Impotence
Impotence
14 Secrets for Success
Sure it's a night you'll remember. For all the wrong reasons.
It had been a hectic week. You'd been working hard on that proposal, and never once made it home before midnight. Tonight, you were going to make it up to your wife.
You brought roses. She uncorked your favorite wine. After dinner, when you took the phone off the hook, she slipped behind you, kissing your neck in that way of hers that always drives you crazy. Everything seemed to unfold according to plan.
Everything, that is, except a certain part of your anatomy. A certain crucial part.
And that left you to wonder: What in tarnation is going on? Is this going to happen the next time? What the heck can I do about it?
Plenty. Realize, first, that you're not the only man in the world who's had this happen. "If men are honest, every one of them will tell you they've sustained an impotence episode at one time in their lives," says Neil Baum, M.D., director of the New Orleans chapter of the Male Infertility Clinic and an assistant professor of urology at Tulane University School of Medicine. "Not every incident is a ten."
"It can be devastating when it occurs," he says. "A man's whole concept of his masculinity may be undermined."
Experts say an estimated ten million men suffer from impotence, the term used when a man is unable to achieve and maintain penetration until he ejaculates.
Until the early 1970s, experts thought that most erection problems pointed to underlying problems in the psyche. Today, the medical community recognizes that almost half of all impotent men have a physical or structural problem that's at least partly responsible.
What can you do to keep erection problems at bay? Here's what our experts advise.
Give yourself time. "As a man gets older, it may take a longer period of genital stimulation to get an erection," says Dr. Baum. "For men aged 18 to 20, an erection may take a few seconds. In your thirties and forties, maybe a minute or two. But if a 60-year-old doesn't get an erection after a minute or two, that doesn't mean he's impotent. It just takes longer."
The time period between ejaculation and your next erection also tends to increase with age. In some men aged 60 to 70, it may take a whole day or longer to regain an erection. "It's a normal consequence of aging," says Dr. Baum.
Consider your medication. Drugs your doctor has prescribed might be at the root of the problem. Or it might be those over-the-counter antihistamines, diuretics, or sedatives you're using. Realize, of course, that what affects your neighbor may have no effect on you.
More than 200 drugs have been identified as problematic. Drug-induced impotence is most common in men over 50, says Dr. Baum. In fact, in an American Medical Journal study of 188 men, drugs were the problem 25 percent of the time.
If you suspect your medication, consult your doctor or pharmacist. He may be able to change the dosage or switch you to a different drug. Do not, however, attempt to do this on your own.
Beware of recreational drugs. Troublemakers that Richard E. Berger, M.D., a urologist with Harborview Medical Center in Seattle, Washington, lists in his book BioPotency: A Guide to Sexual Success, include cocaine, marijuana, opiates, heroin, morphine, amphetamines, and barbiturates.
Go easy on the alcohol. Shakespeare hit it on the head when he said in MacBeth that alcohol provokes desire but it takes away the performance. That happens because alcohol is a nervous-system depressant. It inhibits your reflexes, creating a state that's the opposite of arousal, says Dr. Berger. Even two drinks during cocktail hour can be a cause for concern, he says.
Over time, too much alcohol can cause hormonal imbalances.
"Chronic alcohol abuse can cause nerve and liver damage," says Dr. Baum. "When you have liver damage, you cause a dynamic where the man has an excess amount of female hormones in his body." You need to have the right proportion of testosterone for everything to work properly.
Know that what's good for the arteries is good for the penis. "In the last five years, it's become quite evident that the penis is a vascular organ," says Irwin Goldstein, M.D., co-director of the New England Male Reproductive Center at Boston University Medical Center in Massachusetts. The very things that clog your arteries—dietary cholesterol and saturated fat—also affect blood flow to the penis. In fact, says Dr. Goldstein, all men over age 38 have some narrowing of the arteries to the penis.
So watch what you eat. "High cholesterol is probably one of the leading causes of impotence in this country," says Dr. Goldstein. "It appears to affect erectile tissue."
Don't smoke. Studies show that nicotine can be a blood vessel constrictor, says Dr. Baum. A study of healthy adult mongrel dogs at the University of California at San Francisco showed that the inhalation of smoke from just two cigarettes was enough to prevent five dogs from getting a full erection and a sixth dog from maintaining one. The researchers believe that inhalation of cigarette smoke blocks erection by inhibiting the smooth muscle relaxation of the erectile tissue.
Do what you need to feel good about your body. Are you thinking about taking off a few pounds? Studying karate? Starting a weight-training program? Do it. "Sex is body contact," says James Goldberg, Ph.D., research director of San Diego's Crenshaw Clinic in California. "The more a person feels good about his body, the better he'll feel going into the event."
Don't overdo it on the exercise. If you exercise excessively, you'll stimulate the body's natural opiates, the endorphins. "We're not sure how they work, but they tend to lessen sensation," says Dr. Goldberg. "Over the short run, exercise is good for you. Beyond a certain point, though, the body gets into the habit of protecting itself."
Wait out pain. Your body also produces its own opiates when you're in pain, says Dr. Goldberg. These opiates can turn off any sexual stimuli. "There's not much you can do," he says, except wait for a better time.
Relax. Being in a relaxed frame of mind is crucial. Here's why. Your nervous system operates in two modes. When the sympathetic nerve network is dominant, your body is literally "on alert." Adrenal hormones prepare you to fight or take flight. Nerves shuttle your blood away from your digestive system and penis and into your muscles.
You can turn on your sympathetic nervous system just by being too anxious, says Dr. Baum. "For some men, the fear of failure is so overwhelming that it floods the body with norepinephrine, an adrenal hormone. That's the opposite of what you need to have an erection."
The key here is to relax and let your parasympathetic nervous system take over. Signals that travel along this network will direct the arteries and sinuses of the penis to expand and let more blood flow in.
Avoid whole-body stimulants. That means caffeine and certain questionable substances touted as potency enhancers. "The main thing during sex is to be relaxed," says Dr. Goldberg. "Stimulants tend to have an overall effect. They constrict the smooth muscle that must dilate before an erection can occur."
Refocus your attention. One way to relax is to focus with your partner on the more sensual aspects of intimacy. Play with and enjoy each other without worrying about that erection.
"The skin is the largest sexual organ in the body," says Dr. Goldberg, "not the penis. So don't be led by your penis. The whole body has to react."
Plan ahead. Dr. Berger thinks it is a good idea to decide in advance what you'll do if you don't get an erection. "What are your alternatives?" If you're not so focused on the erection itself, it will make it easier for the erection to come back, he says.
Talk to your partner. Don't risk increasing the tension in the bedroom by maintaining a sullen silence. Together, you can play detective and figure out what's going on. Pressure at work? Strain over a child's illness. A touchy issue you two haven't resolved yet?
"If you understand some of the things that can cause impotence, you can find a way to explain it without attributing it to something that's not there," says Dr. Berger. "And you should talk about what your alternatives are. Will you continue your lovemaking in a different way? Don't let the erection, or lack of it, interfere with your intimacy."
PANEL OF ADVISERS
Neil Baum, M.D., is director of the New Orleans Male Infertility Clinic, a clinical assistant professor of urology at Tulane University School of Medicine, and a staff urologist with Touro Infirmary in New Orleans, Louisiana.
Richard E. Berger, M.D., is a urologist with Harborview Medical Center in Seattle, Washington. He is the author of Biopotency: A Guide to Sexual Success.
James Goldberg, Ph.D., is research director of the Crenshaw Clinic at San Diego, California, and a clinical research pharmacologist.
Irwin Goldstein, M.D., is co-director of the New England Male Reproductive Center at the Boston University Medical Center in Massachusetts and is an assistant professor of urology at Boston University School of Medicine.
