How might cancer patients preserve their sexuality?

How might cancer patients preserve their sexuality?

Many cancer patients face sexual problems from cancer treatment. Diminished libido, arousal difficulties, pain, vaginal dryness, erectile dysfunction (ED), and ejaculation trouble are some of the more common effects.
In some cases, patients can make decisions about sexual function when they plan their treatment with their oncology team. The following slides offer some examples.


 Testosterone is an important sex hormone for men, as it drives much of their libido and sexual function. Some men feel that their quality of life would suffer if they were not able to experience intimacy the same way as they did before cancer. They might opt for less aggressive cancer treatments that preserve testosterone levels, even if that means their prognosis is poorer.

Nerve-sparing Treatments

Nerves play an essential role in sexuality. When a person is sexually stimulated, nerves carry messages between the brain and the genitals. This starts the arousal process – such as an erection for men or vaginal lubrication for women.
Some cancer treatments, such as radical prostatectomy (surgical removal of the prostate gland) can potentially damage nerves related to sexual function. For example, the prostate gland is surrounded by nerves necessary for erections. In nerve-sparing procedures, surgeons preserve as many nerves as possible to lower the risk of ED.
Hysterectomies and colorectal surgeries may also be done in a nerve-sparing manner.

Nipple-sparing Treatments

 Women with breast cancer may choose nipple-sparing mastectomy, which preserves the nipple area. Breasts can then be reconstructed around the nipple. Women may not feel the same nipple sensations as they did before surgery, but keeping the nipples can foster a more positive body image, which contributes to better sexual function.
Keep in mind that there is no one-size-fits-all approach for preserving sexuality after cancer treatment. Patients should ask their doctors what will work best for their personal situation.
While some physical aspects can be addressed, it is still important to maintain healthy intimate relationships with partners and take advantage of products and services that can help maintain sexual function.

For example,

water-based lubricants may make intercourse more comfortable for women with vaginal dryness. Treatments for erectile dysfunction is available, and men should not hesitate to ask about them. (Note: There many approaches to treating sexual problems after cancer, and one’s doctor can provide the best advice.)
Counseling and sex therapy – alone or as a couple – may also be beneficial.

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What should heart patients know about medications and sex?

What should heart patients know about medications and sex?

Some heart and blood pressure drugs do have sexual side effects, such as a decrease in sex drive. If this happens, patients should not stop taking their medication.
Instead, patients are encouraged to talk to their doctor. It might be possible to switch to another medication with fewer side effects. It may take time to find the right medicine, but it’s important to make heart health the priority.
Also, men who are taking nitrates for heart disease should not take erectile dysfunction (ED) drugs like Viagra, Cialis, and Levitra. Taking these drugs together could make a man’s blood pressure drop to a dangerous level.
Men with ED and heart disease may need to try a different ED treatment. Vacuum erection devices and penile implants are two options. Lifestyle changes can be effective, too. An Andrologist can help a man decide what steps are best for him.

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What is a prolactinoma and how can it affect a person’s sexual function?

What is a prolactinoma and how can it affect a person’s sexual function?

A prolactinoma is a benign (noncancerous) tumor of the pituitary gland, which is located at the base of the brain. The pituitary gland is sometimes called the “master gland” and is responsible for producing a number of important hormones involved with growth, metabolism, blood pressure, and reproduction.
One of these hormones is prolactin. In women, prolactin helps with the production of breast milk. Men’s bodies make prolactin, but the hormone doesn’t have a known purpose for them.
Prolactinomas make excessive amounts of prolactin. High levels of prolactin in the blood can reduce levels of the sex hormones estrogen and testosterone.
While the tumor itself is benign, the high levels of prolactin it produces can cause serious problems for both men and women.
A woman with a prolactinoma may start having changes in her menstrual periods. Her breasts might start to produce milk, even if she is not pregnant or nursing. She might become less interested in sex. Vaginal dryness may also occur, as estrogen is important for vaginal lubrication. Some women with prolactinomas have trouble becoming pregnant.
A man with a prolactinoma might develop erectile dysfunction.
Other symptoms include headaches and vision problems. These may occur if the tumor grows large enough to compress the optic nerves, which are close to the pituitary gland.
Prolactinomas can often be treated with medication. If this doesn’t work, surgery to remove the tumor is another option. In rare cases, radiation might be used. Sexual problems usually get better once the tumor is treated and prolactin levels return to normal.
Prolactinomas are the most common type of pituitary gland tumor, but it’s not common for them to cause symptoms.  Women are more likely to get prolactinomas than men are. Scientists aren’t sure exactly why prolactinomas develop.
Men and women who are concerned about prolactinomas should see their healthcare professional. Diagnosing a prolactinoma usually involves a blood test to measure prolactin levels. Imaging tests, such as magnetic resonance imaging (MRI) or a computerized tomography (CT) scan are usually ordered so that the doctor can get a closer look at the pituitary gland and the surrounding area. Sometimes, a vision test is also done.

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Is it safe for heart patients to have sex?

Is it safe for heart patients to have sex?

For most heart patients, sex is safe. However, patients should still check with their doctor first.

Having a heart attack during sex is a common worry. But the risk is small.

Research suggests that having sex is the equivalent of a brisk walk or climbing two flights of stairs.

In 2015, the Journal of the American College of Cardiology published new research concerning sex and heart attack risk. A group of German scientists worked with 536 people who had had a heart attack. The patients answered questions about sexual activity in the year before their heart attack. Then, the scientists followed their health progress for ten years.

Sexual activity is unlikely to trigger a heart attack, the researchers concluded. Less than 1% of the patients had sex less than an hour before their heart attack. And almost 80% didn’t have sex within the previous 24 hours.

During the ten year follow-up period, there were 100 “cardiovascular events” (such as a heart attack or death from heart disease) among the patients. However, these events were not linked to sex, the researchers wrote.

Still, there are times when heart patients should not have sex. For example, a person with symptoms of heart disease (such as chest pains during light activity or at rest) should wait until the symptoms are stable before having sex.

Patients with uncontrolled high blood pressure, advanced heart failure, recent heart attack, an arrhythmia, or a weak heart muscle should not have sex until a doctor says it’s okay.

Sometimes, doctors recommend restricting sexual activity. This might mean having sex less often, playing a more passive role, or having less vigorous sex to keep one’s heart rate down.

Patients who are concerned about heart health and sexual activity should talk to their doctor. He or she can give the best advice on a patient’s personal situation.

Remember, too, that heart patients who have sexual restrictions can still enjoy intimacy with a partner. Kissing, hugging, touching, and caressing are all ways to be physically close.

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What is a penis fracture, and how is it treated?

What is a penis fracture, and how is it treated?

A penis fracture is a tear in a membrane in the penis called the tunica albuginea. This membrane surrounds the corpora cavernosa, the two long chambers that fill with blood when a man has an erection. The tunica albuginea helps maintain the erection’s firmness by keeping the blood in these chambers until the man ejaculates or until sexual stimulation ends.

Vigorous intercourse is one of the most common causes of penile fracture, especially in Western countries. Certain sexual positions, like “woman on top,” can increase the risk. Fracture can also happen if a man masturbates aggressively or rolls over his erect penis while sleeping.

In the Middle East, Africa, and Asia, the Taghaandan maneuver is a frequent cause. Men who practice this forcefully bend the shaft of an erect penis. The maneuver is sometimes compared to cracking one’s knuckles. Some men feel pleasure from it.

Sometimes, men see especially vigorous intercourse depicted in pornographic videos. They may try to imitate those actions when they are with a partner, not realizing that they could fracture their penis. Men should understand that what they see in videos is not necessarily what they should be doing in real life, and that penis fracture is a possibility.

Usually, men hear a cracking or popping noise when they fracture their penis. They might also experience pain, swelling, bruising, or bleeding.

Penis fracture is an emergency. Men who suspect they have fractured their penis should seek medical care immediately. Waiting too long could lead to erectile dysfunction (ED) later.

At the emergency department, a doctor will examine the penis and assess symptoms. He or she may also order an imaging test, such as an ultrasound. This test can help pinpoint the exact location of the tear and determine whether there is damage to urethra as well. (The urethra is the tube in the penis from which a man urinates or ejaculates semen. Recent research suggests that up to a third of men with penis fracture also have an injury to the urethra.)

Surgery is the typical treatment for a penis fracture, and it is usually carried out as quickly as possible, especially if there is damage to the urethra. In some cases, the penis is “degloved” (skin is removed) in order to expose the area that needs repair. However, some men need only a small incision.

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Stop Tramadol

Stop Tramadol

Men who take long-acting opioids for chronic pain appear to be at greater risk of developing low testosterone than men taking short-acting opioids, American researchers have found.

Opioids are pain relievers. Commonly prescribed opioids include hydrocodone, oxycodone, morphine, and codeine.

Opioids are classified as long-acting or short-acting. Long-acting opioids generally provide relief for at least 8 hours. Short-acting opioids release medicine more quickly and relieve pain for less than six hours.

Impact Of Opioids On Testestosterone Levels

The retrospective study focused on 81 men between the ages of 26 and 79 who had been taking an opioid for at least three months. None of the men had been diagnosed with low testosterone before. All of the men were being treated for chronic pain conditions (such as low back pain, chronic headaches, and rheumatoid arthritis) at Kaiser Permanente’s Santa Rosa Medical Center in California.

The hormone testosterone plays a large role in a man’s sex drive. But it is also involved with muscle mass, bone density, and mood. Low testosterone can lead to problems in all of these areas.

Normal testosterone levels are typically between 300 and 800 nanograms per deciliter (ng/dL). For this study, men were considered to have hypogonadism (low testosterone) if their total testosterone levels were less than or equal to 250 ng/dL. All levels were measured before 10 a.m.

Overall, 56.8% of the men were hypogonadal. Rates varied depending on opioid length of action, however. Of the men taking long-acting opioids, 74% had low testosterone. Thirty-four percent of the men taking short-acting opioids were hypogonadal.

After adjusting for daily dosage and body mass index, the researchers found that the risk of developing low testosterone was 4.78 times greater for men taking long-term opioids compared to those who take the short-acting variety.

No association was found between dose and an increased risk of low testosterone.

“We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks,” said researcher Dr. Andrea Rubinstein in a press release. Dr. Rubinstein is from the Departments of Chronic Pain and Anesthesiology at Kaiser Permanente Santa Rosa Medical Center.

“These medications work well for short-term, acute pain,” Dr. Rubinstein added. “It has long been extrapolated that they can also be used safely long-term to control chronic pain. We are now finding that the long-term use of opioids may have important unintended health consequences.”

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What happens if you take too much of an oral erectile dysfunction (ED) medication?

What happens if you take too much of an oral erectile dysfunction (ED) medication?

Oral medications provide a convenient way for men to manage their erectile dysfunction (ED). These drugs are called phosphodiesterase type 5 (PDE5) inhibitors.
These drugs work by relaxing smooth muscle tissue in the penis, allowing more blood to flow in when a man is sexually stimulated. This blood is essential for a firm erection.
While PDE5 inhibitors are effective for lots of men with ED, some men wonder whether they’ll see better results if they take more medicine than their doctor prescribed. But doing this can be dangerous.
Therefore, it is important to use these medications exactly as the doctor prescribes and carefully read the accompanying patient information packet. The doctor should also know what other medications or supplements a man is currently taking.
One of the risks of oral ED drug overdose is priapism, an erection that lasts for several hours. Priapism can happen if too much blood flows into the penis, causing it to swell. Some men with priapism experience discomfort or pain. But they should not take the situation lightly.
Men who have an erection that lasts a long time are urged to seek emergency medical care. When blood is in the penis for too long, it’s difficult for oxygen to reach the area. This situation can lead to tissue damage, permanent erectile dysfunction, or disfiguration of the penis.
Treatment for priapism may include draining the excess blood from the penis, medication, or surgery.
Another risk associated with oral ED medications is a drop in blood pressure. Men might start to feel weak, dizzy, and nauseated. They might start breathing more quickly, experience blurry vision, and have difficulty concentrating.
In severe cases, low blood pressure can substantially reduce the amount of oxygen that reaches important parts of the body, like the heart and brain. Eventually, these organs can become damaged.
Men who believe they have taken too much of any drug are advised to see a doctor as soon as possible and/or call their local poison control center. They should also seek immediate medical attention if they have any of these symptoms after taking an ED drug:
  • Rash
  • Hives
  • Swelling of lips, tongue, or throat
  • Problems breathing or swallowing
  • Vision problems
  • Hearing problems
Men who feel their ED medication is not working as well as they hoped should also talk to their doctor. The dose might need to be adjusted, but this should only be done under a doctor’s care. Men should also remember that these drugs are prescription medications and are not appropriate for every man. For example, men who take drugs containing nitrates should never take ED drugs.

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What is the “normal” frequency of sex?

What is the “normal” frequency of sex?

It’s human nature to wonder whether you are having more or less sex than others. But it’s a difficult question to answer.

Many factors can influence how often people have sex. Relationship status, health, and age can all play a role. Couples who are in the early “honeymoon” stage of their relationship may have sex frequently. As the relationship progresses, the rate might slow down. If they are busy with work or childcare, they might not have as much time for sex as they used to. If they have an illness or chronic pain, they might have less sex – but that might change if they’re feeling better.

The Kinsey Institute’s 2010 National Survey of Sexual Health and Behavior provides us with some statistics on the sexual frequency of men and women. Much depended on whether the respondents were single, partnered, or married.


  • Only 2% of single men between the ages of 18 and 24 had sex 4 or more times per week, but 21% of married men did.

  • Just under half of married men between the ages of 25 and 49 had sex a few times per month to weekly. This was the highest rate in this age category.

  • Age was not necessarily a deterrent to sexual frequency. Thirteen percent of single men age 70 and older had sex a few times per month to weekly. For partnered and married men in this age group, the rates were 63% and 15% respectively.


  • About 5% of single women between the ages of 18 and 24 had sex 4 or more times per week, but 24% of married women did.

  • Like the men, just under half of the women between the ages of 25 and 59 had sex a few times per month to weekly, more than their single and partnered peers.

  • Sexual frequency did decrease with age for women, although almost a quarter of partnered women over age 70 had sex more than 4 times a week, according to the survey.

Even if men and women do have sex more frequently, it doesn’t mean they are happier. Researchers from Carnegie Mellon University conducted a study of 64 couples between the ages of 35 and 65. Half the couples were instructed to double their weekly frequency; the other half were given no such instructions.

The couples answered questions about their sexual activity and their happiness. Those who had sex more frequently were not any happier. In fact, their levels of happiness decreased a bit. It appeared that being told to have more sex made it lose some of its spontaneity and excitement.

Remember that every couple is different. The “right” frequency is one that satisfies both partners. It may take time to figure this out, but putting the focus on intimacy, communication, and bonding with a partner is more important than worrying about numbers, targets, or the sexual frequency of other couples.

It’s also possible that one partner wants to have sex more or less frequently than the other. Communication is critical here, as couples need to make compromises. A qualified sex therapist can help partners with that negotiation.

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Erectile Dysfunction

Erectile Dysfunction

What is erectile dysfunction (ED)? What causes ED? How is ED treated?

Erectile dysfunction (ED) is a man’s inability to achieve or maintain an erection suitable for satisfactory sex.
To understand ED, it’s important to understand how erections occur. When a man is sexually aroused, nerves and chemicals work together to relax smooth muscle tissue and widen arteries so that the penis can fill with blood. Veins constrict to keep the blood inside the penis, forming the erection. Once the man ejaculates, the blood is released back into the body.
ED becomes more common as men get older. It’s also associated with some medical conditions, like heart disease and diabetes. In fact, an estimated 50% of diabetic men have some degree of ED.

ED can happen for many reasons, both physical and psychological:

  • Poor blood flow to the penis.

This is one of the most common causes of ED and can be the result of diabetes, heart disease, high cholesterol, and high blood pressure.
  • Nerve damage.

When a man is sexually aroused, his brain sends messages to his penis to start the erection process. But if there is nerve damage, these messages cannot be transmitted properly. Thus, conditions that affect the nervous system - like diabetes, spinal cord injury, multiple sclerosis, and stroke – can lead to ED. Erectile nerves can also be damaged during cancer treatments, like radiation therapy or radical prostatectomy (removal of the prostate gland).
  • Hormonal issues.

Men with low testosterone or thyroid disorders may have trouble with erections.
  • Medication side effects.

ED is a side effect of some medications, such as those prescribed for high blood pressure, heart disease, peptic ulcers, insomnia, and depression. Not all medications in these categories have sexual side effects, however. For example, some antidepressants do, but other antidepressants do not.
  • Peyronie’s disease.

Peyronie’s disease is a wound healing disorder marked by a distinct curvature of the penis. Many men with Peyronie’s disease develop ED, although experts aren’t sure exactly why.
  • Psychological and emotional issues.

Fighting with a partner, anxiety, depression, stress, past sexual abuse, and concerns about sexual performance can all affect one’s sexual well-being. In these cases, sessions with a sex therapist or counselor may help.
        A man’s lifestyle can also interfere with his erectile function. Smoking, obesity, drug and alcohol abuse, an unhealthy diet, and poor exercise habits can contribute to other health conditions associated with ED.

Men with ED have several treatment options:

  • Psycho-sexual treatments.

These approaches may reduce both the man’s and his partner’s anxiety, enhance arousal, and offer pleasurable options, which may reduce the man’s stress. These interventions can be performed separately or parallel to medical treatments.
  • Oral medications.

Phosphodiesterase type 5 (PDE5) inhibitors like avanafil (Stendra), sildenafil (Viagra), generic sildenafil, tadalafil (Cialis), and vardenafil (Levitra) help increase blood flow to the penis. These drugs are usually the first method patients try, but they should not be used by men who take nitrates. Patients with slow drug absorption (e.g., Parkinsonian patients) may need to wait 2-3 hours for an erection to develop after taking PDE5 inhibitors.
  • Penile injections.

Men can learn to inject medication into the penis. This medication helps blood vessels dilate, allowing more blood for erection.


  • Urethral suppositories.

These medications are inserted into the urethra at the tip of the penis.

  • Vacuum erection devices.

The man places his penis into a vacuum cylinder and pumps air out. He then places a constriction ring at the base of the penis, which keeps the erection.
  • Penile implants.

Implants (sometimes called penile prostheses) are surgically placed inside the penis and allow a man to get an erection when he wishes. Nowadays, most penile implants are inflatable devices controlled with a pump.
Men who are having trouble with erections are encouraged to see a doctor. It’s not unusual for ED to have a combination of causes. It can also be a sign of a more serious medical condition like diabetes or heart disease, so it’s important to have a complete checkup.

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Can gout affect sexual health and performance?

Can gout affect sexual health and performance?

Yes, it can – especially for men.

Gout is a particularly painful type of arthritis, caused by sharp, crystallized deposits of uric acid in the joints. Uric acid is produced when the body processes purines – substances found in some foods and beverages like liver, seafood, peas, and beer. Uric acid is usually absorbed in the blood, processed by the kidneys, and eliminated with urine. But sometimes, the kidneys don’t process uric acid properly, causing it to build up. Uric acid can also accumulate when a person eats too many foods that contain purines.
Eventually, the buildup forms sharp crystals, leading to gout. Gout often starts in the feet, especially in the big toe. But it can also form in the knees, wrists, fingers, and elbows. In addition to pain, patients with gout may experience swelling, stiffness, and redness in the affected area.
Gout is far more common in men than in younger women. Estrogen, a female sex hormone, helps the kidneys process uric acid. However, once women reach menopause, their risk for gout increases, as their estrogen levels drop substantially.
In women, gout tends to occur more in the fingers and ankles. It is also more common in women with high blood pressure and poor kidney function.
Studies have shown that men with gout are at higher risk for developing erectile dysfunction (ED). They are also more likely to have severe cases of ED.
This might be explained by a possible connection between high levels of uric acid and endothelial dysfunction. The endothelium is tissue that lines all blood vessels, including those in the penis. Problems with the endothelium can restrict blood flow to the penis, which weakens erections. As men with gout have higher levels of uric acid, this link might account for their ED.
In 2017, the journal Arthritis Research & Therapy published a large study on gout and ED in men who lived in England. They identified 9,653 men between the ages of 18 and 64 who were diagnosed with gout between 1998 and 2004 and followed them until 2015. For comparison, they also identified 38,218 men without gout who were around the same age.
The scientists found that the men with gout were at higher risk for ED. During the study period, 18% of the men with gout developed ED, compared to 11% of the men without gout.
The men with gout were also more likely to drink more alcohol, be overweight, or have medical conditions like diabetes, high blood pressure, heart disease, chronic kidney disease, and depression.
In addition, the researchers discovered that ED risk might be increased within the year before a gout diagnosis, possibly because of higher levels of uric acid in the blood.
Pain from gout can make sex uncomfortable for both men and women. Some couples try new sexual positions or have sex when medications for gout are most effective. It’s important for patients to tell their partners if a particular activity is painful and feel open to discussing other options for intimacy.
Patients with gout may take non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Other medications may be prescribed to stop production of uric acid or improve the body’s ability to process it. Eating a healthy diet that is low in purines might help relieve the severity and frequency of gout attacks.
Those who think they may have gout, particularly men with ED, are encouraged to see their doctor.

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