Ali finally talked to his doctor about his erection problems. He’d been struggling for a while, but he had been too embarrassed to say anything. Then his wife Lila showed him an article about erectile dysfunction (ED) and how common it was, especially for older men. She went with him to his appointment and, with her support, he had a new prescription for a phosphodiesterase type 5 inhibitor, something his doctor called a PDE5i.
So far, it was going pretty well. He took his pill when he and Lila were starting to feel amorous, and in about a half hour, he was ready to go. Sure, they couldn’t be as spontaneous as they used to be, but that was a small price to pay for a better sexual relationship. Dina said she was enjoying their intimacy again, too.
There was just one problem.
There were times when the medicine didn’t work so well. Last week, they had their first barbeque of the season. Dina made amazing cheeseburgers, and Ali had two. Later, after a dip in the pool, they headed to the bedroom, but he couldn’t get an erection. Dina said not to worry about it, but he hated disappointing her.
Did something change with the meds?
Not necessarily. Sometimes, foods and beverages affect the way ED drugs work.
What are PDE5 inhibitors?
PDE5 inhibitors are a class of drugs designed to treat ED. They work by increasing blood flow into the penis when a man is sexually stimulated. Good blood flow is essential for a firm erection.
Four of the most commonly-prescribed PDE5 inhibitors are sildenafil, avanafil, tadalafil, and vardenafil. Viagra is now available in generic form as well.
Men who take PDE5 inhibitors still need to be sexually stimulated for an erection to occur.
How might foods interact with PDE5 inhibitors?
Foods might limit the effectiveness of PDE5 inhibitors in two ways.
the type of food might delay the erection. Some men find that their ED drugs take longer to work after they have eaten fatty foods, like Ali’s two cheeseburgers mentioned above.
ED drugs, like Sildenafil and Vardenafil, work better on an empty stomach. If a man takes them with food, the stomach needs to do double duty: digest the meal and process the pill.
Men might consider taking their pill and enjoying their sexual activity before they eat. But all men are different, so it might take some trial and error to figure out what you can eat – and how much – around that time.
What about alcohol?
Lots of men have trouble getting erections after consuming alcohol, especially in excessive amounts. Some people even call it “brewer’s droop.” Alcohol can dehydrate you, which interferes with blood flow to the penis.
The effect can be similar for men who take ED drugs. Even though PDE5 inhibitors are meant to help with blood flow, using alcohol can work against the process.
If you discover that you have trouble with erections after alcohol, even when taking an ED drug, you might want to reconsider your alcohol intake.
When should I seek help?
If your ED medications aren’t working as well as you thought they would – and you’re taking them exactly as prescribed – call your doctor. You might need to change medications or adjust the dose. Also, remember that not all men respond to ED drugs. Fortunately, there are other ED treatment options, so don’t give up hope. Patience is key; eventually, you will find the solution that works best for you and your partner.
You probably know it’s important to keep your blood pressure under control. High blood pressure (also called hypertension) can lead to all sorts of health problems, including coronary heart disease, heart failure, stroke, and kidney failure.
But did you know that high blood pressure can cause problems in your sex life, too?
What is High Blood Pressure and How Can it Affect Sex?
As blood travels through your arteries, it exerts a certain amount of force along the arterial walls. This force is blood pressure. The higher your blood pressure, the more force your blood exerts against these walls.
Over time, high blood pressure can damage the linings of your blood vessels, leading to plaque buildup and atherosclerosis – hardening of the arteries. When this happens, blood has a harder time flowing to essential parts of the body.
Since blood flow to the penis is an important mechanism for erection, many men with high blood pressure develop erectile dysfunction, which means they can’t get or keep an erection firm enough for sex.
Men with high blood pressure might have problems with ejaculation and desire, too.
Reduced blood flow to the genitals can also be an issue for women, interfering with desire, arousal, vaginal lubrication, and orgasm.
Anxiety over high blood pressure and its associated health problems can affect with the sex lives of both men and women, especially if it weakens relationships. Couples may have less desire for sex. Or they may not feel sexually satisfied.
Sexual Side Effects of Blood Pressure Medications
Unfortunately, medications used to treat high blood pressure can cause sexual problems themselves. For example, diuretics (water pills) can reduce blood flow to the penis and lower levels of zinc, which a man’s body needs to make testosterone. Beta blockers are another type of blood pressure drug that can have sexual side effects.
If you think your medication is causing sexual problems, don’t hesitate to talk to your doctor. It might be possible to adjust your dose or change the drug you take. Don’t make any changes without a doctor’s guidance, however.
Manage Your Blood Pressure
There are many steps you can take to lower your blood pressure and keep it at a healthy level. Sometimes, all it takes is changing your lifestyle a bit:
Eat a healthy diet that includes fruits, vegetables, and whole grains. You might also consider fat-free or low-fat dairy products, fish, and nuts. Keep red meat, added sugars, and alcohol to a minimum.
Cut back on salt and sodium. The National Heart, Lung, and Blood Institute recommends no more than one teaspoon of salt each day. Check the sodium content of the foods you eat. Remember, processed foods tend to be high in sodium.
Keep your weight under control. Being overweight increases your risk for high blood pressure.
Exercise regularly. Talk to your doctor about a fitness plan that’s right for you.
If you smoke, quit. Avoid secondhand smoke as well.
Reduce your stress levels. Blood pressure can rise when we’re excited or stressed. Find ways to relax and try not to overextend yourself with commitments. Ask your friends and family for help if you need to.
Your doctor can help you with these strategies and suggest others tailored to you. If you need medication, be sure to take it as directed.
For centuries, men and women have searched for foods, herbs, and other substances that could enhance their sexual experiences. The U.S. Food and Drug Administration (FDA) defines “aphrodisiac” as “any product that bears labeling claims that it will arouse or increase sexual desire, or that it will improve sexual performance.”
In 2015, scientists analyzed approximately fifty medical studies on popular products marketed as aphrodisiacs. Overall, they concluded that more trials are needed before doctors can recommend any substances. They also noted that some products could be unsafe and cause dangerous interactions with drugs one is already taking
The study identified some products that should be avoided completely due to harmful side effects:
The following products didn’t have enough data to support their use:
Horny goat weed
The authors added that there is not enough evidence to support the use of vitamins, minerals, and vaginal tightening products as aphrodisiacs.
The authors did find evidence to support the use of these products as aphrodisiacs.
However, patients should be aware that these products can still interact with other medications. For example, ginseng can interfere with anticoagulant medications, which help prevent blood clots. In addition, people with hormone-sensitive cancers, such as breast cancer, should not use ginseng.
Patients should always consult with their doctor before trying any supplement or over-the-counter product. They should also notify their doctor about any products they are currently using.
It’s important to remember that sexual desire, arousal, and performance depend on a wide range of factors. A person’s overall health, psychological well-being, and emotional state can all be involved. For example, medical conditions like diabetes and heart disease can impair a man’s erections. Women going through menopause might have trouble with vaginal lubrication. Fatigue, stress, anxiety, and relationship problems can make people less interested in sex.
If you are having a sexual issue, be sure to see your doctor. Medical treatment and sexual therapy may be needed, but your healthcare provider can tailor your treatment to your specific needs.
Mind if I smoke?
It’s not a question you hear much nowadays. Still, almost 18% of adults in the United States smoke cigarettes, according to the Centers for Disease Control and Prevention (CDC). And more men smoke than women.
Most people are aware that smoking is bad for their health. Smoking is linked to cancer, heart disease, respiratory disease, and a host of other illnesses.
What men might not know, however, is that smoking can also lead to erectile dysfunction (ED). Studies have shown that men who smoke are more likely to develop ED. And the more a man smokes – both quantity and duration of time - the worse his ED tends to be.
The good news is that quitting smoking can help restore erections. Let’s look at this relationship more closely.
How does smoking cause ED?
First, let’s go over the physiology of erections.
When a man is sexually stimulated, his brain sends signals to the penis to trigger an erection. Smooth muscle tissue relaxes and arteries widen, allowing the penis to fill with blood. When enough blood flows in, veins constrict to keep it there until the man ejaculates (or the stimulation stops). Then the veins open and blood flows back into the body.
As you can see, blood flow is critical for a good erection. Blood is what gives the penis the firmness needed for sex. When blood flow is compromised, so is the erection.
Smoking tobacco releases chemicals that interfere with this process. This can happen in a few ways.
Hardening of the arteries (atherosclerosis). Chemicals can damage the lining of blood vessels, making it difficult for blood to flow into the penis.
Damage to smooth muscle tissue. When this tissue can’t relax properly, blood flow becomes impaired.
Decreased nitic oxide. Smoking interferes with the body’s production of nitric oxide, a compound needed for erections.
Other health conditions, like diabetes and heart disease can contribute to ED, too. If you’re having erection problems, it’s important to have a full checkup with your doctor. But quitting smoking definitely can’t hurt.
Tips for Quitting
Ready to quit? Here are some tips to consider:
Talk to your doctor. He or she can give you personalized advice and refer you to a smoking cessation program in your area. Your doctor can also monitor other medical conditions that might be contributing to your erection problems and guide you toward making healthy lifestyle choices, like exercising and eating well.
Manage stress. For many people, stress and anxiety are smoking triggers. It may be easier said than done, but try your best to manage stress. If you need help, don’t hesitate to ask for it. For example, if you need a hand caring for children, see if a friend can babysit once in a while. If work is overwhelming, talk to your boss about possible changes. There are times when we need a healthcare professional to help us through stressful times. That’s okay, too. Your doctor can put you in touch with a therapist or counselor.
Get support. Tell your friends and relatives about your goal. They can cheer on your progress and encourage you when you’ve hit a rough spot. You might also consider a formal support group of people who are facing the same challenges you are.
Set mini-goals. Break your goal down into reasonable mini-goals. Instead of saying, “I’ll go 24 hours without a cigarette,” try going an hour, then two, then three.
Celebrate your successes. If you’ve met one of your mini-goals, pat yourself on the back! Quitting smoking is difficult, so reward yourself by going out with friends, catching a movie, or any other activity you enjoy.
Be Kind to Yourself. If you don’t meet a mini-goal, don’t beat yourself up. Give yourself credit for trying and resolve to tackle it again tomorrow.
Try technology. There are a number of free and low-cost smartphone apps for Apple and Android devices designed to help users quit smoking. Some will keep track of how many cigarettes you haven’t smoked and how much money you’ve saved. Some offer tips and words of encouragement, too.
Quitting smoking should make you feel better overall. You’ll feel good about yourself knowing that you’ve taken an important step toward better health – and possibly better sex!
Delayed ejaculation can be tough to deal with.
It happens when it takes a man longer than he’d like to ejaculate. Most men ejaculate within a few minutes of starting intercourse. Men with delayed ejaculation may take between 30 and 45 minutes. Some men are completely unable to ejaculate. Or, they may be able to ejaculate through masturbation but not with a partner.
It’s easy to understand why a man with delayed ejaculation would feel confused and frustrated.
Many men don’t want to admit they have trouble in the bedroom, especially when they’re unable to climax. Some have trouble talking with their partners about it, leaving partners to wonder what’s wrong. Is the man no longer attracted to his partner? Is the partner doing something wrong? Is he seeing someone else?
Today we’ll talk about some of the causes of delayed ejaculation and some treatment options.
If you are experiencing delayed ejaculation, your first step should be seeing your doctor. Sometimes, delayed ejaculation is caused something physical. For example, nerve damage from stroke, spinal cord injury, or multiple sclerosis can cause ejaculation problems.
Some medications for anxiety and blood pressure have sexual side effects. Excessive use of drugs and alcohol can also contribute.
It might even be a matter of technique. If the pressure and movement you use during masturbation is different from the way your partner stimulates you, or from the rhythm of intercourse, it might take you longer to ejaculate.
What if your delayed ejaculation has psychological roots?
This is pretty common, actually. In fact, some experts believe that most cases of delayed ejaculation stem from psychological issues, since most men are still able to ejaculate through masturbation.
Still, it can be hard to pinpoint what those psychological issues might be.
Try thinking back on your childhood or the time when you were becoming sexually aware. Were you brought up to think that sex was sinful? Did you ever feel ashamed about having sexual thoughts or feelings? Did you think you didn’t deserve to feel sexual pleasure? Were you ever caught in a sexual act that authority figures didn’t approve of, such as masturbating in the bathroom or touching someone they thought you shouldn’t?
Also think about your relationship with your current partner. Are you happy? Do you trust your partner? How do you get along? Are you fighting a lot these days? Do you give each other the silent treatment? Do you communicate your wants and needs to each other?
It may be that your delayed ejaculation is caused by a combination of these issues.
One way to work on them is through counseling. A trained therapist can help you process any thoughts and feelings that have been bottled up.
You might also consider couples counseling with your partner. A therapist can teach you both how to better communicate with each other and help you resolve any conflicts you’re having.
With any type of therapy you choose, be open and honest with yourself and your therapist. It’s not always easy. But honesty will help you get to the heart of the matter and move progress along.
Finally, let’s talk about performance anxiety. You might feel nervous about performing in the bedroom. After all, you want to satisfy your partner. You don’t want anyone to think you’re inadequate or that you can’t deliver. You might feel you have a reputation to live up to. It can be hard to relax with all this pressure.
Performance anxiety often becomes a predictable pattern. If you start a sexual encounter worried about how it will go, that worry will take over and it will be more difficult to ejaculate. That can make you worry more about the next time you have sex. And so on.
Sex therapy can help men with performance anxiety. A sex therapist can help you get your mind off performance and back to enjoying the intimacy you share with your partner.
One strategy is called sensate focus. This is a practice couples can do at home. There are variations, but it usually starts with touching, kissing, and exploring each other’s bodies without intercourse. The goal is to relax and enjoy the experience, not necessarily to ejaculate. With intercourse off the agenda, you won’t feel as much pressure to perform well.
Eventually, couples trying sensate focus do try intercourse again. Often by this time, the man’s anxiety levels have decreased and ejaculation becomes less of an issue.
Don’t suffer in silence.
No matter what you think may be causing your delayed ejaculation, you don’t need to suffer in silence. Talk to your partner and your doctor. Work together on a treatment plan designed for you.
What is testosterone deficiency?
You have probably heard about testosterone in light of men’s sexual health. Produced by the testes, this hormone drives libido, gives men their physical characteristics (like facial hair), and helps maintain muscle mass.
Some men’s bodies don’t make enough testosterone. This situation, called hypogonadism, can happen when there are problems with the testes or the part of the brain that triggers testosterone production. Hypogonadism can also be a result of chemotherapy, radiation therapy, inflammation, infection, and obesity.
In addition, men’s bodies make less testosterone as they get older. In fact, testosterone levels drop from 1% to 3% each year after a man’s 40th birthday. As a result, some – but not all – men start to have symptoms like low sex drive, fatigue, moodiness, erectile dysfunction (ED), and diminished muscle mass.
How is testosterone deficiency diagnosed?
Two criteria must be present for a man to be diagnosed with testosterone deficiency:
His testosterone levels must be lower than 300 ng/dL. Two total testosterone measurements taken on two different occasions are recommended. Because men’s testosterone levels fluctuate throughout the day, early morning measurements are the rule of thumb.
The man must exhibit symptoms of low testosterone, like the ones mentioned above – low libido, low energy, depression, ED, etc.
If a man meets only one of these criteria, then he does not have testosterone deficiency.
What is testosterone replacement therapy (TRT)?
Testosterone replacement therapy (TRT) is prescribed to some men with testosterone deficiency. This synthetic form of testosterone is typically administered through gels, patches, or injections.
What are the Recommendatios for TRT?
Clinicians should inform testosterone deficient patients that low testosterone is a risk factor for cardiovascular disease. Note: In 2015, the U.S. Food and Drug Administration (FDA) issued an advisory, expressing concerns that men who take testosterone might be at higher risk for heart attack and stroke. (Read more here.) However, the link to such events was considered controversial.
Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer. Note: There have been concerns that testosterone therapy might lead to prostate cancer, but this link has not been proven. However, testosterone can fuel the growth of existing prostate cancer cells, so TRT is not usually recommended for men with prostate cancer.
The long-term impact of exogenous testosterone on spermatogenesis should be discussed with patients who are interested in future fertility. Exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. Note: Testosterone is important for sperm production, but the synthetic form used in TRT might interfere with this process. Sometimes, sperm counts increase after men stop TRT, but this cannot be guaranteed. Men may decide to bank their sperm before starting therapy.
Clinicians should discuss the risk of transference with patients using testosterone gels/creams. Men are advised to wash their hands thoroughly after applying testosterone to the skin to avoid transfer to another person. They should also cover the application area before sex. (For example, if testosterone is applied to the shoulder, wearing a T-shirt can reduce the risk of transferring the gel or cream to a partner.)
Testosterone levels should be measured every 6-12 months while on testosterone therapy. Note: While on TRT, it’s important for men to see their doctor regularly for follow-up appointments so that testosterone levels can be assessed, and treatment can be adjusted, if necessary.
Sexual performance anxiety and erectile dysfunction (ED) are both troublesome issues, and it’s possible for a man to have both. But they do have some clear differences.
A man with sexual performance anxiety has worries about his sexual function or his ability to please his partner sexually. He might have questions like these:
Will I be able to get a firm erection?
Will I ejaculate too quickly?
Will I have an orgasm?
Does my partner find me attractive?
Is my penis big enough?
Am I sexually skilled enough?
Will my partner reach orgasm?
What will happen if my partner is not sexually satisfied?
Men who use pornography can develop sexual performance anxiety if they compare their real-life experiences to what they see in adult films and videos. Usually, such depictions are not realistic, but men may feel nervous or inadequate if they don’t perform the same way.
Sometimes, a man may become so concerned about his performance that he develops erectile dysfunction (ED). The anxiety triggers the production of stress hormones (such as epinephrine and norepinephrine) which can narrow blood vessels in the penis and make it difficult for blood to flow in and form an erection.
Erectile dysfunction (ED) occurs when a man cannot get and maintain an erection firm enough for sex. As noted earlier, ED can be a result of performance anxiety.
But health situations can affect erections, too. Here are some examples:
High blood pressure
Cancer treatment (such as prostatectomy – removal of the prostate gland)
Medication side effects
Attention deficit (especially in young men)