Blog #138 Andrew Siegel MD
“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”
God’s Doodle: The Life and Times of the Penis
The term ED (Erectile Dysfunction) is commonly bandied about these days. There are plenty of men who do not have a dysfunction, but simply do not have quite the function they had when they were younger. Their “plumbing” is intact and they function without complaint from their partner, but things are just, well… different from the way they were.
Simply stated, change is to be expected coincident with the aging process. Performance ability with respect to virtually any physical activity will decline with aging and this explains why most professional athletes are in their twenties or early thirties. Everything eventually goes to ground, but hopefully does so slowly.
Young men can achieve a rock-hard erection simply by seeing an attractive woman or thinking some vague sexual thought. As we get older, it is not uncommon for erotic thoughts or sights to be insufficient to provoke an erection, with the need for direct “hydraulic” assistance through touch. Some of the common male sexual changes that occur with aging are the following: diminished sex drive; decreased rigidity and durability of erections; decrease in volume, force, and trajectory of ejaculation; decreased orgasm intensity; and an increase in the time it will take for recovery before being able to get another erection (refractory period).
Altered sexual function can present in various forms, dimensions and magnitudes. Some men can achieve a very rigid erection readily capable of penetration, but then, much to the bewilderment and dismay of its owner, display a short “attention” span and deflate before business is fully conducted—one might refer to this as penile attention deficit disorder (PADD). (See Urban Dictionary for full definition—guess who coined this term!)
Other men are capable of obtaining, at best, a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating. For some, an erection is but a pleasant memory lodged deep in the recesses of the mind. So what can a man do?
For starters, good lifestyle habits are first-line measures. Proper eating habits, exercise, adequate quality and quantity of sleep, tobacco avoidance, use of alcohol in moderation, stress avoidance, and a balanced lifestyle are simple means of optimizing sexual potential. The “golden rule” is relevant to one’s penis: Be nice to your penis (in terms of a healthy lifestyle) and it will be nice to you; treat your penis poorly and it will rebel…and no one wants a rebellious penis!
Pelvic floor muscle exercises are a first-line measure for helping to manage erectile dysfunction. When the pelvic floor muscles contract, they increase blood flow to the genitals, specifically by the actions of the two muscles—the bulbocavernosus and ischiocavernosus—that become engaged at the time of an erection. Contractions of these muscles help prevent the exit of blood from the penis, enhancing rigidity. With each contraction of these muscles, a surge of blood flows into the penis. Additionally, they act as powerful struts to support the roots of the penis, the foundational support that, when robust, will allow a more “skyward” angling erection. It stands to reason that if you can increase the strength, tone and conditioning of these muscles through pelvic muscle floor training, they will function in an enhanced manner—namely more powerful contractions, and more penile rigidity and stamina.
What to do when one employs lifestyle measures and pelvic exercises, but the rebel-down-below still displays some degree of penile attention deficit disorder? One should stick to the lifestyle measures and the exercises, but consider adding a pill to the regimen.
The Rolling Stones’ song, “Mother’s Little Helper,” referred to Valium in terms of a little yellow pill. In 1998, a little blue pill was manufactured that could be considered “Daddy’s Little Helper”—aka Viagra. This medication was discovered by chance. In an effort to treat high blood pressure and chest pain, Pfizer scientists conducted a clinical trial with this experimental medication that caused blood vessels to dilate (open). It did not work particularly well for the intended purposes, but had a side effect in that it dramatically improved erections. When the study ended, the participants were profoundly disturbed that the drug was no longer available. The rest is simply history.
The PDE5 Inhibitor class of medications includes the following: Viagra, Levitra, Cialis, and Stendra. Stendra is now FDA approved and available as of last week.
Viagra (Sildenefil). Viagra was born as a fusion of the words “vigor” (physical strength) and “Niagara” (the most powerful waterfall in North America). Viagra is available in three doses: 25 mg, 50 mg, and 100 mg. It is taken on demand and once swallowed, it will produce an erection in most men within 30-60 minutes if they are sexually stimulated, and will remain active for up to 8 hours.
Levitra (Vardenefil). This is an oral medication similar to Viagra, available in 5 mg, 10 mg, and 20 mg doses.
Cialis (Tadalafil). This is an oral medication similar to Viagra, available in 2.5 mg, 5 mg, 10 mg, and 20 mg doses. The fact that it lasts for 36 hours or so has earned it the nickname “the weekender,” as it can be taken on Friday evening and remains effective for the remainder of the weekend without the need for an additional dose. This affords a considerable advantage in terms of spontaneity. In 2012, daily lower doses of Cialis were FDA approved for the management of urinary symptoms due to benign prostate enlargement.
Who Knew? Cialis—a pill that helps erections and urination…now that’s a winning combo for the aging male. Talk about killing two birds with one stone!
Stendra (Avanafril). This supposedly has the advantage of a very rapid onset of action. It is available in 50 mg, 100 mg, and 200 mg doses.
These medications are not for everybody and are not effective in everyone. However, for many, they are highly beneficial in treating ED and in improving erectile function that may have diminished a bit over the years. Many men use a low dosage (typically one-quarter of the full dosage) of these medications “recreationally,” meaning that they can function perfectly well without the medication, but with it their function is enhanced significantly.
BOTTOM LINE: If you are experiencing ED or just some changes in function, there are several courses of action to improve the condition: first-line treatments include a healthy lifestyle as well as pelvic floor muscles exercises to increase erectile strength, endurance, stamina and rigidity. Should these measures fail to restore erections to the degree desired, there are oral medications that can prove beneficial. And if pills don’t help enough, us urologists have many other tricks up our sleeves, but that is a topic for another day.
TAKE HOME MESSAGE: Even if you are young and functioning superbly, pursue a healthy lifestyle and do pelvic floor exercises to maintain that functional status!
Andrew Siegel, M.D.
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Author of: Male Pelvic Fitness: Optimizing Sexual and Urinary Health; in press and available in e-book and paperback formats in March 2014. www.MalePelvicFitness.com
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food:www.promiscuouseating.com
Author of Finding Your Own Fountain of Youth: The Essential Guide For Maximizing Health, Wellness, Fitness & Longevity (free electronic download) www.findyourfountainofyouth.com
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Tags: Andrew Siegel MD, Cialis, ejaculation, erectile dysfunction, golden rule, healthy lifestyle, Levitra, male pelvic fitness, orgasm, pelvic floor muscle exercises, pelvic floor muscle training, penetration, penile attention deficit disorder, refractory period, rigidity, sex drive, Stendra, Viagra