Tuesday, April 29, 2008

Frequent Questions on Male Sexual Health

Q How can I enlarge my sexual parts?

A The first question I have is why do you want to enlarge your sexual parts? Penis size varies considerably. Do you feel that your penis is too small for you to give your partner pleasure? If so, you should know that studies have confirmed that the penis size does not make any difference to a man or woman's sexual satisfaction. Do you worry that a small penis size makes you less of a man? If so, this is probably more of a self-esteem issue than anything else.

I urge you to work on improving your feelings about yourself and your body rather than seeking out surgery or some other solution. It's understandable that you have these concerns, as do many men in our modern-day society. We place so much emphasis on penis size, when in reality this organ is no different from any other part of your body, including your hair, nose, height, and so on. Appearances, length and width all differ, and I encourage you to try to accept yourself as you are. You might want to join our bulletin board discussion regarding penis size to interact with others with similar questions. If this continues to be a problem, I suggest that you see a therapist. Please do not have enlargement surgery, as these operations can cause permanent damage. And wouldn't you rather have a small but functioning penis than a big one that doesn't work?


Q How can I help myself last longer during sex? I have a hard time satisfying my wife during sexual intercourse.

A This is really a two-part question. There are techniques that sex therapists teach for lasting longer during sexual intercourse. For example, try holding your testicles tightly during sex (but not so that it is painful). You can also try squeezing the tip of the penis just before ejaculation. Or simply vary your rhythm so that you slow down or even withdraw completely prior to ejaculation, cool off for a while, then start again.

However, the issue of satisfying your wife may or may not have to do with lasting longer. You may be able to satisfy your wife without sexual intercourse at all! What exactly is your wife's complaint? Do you give her oral sex? Do you pay attention to her requests during intercourse? Perhaps you could try bringing her to orgasm through oral or manual stimulation before even engaging in intercourse. I would suggest that you have an open discussion with your wife about what she feels is missing from the entire sexual experience, not just intercourse. Both of you should be willing to experiment a little to make sure that you're both satisfied with your sex life.


Q I am a middle-aged man who is very interested in improving my sexual performance. Where should I start?

A If you are looking for a general improvement in the quality of your erections, a boost in sexual energy, and increased stamina, the best place to start is by looking at your lifestyle. There may be some very straightforward factors in your life that are negatively impacting your ability to perform. Ask yourself these questions:

  1. Do you eat a low-cholesterol diet with plenty of fresh fruits and vegetables?

  2. Do you take nutritional supplements?

  3. Are you a drinker or a smoker?

  4. Do you take a prescription medication that has negative sexual side effects?

  5. Do you get yourself "in the mood" before attempting sexual activity?

  6. Do you exercise?

  7. Do you wake up after a night's sleep feeling refreshed?

  8. Do you often feel "stressed out"?


For optimum Sexual Fitness, you should have the following answers:
Yes: 1, 2, 5, 6, 7
No: 3, 4, 8

Most likely, you did not receive a perfect score. Hardly any of us would. Note which parts of your life you need to change. Then begin with the easiest area to improve. For example, nutritional supplements offer a simple and satisfying way to begin taking control of your sex life. The supplement ArginMax from the Daily Wellness Company contains L-arginine, ginseng, and ginkgo biloba. These ingredients are known to help improve blood flow and may aid in helping you have more normal erections. Once you have made a change in one area, move on to the next.

Most men also report significant improvement in the quality of their erections, and therefore in their sexual performance, from Viagra. A medical consultation can determine if Viagra therapy is suitable for you.



Q I have trouble talking to women, especially pretty ones. I look at them and get all flustered that I can't think of what to say. I'm not even thinking about sex but somehow I get really embarrassed thinking that they're thinking I'm thinking about sex. What can I do?

A Almost everyone in the world, even the most outgoing and self-confident of us, gets embarrassed when trying to approach and meet a person whom we find attractive. You're normal. That's the first thing to remember. That having been said, here are some specific tips that I hope will help you out:

  1. Try thinking of something when you look at a sexy woman that's funny or in some way helps you relax. Don't get flustered...it's not about sex, and the woman is most likely not viewing it that way. This encounter is about building rapport. Imagine that you're talking to a friend.

  2. Engage in conversation. This will let the woman know that you're not thinking about sex. Ask lots of questions - get the woman to talk about she is really interested in, and let things flow naturally from there.

  3. Another thing to do is join a group where you do activities with women: try swing dancing lessons, join a book club, or become a member of the Sierra Club and take hikes in your area. Pick something that you really like to do. This will give you an opportunity to meet women in a fun, relaxing environment where you are focused on a specific activity rather than the encounter. Also, if it's something that you're good at and enjoy, you'll feel more self-confident and secure.

  4. Take risks. The more chances that you take on talking to a woman, the more success you will have!


You've already taken the first step by sending in this question. There are many benefits to a relationship and sharing with others more fully. Rather than letting your fears and insecurities rule you and limit your life, conquer them by facing them.


Q I am finding that when I ejaculate there is sometimes congealed sperm? (for want of a better description) that seems to block or reduce the flow of semen at the time of orgasm. Why is this?

A Sometimes the sperm can become congealed due to general dehydration. Are you drinking enough fluids? Another cause can be an infection. Have you had any other symptoms such as burning when you urinate? Another factor is your overall nutrition. Semen is composed of protein and fructose. Be sure your diet and supplement regimens are up to par.

If you find this is a continuing problem, seek medical attention, since advice without direct examination is necessarily limited


Q Was married for 25 years with average once a month sex (sometimes less). Initially I had numerous sex partners, but for approx. a year have a steady relationship with 30 year old very sexy woman. Initially was able to respond for sex at least twice a day. Abruptly, about 8-9 months ago, after an all day picnic outing, was unable to obtain an erection. Have since had several occasions of similar problem. Sometime it works, sometimes not. Sometimes erection is not as rigid. Now I'm worried. Have supplemented activity with Viagra, which works incredibly well; only need 1/2 of a 25mg pill for 1-2 hour performance. Would like to have sex at least twice a day. Is it possible for a man my age? By the way, I'm in excellent physical condition; work out average of 1 hr a day, every day; am 6' 190lbs, very little body fat. I'm 51, look more like 40. Feel I should be at peak performance. I love sex, especially with my woman. Any help for me?

A Having some difficulty with erections at your age is not unusual. You should be aware, however, that there is no "normal" for when and how a man begins to notice changes in his ability to have erections.

This can be the result of many causes other than disease. As we age, our nerves, hormone system, and blood vessels change. Any one of these or a combination of these may cause problems.

You mentioned that Viagra is helpful to you. Natural nutritional supplementation may also be considered in addition to Viagra. For example, the supplement ArginMax from the Daily Wellness Company contains L-arginine, ginseng, and ginkgo biloba. These ingredients are known to help improve blood flow and may aid in helping you have more normal erections. The vitamins and minerals found in ArginMax have general health benefits, too.


Q Please answer this question for me. I do not have any problems getting an erection or having an orgasm, but it happens far too quickly. My wife and I used to enjoy sex for up to an hour sometimes, now it is literally always under 4 minutes. What is going on with me, and what can I do about it?

A The medical term for your condition is premature ejaculation. It is a very common problem for men. In fact, some patients don't even last long enough for penetration. The causes of premature ejaculation are complicated. They can range from conflict between the partners to a physical problem. There are many methods to solve the problem, but it starts with communication. You and your wife should discuss what is happening and try to work together. Most techniques require your partner's cooperation. You should try to create an atmosphere that is not rushed or hurried. Give yourselves some space: for example, try going away to a hotel for the weekend. Have children entered your life or have you changed your job recently? Have you lost a parent, relative, or someone close to you? These life events can all affect your lovemaking. For details on combating premature ejaculation, I recommend buying a book on techniques. Amazon.com is a good place to start.


Q Treatments for Male Infertility

A The trauma of infertility afflicts approximately 4.5 million couples in the US today. One in ten couples who are trying to have a baby cannot conceive. Fortunately, couples can improve their chances for conception if they are evaluated and treated appropriately by a urologist and a gynecologist.

When a couple has difficulty conceiving a child, many people assume that the problem is due to a female factor. This misconception may be rooted in the fact that fertilization and fetal development occur within the female reproductive tract. However, in 50% of all infertility cases, male factors account for or contribute to the problem. Therefore it is paramount that if a couple is having difficulty becoming pregnant, both the man and the woman visit the doctor.

An evaluation for male infertility begins with a directed history and physical. The urologist should ask about your past history of non-descended testicles, hernia, mumps, testicular or venereal disease, tobacco, alcohol, and medication use, and other potential factors. He should also examine your body, hair distribution, and external genitalia.

If the cause of infertility appears to be lifestyle-related, your doctor may recommend that you make some basic changes to your daily habits. For instance, if you smoke or drink, he will advise you to stop these behaviors. He may also counsel you to take a nutritional supplement if he feels that you are not getting the vitamins and minerals that your body needs to function effectively. Zinc, for example, is crucial to sperm development and motility (movement), yet many American men do not absorb adequate levels of this mineral through diet alone.

In addition, the doctor may conduct laboratory tests including semen analysis and hormone studies. Abnormal sperm count, shape, or motility can all decrease fertility. Blood hormone levels of LH, FSH, and testosterone also indicate whether or not the body is functioning properly.

Varicoceole, an enlarged testicular vein, is the most common and most treatable cause of decreased fertility. Normally, blood drains away from the testicle via the testicular vein to the renal (kidney) vein. Forty percent of sub-fertile men suffer from varicoceole, engorgement and impaired drainage through this vein. Most urologists believe that the engorged vein interferes with testicular temperature regulation. This causes a decrease in sperm motility and concentration, and results in abnormal shape. A surgical procedure improves semen quality in 71% of cases and results in a 40-60% pregnancy rate after one year.

Another cause of infertility is obstruction of the tubes, called ejaculatory ducts, which drain the testicle to the prostate. Complete obstruction of these ducts results in total lack of sperm in the semen. Partial obstruction causes low sperm count, decreased volume, and impaired motility. The urologist can resect the junction of the prostate and the ducts to restore fertility in many cases.

In my opinion, the most exciting work on infertility is in the arena of assisted reproductive technologies. Sperm from the man is washed, concentrated, and placed in the womb by artificial insemination. With in vitro fertilization, doctors fertilize harvested eggs from the woman's womb and sperm from the man in a test tube. The fertilized egg is then implanted in the womb. The pregnancy rate with this procedure is 20%. Finally, fertilization of the harvested egg can be further enhanced by inserting the sperm directly into the egg cell, thereby increasing the chances of conception. All of these procedures can prove quite expensive, however.

Many men are infertile because they chose to be. In a procedure called a vasectomy, a form of birth control, the doctor severs the tube that delivers sperm to the semen so that the man can no longer impregnate a woman. The good news for men who now want to become fathers is that this procedure can be reversed. Urologists can use a microscope and reconnect the divided ends of the tube (vasovasotomy). The return of fertility rate is good as long as the repair is done within five years of the initial procedure. Unfortunately, the success rate drops dramatically after five years


Q I am a healthy male aged 28 and work out regularly to stay fit. But have a crooked shape of the penis. Is this because of my masturbating since a young age of 10-11 years? Pls advise. Also please advise if this has a medical or any other form of remedy. Hope this does not come in the way of healthy sexual life.

A I can assure you that masturbation does not cause any physical deformity of the penis and is in no way harmful to your health. Don't worry, this is not something that you did to yourself.

A crooked penis may be natural and normal, but it may also be cause for medical concern. You may have a medical condition such as Peyronie's Disease, a curve in the penis that often appears suddenly and may be quite painful during an erection. Peyronie's Disease can sometimes be treated with supplements or surgery. I strongly urge you to consult a medical professional, preferably a urologist, to find out what the problem is, if you have one, and how it might be treated


Q I have lately lost all interest in sex. I am seldom aroused. My last sexual encounter was a month ago and I performed adequately. (I was a little surprised by that). I have scar tissue in my urethra and I use a catheter in order to keep a steady flow. It seems that I perform better after I've been dilated. I am a little stressed out and have gained some weight. (I'm working on both of those). Generally neither of these factors greatly impact my performance. I am also not maintaining a strong erection when having sex. I was checked recently for diabetes (negative). I have a great deal of gas (more after sex) and I was planning to get checked for a peptic ulcer. I am drinking Ginseng tea, saw palmetto tea, and gingko biloba tea. What else can I try? Last part of a long question are there doctors in the San Francisco / Oakland area that you recommend. Thanks for your help.

A Unfortunately, your question has no simple or straightforward answer. That's because any one of the conditions that you listed could be the cause of your lack of arousal. In fact, stress, urinary discomfort, ulcers, lack of exercise, and poor nutrition can each result in sexual problems when experienced alone. As with any complex system, (and the erectile mechanism is complex), different factors may also act together to cause difficulty. So it's impossible for me to diagnose the specific origin of your problem, and therefore I cannot recommend an appropriate treatment.

You should definitely see an urologist for a complete physical, including lab tests. Be sure to discuss with your doctor all of the contributing factors that you mentioned to me. He or she may then recommend treatments as varied as a new diet and exercise program, medications, or possibly even surgery. Dr. Tom Lue at the University of California, San Francisco is well known in the field of impotence.


Q What is the best way to stimulate your appetite for sex? Natural food? No drugs?

A There is no such thing as an "aphrodisiac": no food that you can eat that will magically and instantly stimulate your sexual appetite. Anyone who tells you otherwise is trying to sell you a snake oil or magic potion. However, there are many nutrients, vitamins and minerals that will enhance your sexual performance, especially if you consume large amounts over an extended period of time (more than 4 weeks).

One option is to take a supplement containing these nutrients. The ingredients in them are all available in natural foods, but usually in much lower quantities. An amino acid, Arginine is critical to male erection. The nutrient exists in naturally in dairy products, meats, and nuts -particularly peanuts. Niacin and many of the other B vitamins that contribute to sexual function can also be found in these protein foods.

Vitamins A, C, E and folic acid are needed for ovarian fertility and sperm production, as well as for healthy mucous membranes and skin. These vitamins are highest in leafy green vegetables, and most orange colored fruits and vegetables. Vitamin E is high in vegetable, nut and seed oils.

Minerals needed for prostate gland health and sperm production include zinc and selenium. These minerals are high in shellfish, such as oysters and clams, and in whole grains, nuts and seeds.

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