Posts Tagged ‘nervous system’

Performance Anxiety (Stage Fright)

June 6, 2015

Andrew Siegel MD  6/6/15

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(Thank you, Wikipedia Commons for the use of the image above)

No matter how sexy you think sex is, it comes down to some very unsexy biology, chemistry and physics. I will briefly review the science of the male sexual response and how certain chemicals in the right place at the right time can cause you to be a real Romeo, or alternatively, doom you to having a soft-as-a-marshmallow, good-only-for-standing-up-when-you-pee penis.

“It is like a firstborn son—you spend your life working for him, sacrificing everything for him, and at the moment of truth he does just as he pleases.” Gabriel Garcia Marquez, Love In the Time of Cholera

“The penis does not obey the order of its master, who tries to erect or shrink it at will. Instead, the penis erects freely while its master is asleep. The penis must be said to have its own mind, by any stretch of the imagination.” Leonardo da Vinci

Sex Ain’t Simple Sex is a complicated event that depends upon a number of systems working together in harmony: The endocrine system (produces sex hormones), the central nervous system (where sensations of sexual arousal are experienced and processed), the peripheral nervous system (provides nerve control), the vascular system (blood flow) and the pelvic floor muscles (elevate penile blood pressure to provide rock-hard rigidity).

The Mind-Body Connection The mind-body connection is nothing short of profound and one’s emotional state—which obviously varies from moment to moment—is responsible for the release of a “cocktail” of internal chemicals that can make or break an erection, despite all of the aforementioned systems being in perfect working order. In other words, one’s internal “biochemical environment” at any given moment in time can influence these systems in such a way that may lead to a bone-hard erection or at times, no erection at all.

Stress—The Erection Killer Under certain circumstances—particularly stress—internal chemical release can cause a situational erection problem. Performance anxiety (stage fright—the stage usually being the bedroom) is often due to emotional stress that causes the release of adrenaline, the “flight or fright” chemical that causes tightening of blood vessels and restricts the blood flow to the penis. This is the same chemical that causes one’s pupils to dilate, blood pressure to rise and pulse and breath to quicken. Adrenaline is a great chemical to have onboard when you are in precarious situation, such as being chased by a lion in the jungle. By causing dilation of the pupils, a rise in pulse and blood pressure and rapid breathing, it prepares you to confront the danger in a turbo-charged state so that you can perform optimally. The last thing on your mind in this situation is sex, and by restricting blood flow to non-vital organs including the penis, blood flow is directed to where it will best serve you to get out of the precarious situation. So, stress does not belong in the same sentence as sex, and when it does, it is a formula for a losing situation. Emotional stress can have many causes including a new sexual partner, worry about getting an erection, guilt, work concerns, worry about child care or caretaking of parents, financial woes, unemployment, or life in general (who isn’t stressed?). For some men, the stress of having to wear a condom can cause the inability to obtain or loss of an erection, known as condom-associated erectile dysfunction.

Fact: On the rare occasion that a man has a prolonged erection (a.k.a. priapism), an adrenaline-like drug needs to be injected directly into the erectile chambers of the penis in order to cause the erection to subside. When anxiety strikes, adrenaline is precisely what dooms your erection. The adrenal glands pump out adrenaline, which circulates to all organs, including the penis, and presto, the blood flow to the penis is choked off and the erection is history.

The Chemistry Of Love With erotic stimulation or touch, the erectile chamber nerve (cavernosal nerve) releases nitric oxide, which in turn causes the release of cyclic guanosine monophosphate (cGMP). This causes the erectile chamber arteries (cavernosal arteries) to dilate and blood to gush into the penis and also causes the smooth muscle of the erectile chambers to relax, allowing space for blood to fill the chambers. You now have a plump penis, congested with blood. The pelvic floor muscles then engage and further increase the pressure within the erectile chambers, and voila, you have a rigid erection. After ejaculation, the enzyme phosphodiesterase (PDE) is released. PDE is the flaccidity chemical that by decreasing levels of cGMP, results in a return to the flaccid state by a reversal of the aforementioned chemical mechanisms. Viagra, Cialis, Levitra and Stendra work by inhibiting PDE.

Let’s say that you are emotionally stressed before entering an erotic situation or become stressed after it has started. Enter adrenaline in high enough levels and that erection will never occur or if it does so, will rapidly be lost. Adrenaline is your friend in life and death situations, but not in the bedroom!

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and Private Gym website The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.

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Bicycling and the Bedroom: Boom or Bust???

July 4, 2014

Please note that although the discussion that follows is specifically about cycling, it is relevant to any activity that places prolonged pressure on the saddle region of our bodies, including motorcycle, moped, and horseback riding. Also please note that this blog was published in an abridged version in the July 2014 edition of Masterlink, the newsletter of the Bicycle Touring Club of North Jersey.

Historical Trivia: Hippocrates reported sexual dysfunction among the wealthy residents of Scythia and judged excessive horseback riding to be the culprit.

Indisputable Fact: When sitting on a saddle, one places a much greater amount of body weight on the perineum (area between the genitals and anus where the genital blood and nerve supply lives) than one would otherwise, putting anatomy that is usually well protected into a vulnerable situation. The million-dollar question is whether or not this has the potential for a permanent injury.

Bottom Line: Cycling is an enjoyable recreational sport that provides a fabulous low-impact aerobic workout. It can result in outstanding cardiovascular health and fitness, the achievement of which is beneficial to sexual health. However, unlike running or swimming, cycling necessitates human interfacing with machine and contact points between the cyclist and the bike; these include the hands (on handlebars), feet (on pedals) and perineum (on saddle). Long distance cycling—in which prolonged time is spent in the saddle—can potentially adversely affect sexual function by causing compression trauma to the nerves, blood vessels, and muscles that support genital health and sexual function in both men and women.

As shocking as it seems, the male and female genitals are much more similar than one might imagine, as they share a common embryological origin. In embryological terms, the penis and the clitoris are the same structure, as are the scrotum and outer labia. The female is the default model that develops in the absence of testosterone; however, in the presence of testosterone, the clitoris becomes masculinized into the penis and the labia majora fuse to become the scrotum. Also virtually identical are the genital blood and nerve supply as well as the perineal muscles that support the genitals. What is different among the genders is the pelvic bone anatomy, with women having a much more open pubic arch and a wider distance between the ischial tuberosities (sit bones). Because of the perineal anatomical similarities among the genders, both men and women are susceptible to activity-related perineal trauma.

Healthy sexual functioning requires the on demand delivery of adequate volumes of oxygenated blood to the genitals. In terms of male sexual function, this penile surge of blood can occur within seconds and blood flow is increased by a factor of 40-50 times over baseline, a marvel of human engineering.1 Any compromise to blood flow may adversely affect a man’s ability to obtain and maintain an erection. With regard to female sexual function, blood flow compromise can negatively impact the ability to attain clitoral engorgement and vaginal lubrication.

The following is a simplified version of what happens in an arousing sexual situation, important foundational information for understanding why prolonged time in the saddle may potentially compromise sexual function. Under erotic circumstances, genital nerves release chemical mediators that increase arterial flow. Blood floods into the genitals and engorgement of the vascular sinuses of the penis and clitoris occur. As the process continues, the penis and clitoris become increasingly rigid. The bulbocavernosus and ischiocavernosus muscles of the perineum engage, their contractions further supporting penile and clitoral rigidity. In the female, the increased blood flow results in lubrication to the vagina. At the time of orgasm, the perineal muscles in both men and women contract rhythmically and in the male they facilitate ejaculation by propelling semen through the urethra.

Every tissue of our body is reliant on the nervous and the vascular systems for proper functioning. The nervous system is the electrical circuitry that provides sensation to touch, the ability for muscles to contract and thus motion, and the message to blood vessels to change in diameter. The vascular system is the lifeline of blood vessels that bring oxygen and nutrients to our tissues. The pudendal nerve is the main nerve of the genitals and is situated in the perineum. It provides sensation to the penis and clitoris, scrotum and labia, anal area and perineal skin, as well as motor function to the perineal and pelvic floor muscles. If the pudendal nerve gets traumatized it can cause numbness, a “pins and needles” sensation, and altered functioning of the perineal muscles. The pudendal artery is the main artery of the genitals and is also situated in the perineum, providing blood to the penis and clitoris, scrotum and labia, perineum and anus. It, too, must function properly as it is vital for sexual health.

Prolonged time in the saddle can compress and thereby “stun” the pudendal nerve and artery and can traumatize the perineal and pelvic floor muscles that support sexual function and are essential for penile and clitoral rigidity. Furthermore, the internal aspect of the penis and clitoris (the “root”) is anchored to the pelvic bones and is also subject to perineal compression as is the scrotum in men and the labia in women. The downward force of the cyclist’s weight while tilting forward on the saddle generates extreme pressure on the perineum that pinches the pudendal nerve and artery against the pubic arch.2 Both the duration and the magnitude of compression are factors in determining the degree of pudendal nerve and artery trauma.3 Pressure maps of the perineum demonstrate particularly high pressures on the saddle nose, under the cyclist’s pubic bone.4

Further compounding the issue is that there is a “steal” of blood flow from non-essential areas (including the genitals) to the muscles that are being utilized for the sport—in the case of cycling, the lower extremities being responsible for most of the work. Between the compromise to the penile and clitoral blood flow and the nerve supply, the direct effect of the compression of the perineal muscles and roots of the penis and clitoris, and the steal, there is a perfect storm for sexual dysfunction.5 Moreover, many cyclists are lean and their paucity of body fat does not provide much padding and insulation that could potentially offer some relief from saddle pressure. Over time, with repeated perineal stress to the pudendal nerve and artery, perineal muscles, and penile/clitoral roots, permanent damage may lead to sexual dysfunction.

Cycling-induced sexual dysfunction is a complex issue with multiple factors involved including the specifics of the geometry and hardness of the saddle, the anatomical variations of the individual, the amount of time spent in the saddle, the weight of the cyclist, the intensity of the cycling effort, and the particular style of sitting, which is nuanced and variable. Greater saddle width and the absence of a saddle nose have been demonstrated to be the most important factors in preventing arterial compression.6 If the saddle is not wide enough to support the ischial tuberosities (sit bones), then body weight is borne by the perineum. The wider saddles provide greater surface area that may allow the ischial tuberosities to bear more of the body weight.7,8 To reduce perineal compression, the back part of the saddle should be at least as wide as the distance between the two ischial tuberosities.9 However, too wide is no good because it may chafe the inner thighs. It is important for a saddle to be flat enough because if there is too much curvature, the center of the saddle can push up on the perineum and cause compression.

In addition to wide enough and flat enough, it is important that a saddle is firm enough. Gel saddles actually cause more trauma than unpadded saddles by virtue of the body sinking into the soft padding and the saddle thus squishing up into the perineum.10 The reduced surface area of saddles with a narrow cutout can actually increase the extent of the perineal pressure11 (on the edges of the cutout); however, for those cyclists who find that if they have a saddle that is sufficiently wide, flat and firm yet remains uncomfortable, they may need a cutout to help relieve some of the perineal discomfort.4

A horizontal or even downward-pointing saddle position has been associated with reduced perineal pressure.12 Heavier riders exert more pressure on their saddles than lighter riders.13 Lower handlebars may exacerbate perineal stress by forcing the rider to lean forward, putting more body weight on the perineum.14 Schrader15 did a study of male police officers recruited from several U.S. metropolitan areas who spent many hours a week in the saddle, testing the effectiveness of no-nose ergonomic saddles. After 6 months in a no-nose saddle, there was a significant reduction in saddle contact pressure with the perineum, improvement in penile sensation and better erectile functioning.

As a cyclist goes from sitting upright to the bent over aerodynamic position, the torso and pelvis rotate forward and the ischial tuberosities are lifted off the saddle surface, shifting more weight onto the perineum.4 This is clearly a superior position for time trials and triathlons, but inferior for one’s genital health. On the other extreme, when standing on the pedals, there is no perineal pressure and studies have shown that genital oxygenation is significantly increased.16,17 Interestingly, professional cyclists place less pressure on the saddle and appear to “float” over it.6 Mountain bikes have been associated with a greater degree of sexual dysfunction than road bikes,18 likely because of the additional perineal hammering and vibrational trauma from cycling over rough terrain; however, this is balanced to some extent by the use of suspension mechanisms, the increased time spent out of the saddle and more frequent dismounts.

The sexual dysfunction that may occur after a prolonged bike ride is often temporary, but can potentially become permanent if the perineum is subjected to chronic, sustained and repeated pressure trauma. It is much less likely to occur with recreational weekend cyclists and commuter cyclists who do not log in significant miles and more likely to occur in serious road cyclists and mountain bikers. It is estimated that 5% of men who cycle intensively have moderate to severe erectile dysfunction, and the number may be higher because many men are too embarrassed to discuss the issue or fail to make the connection between cycling and the resultant ED.13 Female cyclists have not been studied as closely as have male cyclists, but clearly cycling is potentially hazardous to a woman’s sexual health. Studies have shown that women cyclists as opposed to runners had significantly higher genital vibratory thresholds (reduced sensation) of the clitoris, perineum, vagina and labia.19

The first clue that trouble may be lurking is unusual sensations including genital numbness and tingling, symptoms commonly experienced by cyclists, correlating with time spent in the saddle.20 These are signs to shift position and perhaps assume a standing posture on the pedals to allow the symptoms to subside. Frequent subtle adjustments by shifting and shimmying and making an effort to sit on the ischial tuberositiesare helpful. Other measures one can take are wearing well padded cycling shorts and investing in a well-fitted seat tailored to the specifics of one’s anatomy. The saddle needs to be carefully adjusted and fine-tuned in terms of height and angulation to minimize perineal pressure

Dr. Arnold Kegel popularized pelvic floor muscle exercises in order to improve female sexual and urinary health after childbirth; his legacy lives on in these exercises that bear his name—Kegel exercises. Men have essentially the same pelvic floor muscles that women do and an equivalent capacity for exercising them, with a parallel benefit to urinary and sexual health. Cyclists can tap into their pelvic floor muscles to pump some “life” back into their compromised genitals after a long ride.5 Similar to using a bike pump to inflate tires so that they are well pressurized, with each contraction of the pelvic floor muscles, blood pumps into the genital tissuesto help “resuscitate” them. Performing Kegel exercises on a regular basis can help prevent perineal compression trauma by building bulbocavernosus and ischiocavernosus muscle strength and tone. Pelvic floor muscle exercises performed before, during and after cycling can help mitigate compression trauma. Most cyclists will periodically take a break from sitting in the saddle by standing up—this provides a perfect opportunity to take the pressure off the perineum and to do a few pelvic floor muscle contractions to restore genital blood flow.

Long distance cyclists may benefit from using oral medications for ED—including Viagra, Levitra, Cialis, and Stendra—to help maintain genital blood flow and oxygenation.21   These medications increase genital blood flow in both genders, and although research has only been reported in male cyclists, on a physiological basis there is no reason to believe why they would be any less effective in females.

Keys To Reducing Risk For Sexual Dysfunction

  1. Wear well padded cycling shorts.
  2. Be proactive—shift from sitting to standing every 10 minutes or so.
  3. When numbness and tingling occur, shift into an alternative position on the saddle and/or stand on the pedals.
  4. Sit back firmly on your ischial tuberosities and not on your perineum—as you shimmy from the saddle nose (which can really dig into your perineum) towards the back of the saddle (where you sit on your ischial tuberosities), you can feel your body engage properly.
  5. Invest in an ergonomic bicycle saddle tailored to the nuances of your anatomy—make sure it is wide enough to support your sit bones, firm enough so that your perineum doesn’t sink and flat enough so that you don’t slide and that it doesn’t wedge up under the perineum.
  6. Adjust seat and handlebar height and angle to minimize perineal compression.
  7. Do pelvic floor muscle contractions periodically while cycling and pelvic floor exercises when not cycling.
  8. If you start having sexual issues, seek help pronto…help is available!

Final word: Cycling is an awesome sport that occasionally may contribute to male and female sexual dysfunction, especially for serious cyclists who spend prolonged time periods in the saddle. Pay careful attention to your perineum, very valuable human real estate that contains structures that are vital to sexual health.

About the author: Andrew Siegel (www.AndrewSiegelMD) is a physician in practice at Hackensack University Medical Center who is board-certified in urology and female pelvic medicine/reconstructive surgery. He is a recreational cyclist who is a member of Bicycle Touring Club of North Jersey and is the author of three books, the most recent being Male Pelvic Fitness: Optimizing Sexual and Urinary Health. (www.MalePelvicFitness.com)

References

1. Pauker-Sharon Y, Arbel Y, Finkelstein A, et al. Cardiovascular risk

factors in men with ischemic heart disease and erectile dysfunction.

Urology. 2013;82:377-380.

2. Nanka O, Sedy J, Jarolim L. Sulcus nervi dorsalis penis: Site of

origin of Alcock’s syndrome in bicycle riders? Med Hypotheses

2007;69:1040–5.

3. Mackinnon SE. Pathophysiology of nerve compression. Hand

Clin 2002;18:231–41.

4. Damon Rinard: The Four And A Half Rules Of Road Saddles

http://www.cervelo.com/en/engineering/ask-the-engineers/the-four-and-a-half-rules-of-road-saddles-.html

5. Siegel, A. Male Pelvic Fitness: Optimizing Sexual and Urinary Health. Rogue Wave Press; 2014:55.

6. Schwarzer U, Sommer F, Klotz T, et al. Cycling and penile oxygen pressure: The type of saddle matters. Eur Urol 2002;41:139–43.

7. Lowe BD, Schrader SM, Breitenstein MJ. Effect of bicycle saddle designs on the pressure to the perineum of the bicyclist. Med Sci Sports Exerc 2004;36:1055–62

8. Munarriz R, Huang V, Uberoi J, et al. Only the nose knows: Penile hemodynamic study of the perineum-saddle interface utilizing saddle/seats with and without nose extensions. J Sex Med 2005;2:612–9.

9. Colpi GM, Contalbi G, Ciociola E, et al. Erectile dysfunction and amatorial cycling. Arch Ital Urol Androl 2008;80 (3):123-6.

10. Sommer F, Goldstein I, Korda JB. Bicycle Riding and Erectile Dysfunction:

A Review. J Sex Med 2010;7:2346-2358

11. Rodano R, Squadrone R, Sacchi M, et al. Saddle pressure distribution in cycling: Comparison of saddles of different design and materials. Proceedings of the XXth International Symposium on Biomechanics in Sports 2002:606–9.

12. Spears IR, Cummins NK, Brenchley Z, et al. The effect of saddle design on

stresses in the perineum during cycling. Med Sci Sports Exerc 2003;35:1620–5.

13. Blakeslee, S: Serious riders, your bicycle seat may affect your love life.

http://www.nytimes.com/2005/10/04/health/nutrition/04bike.html?pagewanted=all&_r=

14. Handlebar level can affect sexual health of female cyclists.

http://www.sciencedaily.com/releases/2012/07/120709121626.htm

15. Schrader SM, Breitenstein MJ, Lowe BD. Cutting off the nose to save the penis. J Sex Med 2008;5(8):1932-1940.

16. Cohen JD, Gross MT. Effect of bicycle racing saddle design on transcutaneous penile oxygen pressure. J Sports Med Phys Fitness 2005; 45(3):409-418

17. Potter JJ, Sauer JL, Weisshaar CL, et al. Gender differences in bicycle saddle pressure distribution during seated cycling. Med Sci Sports Exerc 2008;40:1126–34.

18. Dettori JR, Koepsell TD, Cummings P, et al. Erectile dysfunction after a long-distance cycling event: Associations with bicycle characteristics. J Urol 2004;172:637–41.

19. Guess MK, Connell K, Schrader S et al. Genital sensation and sexual function in women bicyclists and runners: Are your feet safer than your seat?

J Sex Med 2006;3:1018–27.

20. Andersen KV, Bovim G. Impotence and nerve entrapment in long distance amateur cyclists. Acta Neurol Scand 1997;95: 233–40.

21. Sommer F. Cycling and erectile dysfunction (ED): Can sildenafil prevent hypooxygenation of the penis during cycling? Pre- Bicycle Riding and Erectile Dysfunction J Sex Med 2010;7:2346–2358

 

Sex and the Mediterranean Diet

February 1, 2014

Blog # 139

Sexuality is a very important part of our human existence, both for purposes of procreation as well as pleasure.  Although not a necessity for a healthy life, the loss or diminution of sexual function may result in loss of self-esteem, embarrassment, a sense of isolation and frustration, and even depression. Therefore, for many of us it is vital that we maintain our sexual health. Loss of sexual function further exacerbates progression of sexual dysfunction—the deficiency of genital blood flow that often causes sexual dysfunction produces a state of poor oxygen levels (hypoxia) in the genital tissues, which induces scarring (fibrosis) that further compounds the problem.  So “use it or lose it” is a very relevant statement when it comes to sexual function, as much as it relates to muscle function.

Healthy sexual function for a man involves a satisfactory libido (sex drive), the ability to obtain and maintain a rigid erection, and the ability to ejaculate and experience a climax. For a woman, sexual function involves a healthy libido and the ability to become aroused, lubricate adequately, to have sexual intercourse without pain or discomfort, and the ability to achieve an orgasm.   Sexual function is a very complex event contingent upon the intact functioning of a number of systems including the endocrine system (produces sex hormones), the central and peripheral nervous systems (provides the nerve control) and the vascular system (conducts the blood flow).

A healthy sexual response is largely about adequate blood flow to the genital and pelvic area, although hormonal, neurological, and psychological factors are also important.  The increase in the blood flow to the genitals from sexual stimulation is what is responsible for the erect penis in the male and the well-lubricated vagina and engorged clitoris in the female. Diminished blood flow—often on the basis of an accumulation of fatty deposits creating narrowing within the walls of blood vessels—is a finding associated with the aging. This diminution in blood flow to our organs will negatively affect the function of all of our systems, since every cell in our body is dependent upon the vascular system for delivery of oxygen and nutrients and removal of metabolic waste products.  Sexual dysfunction is often on the basis of decreased blood flow to the genitals from pelvic atherosclerosis, the accumulation of fatty deposits within the walls of the blood vessels that bring blood to the penis and vagina.

Sexual dysfunction may be a sign of cardiovascular disease. In other words, the quality of erections in a man and the quality of sexual response in a female can serve as a barometer of cardiovascular health. The presence of sexual dysfunction can be considered the equivalent of a genital stress test and may be indicative of a cardiovascular problem that warrants an evaluation for arterial disease elsewhere in the body (heart, brain, aorta, peripheral blood vessels).  The presence of sexual dysfunction is as much of a predictor of cardiovascular disease as is a strong family history of cardiac disease, tobacco smoking, or elevated cholesterol. The British cardiologist Graham Jackson has expanded the initials E.D. (Erectile Dysfunction) to mean Endothelial Dysfunction (endothelial cells being the type of cells that line the insides of arteries), Early Detection (of cardiovascular disease), and Early Death (if missed). The bottom line is that heart healthy is sexual healthy.

Many adults are beset with Civilization Syndrome, a cluster of health issues that have arisen as a direct result of our sedentary lifestyle and poor dietary choices.  Civilization Syndrome can lead to obesity, high blood pressure, and elevated cholesterol and can result in such health problems as diabetes, heart attack, stroke, cancer, and premature death.  The diabetic situation in our nation has become outrageous—20 million people have diabetes and more than 50 million are pre-diabetic, many of whom are unaware of their pre-diabetic state! It probably comes as no surprise that diabetes is one of the leading causes of sexual dysfunction in the United States.

Civilization Syndrome can cause a variety of health issues that result in sexual dysfunction.  Obesity (external fat) is associated with internal obesity and fatty matter clogging up the arteries of the body including the arteries which function to bring blood to the genitalia.  Additionally, obesity can have a negative effect on our sex hormone balance (the balance of testosterone and estrogens), further contributing to sexual dysfunction. High blood pressure will cause the heart to have to work harder to get the blood flowing through the increased resistance of the arteries. Blood pressure lowering medications will treat this, but as a result of the decreased pressure, there will be less forceful blood flow through the arteries.  Thus, blood pressure medications, although very helpful to prevent the negative effects of hypertension—heart attacks, strokes, etc.—will contribute to sexual dysfunction.  High cholesterol will cause fatty plaque buildup in our arteries, compromising blood flow and contributing to sexual dysfunction.  Tobacco constricts blood vessels and impairs blood flow through our arteries, including those to our genitals. Smoking is really not very sexy at all!  Stress causes a surge of adrenaline release from the adrenal glands. The effect of adrenaline is to constrict blood vessels and decrease sexual function.  In fact, men with priapism (a prolonged and painful erection) are often treated with penile injections of an adrenaline-like chemical.

A healthy lifestyle is of paramount importance towards the endpoint of achieving a health quality and quantity of life.  Intelligent lifestyle choices, including proper eating habits, maintaining a healthy weight, engaging in exercise, adequate sleep, alcohol in moderation, avoiding tobacco and stress reduction are the initial approach to treating many of the diseases that are brought on by poor lifestyle choices.  Sexual dysfunction is often in the category of a medical problem that is engendered by imprudent lifestyle choices.  It should come as no surprise that the initial approach to managing sexual issues is to improve lifestyle choices.  Simply by pursuing a healthy lifestyle, Civilization Syndrome can be prevented or ameliorated, and the myriad of medical problems that can ensue from Civilization Syndrome, including sexual dysfunction, can be mitigated.

In terms of maintaining good cardiovascular health (of which healthy sexual function can serve as a proxy), eating properly is incredibly important—obviously in conjunction with other smart lifestyle choices. Fueling up with the best and most wholesome choices available will help prevent the build up of fatty plaques within blood vessels that can lead to compromised blood flow. Poor nutritional decisions with a diet replete with fatty, nutritionally-empty choices such as fast food, puts one on the fast tract to clogged arteries that can make your sexual function as small as your belly is big!.

A classic healthy food lifestyle choice is the increasingly popular Mediterranean diet.  This diet, the traditional cooking style of the countries bordering the Mediterranean Sea including Spain, France, Greece, Cyprus, Turkey, Southern Italy, and nearby regions, has been popular for hundreds of years. The Mediterranean cuisine is very appealing to the senses and includes products that are largely plant-based, such as anti-oxidant rich fruits and vegetables, whole grains, nuts, seeds and legumes.  Legumes—including peas, beans, and lentils—are a wonderful source of non-animal protein.  Soybeans are high in protein, and contain a healthy type of fat.  Soy is available in many forms— edamame (fresh in the pod), soy nuts (roasted), tofu (bean curd), and soymilk. Fish and poultry are also mainstays of the Mediterranean diet, with limited use of red meats and dairy products.  The benefits of fish in the diet can be fully exploited by eating a good variety of fish.  Olive oil is by far the principal fat in this diet, replacing butter and margarine. The Mediterranean diet avoids processed foods, instead focuses on wholesome products, often produced locally, that are low in saturated fats and high in healthy unsaturated fats. The Mediterranean diet is high in the good fats (monounsaturated and polyunsaturated) which are present in such foods as olive, canola and safflower oils, avocados, nuts, fish, and legumes, and low in the bad fats (saturated fats and trans fats).  The Mediterranean style of eating provides an excellent source of fiber and anti-oxidants.  A moderate consumption of wine is permitted with meals.

Clearly, a healthy diet is an important component of a healthy lifestyle, the maintenance of which can help prevent the onset of many disease processes.  There are many healthy dietary choices, of which the Mediterranean diet is one.  A recent study reported in the International Journal of Impotence Research (Esposito, Ciobola, Giugliano et al) concluded that the Mediterranean diet improved sexual function in those with the Metabolic Syndrome, a cluster of findings including high blood pressure, elevated insulin levels, excessive body fat around the waist and abnormal cholesterol and triglyceride levels.  35 patients with sexual dysfunction were put on a Mediterranean diet and after two years blood test markers of endothelial function and inflammation significantly improved in the intervention group versus the control group. The intervention group had a significant decrease in glucose, insulin, low-density lipoprotein cholesterol (LDL—the “bad” cholesterol), triglycerides, and blood pressure, with a significant increase in high-density lipoprotein cholesterol (HDL—the “good” cholesterol).  14 men in the intervention group had glucose intolerance and 6 had diabetes at baseline, but by two years, the numbers were reduced to 8 and 3, respectively.

Why is the Mediterranean diet so good for our hearts and sexual health?  The Mediterranean diet is high in anti-oxidants—vitamins, minerals and enzymes that act as “scavengers” that can mitigate damage caused by reactive oxygen species.  Reactive oxygen species (also known as free radicals) are the by-products of our metabolism and also occur from oxidative damage from environmental toxins to which we are all exposed.  The oxidative stress theory hypothesizes that, over the course of many years, progressive oxidative damage occurs by the accumulation of the chemicals the accumulation of reactive oxygen species engender diseases, aging and, ultimately, death.  The most common anti-oxidants are Vitamins A, B-6, B-12, C, E, folic acid, lycopene and selenium.  Many plants contain anti-oxidants—they are concentrated in beans, fruits, vegetables, grain products and green tea.  Brightly colored fruits and vegetables are good clues as to the presence of high levels of anti-oxidants—berries, cantaloupe, cherries, grapes, mango, papaya, apricots, plums, pomegranates, tomatoes, pink grapefruit, watermelon, carrots, broccoli, spinach, kale, squash, etc.—are all loaded with anti-oxidants as well as fiber. A Mediterranean diet is also high in omega-3 fatty acids, a type of polyunsaturated fat present in oily fish including salmon, herring, and sardines.  Nuts—particularly walnuts—have high omega-3 fatty acid content.  Research has demonstrated that these “good” fats have numerous salutary effects, including decreasing triglyceride levels, slightly lowering blood pressure, and decreasing the growth rate of fatty plaque deposits in the walls of our arteries (atherosclerosis), thus reducing the risk of cardiovascular disease, stroke, and other medical problems. Mediterranean cooking almost exclusively uses olive oil, a rich source of monounsaturated fat, which can lower total cholesterol and LDL cholesterol while increasing HDL cholesterol. It is also a source of antioxidants including vitamin E.  People from the Mediterranean region generally drink a glass or two of red wine daily with meals. Red wine is a rich source of flavonoid phenols—a type of anti-oxidant—which protects against heart disease by increasing HDL cholesterol and preventing blood clotting, similar to the cardio-protective effect of aspirin.

The incorporation of a healthy and nutritious diet, such as the Mediterranean diet, is a cornerstone for maintaining good health in general, and vascular health, including sexual health, in particular.  The Mediterranean diet—my primary diet and one that I have incorporated quite naturally since it consists of the kinds of foods that I enjoy—is colorful, appealing to the senses, fresh, wholesome, and one that I endorse with great passion. Maintaining a Mediterranean dietary pattern has been correlated with less cardiovascular disease, cancer, and sexual dysfunction.  And it is very easy to follow.  It contains “good stuff”, tasty, filling, and healthy, with a great variety of food and preparation choices—plenty of colorful fresh fruit and vegetables, a variety of fish prepared in a healthy style, not fried or laden with heavy sauces, healthy fats including nuts and olive oil, limited intake of red meat, a delicious glass of red wine.  It’s really very simple and satisfying.  Of course the diet needs to be a part of a healthy lifestyle including exercise and avoidance of harmful and malignant habits including smoking, excessive alcohol, and stress.  So if you want a sexier style of eating, I strongly recommend that you incorporate the Mediterranean diet into your lifestyle.  Intelligent nutritional choices are a key component of physical fitness and physical fitness leads to sexual fitness.

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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