Use it or LOSE it

Dear Friend,

Sexual health is such an integral part of our happiness and mood, yet not openly talked about especially when things aren’t glorious with our partner. Anecdotally for me, my group of male friends have been openly talking about sexual challenges since our 30s, but we’re likely an outlier.

Erectile dysfunction (ED) affects 52% of men over 40, Massachusetts Male Aging Study, but may be higher worldwide and is likely under-reported.

ED is defined as the inability to obtain or maintain an erection firm enough for satisfactory sexual intercourse.

Multiple aspects impact ED including psychological health, metabolic health, and smooth muscle.

Mental Health:

Most men are not the type to openly talk about their sexual issues and less likely to speak to their partners. A man experiencing ED with a first time partner will now be under added stress to perform the second time, further exacerbating the issue.

Vascular Health:

To generate an erection the arteries need to inflow blood, then the blood needs to persist by limiting the outflow from the veins. Arterial flow into the penis is affected by the same factors for cardiovascular health: Hypertension, Diabetes, Cholesterol - so the same management applies.

15% of men will have a heart attack 7 years after being diagnosed with ED, based on a 2005 study.

Smooth Muscle:

Limiting the venous outflow is dependent on the smooth muscle to contract within the area called the corpora cavernosa. This traps the blood in the veins to create/maintain an erection, however when this system is inadequate it is called Venous Leak. Lower testosterone can cause muscle loss in the penis in the similar way it affects skeletal muscle. As we age the penile muscle can atrophy or scar.

The commonly used ED medications Viagra (Sildenafil), Cialis (Tadalafil) are PDE5 inhibitors, which increase the inflow of blood and overpower the venous leak. Daily use of PDE5 inhibitors can be preventative by causing hypertrophy of the cavernosal smooth muscle and keeps the tissue healthy based on a 2001 study. Because smooth muscle is involved, this process can also be trained like skeletal muscle with regular erections and sexual activity.

You heard it right: “Use it or lose it” applies here.

Beyond these medications, there are further treatments including ultrasound shock, platelet-rich plasma (PRP), stem-cells, penile injections, and prosthetics. Aside from prosthetics, these treatments are very much under research from an efficacy standpoint.

ED is just the tip of the iceberg, other forms of sexual dysfunction:

• 30% of men have premature or ejaculatory dysfunction

• 7-9% have Peyronie's disease (scar tissue that causes unwanted curvature)

Benign prostatic hypertension (BPH), while not technically sexual dysfunction, can play a factor due to the side-effects from its common treatments: Finasteride and Flomax.

• Flomax: retrograde ejaculation (ejaculate into the bladder)

• Finasteride: anorgasmia, post finasteride syndrome

What is Post Finasteride Syndrome?

An irreversible condition causing anxiety, depression, cognition, and even suicide. Affects 5% of users. It is a controversial condition that some Urologists deny the association.

There is a lot to unpack in this newsletter, coming up next will be women's sexual health. The most important step is honesty with yourself, your partner, and your physician. The more we can openly talk about our sexual challenges as a community, the less of a stigma we will have associated with it.

At BodyTimeMD, we learn about the complete individual and ask the questions that may even be uncomfortable for our clients. Let's talk if you are interested in finding out more about your body.

 This newsletter is intended for informational purposes only and does not constitute giving medical advice or endorsing any treatment. The use or application of the content herein forms no doctor-patient relationship. The information in this newsletter should not substitute for professional medical evaluation, advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.

Thanks,

Mike