation Director for Cancer at Movember. “Sexual wellbeing – the balance between the physical, social and emotional aspects of sex – has not always been a common topic of conversation, but fortunately that is changing,” she says.

“Talking about sex after prostate cancer can be uncomfortable but open communication between you and your partner, if you have one, is a key part of sexual recovery following treatment. Acknowledge what has changed for you so that you can do something about it, with the right support.”

Almost every kind of prostate cancer treatment, including surgery, can cause sexual dysfunction, the most common of which is erectile dysfunction or ED, following a prostatectomy (surgical removal of the prostate).

This means that although you may feel aroused or in the mood for sex, chances are you’ll have difficulty getting an erection.

Why does ED happen after prostate cancer surgery?

“Surgery to remove the prostate affects the nerves and blood supply around the penis,” explains Karen. “The penis needs a healthy blood flow to get an erection. Without this, it won’t become as hard as it did before surgery.”

During surgery, the entire prostate is removed. The nerves that help create erections run down the left and right sides of the prostate gland. The surgeon can usually take out the prostate without causing permanent harm to the nerves on either side.

But if your cancer is too close to the nerves, they may need to be cut out.

How long does ED last after surgery?

It might take some time to improve, and the level of function you get back depends on a number of things including your age, lifestyle, any medications you take and whether you had nerve-sparing surgery.

As Karen explains: “Some things you can work on, such as exercise and keeping a healthy weight.

“Some are a bit more out of your control. However, all are things you can talk about with your doctor and see what recommendations they have that can help.”

What can you do about ED after prostate cancer?

Sex and intimacy after prostate cancer can look different for everyone, but there are options to keep your sex life thriving. Exploring new ways to have sexual pleasure and intimacy is essential after treatment and can even be a way of improving your erections.

There are different types of ­medication and sexual aids that you can try, all with pros and cons.

Everyone is unique so you may need to try out a few options a number of times and perhaps in combination to settle on the best solution for you. Discuss this with your healthcare provider.

To support men and their partners following prostate cancer treatment, Movember has launched an evidence-based online guide
called Sex and Intimacy After Prostate Cancer.

Informed by sexual health experts, it covers ED, dealing with physical changes after surgery, connecting with a partner, restoring intimacy, and coping with stress and anxiety. It also provides practical strategies, such as exercises, information about medication and devices, and how to have conversations with your doctor or care team.

“It’s vital to talk and not to just ignore it”

Chris Pedlar, 56, took early retirement from the Environment Agency in 2022 after 33 years, and lives with his partner in Devon. Nine years ago, Chris became the third generation in his family to bediagnosed with prostate cancer.

“My grandfather died from prostate cancer and my father was treated for it when he was 60. He went on to live for another 25 years, cancer free. He made sure that I started having PSA tests at 45 and I was picked up as having medium-risk cancer at 48.

“I opted for surgery rather than radiotherapy as I knew I would have the option of additional radiotherapy later on.

“Due to my father’s experience, I knew beforehand what to expect. Although I recovered quickly from the surgery itself, I had some of the usual side effects, including erectile dysfunction and some minor urinary problems, which I’ll have for life. I tried all the usual interventions such as injections, which made me feel terrible, and pumps which, while they serve a purpose, are a huge commitment. It didn’t put me off seeking advice though.

“Sex is an important part of a relationship and just because you’ve had a cancer diagnosis, it doesn’t mean that part of your life is over.

“Cancer can put a massive strain on a relationship – it affects both partners and you need to be able to talk about it honestly with each other. My partner and I have found that humour is the best way to deal with the problems we had, and I was determined from day one, this was not going to get me down.

“Because of the stage my cancer was at when it was discovered, I wasn’t able to have nerve-sparing surgery. That meant drugs like sildenafil (Viagra) shouldn’t have worked for me because of the nerve damage caused by the surgery. Everyone’s situation is different, but I never gave up hope, and after three years I asked my doctor if I could give sildenafil a try to see if it would help in any way, and I was pleasantly surprised to find it worked for me.

“From the beginning, I decided to be very open about my cancer. I recognise that not everyone deals with the experience in the same way. A lot of men bury their heads in the sand and won’t ask for help, even though it is having a negative impact on their lives.

“I was comfortable with talking to my doctor about ED because I wanted to find a solution – but a lot of men are reluctant to even mention it and so they just suffer in silence, which can have a negative effect on their mental health and their relationships.

“We need to work harder to break down those barriers that prevent men from talking about problems seeking help and seeing their GP when they need to.”

Complete Article HERE!

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.

Complete Article HERE!

10 Top Sex Ed Tips for Those 50 and Older

Making love is about more than intimacy. It’s good for your health, too

By Robin Westen

How sexy are your 50s?

If you think sex is the province of the young, you’re wrong. People in their 20s are having less sex now than ever before, studies show, so it’s possible that you’re as active, or more so, as the average millennial. About a third of us are getting busy several times a week, one survey found.

And most of us are still in the game: 91 percent of men and 86 percent of women in their 50s report being sexually active, although activity levels vary widely. So, there’s no “normal” amount of sex for people our age. What matters more is that you and your partner are happy with your sex life. Men and women age differently, and some studies indicate that sexual interest wanes differently as well. Combine that with emotional and physical issues, and it’s possible that you and your partner aren’t on the same wavelength when it comes to making waves.

The upsides, however, go way beyond our cravings for intimacy, pleasure and connection. Sex boosts our immune systems, improves self-esteem, decreases depression and anxiety, relieves pain, encourages sleep, reduces stress and increases heart health. (In one study, men who had sex at least twice a week were 50 percent less likely to die of heart disease than their less active peers were.) Another bonus: You burn more calories making love than by watching The Great British Baking Show.

Not only is there a lot of science around the subject of later-life lovemaking; there’s also a range of products and medicines that can help. Take these steps to revitalize your sex life.

1. Connect emotionally

Women are twice as likely as men to lose their enthusiasm for sex in long-term relationships, research shows. The problem isn’t always reduced estrogen; it could be an absence of emotional closeness. In these cases, try listening more, praising more and showing more kindness. Individual, couples and/or sex therapy can help as well. Look for a sex therapist certified by the American Association of Sexuality Educators, Counselors and Therapists.

2. Address vaginal dryness

It’s one of the top impediments to sex among older women: 34 percent of women ages 57 to 59 experience dryness and discomfort during intercourse, one study found. For help, try over-the-counter remedies before and during sex, such as water-based lubricants (K-Y Jelly and Astroglide), oil-based lubes (olive, coconut and baby oils) and OTC moisturizers (Replens and Revaree). Use these a few times a week, even if you’re not having sex.

3. Emphasize foreplay

“Regardless of the level of dryness, every woman needs to be primed with foreplay before intercourse,” says Elizabeth Kavaler, M.D., a urologist-urogynecologist at Total Urology Care of New York. Another tip: Encourage a woman to orgasm first, which provides more moisture for intercourse and other penetration.

4. Don’t let ED keep you down

Half of men who are in their 50s experience erectile dysfunction (ED), and the gold standard for treatment is prescription meds. Safe, effective options include Viagra (which lasts for four to six hours), Levitra (four hours), Cialis (up to 18 hours) and Stendra (up to six hours).

For the minority of men who can’t rely on a pill, other choices include alprostadil (a drug that’s self-injected into the penis) and Muse (a suppository that slides into the penis). Vacuum pumps use suction to coax erections, and new treatments include platelet-rich plasma (PRP) therapy, which may regenerate nerves and improve blood circulation.

5. Don’t ignore other conditions

Any problem that affects overall health can interfere with sexual pleasure. “Cardiovascular issues such as high blood pressure, as well as diabetes, can negatively impact blood flow,” which isn’t good for sexual arousal, notes New York ob-gyn Alyssa Dweck, M.D., coauthor of The Complete A to Z for Your V. “And depression or anxiety can reduce the desire or ability to have sex.” The problem? Medicines that treat these conditions may also affect sexual desire and response. Speak with your health care provider about side effects and possibly switching meds or adjusting the dosage or timing.

6. Consider estrogen

Women, if over-the-counter lubricants aren’t doing the trick, consider estrogen replacement therapy (ERT), which treats hot flashes and vaginal dryness. The most common delivery methods are creams and pills (you can self-apply Estrace and Premarin with an applicator or take these in pill form), insertable tablets (with Vagifem, you use an applicator to slide a tiny tablet into the vagina) and a ring (Estring, which your doctor inserts, or you can do this yourself; it needs to be replaced every three months). ERT is not recommended for anyone who has or had breast cancer, or for those who have recurrent or active endometrial cancer, abnormal vaginal bleeding, recurrent or active blood clots, or a history of stroke.

7. Think about lasers

A treatment called fractional laser therapy can help reduce vaginal dryness without estrogen. It works like this: A laser creates tiny superficial burns in the vaginal canal. As the area heals, this leads to fresher collagen development and increased blood supply, which makes the area more elastic and responsive, Kavaler explains. (She cautions against vaginal rejuvenation surgery, which is a cosmetic procedure: “It can reduce sensitivity in the area and can make orgasms even more difficult to achieve or, in some cases, sexual intercourse permanently painful.”)

8. Confront incontinence issues

In a national poll of more than 1,000 women, nearly half of those over age 50 reported bladder leakage during sex. The primary reason: Sexual stimulation puts pressure on the bladder and urethra. If you’re hoping to get lucky in the hours ahead, avoid consuming beverages or foods with caffeine, such as coffee and chocolate; caffeine stimulates the bladder and acts as a diuretic (citrus fruits and juices are diuretics, too). Men whose prostates have been removed can also experience incontinence during sex. This condition, known as climacturia, can be treated in a number of surgical and nonsurgical ways. Plus, medications such as Ditropan and Vesicare can decrease urination frequency.

9. Turn down testosterone

In late 2020, the American College of Physicians stated that testosterone replacement should no longer be administered to treat a lagging libido (testosterone can have serious side effects, including an increased risk of prostate abnormalities). Denver urologist David Sobel, M.D., offers three easy alternatives: “sleep, reducing stress, and — the big one — exercise.” Even better: Work out with your lover. Seventy-one percent of runners say that running as a couple plays a healthy role in their sex life, according to a 2021 survey according to a 2021 survey.

10. Overcome arthritis aches

About 58 million Americans have arthritis, and over half are younger than 65, reports the Centers for Disease Control and Prevention. Arthritis can limit your ability to engage in sex. In addition, an empathetic partner may resist sex to avoid creating discomfort. An option: Ask your partner to experiment with more comfortable positions. Also, time sex for when you feel best (rheumatoid arthritis pain is usually more acute in the morning), the Arthritis Foundation advises. Taking a warm bath, alone or together, can help relax joints before making love. If the pain is severe, try an OTC medicine such as ibuprofen before having sex, or speak with your doctor about prescription medications.

Complete Article HERE!

Death during sex isn’t just something that happens to middle-aged men, new study finds

By

Sex has many beneficial physical and psychological effects, including reducing high blood pressure, improving the immune system and aiding better sleep. The physical act of sex and orgasm releases the hormone oxytocin, the so-called love hormone, which is important in building trust and bonding between people. But there’s a dark side: people sometimes die during or shortly after sex. The incidence is, thankfully, extremely low and accounts for 0.6% of all cases of sudden death.

There are many reasons why this happens to people. In most cases, it is caused by the physical strain of the sexual activity, or prescription drugs (drugs to treat erectile dysfunction, for example), or illegal drugs, such as cocaine – or both.

The risk of any sudden cardiac death is higher as people age. A forensic postmortem study from Germany of 32,000 sudden deaths over a 33-year period found that 0.2% of cases occurred during sexual activity. Sudden death occurred mostly in men (average age 59 years) and the most frequent cause was a heart attack, also known as myocardial infarction. Studies of sudden cardiac death and sexual activity from the US, France and South Korea show similar findings.

Person snorting cocaine.
Cocaine can increase the risk of sudden cardiac death during sex.

Not just the middle-aged men

Recently, however, researchers at St George’s, University of London, found that this phenomenon is not just limited to middle-aged men. The study, which is published in JAMA Cardiology, investigated sudden cardiac death in 6,847 cases referred to the centre for cardiac pathology at St George’s between January 1994 and August 2020. Of these, 17 (0.2%) occurred either during or within one hour of sexual activity. The average (mean) age of death was 38 years, and 35% of the cases occurred in women, which is higher than in previous studies.

These deaths were typically not caused by heart attacks, as seen in older men. In half of the cases (53%), the heart was found to be structurally normal and a sudden abnormal heart rhythm called sudden arrhythmic death syndrome or Sads was the cause of death. Aortic dissection was the second largest cause (12%). This is where the layers in the wall of the large artery from the heart supplying blood around the body tear and blood flows between the layers causing it to bulge and burst.

The remaining cases were due to structural anomalies such as cardiomyopathy (a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of your body), or from a rare group of genetic conditions known as channelopathies. This is where the ion channels that let sodium and potassium in and out of the cells in the heart muscle don’t work properly. The change to the sodium and potassium in the cells can alter the electrical current through the heart muscle and change the way it beats. An altered heart rhythm can cause a lack of oxygen (myocardial ischemia) and can lead to a sudden cardiac arrest where the heart stops beating.

This new study suggests that sudden cardiac death in people under the age of 50 is mainly due to sudden arrhythmic death syndrome or cardiomyopathies. Younger adults who have been diagnosed with these conditions should seek advice from their cardiologist on the risk associated with sexual activity. However, the low incidence of death in these studies suggests the risk is very low – even in people with existing heart conditions.

Complete Article HERE!

More than half of men over 60 may have problems in the bedroom

By Steven Petrow

Ask a roomful of men in their 60s whether they have any kind of sexual dysfunction — such as problems with erections, sex drive and overall satisfaction — and about 60 percent should raise their hand, studies suggest. They probably won’t, since the topic is fraught with stigma, shame and fear of rejection, but statistically they are likely to be a part of this unhappy club.

That’s cold comfort to people like me, because I would have to — if I were to be honest — raise my own hand.

I didn’t have to wait until I was 60, though, to join the club. I got in about 35 years ago as a side effect of cancer surgery. Picture me then, sitting on a cold examination table at Memorial Sloan Kettering Cancer Center in New York, in a hospital gown that didn’t cover my backside. Having just confirmed my testicular cancer diagnosis, the oncologist went on to tell me about a common side effect called “retrograde, or dry, ejaculation,” in which things don’t flow where they should during sex — instead of exiting my body, semen would flow into my bladder. He did assure me that it wouldn’t diminish my sexual pleasure.

I was 26 at the time, and I felt completely alone. Sexual dysfunction isn’t usually considered a young man’s issue, and this was long before there were online support groups for every disease known to humankind.

My oncologist’s prediction didn’t matter much because I entered a years-long period of celibacy in which I tried to get comfortable with my “new normal.” At the time, I was less confident in myself and didn’t have the language to explain my condition.

“For many of these treatments, whether it’s surgery or radiation and whether it’s prostate cancer or bladder cancer, about 85 percent of men will report some difficulty with erections,” says Christian Nelson, chief of the psychiatry service at Memorial Sloan Kettering. “The most prominent sexual dysfunction we see related to those treatments are difficulty with erections, or erectile dysfunction.”

Nelson wasn’t surprised to learn I had been celibate for a number of years after surgery. He has learned that when things don’t work as they should for many men, “there’s upset and sometimes shame . . . that can lead to avoidance.” His practice helps guys identify and use the medications and penile injections that will “help them re-engage sexually, re-engage in dating, re-engage in intimacy.”

But you don’t need cancer treatment to get into the sexual dysfunction club. Admission can be granted through smoking, diabetes or hypertension, but mainly through growing older, says Brant Inman, the co-director of Duke Prostate and Urologic Cancer Center who has studied male sexual function.

His study found that erectile dysfunction hit 2 percent of men ages 40 to 50, 6 percent ages 50 to 60, 17 percent ages 60 to 70 and nearly 40 percent ages 70 and older. A Canadian study showed even higher rates among all age groups.

Inman says that for men under 40, erectile dysfunction is more commonly caused by psychological issues (anxiety, depression, stress), while for older men it is more likely caused by “vascular, impaired blood flow to the penis.”

I spoke with several men for this column, all of whom asked me not to use their names for privacy reasons. One of them, a 60-year-old art dealer from Manhattan, told me he hasn’t been able to achieve an erection for years, which he finds “incredibly frustrating and embarrassing.” He says he tells partners that it is because of his meds, which it may well be (he has taken antidepressantsthat can have sexual effects). One partner told him, “it’s not the destination that’s important. It’s the journey” — a gentle acceptance that, as he put it, helped him to relax.

A 45-year-old advertising executive said he was too embarrassed to talk to his doctor about erection problems that had begun to plague him and instead bought Cialis and Viagra from a friend. The Cialis helped somewhat, but he still couldn’t reach orgasm — and even then, he wasn’t comfortable talking to his doctor, especially after having obtained his drugs through a murky way.

Inman says he understands the embarrassment, but asked, rhetorically, “Would you buy your cholesterol or blood pressure lowering medication from a street vendor?” Of course not, he says, because you can’t be sure of the dosage (milligrams of active agent) or quality (active agent vs. filler), which could be dangerous.

It’s not just with doctors, however, that full disclosure can be fraught for men experiencing sexual dysfunction. When and how to tell a partner feels like a big issue, one I faced as a young man. Before undressing? Post-intimacy? It depends, Nelson says.

It’s certainly easy enough to take a pill without telling your partner, he says, but if performance is unpredictable or for other types of treatment, such as injections to help with an erection, it’s dicier.

“I certainly have some men who haven’t told new partners that they use injections,” he says. “They step into a bathroom, inject, and 10 minutes later they engage in sexual relations.” But he recommends a discussion beforehand when someone plans to use an injection so there are no last-minute surprises

Sometimes, being frank about your own sexual dysfunction leads to a discovery that you’re not the only one. That’s what happened to me with a man I dated for a while. After we had gotten to know each other, he told me he’d had radical prostate cancer surgery and needed injections to have sex. This led me to talk about my own condition. The result was a deeper level of intimacy — and less anxiety.

Recently, after a divorce, I reentered the dating pool and discovered I was no longer so alone in terms of sexual issues. My anecdotal evidence with guys my age or older indicates many are challenged by some form of sexual dysfunction, some minor (slower to get going) some more serious, needing medical intervention.

“People are just afraid” to talk about many of these issues, including doctors, Inman says. It’s important to try to destigmatize the issue. Indeed, it’s still a delicate subject, and someone has to raise his hand to start the talking.

Complete Article HERE!

Erectile Dysfunction:

Two Women On What It Did To Their Sex Lives

By Natalie Gil

Erectile dysfunction (ED) has been getting the millennial marketing treatment recently. On London transport earlier this year, you may have seen a ‘quirky’ ad campaign for a viagra delivery service called Eddie, which urged men not to be shy about the condition, proclaiming “ED isn’t an ‘old man problem'”. Men’s health company Numan, which manufactures treatments for ED, uses a minimal, earthy-toned colour palette for its packaging – clearly targeted towards the same younger audience. In the US, the hipster-friendly viagra company Hims (with its cacti motif) has even been credited with making erectile dysfunction ‘trendy'</a

It’s refreshing that brands are trying to de-stigmatise an issue that can emasculate men – and it makes sense, given that there’s cause to believe younger men are increasingly finding it difficult to get or maintain an erection for long enough to have sex. A study of 2,000 British men last year found that half of men in their 30s and 35% of men in their 20s are “struggling in the bedroom”, with stress, tiredness, anxiety and boozing too heavily cited as the predominant causes. The ubiquity of porn is also named as a possible cause.

The Instagram-ready billboards might do something to tackle the stigma surrounding ED for some men but certainly not all – a recent study of 1,000 men and 1,000 women by Numan found that less than half (42%) of men who have experienced ED took steps to fix it. Nor is the taboo lifting among the sexual partners of those with the condition. The fallout and shame arising from ED remains far worse for men themselves, of course – nearly 50% of men with ED told Numan’s survey they felt self-conscious during sex, while nearly 20% avoided it altogether, and 79% were experiencing anxiety of some kind – but its impact on their romantic partners and relationships shouldn’t be overlooked.

How do affected couples communicate about an issue that is so sensitive? How does it make them feel about themselves? And how does it affect their own sexual satisfaction and experience of sex? Sex and relationship experts advise “talking to him and letting him know that he has nothing to feel ashamed of” and suggesting that he seek professional help if the problem persists. But it can be difficult squaring your partner’s wellbeing, self-esteem and masculine identity with your own needs, as two women in heterosexual relationships told Refinery29

Jo, 36, a strategist and self-described serial monogamist, was in a relationship with a man with erectile dysfunction which was “cut short due to ED and how it manifested in the relationship,” she says.

“The situation was twofold; he’d had health issues in the past brought on by a partying lifestyle that resulted in a mild heart issue, and he previously had an addiction to pornography, which he felt had warped his mind and changed how his body responded in intimate situations. I didn’t know any of this, of course, but I sensed a disconnect when we were intimate. Like his mind went somewhere else. I found out a few months in that he regularly used Viagra to deal with it. He hadn’t spoken to anyone else before and god knows where he was getting the medication.

During the next few months, sex changed… I acted more like a sex therapist than a girlfriend. It was probably the first time he’d discussed it with anyone. I wished there was someone else, like a professional, who he could speak to, to take the pressure off me. Sex became less about my enjoyment and more about ‘fixing’ him. I did a lot of research but didn’t really know what to do in this situation and if I was being a ‘good’ girlfriend or not. Was I making it worse or better? I was kind and patient for sure but pushed my needs and feelings aside as a result.

The ED took over everything. If we wanted guaranteed sex then it had to be planned, so it was less spontaneous and felt fake. I think he possibly took too strong a dose or was on the wrong medication too, because I felt he changed a bit as a person sexually. As I say, it felt like a therapy session, which brought us closer together in a way but also got boring very quickly for me. I sound like a bitch even now saying it, but that’s the truth.

The experience gave me a good insight into how hard it can be to be a man in 2019 and opened my eyes to how modern lifestyles, porn and mental health can really affect the physiology of a human; we all need to get to know and understand our bodies better. It taught me to be more patient and how to have tough conversations. Moreover, it taught me to care about my own feelings more, when to set boundaries and when to cut out.”

Melissa (not her real name), 29, who works in recruitment, saw a man for several months from September last year, and it soon became clear that his religious beliefs were hampering his ability to have sex.

“I was really excited about him as we clicked on so many levels. Before we’d slept together, he told me he was quite religious and that he’d probably want to explore it more when he got older and settled down. I’m not religious, but I didn’t think too much of it. On another occasion, he started talking about certain foreplay things he liked to do and asked if I was game – I was. Back at mine we started getting into it and he focused his attention on me during foreplay. He didn’t let me pay much attention to him. He had an erection at the time. However, when it came to having intercourse he lost it, proceeded to hug me and said that what we had just done was so amazing, etc. The foreplay was good and I’d been hoping we’d go the whole way since the dirty talk at dinner. I brushed it off.

We met up again and the same thing happened – he couldn’t get hard to have sex. We tried and it got a little hard but he lost it immediately. I could see that he was frustrated, but I could also sense he knew what was going on. I told him he could feel comfortable speaking to me about it, as we’d already had several deep conversations. Eventually, he told me his ex-girlfriend of five years was very religious and only wanted to have sex once she was married. He’d had a few sexual partners before her and was willing to wait. In the last year of his relationship they began to experiment with foreplay and when they eventually had sex, at his insistence, it didn’t feel right and they ended up splitting up. Essentially, he could only get hard off his kinky foreplay fantasy and had gone so long without intercourse that when it came to it, he had a mental and physical block.

We got on well but the lack of sex and his unwillingness to address it meant we didn’t see much of each other after that. I was willing to try and help out, be understanding and patient but he kept me at a distance and ultimately didn’t want to talk to me about it. Since he’d been so forward about what he wanted in bed I felt deflated that he couldn’t go the whole way. It made me think I was the problem. I now realise this wasn’t the case, but if your partner has ED and doesn’t admit it, doesn’t talk about it and distances themselves, it doesn’t make you feel good. Men rarely talk about it and women are often embarrassed to talk about it with their friends to avoid embarrassing their partner, so seek your own advice and if your partner is hesitant, broach the subject yourself. Give them resources or solutions and let them know it’s a common problem. Help them to find out what really might be causing it.”

For elders and others, drugs are available that aid sexual experience.

But insurers and Medicare won’t pay for them.

A tablet of Pfizer’s Viagra, left, and the company’s generic version, sildenafil citrate.

By Michelle Andrews

For some older people, the joy of sex may be tempered by financial concerns: Can they afford the medications they need to improve their experience in bed?

Medicare and many private insurers don’t cover drugs that are prescribed to treat problems people have engaging in sex. Recent developments, including the approval of generic versions of popular drugs Viagra and Cialis, have helped consumers afford the treatments. Still, for many people, paying for pricey medications may be their only option.

At 68, like many postmenopausal women, Kris Wieland, of Plano, Tex., experiences vaginal dryness that can make intercourse painful. Her symptoms are amplified by Sjogren’s syndrome, an immune system disorder that typically causes dry eyes and mouth, and can affect other tissues.

Before Wieland became eligible for Medicare, her gynecologist prescribed Vagifem, a suppository that replenishes vaginal estrogen, a hormone that declines during menopause. That enabled her to have sex without pain. Her husband’s employer plan covered the medication, and her co-payment was about $100 every other month.

After she enrolled in Medicare, however, her Part D plan denied coverage for the drug.

“I find it very discriminatory that they will not pay for any medication that will enable you to have sexual activity,” Wieland said. She plans to appeal.

Under the law, drugs used to treat erectile or sexual dysfunction are excluded from Part D coverage unless they are used as part of a treatment approved by the Food and Drug Administration for a different condition. Private insurers often take a similar approach, reasoning that drugs to treat sexual dysfunction are lifestyle-related rather than medically necessary, said Brian Marcotte, chief executive of the National Business Group on Health, which represents large employers.

So, for example, Medicare may pay if someone is prescribed sildenafil, the generic name for Viagra and another branded drug called Revatio, to treat pulmonary arterial hypertension, a type of high blood pressure in the lungs. But it typically won’t cover the same drug if prescribed for erectile dysfunction.

Women such as Wieland may encounter a similar problem. A variety of creams, suppositories and hormonal rings increase vaginal estrogen after menopause so that women can have intercourse without pain. But drugs that are prescribed to address that problem haven’t generally been covered by Medicare.

Sexual-medicine experts say such exclusions are unreasonable.

“Sexual dysfunction is not just a lifestyle issue,” said Sheryl Kingsberg, a clinical psychologist who is the chief of behavioral medicine at University Hospitals MacDonald Women’s Hospital in Cleveland. She is the immediate past president of the North American Menopause Society (NAMS), an organization for professionals who treat women with these problems. “For women, this is about postmenopausal symptoms.”

Relief may be in sight for some women.

Last spring, the federal Centers for Medicare and Medicaid Services sent guidance to Part D plans that they could cover drugs to treat moderate to severe “dyspareunia,” or painful intercourse, caused by menopause. Plans aren’t required to offer this coverage, but they may do so, according to CMS officials.

The NAMS applauded the change.

“Dyspareunia is a medical symptom associated with the loss of estrogen,” Kingsberg said. “They had associated it with sexual dysfunction, but it’s a menopause-related issue.”

For men who suffer from erectile dysfunction, treatment can confer both physical and emotional benefits, sexual health experts said.

“In my clinical work, I see a lot of older couples,” said Sandra Lindholm, a clinical psychologist and sex therapist who is also a nurse practitioner in Walnut Creek, Calif. “They are very interested in sex, and they feel like they’re able to embrace their erotic lives. But there may be medical issues that need to be addressed.”

About 40 percent of men over age 40 have difficulty getting or maintaining an erection, studies show, and the problem increases with age. A similar percentage of postmenopausal women experience genitourinary syndrome of menopause, a term used to describe a host of symptoms related to declining levels of estrogen, including vaginal dryness, itching, soreness and pain during intercourse, as well as increased risk of urinary tract infections.

Low sexual desire is another common complaint among women and men. A drug called Addyi was approved in 2015 to treat low sexual desire disorder in premenopausal women. But many insurers don’t cover it.

Unfortunately, medications that treat these conditions may cost people hundreds of dollars a month if their insurance doesn’t pick up any of the tab. A 10-tablet prescription for Viagra in a typical 50-milligram dose may cost more than $600, for example, while the price of eight Vagifem tablets may exceed $200, according to GoodRx, a website that publishes current drug prices and discounts.

In recent years, much more affordable generic versions of some of these medications have gone on the market.

Generic versions of Viagra and Cialis, another popular erectile dysfunction drug, may be available for just a few dollars a pill.

“I never write a prescription for Viagra anymore,” said Elizabeth Kavaler, a urogynecologist at Lenox Hill Hospital in New York City. “These generics are inexpensive solutions for men.”

There are generic versions of some women’s products as well, including yuvafem vaginal inserts and estradiol vaginal cream.

But even those generic options are often relatively pricey.

Some patients cannot afford $100 for a tube of generic estradiol vaginal cream, said Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive medicine at Yale School of Medicine.

“I’ve asked, ‘Did you try any of the creams?’ And they say they used up the sample I gave them. But they didn’t buy the prescription because it was too expensive,” she said.

— Kaiser Health News

Viagra rising: How the little blue pill revolutionized sex

[T]wenty years ago, a little blue pill called Viagra unleashed a cultural shift in America, making sex possible again for millions of older men and bringing the once-taboo topic of impotence into daily conversation.

While the sexual improvement revolution it sparked brightened up the sex lives of many couples, it largely left out women still struggling with dysfunction and loss of libido over time. They have yet to benefit from a magic bullet to bring it all back, experts say.

About 65 million prescriptions have been filled worldwide for the blockbuster Pfizer drug approved by the US Food and Drug Administration on March 27, 1998.

It was the first pill aimed at helping men get erections.

Suddenly, talk of an amazing drug that could make an older man’s penis hard again was all over television and magazines.

The Viagra boom also coincided with the rise of the internet, and the explosion of online pornography.

Ads for Viagra were designed to reframe what had been known as “male impotence” as “erectile dysfunction” or ED, a medical condition that could finally be fixed.

Republican senator, military veteran and one-time presidential candidate Bob Dole became the first television spokesman for Viagra, admitting his own fears about erectile dysfunction to the masses.

“It’s a little embarrassing to talk about ED, but it is so important for millions of men and their partners,” he said.

The strategy worked.

Before Viagra, men wanted to talk about their erectile problems, and did, but the conversations were awkward and difficult, recalled Elizabeth Kavaler, a urology specialist at Lenox Hill Hospital in New York.

“Now, sexuality in general is very out there,” she added.

“Sex has become an expected part of our lives as we age. And I am sure Viagra has been a big part of that.”

MISUNDERSTOOD DRUG

Viagra has had a “major impact” — on a par with the way antibiotics changed the way infections are treated, and how statins became ubiquitous in the fight against heart disease, said Louis Kavoussi, chairman of urology at Northwell Health, a New York-area hospital network.

Viagra’s release also came amid a “sort of a clampdown on physicians interacting with companies,” he said.

“So this was a perfect medicine to advertise to consumers. It was a lifestyle type of medicine.”

Viagra, or sildenafil citrate, was first developed as a drug meant to treat high blood pressure and angina.

But by 1990, men who took part in early clinical trials discovered its main effect was improving their erections, by boosting blood flow to the penis.

For all its popularity, Viagra is still often misunderstood.

“It isn’t an aphrodisiac,” said Kavoussi.

“A lot of men who ask about it say, ‘My wife isn’t very interested in relations,” he added.

“And I say, ‘Viagra is not going to change that.'”

SEXUAL REVOLUTION

In 2000, the comedy show “Saturday Night Live” featured a spoof on ads that showed sexually satisfied men saying, “Thanks, Viagra.”

In it, one eye-rolling actress after another was featured groaning “Thanks, Viagra,” as a horny male partner groped her from behind or gripped her in a slow-dance.

The skit was funny because it reflected a reality few people were talking about.

“We are a very puritanical society, and I think Viagra has loosened us up,” said Nachum Katlowitz, director of urology and fertility at Staten Island University Hospital.

“But for the most part, the women have been left out of the sexual improvement revolution.”

Pfizer finally did include women in its marketing for Viagra, in 2014. The commercials featured sultry women, including at least one with a foreign accent, speaking directly to the camera, telling men to get themselves a prescription.

‘FEMALE VIAGRA’

In 2015, the FDA approved a pill called Addyi (flibanserin), which was cast in the media as the “female Viagra,” and was touted as the first libido-enhancing pill for women who experienced a loss of interest in sex.

The pill was controversial from the start.

A kind of anti-depressant, women were warned not to drink alcohol with it. It also cost hundreds of dollars and came with the risk of major side effects like nausea, vomiting and thoughts of suicide.

“It didn’t go over too big,” said Katlowitz.

Valeant Pharmaceuticals bought Addyi for $1 billion in 2015, but sold it back to the developer, Sprout Pharmaceuticals, at a steep discount last year.

Older women’s main problem when it comes to sex is vaginal dryness that accompanies menopause, and can make sex painful.

Solutions tend to include hormones, or laser treatments that revitalize the vagina. They are just beginning to grow in popularity, but still cost hundreds to thousands of dollars, said Kavaler.

“We are at least 20 years behind men,” she said.

For Katlowitz, Viagra was a prime example of “the greed of the pharmaceutical industry.”

Viagra cost about $15 per pill when it first came out, and rose to more than $50. It finally went generic last year, lowering the price per pill to less than $1.

“There was absolutely no reason to charge $50 a pill,” said Katlowitz.

“It was just that they could, so they did.”

Complete Article HERE!

A stressful life is bad for the bedroom

If you are consistently emotionally distressed due to social, economic or relationship pressures, you can be sure to lose erections. Being annoyed with your intimate partner all the time, and feeling undermined or frustrated are bad for your erections.

By JOACHIM OSUR

Lois came to the sexology clinic because she was sexually dissatisfied with her husband. It had been six months of no sex in their 11-year old marriage. Before that, her man had suffered repeated episodes of erection failure. “The few times he did get an erection, it was flaccid and short-lived,” Lois explained. “You can only imagine how that can be frustrating to a faithful wife.”

Lois suspected that her husband was getting sexual satisfaction elsewhere, and had angrily told him she didn’t want to have sex with him anymore. “I thought he was no longer interested in me because I had gained too much weight after bearing our two children, a very hurtful thought,” she explained sadly.

And so for six months the couple kept off each other. The relationship got strained and unfortunately Andrew, Lois’ husband, threw himself into his work. He stayed late at work and came home after everyone was asleep. He woke up and left the house early. He paid no attention to their two children anymore.

“So how can I help you?” I asked, lots of thoughts going through my mind due to the complexity of the case. You see, the man, who was the one having a problem, had not come to the clinic. Erection failure or erectile dysfunction (ED) is a complex symptom that requires a thorough assessment for its cause to be pinpointed. I needed Andrew to come see me himself.

VICTIM OF THE RELATIONSHIP

“What do you mean that it is a symptom of complex problems?” Lois asked, frowning. ED is simply a failure to be aroused sexually. This could be due to the derangement of some chemicals in the brain such as dopamine. It could also be due to hormonal problems such as low testosterone, high prolactin and so on.

What we are also seeing at the clinic is a rise in cases of diabetes and hypertension, usually accompanied by obesity. Most of the affected people have high cholesterol. These diseases destroy blood vessels, including those in the penis, making erections impossible. Further still, the diseases can destroy nerves, and if the nerves of the penis are affected, erections fail. People with heart, kidney, liver and other chronic illnesses may similarly get ED either from the diseases or from the medicines used to treat them.

Stressful lifestyles are also contributing to ED quite a bit these days. Many people work two jobs to get by, and have no time to relax or get adequate sleep. A physically worn out, sleep-deprived body is too weak to have an erection and you should expect ED to befall you any time if this is your lifestyle.

But emotional distress is even more dangerous for ED. If you are consistently emotionally distressed due to social, economic or relationship pressures, you can be sure to lose erections. Being annoyed with your intimate partner all the time, and feeling undermined or frustrated are bad for your erections. Further, feeling like a victim in the relationship can lead to ED. All these are further complicated by anxiety and depression, which are bound to set in as part of the relationship problem or as a result of the ED itself.

“So can’t you just give me some medicine for him to try then if it fails he can come for full assessment?” Lois asked, realising that my explanation was taking longer than she had anticipated.

Unfortunately that was not possible. We get this kind of request all the time at the clinic. In fact, people make phone calls asking for tablets to swallow to get erections immediately. Sometimes they call from the bathroom with their partner in the bed waiting for action yet the erection has failed. There is however no alternative to a thorough assessment and treatment of the cause of the ED.

Andrew came to the clinic a few days later. A full assessment found that he had a stressful career and relationship difficulties, and both had taken a toll on his sex life. He had to undergo a lifestyle change. Further, the couple went through intimacy coaching. It was another six months before they resumed having sex.

Complete Article HERE!

Giddyup

It’s Product Review Friday again! This week I have Part 1, of a two part series, aimed at the men folk in our audience. This week’s product, as well as next week’s product, come to us from the ingenious people over at Bodispa.  When they sent us two of their massagers for us to review early last summer, we had no idea what kind of interesting things would soon follow. If you haven’t been keeping tract of the reviews, all meand do! Simply use the search function in the header and type in “Bodispa” and PRESTO. All the products we’ve review will appear.

Dr Dick Review Crew member, Carlos, is here with his thoughts and comments on today’s product.

Tigra 24 capsules —— $29.95

Carlos
Wow! Here we are at the end of 2013 and I’m just getting around to positing my first review of the year. Last time I posted, I was lucky enough to review one of last 2012’s Best Products of the Year. I reviewed the Deuce Male Harness.  This time around I think I have another winner.

Those of you who follow my reviews will know that I disclosed last year that I had prostate cancer and that I had a radical prostatectomy, which removed my prostate gland as well as some of the surrounding tissue. This totally devastated my sex life. Not only did my parts no longer work, I couldn’t get an erection to save my life, but I had no libido either. I mean I was never a sexual maniac or anything, but I always enjoyed sex and thought I was pretty good at it. And I gotta tell ya, not having things work like they should, can be very depressing. I used to take all of this for granted. Not any more.

Over the past 18 months, since my surgery, I’ve been working at regaining a sense of my sexual-self. It’s been a slow process. Mostly it involves masturbation. With the help of a penis pump and a cockring, I’m beginning to enjoy an erection again. This is where today’s product, Tigra, comes in. By the way, this product comes to us from the Bodispa people out of Canada.TIGRA small

Tigra is what we here at the Review Crew lovingly call a boner pill. It’s a safe, all natural herbal erection enhancing formula. Look HERE for a list of ingredients.

Perhaps you are like me; I’ve tried other erection enhancers only to be disappointed or concerned that these products are not what they say they are. But one thing Tigra can say about itself, that no other similar product can claim, is that it is certified by Health Canada.

Tigra is more of a supplement than some kind of a Viagra knockoff. It’s the kind of product that builds up in your system and not one that simply provides a jolt from the blue. One of the reasons I don’t take the pharmaceuticals or their knockoffs is I don’t like all the side effects — headache, that flushed feeling, upset stomach, rise in blood pressure, or altered vision.

The suggested dose for Tigra is one or two capsules daily. I found that one is plenty for me. I did experience an improved erection after a few days on Tigra. But more importantly, I seem to have more of an interest in sex since I started using this product. I’m not anywhere near where I once was before my diagnosis and surgery, but I’ve learned, from working with Dr Dick on this, that I need to stay focused on what’s possible for me now because this is my new normal.

The thing I’m most grateful for, now that I have been using Tigra, is I’ve regained some of my lost confidence. I can’t tell you how important that is to me. So I’m thinking, if this product has made such a big impact on my sex life, with all the problems I’ve been having lately, I’m pretty confident that other guys, with just run of the mill erection concerns, will benefit too. Let’s face it; even if we care for ourselves, eat right, and get lots of exercise, the aging process takes its toll. Tigra might be just the lift, no pun intended, that you need to regain your sexual edge.

At the same time, I don’t want anyone to get the wrong impression. Tigra isn’t some kind of miracle potion, nor is it an aphrodisiac, whatever that is. But it does stimulate blood flow to my genitals, gives me an energy boost, it also stimulates my libido, and all that builds my confidence. Frankly, when you have all that goin for ya, ya don’t need a miracle.
Full Review HERE!

ENJOY!

Is bigger better?

Name: Marie
Gender: Female
Age: 21
Location: Florida
I’ve had sex with exactly two guys. Each one has had an average sized penis, but both thought they were small. The sex we had was nice and I was happy with it. What I don’t understand is why guys have this obsession with having a large penis? From everything I’ve read, most women don’t care about size and yet that’s all I hear about from my guy friends. What gives?

Like I always say — Nothing quite captures a dude’s imagination like his cock. Its size, shape and general appearance is a source of endless wonderment. Unfortunately, along with all that wonderment there often comes envy. I wrote a long column about much the same thing back in February — Willie Worry & Willie Pride.huge pen..

I suppose if we never had anything to compare it to, our precious willie would be the best darn willie there ever was. That’s the beauty of self-love. Funny though how a guy’s self-admiration can evaporate when he’s confronted with the sight of some other fella swinging some heavy pipe. This change in mood is pretty predictable. Some people suggest that we have been programmed to believe that big is better. And this is a throwback to when us men folk were just learning to stand upright and move about on two legs. It would have been pretty obvious what we have hangin’ down there

Since the time of our primate ancestors, humans have worshiped the male phallus. At first the representations were nothing more than crude upright pillars of wood or stone called a lingam. The Egyptians created a more exalted depiction — the obelisk — to represent the sun god, Ra’s, cock. In time, the obelisk would morph into the church steeple and the mosque’s minaret, as the preferred religion changed with the ages. When capitalism became the new creed, the steeple and minaret morphed once again into the skyscraper. Simple upright pillar or immense high-rise they’re all statements of virility, power and prestige. And isn’t it just like us to believe that the city with the biggest skyscraper wins. If this “bigger is better” sort of mentality has been going on in art, architecture and religion for several millennia, you know for sure it’s been happening on an individual level too.

tantric_lingam_stone_536   Munich, Obelisk     Toshiba Exif JPEG     Istanbul_+Blaue+Moschee+Minarette14     swirl-skyscraper

From the beginning of recorded time different cultures have designated cock size as an outer sign of a man’s inner values. The size of a guy’s dong was synonymous with his status, power, masculinity and sexual potency. Curiously, the ancient Greeks prized a puny pecker as the standard of male beauty. A big dick was an object of ridicule. Their mythology saddled the satyrs — woodland creatures with pointy satyrears, hairy legs, and short goat-like horns — with exaggerated cocks to symbolize their excess and lechery. Aristotle reasoned that a small penis was more fertile than a large one, because the semen didn’t have to travel as far and it didn’t cool as much while making its ejaculatory journey. Whatever, Aristotle!

The Hindus also cherished a tiny endowment. Men with the smallest phallus, 2-3 inches, were the beautiful ideal. They were characterized as lithe and strong. Prodigious packages of 9+ inches were compared to those of the beasts. And men who possessed them were considered worthless and lazy. Imagine trying to sell these concepts today.

Except for the Greeks and Hindus, everyone else idolized generous phallic dimensions. For example, so obsessed were the Arabs with the notion big dick superiority that the Turks of the Ottoman Empire took advantage of this mindset. It was the practice of the Turks to publicly compare the cock size of vanquished Arab leaders with the superior size cocks of their own Turkish commanders. This, in the end, effectively shattered Arab resistance.

shunga5fbooks5fpillow5fbooks5f5f77Japanese “pillow books,” an early form of Asian porn, always depicted the men with exaggerated cocks and this was always to the delight of the admiring women. In renaissance Europe it was fashionable for men to don a “codpiece,” a primitive jock strap sort of thing sewn inside a guy’s drawers. The design was obviously intended to emphasize his package. Men of modest endowment, of course, found it necessary to pad their codpiece or be the object of scorn.

Here’s a startling statistic — Dr. Barry McCarthy, author of “Male Sexual Awareness,” found that two out of three men believe their dick is smaller than average. Isn’t that astonishing? How is that possible? I suppose given this culturally induced big dick bias, it’s no wonder men, of almost every historical age and society, have been obsessed with disguising their shortcomings, or trying to develop a method to compensate for what they consider to be their woeful inadequacy?

Around two thousand years ago, men in several tribes in Africa popularized the practice of hanging a weight from their cock. Actually, many historians believe the practice harkens back to ancient Egypt. The pharaohs were known to stretch their cock and balls using weights to increase sexual pleasure. Lots of guys do this very thing today — mostly for pleasure enhancement, but there are always those who think this is an effective way to increase the size of their dick.SURMA SURI TRIBE - OMO ETHIOPIA

Hanging a weight from the end of your cock (and/or balls) will sure enough stretch the tissues that make up your shaft (and/or sack). It’s gravity at work. But this can be dangerous because this practice can diminish the circulation of oxygen-rich blood, which is essential for the upkeep of the smooth muscle tissue. And smooth muscle tissue makes up about 90% of your cock. And doggoneit, this technique simply robs Peter to pay Paul, so to speak. What lengthening might happen comes at the expense of your dick’s thickness. Just stands to reason, you have only so much cock to work with. If you pull on it; it may get longer, but it’ll also gonna get thinner.

A modern variation on the age-old stretching techniques is the traction method. A guy puts his cock in a kind of noose and either straps his wiener to his leg, or hooks it up to a traction contraption that looks way too much like a medieval torture device for my tastes. The claim here is that constant stretching, makes the cells in this area divide and multiply, thus increasing the tissue mass. There’s no arguing with the concept, people have been using this method of centuries as a means of adorning and customizing their bodies, particularly lips and ears. Consider the women of the Surma tribe in Ethiopia — they wear lip plates. Their lower lip is pierced when they are young girls and stretched with ever-larger plates over time. But what they gain in beauty, they loose in sensitivity. The same thing is true of a guy’s cock. What he may gain in size he will surely loose in sensitivity. And that’s not a good thing.

The Jelq or Milking technique is an ancient method of penis enlargement practiced in the Middle East. Traditionally it was taught father to son when the kid reached adolescence. Wealthy families sent their boys to a gym or health club where a highly trained attendant would perform the Jelq technique on the boy each day. As a result of these daily treatments the kid’s dick would develop to dimensions not otherwise attained without the method. Modern day advocates of this technique claim that milking also works on the fully developed adult penis, but I have my reservations.

The Jelq involves massaging the semi-erect cock in a rhythmic and regular manner, enhancing blood flow within the shaft. The claim is that after several months of this, one could see a size increase, both in girth and length. Long-time practitioners claim gains of several inches in length are possible, but one can only imagine how many hours that might take over the course of a year or longer. Effective jelqing demands an hour or more each day for exercises. I mean, who has that kind of free time on his hands? No wonder most men fail to complete their jelqing programs.

Old_penis_pumpPenis enlargement pills and patches proliferate on internet, but there is virtually no documented evidence that they work. All such products use herbal ingredients, like ginkgo biloba and yohimbe, which act as stimulants and vasodilators. The best one can say is that some pills may enhance blood flow, which may, in some cases, cause an ever so slightly bigger woody. Once a program like this is started, it needs to be continued for as long as you want the effect to last. Imagine how much that would cost; this stuff is expensive

Finally, the early 20th century brings the advent of modern technology to the “treatment” of impotence, or as we currently know it: erectile dysfunction. Please note, all the devices and surgical interventions of the last 100 years were initially designed to treat ED. Only later did folks begin to use these interventions as male enhancement schemes. Take the Austrian inventor Otto Ledever for example. He reasoned that if a stiffy was all about blood flow then maybe he could come up with a device that would draw blood into a cock creating an erection where there wasn’t one before. In 1917, our hero patented an airtight cylinder topped by a bulb that created a vacuum within the chamber. Insert a limp dick — pump, pump, pump and TADA! — An impressive erection resulted. There was a rub, however. When the vacuum was eliminated and the cylinder removed the “faux-erection” drained away nearly as quickly as it arrived. It was only a matter of time till our friend, Otto, discovered that ya gotta constrict the flow of blood back into the body once the guy’s peanut was engorged. And that, my friends was the birth of the cockring! Isn’t science amazing?

Good luck

Get your wood the natural way!

Hey there sex fans,

It’s Product Review Friday and I have the pleasure of welcoming yet another new company, LibidoStack, to our review effort.

Dr Dick Review Crew members, Mick, Carlos and I bring you the results of our experimentation.

LibidoStack —— $49.95 (10 capsules, one month supply)

Dr Dick: For review purposes, the manufacturer of LibidoStack sent me a package containing ten capsules in a tamperproof bubble-pack. The claim is that their all-natural herbal product is supposed to improve one’s sexual health and performance. This is equivalent to 10 doses — one capsule per dose. (My contact at LibidoStack tells me that a 10-pack is a month’s supply; a capsule every three days.)

Being the generous kinda guy that I am, I shared my LibidoStack stash with two of my fellow Dr Dick Review Crew members — Carlos and Mick. I gave my colleagues the lion share of the product. They both got four capsules equaling 4 doses. I used the remaining two myself. We will each take our turn reporting our findings. I’ll go first.

So what is LibidoStack exactly? The manufacturer says it’s a “…proprietary all natural male enhancement blend was researched and developed by our team of highly-acclaimed biochemists, and research analysts.” They claim their product will produce “…increased sexual pleasure, harder and longer lasting erections, and increased sex desire.”

The LibidoStack website list the ingredients, which they claim “consists of herbs, minerals, and amino acids.” They list the ingredients HERE! http://libidostack.com/index.php/how-it-works.html

I took the time to look up each and every ingredient listed. I found that the health benefits associated with these herbal extracts include — an increase in energy and virility; as well as antioxidant, anti-inflammatory and antibacterial properties. So if nothing else, I figured my LibidoStack experience would not harm me in any way.

My experience — I used LibidoStack on two different occasions and followed the directions on the package each time — Take one capsule with warm water 60 minutes after a meal.

Before I continue, I must confess that I always approach products like this with a healthy dose of skepticism. And I’m always on the lookout for the placebo effect — the suggestion of an effect creates the effect. But I did have two opportunities to test this product over a span of 10 days so I would have had to be very suggestible for the placebo effect to play much of a role on both occasions. And I can tell you; I’m not that suggestible.

I am familiar with the effects of Viagra and its companion drugs, Levitra and Cialis. So I do have a frame of reference when it comes to judging the effects of herbal products, like LibidoStack. I can honesty say I was pleased with this product’s performance. It works by building up in your system as opposed to producing its effect immediately.

LibidoStack had a more gradual effect than the pharmaceuticals I’ve used, but that’s not a bad thing. What amazed me is that LibidoStack is as effective as any the medically prescribed drugs I’ve tested, but it is much kinder to my system. There were no headaches, unsightly flushes, upset stomach, rise in blood pressure or altered vision. This made me very happy indeed.

In doing reviews like this there is the danger of generalizing from one person’s experience. I want to avoid this by stating every human body is unique. Each of us metabolizes what we consume in a slightly different way. Keep this in mind if you try LibidoStack. The degree of erection, as well as the time it takes to get hard on this product (or any such product, including the pharmaceuticals) will depend on one’s age, overall health and the amount of sexual stimulation one is receiving.

Oh, and this is not an aphrodisiac, people! Wood is not gonna miraculously happen on it’s own.

I also want to be clear on another point — LibidoStack is not miracle potion. It will not override an unhealthy lifestyle. But it can positively effect one’s sexual response cycle; making arousal easier, which will make one a more confident lover.

I have a couple more thoughts that I will share at the end of this review. But now I want to bring in Carlos and Mick so that they can share their findings.

Mick: “I’m sold on LibidoStack. I’ve been having erections issues since my prostate cancer diagnosis. My doc believes the problem is all in my head. He can’t find any physical reason why the plumbing doesn’t work like it should, although I do have high blood pressure. So I can’t take Viagra because of that.
LibidoStackworked fine the first time, but better the fourth time I tried it. LibidoStack doesn’t come on like a freight train; it’s way more subtle than that. Like Dr Dick said, it really boosted my confidence. And if that’s all I needed, I’m a happy guy.”
Carlos: “I’m impressed too. LibidoStack exceeded my expectations.
I’ve tried several other herbal products in my time, because Viagra is so fuckin’ expensive. But none of the other products matched LibidoStack’s performance.
I do need to say, however, that I didn’t experience the effects of LibidoStack as quickly as did Mick. Of course, I’m a much bigger guy. I also took my first two doses an hour after a full meal, just as the package suggests. I took the other two doses on an empty stomach and it worked better.”
Mick: “I discovered that too. If I take LibidoStack on an empty stomach, the effect is more immediate.
Here’s another thing I noticed. After the second dose I started having nighttime boners, a lot of them. I would wake up from a sound sleep with a raging hardon. It was like it was in my 20’s.”
Carlos: “I had that happen to me too. At first I said, ‘whoa nelly!’ My wife was surprised as hell too. I hadn’t been feeling very randy for the last six months.”
Mick: “Yeah, my partner Chuck, noticed a difference right away too. I’m gonna guess that this stuff builds up in your system and maybe a maintenance dose is all ya ever need.
I was kidding with Chuck about those warnings you see on TV, the ones that say; ‘Warning: If you experience an erection for more than 4 hours, please seek medical assistance immediately.’ I told Chuck that if I had a boner that lasted 4 hours I wouldn’t call a doctor; I’d call a hustler!”
Full Review HERE!

ENJOY

LORDY, LORDY, LORDY!

Hey Dick!
As you know, I am an escort. My business is doing very well. In fact, so well I need to ask if you know of any meds, besides Viagra, that I can take that will help me maintain an erection over a longer period of time?
Can I be frank? Here’s the deal, let’s say I have I have two one-hour clients during the day. Then a regular of mine calls and wants an all-nighter. That’s not a problem other than the fact that this particular client wants to get fucked hard. I mean real hard, for hours at a time. He’s an insatiable power bottom.
I want to be able to ride his ass, like the bitch he is. Hell, I’m even attracted to him. I just can’t stay hard enough to fuck him like he likes (especially after having had the two clients before him that same day). Sometimes I have difficulty getting it up for him, and wind up finger-fucking him till my hand is sore. I do not want to lose this client. And shifting days is not the solution. Because when he wants it he wants it and I have to produce. That’s what I do, I sell “muscle.” I have a reputation for giving the best hard driving, dominating and controlling sex around.
Again, is there a medication I can take to maintain the erection?
— Works Hard

Dear WH,

Your life reads like a cheap porn movie script. Lordy, the good doctor nearly got the vapors simply reading through your very explicit missive. (As you can see, I had to edit out some of the more gory details so I could protect your identity in this public forum.) Of course, as you suggest, it never hurts to advertise. You’re so bad!

I thoroughly understand the pressures you and other sex workers face. It’s not as glamorous a life as it is often portrayed, huh? Ok, so you’re beautiful, men idolize you and crave your attention. You’re getting loads of sex, putting all those “bitches” in their place, and crying all the way to the bank to boot. It’s a tough job, but someone’s got to do it. But then again, there are all those sniggling performance issues that even a he-man like you must contend with.

The trouble lies in the fact that you are a workaholic. And that’s never good, regardless of the work one does. Sex work, like any other work, will burn you out if you’re not careful. If you don’t learn to pace yourself, darlin’, you’ll fizzle. (How’s that for an appropriate euphemism?) And from what you tell me, this is already beginning to happen. Keep it up (no pun intended), and you won’t be the first causality in this line of work, nor will you be the last. But If you ask me, and I happen to know a little something about sex work myself, the object here is to grow old (or older in your case) in your chosen profession.

I’m tellin’ ya, WH, if the erectile burnout don’t get ya the psychological torment will. I’ll bet you’re terrified the word will get out that Mr. Big-Beautiful-29-year-old-Stud-Power-Fucker can’t get it up. That would be real bad for business. And you know how those johns can gossip. Bitches! They don’t know that you’re servicing men at a rate that would make a superhero blush. All they see is limp willie and that spells trouble right there in River City.

It’s not surprising that you are having erection concerns given the number of clients you are seeing in one day. I mean, girlfriend, when do you find time to eat? You don’t need a new med, you need a vacation. If Viagra and a good cock ring don’t do the trick, then, in my humble opinion, your body is telling you to slow the fuck down.

And here’s another tip; research is beginning to show that prolonged and persistent use of Viagra can have some very unpleasant side effects. Those who overuse this potent cardiovascular drug, particularly young men who use it recreationally, may be in for some very unpleasant surprises down the road. So, I have one simple suggestion, WH, have a care about your sexual wellbeing and treat your dick gently. Despite the pounding you can inflict with it, it is a very delicate mechanism.

Good Luck

IN THE MOOD

Hey Sex Fans!

We came dangerously close to having a fantastic Sex EDGE-U-cation podcast for ya today.  Unfortunately, my scheduled guest had technical difficulties and we had to put off the interview till next week.  Such is life!

In lieu of a podcast, we have some swell Q&A.

Name: Brian
Gender:
Age: 40
Location: Canada
After a guy ejaculates can he have another ejaculation? Like after I cum if I put on a cock ring will it stay hard enough to continue with intercourse and achieve another orgasm? I basically want to cum twice in a row.

Yep, that’s doable.  All depends on your particular refractory period and how turned on you are.  Let’s take a quick look at the male sexual response cycle again, just so we understand what we’re talkin’ about.  Ok?

The sexual response cycle refers to the sequence of physiological changes that occur as we become sexually aroused and move through to afterglow. The sexual response cycle has four phases: excitement, plateau, orgasm and resolution. Both women and men experience these phases of course, although the timing usually is very different for each gender.  In addition, the intensity of the response and the time spent in each phase will vary from person to person and from situation to situation. That’s why I say cuming twice in a row is doable.  But is it gonna happen for you?  I guess we’ll just have to wait and see, huh?

Ok, Phase 1: Excitement (or the boner stage)

  1. Muscle tension increases.
  2. Heart rate quickens and breathing accelerates.
  3. Our skin may become flushed particularly on our chest and back).
  4. Our nipples may become erect.
  5. Blood flow to the genitals increases, thus the boner.
  6. Our balls swell, our sack tightens, and we may drip precum.  Mmmm, precum!

Phase 2: Plateau (or the strokin’ or pumpin’ stage)

  1. Everything in phase 1 intensifies.
  2. Our balls may pull up into body cavity.
  3. Our breathing, heart rate and blood pressure increase.
  4. Our toes curl, face contorts and hands clench.

Phase 3: Orgasm (or the “yabba dabba doo” stage)

  1. Involuntary muscle contractions begin.
  2. Blood pressure, heart rate and breathing excelerate.
  3. There’s a rapid intake of oxygen.
  4. Muscles in the feet spasm.
  5. There is a sudden, forceful release of sexual tension.
  6. Rhythmic contractions of the muscles at the base of our cock result in the ejaculation of spunk.
  7. A “sex flush” may appear all over our body.

Phase 4: Resolution (or the “I need a nappy” stage)

  1. During this phase, the body slowly returns to its normal level of functioning, and the parts of your body that swelled and engorged return to their previous size and color.
  2. This phase is marked by a general sense of well-being, enhanced intimacy and, often, fatigue.
  3. Most women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms.

Men, on the other hand need recovery time after orgasm, this period is called the refractory period.  This doesn’t have to be the end of sex.  Like you suggest, a cockring may prevent your dick from going soft.  But don’t count on an immediate second ejaculation, even if your dick stays hard. Don’t forget, the duration of the refractory period varies and is situational.  It will also increase as we age.

Name: Ivan
Gender: Male
Age: 33
Location: Spain
I am considering the social usage of Viagra or Cialis to improve sexual performance. Which of the two would you recommend for recreational usage?

I don’t recommend recreational use of prescription drugs, particularly these vascular dilators.  And certainly not when used in conjunction with other non-prescription drugs.  Maybe you ought consider a low-tech solution like a cockring instead.

I hasten to add that I’m not averse to using some drugs recreationally.  But I think that we’d do well to stick to those that are more natural.  The less processing involved and fewer added chemicals the better, in my humble opinion.

Did you know that health officials in the UK and here in the US are investigating reports of blindness among men using Viagra and Cialis?  Why risk that if ya don’t have to.

I’m really concerned with the alarming rise in recreational use of these drugs by younger men, men in their 20’s and 30’s.  And like I said, this is even more troubling when they combine these drugs with ecstasy, cocaine, or crystal meth.  If your young body is having difficulty producing an erection at this tender age, then you need medical attention ASAP.

Besides the risk of blindness, there are several other reasons why you ought not abuse Viagra or a similar drug just so you can have wood that lasts for hours.  Your body will habituate itself to the substance and, in time, you won’t be able to get it up at all without ever increasing doses of these drugs.  This will surely fuck up your cardiovascular system big time.  In fact, you may very well be inducing the very sexual dysfunction the drug is supposed to help.

Consider the person who overuses eye drops or lip balm or any other otherwise innocuous over the counter health and beauty products.  Their bodies stop making the natural substances that these products are intended to assist.  It’s counterproductive and it’s ill advised.  And if this is a problem with relatively harmless over the counter products, you know you are playing with fire when you abuse powerful prescription meds.

Name: Yuri
Gender: male
Age: 20
Location: Russia
I want to make love kisses on my girlfriend’s vagina.  But I never did this.  What can I do?

Love kisses on her vagina, huh? You Russians are so romantique!

I think you are talkin about some good old fashioned cunnilingus, right?  Or as we say here in the US or A — eatin’ out at the Y, munchin’ carpet, muff divin’, pussy lappin’ and what have you.

If your girlfriend is as unfamiliar with gettin’ love kisses on her vagina as you are at givin’ them, you might want to give her a head’s up on what you plan to do.  Ya see some of our women folk are none too keen on the idea.  They have it in their head that their pussy is icky and not for oral consumption.  This is very unfortunate, but it is what it is.  If you think you’re gonna get a lot of resistance from your lady friend, you might start kissing her on the face and neck, then to the tops of her tits, her nipples, and her belly.  This will give her an idea where you’re headin’.  If you’re doin’ this right, hopefully she’ll be so busy enjoying herself she’ll not protest your trip south.

Proceed slowly. Make sure you’re you’re both comfortable. If you’re lying down, you best be on your stomach between her legs so that your string of kisses is as effortless as possible. Have a pillow ready to shove under her hips to raise her a bit if she’s willing to proceed.  If, by the time you get to her pussy, she doesn’t try to stop you, you’re home free.  Basically she is giving you tacit permission to proceed.  Of course you could check in with her and ask if you can continue.  But sometimes, in delicate situations like this, you may be better off keeping the conversation to a minimum.  She might be fine with it if she doesn’t actually have to agree to it.  Women are like that sometimes.

Try scooting her butt to the side of the bed while you kneel on the floor between her legs. This will give you all the access you’ll need.  And hey, don’t go divin’ right in there, for heaven’s sakes.  Take a moment to two to admire the beautiful spectacle before you.  Lordy, lordy ain’t that a sight for sore eyes.

Gently nuzzle, kiss, and lick her inner thighs and the area around her vulva.  With a little luck your gal-pal will be so aroused she’ll begin to guide your head into her snatch.  Lick her outer lips. Run your tongue up and down them. Nibble them gently with your lips. Next, work your tongue in between the outer lips to caress her smaller, thinner inner lips.  Circle her vaginal opening and perhaps dart your tongue inside her cunt.

I hope you know your way around a woman’s genitals, because If you don’t you’ll be bumbling around down there to no great effect.  And, while you may get an “A” for effort, you might very well wreck the moment by being too aggressive on her more sensitive parts.  Her clit is her magic button.  If you don’t know a clit from a hole in your head, do some research before you head south.

Approach her clit very slowly and gently.  Some women enjoy a tongue lashing directly on her clit. Others find direct contact too intense, even uncomfortable. Now is a good time to check in with her.  Ask for direction on how she wants you to proceed.  She may prefer you to circle her clit with your tongue, avoiding direct contact.

If your gal is unfamiliar with this kind of pleasure, she may not  kow to direct you.  If that’s the case, you’re gonna have to ask direct questions like:  Do you want it lighter? Or would you like more pressure? More of this?  Not so much of that?  Soon you will be able to tell on your own by observing her pelvic movements and listening to her moan if you’re doing a good job.  Sometimes the best communication is non-verbal.

While you’re down there, why not employ a couple fingers to spread things apart?  Add a little massage.  Use the tip of your tongue, then the flat of your tongue, then your lips as you move around her vulva.  All three feel a little different and each provide subtly different sensations.  Some chicks love pussy raspberries, you know…

Come up for air from time to time.  Look into here eyes, caress and massage her boobs.  Try slipping a finger or two into her mouth so she can suck them while you’re licking her. Or move into a 69 position and enjoy a little blowjob with you’re eating her out.

You may want to incorporate some ass play too.  Insert a lubed finger into her butt hole.  Just make sure that whatever goes in her ass doesn’t then come in contact with her cunt.  You definitely don’t want to introduce bacteria that can cause a urinary infection.

Good luck ya’ll