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