Sex Ed – Part 2

When Ed senior came for a doctor’s visit, he was concerned about one thing, his sex life, or lack there of. He was a sixty seven year old African American that’s been in an intimate relationship for thirty years. He was diagnosed with diabetes and hypertension when he initially started seeing doctors about fifteen years ago. 

“Hey Doc,” he began. “I’m still a man and I got needs.” Apparently, he’d been having difficulty achieving an erection ever since starting his medications fifteen years ago. Typically, when this happens, patients have an immediate tendency to throw their medications in the garbage, knowing full well that it may kill them, which is exactly what Ed did. And it nearly lead to him dying as he ended up in the hospital, having a heart attack secondary to uncontrolled blood pressure. They then placed him on even more medications and now, he was more frustrated than ever. 

Truth be told, sex is an important part of the male psyche. It’s as if it is hard wired in that primal center in our brain and that without spreading our seed, we might as well be dead. I see it in my clinic all the time, from eighteen to eighty. They have movies about it, where teenagers are molesting pies or old folks are going to the hospital because the little blue pill was working a little too well. But as men, we need to also distinguish the difference between sex and intimacy.  While sex may be what kindles the fire, intimacy is what sustains it. 

A 2017 study found in the archives of sexual behavior found that the happiest couples have sex about 54 times annually or one time a week. I found this study interesting for two reasons. First, who counts how many times a year that they have sex? I mean, after actually having sex, did they go into their journal and tally another notch? And second, this number seemed low. But the more I thought about it, the more it made perfect sense. Good, long lasting, happy relationships evolve from a physical relationship to a more intimate one. For example, once you have kids, the partnership between two people becomes more demanding and the opportunities to be physical are likely to lessen, but surprisingly the bonds within the relationship either strengthen or break.

That being said, erectile dysfunction is a very common issue for men. The reasons for it can be broken down into two categories: psychological and medical. Psychological issues tend to happen in younger patients, where anxiety and stress play a major factor. Bob was another patient of mine, with a complaint of ED (erectile dysfunction). He was forty six. He was having troubles in the bedroom with his wife and it had been consistently occurring for the past year. The wrinkle in his history was that it would only occur during weekdays. During the weekends or on vacations, he was the stallion he was desiring to be. I asked him about work and he mentioned that his boss had been fired and that a whole lot of responsibility had been placed on him. I’ve also had patients feel the pressure of trying to start a family or having a philandering spouse be the reason for their short-comings (I needed at least one pun in here).

The medical reasons vary, but the big ones have to do with vascular or circulatory issues. Having heart disease, hypertension, diabetes, or any combination of the above can lead to erectile dysfunction. Other medical issues include problems with the prostate, including cancer, as well as substance abuse with alcohol or drugs. Also neurological problems like Parkinson or multiple sclerosis or even spinal cord injuries can be the reasons for ED. Smoking can also contribute to all causes of death as well as death of the erection.

And of course, testosterone can affect performance, but it is rarely the main reason for ED. Usually, a testosterone level can be checked if ultimately the goal would be to replace the testosterone, which in itself, has some risky side effects that patients would need to be informed of prior to starting.

Treatments vary and not all treatments are appropriate for patients. It begins with treating the underlying cause. If diabetes or heart disease are to blame, let’s tackle those issues first. Obviously, Viagra among other medications on the market will help. Outside of pills, there are direct injectable medications that will directly vasodilate the penis, there are pumps and implants, and testosterone replacement. But before we get to the point where medical treatment becomes necessary, I can’t urge regular exercise and stress management enough as important factors in prevention. Maintaining a healthy body weight is an important variable to prevention. 

When ED happened to Ed senior, his world changed. After multiple trials of oral medications, we found one that worked for him. But as I stated before, sex is not intimacy. You cannot substitute sex for intimacy, but in some cases, intimacy can substitute sex. Before starting any treatment for ED talk to your partner about whether or not it’s right for you and then if it is, talk to your doctor about your options.

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