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Growing Healthy podcast


Dec 18, 2017

Lets talk about sex....and all the things that can cause trouble to make it challenging for men!  right after this quick reminder......

AP: The Growing Healthy Podcast and website is meant for general medical information only.  this does not apply to every situation.  If you have questions, or if you have received different advice please contact your health care provider.  

MK: The views expressed by growing healthy and our guests are not representative of any institution with which we are affiliated.

MK: So Alicia....who would have thought sex was so complicated!!

AP: I know...so many different systems that have to come together at the same time to make an enjoyable and effective event happen!  We thought we would start with male sexual dysfunction and tackle female sexual dysfunction at a later date. 

MK: So I took this quote from up to date...which gives you a sense of the complexity of what we always think of as a fairly automatic thing....
"Normal male sexual function requires interactions among vascular, neurologic, hormonal, and psychological systems. The initial obligatory event required for male sexual activity, the acquisition and maintenance of penile erection, is primarily a vascular phenomenon, triggered by neurologic signals and facilitated only in the presence of an appropriate hormonal milieu and psychological mindset."

What that means is that to get an erection men need to want to, and have the proper amounts of hormones with properly functioning blood vessels and nerves....a lot to coordinate with a few areas for things to go wrong!

AP: Lets talk a bit more about normal erections.  When men are younger, like teenagers, most erections are influcenced by thoughts and visual stimuli, these are called psychogenic and as men age these occur less, and erections become more as a response to touch and these are called reflex erections.  Most men have nocturnal erections which occur 3-4 times a night, and most men will awaken with an erection in the morning.  Nocturnal erections occur during REM sleep, and so those men who do not achieve REM sleep, for instance those who sleep fitfully or those men who are depressed may not have nocturnal erections. 

Erections occur when blood flows into certain chambers in the penis and cause a certain amount of pressure that stops the flow out of the penis.  And this is all controlled by a substance called nitric oxide....so you need proper blood flow and the appropriate amounts of nitric oxide. This nitric oxide proves an important factor in erectile dysfunction...so dont forget about it!

The hormone testosterone plays two roles...one back to the nitric oxide...it helps makes sure there is enough in the penis, and it increases the libido, or desire for sex. 

MK: There are certainly some normal age related changes when it comes to sexual function and these include delay in erection, diminished intensity and length of orgasm and decrease force of ejaculation.  It is reported that about 39% of men between 75-85 yrs of age are still sexually active. 

MK: Lets talk about sexual dysfunction....and the different ways this can present...

AP: Sure... decreased Libido - this occurs in about 5-15% of men, it can be as a result of many things including medications, systemic illness, relationship challenges, alcholol and drug use, low testosterone, fatigue and depression to name a few.  Many of these are manageable, so if you suffer from any of these make sure you talk to your health care providor. 

AP: Erectile dysfunction: which is basically the recurrent inability to get or keep an erection that is rigid enough for intercourse. This too can happen for a variety of reasons. This certainly increases with age, often because as we age we get more of the medical conditions that can contribute to this. We know that the fitter and healthier you are the lower the risk of you having erectile dysfunction.  Diabetes, obesity, smoking (it decreases your nitric oxide), high blood pressure, high cholesterol and cardiovascular disease are the highest predictors of getting erectile dysfunction.  Obstructive sleep apnea is also associated with erectile dysfunction, as is prostate cancer treatment. It is so important to talk to your health care provider about erectile dysfunction, as it may be one of the symptoms of these other medical issues, that needs to be investigated and managed appropriately.  

About 25% of cases of erectile dysfunction can be linked to a medication men are taking, so it is important to discuss this with your health care provider and review your medications. 

MK: I imagine nerve problems such as Spinal cord injuries, or strokes can also increase the risk for erectile dysfunction

AP: yup they sure can, as can hormonal levels. 

AP: Hormones, including both testosterone and thyroid can also play a role in erectile dysfunction, and erectile dysfuction can improve if low states are corrected. 

MK: So when looking at treatments, we really need to identify the cause.  For example, if there are significant relationship stressors or depression - those issues need to be addressed with counselling to help improve symptoms.  If a man is obese and smokes and has poor health generally, hopefully optimizing all of those things will help to decrease the dysfuction.  If testosterone is low, then we can consider supplementing with testosterone once all other issues have been optimized.  Can we talk about our first line therapy for erectile dysfunction. 

AP: Our first line medical therapy with issue with erectile dysfunction are the PDE-5 inhibitors such as Sildenafil(Viagra), vardenafil (Levitra)  and tadalafil (Cialis).  These all work in the same way, but have different lengths of action and some will work more quickly than others.  They act to increase that Nitric Oxide we were talking about earlier....but they only work if there is interest and desire there.....and just like you see in the movies...you should not take these if you are using nitrates for heart disease or a few other medications.   Please have a good review by your health care provider prior to using these medications, if you have heart problems they can cause big troubles!!! 

If these medications do not work, there are vacuum devices, drugs that you can inject into your penis and penile implants. 

MK: Great, so we have reviewed decreased libido, and erectile dysfunction, what is the third type of sexual dysfunction?

AP: Premature ejaculation is the last topic we are going to discuss today.  This is defined as < 1-2 minutes until ejaculation with no ability to control this and distress to the man or his partner.  There are a few ways to help optimize this.  Most of these treatments centre around decreasing the sensation of the penis.  So the first option men can try on their own is condoms.  Another option which is simple is the start stop method, which basically gets men to stop the stimulation when mid level excitment is present. and restart when excitement has decreased.  See show notes for more details on this. There is also a squeeze technique which is just that, squeezing the penis before ejaculation occurs to decrease the erection.  

https://www.cua.org/themes/web/assets/files/pdf/consumers_handbook/31-premature_ejaculation.pdf

We can also try treatments with medications if these methods do not help.  These are  often an antidepressant or SSRI, a topical anesthetic cream or spray applied to the glans penis 5-10 min prior to intercourse to decrease the sensation and psychotherapy or counselling to improve confidence, communicaiton and thereby increase the time to ejaculation.  the most beneficial is a combination of medical and psychological...which tends to be the case for most things in life!!!

MK: Well there you have it....Male sexual dysfunction.....Make sure you talk to your health care provider, it is very common and there may be some relatively simple things that can improve your ability to and enjoyment of sex.  Keep on Growing Healthy!