October 17th 2022
Kristopher Bunting, MD
Updated on October 17, 2022
This article is a repost which originally appeared on healthnews.
Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.
Whether you have problems with premature ejaculation or you simply want sex to last longer, there are many ways to last longer in bed. Making sex last longer can involve maintaining an erection for longer, delaying ejaculation, and reducing the time to achieve another erection after ejaculating. There are a variety of ways to improve your sexual stamina and make sex more satisfying for both you and your partner.
Key takeaways:
‧ There are many ways to improve male sexual stamina, including medications and sexual techniques. Increased foreplay and emotional intimacy may also improve sexual performance.
‧ Medications for erectile dysfunction and premature ejaculation can improve stamina and sexual performance.
‧ Controlling sexual stimulation by using numbing sprays or gels, certain sexual positions, and other techniques can help men control when they orgasm.
Ideally, sex should last for as long as you want it to. Many people think of sex as penetration, but it can (and should) involve much more. Research shows that the average time until ejaculation during penetrative sex is between 5 and 6 minutes. For most people, achieving orgasm is the goal of sex. While 5 minutes of penetration (or less) will get many men where they want to get to, it takes longer for women to climax from penetration alone. So, how can you make sex last longer?
There is more to sex than just penetration and orgasm. Foreplay is important for mutual arousal; it gives you and your partner time to stimulate yourselves and each other. Take time to use all of your senses to get excited and prepare for the main event.
Kegel exercises can help both men and women strengthen pelvic floor muscles, improving continence and sexual function. A strong pelvic floor can help you control when you ejaculate.
Sex is both physical and mental. Both the body and the mind need to be stimulated and aroused to enjoy sex. Emotional intimacy plays a role in sexual arousal, especially in long-term relationships. Research has shown that emotional intimacy is linked to sexual desire. Furthermore, good communication in a relationship is linked to improved sexual satisfaction and decreased sexual dysfunction. Communicating sexual needs with your partner can improve sex and may help you last longer.
Medications used to treat erectile dysfunction (ED) and premature ejaculation (PE) can also improve sexual stamina. Commonly used antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), and other drugs that raise serotonin levels in the brain can help delay ejaculation. While this can be an unwanted side effect for some, it can help people with PE have more control over when they orgasm.
ED medications can help some men recover more quickly after ejaculating and may improve sexual performance in men without erectile dysfunction. Viagra (sildenafil), Cialis (tadalafil), and other erectile dysfunction medications improve blood flow to the penis. This allows men with mild to moderate ED to have firmer, longer-lasting erections. Remember, these are prescription medications; you should not take them without first being evaluated by a doctor. They can have extremely dangerous interactions with other medications, including nitrates taken for chest pain or amyl nitrate and amyl nitrite (poppers) taken recreationally.
Topical anesthetics are used to treat PE and can help men delay orgasms. A variety of topical numbing creams, sprays, and personal lubricants are available that reduce stimulation of the penis, including condoms with numbing lubricant. However, these can cause skin irritation and discomfort in some people, so check with your partner before using a topical anesthetic.
Other ways to reduce penile stimulation and delay orgasm include wearing a condom and using more lubrication. Wearing a condom not only helps prevent sexually transmitted diseases and unwanted pregnancy, but it can also decrease stimulation of the penis, especially thicker condoms. Using lubrication during sex can reduce friction and stimulation.
There are a variety of techniques that can be employed to help delay orgasm and ejaculation. Techniques recommended for people with PE include the squeeze technique (gently squeezing the head of the penis for several seconds) and the start and stop technique (stop penile stimulation for 30 seconds). Other techniques include pausing and taking a deep breath or shifting your focus away from sexual sensations during sex. In other words, slow down and take a moment to rest before you reach orgasm.
Masturbating before sex can help delay ejaculation, but timing is important. Practicing edging, bringing yourself to the brink of orgasm while masturbating, can help you learn how to recognize when you are about to orgasm and allow you to practice techniques to delay orgasm.
There are many Tantric and Taoist sexual practices that can help control ejaculation and improve sexual pleasure for men and their partners. The “sets of nines” technique is an easy way to control mutual stimulation. It involves performing 9 sets of 9 controlled thrusts, beginning with 9 shallow thrusts, followed by 8 shallow thrusts and 1 deep thrust, then 7 shallow thrusts and 2 deep thrusts, and so on, ending with 9 deep thrusts. It is a simple technique, but it is very effective for controlling ejaculation and building up sexual excitement.
Certain sexual positions can help control ejaculation, especially positions that allow for grinding, as opposed to thrusting. Partner on top positions, the lotus position, and the Coital Alignment Technique can maintain constant stimulation for your partner while limiting stimulation to the penis from thrusting. Explore the Kama Sutra and other books for tips on which positions can help you control when you orgasm.
Get healthy
Overall health affects sexual function; eating a proper diet and getting enough exercise can improve your sexual health. Obesity, type 2 diabetes, high blood pressure, heart disease—all of these conditions can affect sexual function and they can all be improved or prevented through diet and exercise.
There are many ways for men to improve their sexual stamina. Foreplay, communication, and emotional intimacy can improve sex. Medications, condoms, and lubricants can delay orgasm and reduce stimulation. A variety of techniques can help men control when they orgasm, including techniques used for premature ejaculation and certain sexual positions. Give some of these a try and find out what works best for you.
Resources:
1. Urology Care Foundation. Premature Ejaculation.
2. The Journal of Sexual Medicine. Original Research—Ejaculation Disorders: A Multinational Population Survey of Intravaginal Ejaculation Latency Time.
3. International Society for Sexual Medicine. Women’s Orgasm Takes Longer During Partnered Sex.
4. Mayo Clinic. Kegel Exercises for Men: Understand the Benefits.
5. Journal of Social and Personal Relationships. The Associations of Intimacy and Sexuality in Daily Life.
6. The Journal of Sex Research. Couples’ Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis.
7. Cleveland Clinic. Premature Ejaculation.
8. International Journal of Impotence Research. Sildenafil Does Not Improve Sexual Function in Men Without Erectile Dysfunction but Does Reduce the Postorgasmic Refractory Time.
9. Nature Reviews Urology. Sildenafil Improves Sexual Function in Men Without Erectile Dysfunction.
10. Mayo Clinic. Erectile Dysfunction: Viagra and Other Oral Medications.
11. Circulation. Drug Interactions With Phosphodiesterase-5 Inhibitors Used for the Treatment of Erectile Dysfunction or Pulmonary Hypertension.
12. Journal of Sex & Marital Therapy. The Coital Alignment Technique (CAT): An Overview of Studies.
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By Brynna Standen/Updated: Oct. 7, 2022 12:49 pm EDT
This article is a repost which originally appeared on Health Digest.
Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.
Our Takeaways:
· Only 30% of fertility complications are due to complications in the woman alone.
· There’s a cultural stigma against infertility in men.
· Male fertility can be caused by a number of factors.
While in theory, the idea of trying to get pregnant sounds like a whole lot of fun (wink, wink), for some couples it can start feeling a little more like one of the Sphinx’s riddles — difficult to navigate and laden with pressure and high stakes. In the U.S., one in eight couples have difficulty conceiving (per Fertility Answers). While fertility experts agree that only 30% of these cases can be attributed to a complication in the woman alone, society often seems to be in silent agreement that fertility issues start and end with women.
This unspoken consensus seems to point toward a gender bias within the medical field. A 2006 review published in Medical Anthropology Quarterly found that out of 157 articles published on the topic of fertility, only one was centered around men. Adding to this, a 2016 study published in the American Journal of Preventive Medicine reports that in federally funded clinics that offer family planning services, 81% of them educate women on preconception care, while only 38% of them provide the same education opportunities to men.
Health Digest sat down for an exclusive interview with Dr. Justin Dubin — a urologist and men’s health specialist practicing in South Florida, and co-host of the men’s health podcast “Man Up: A Doctor’s Guide to Men’s Health” — who gave us the scoop on the stigma surrounding male fertility and offered advice on how men can boost their fertility, giving them and their families the best chance at conception.
Well aware of the societal bias surrounding fertility struggles, Dr. Dubin wants men to understand their role in family planning. “When it comes to fertility and family planning, it’s important for guys to remember that it takes two to tango,” he asserts. While there are certainly times that fertility issues solely fall on the female, Dr. Dubin points out, “In couples struggling with fertility, 50% of the time there is a male factor component to the couple’s fertility problems. In fact, 30% of the time, a couple’s fertility issues are strictly due to the male! Despite these statistics, there continues to be an unfair focus and pressure on female partners when it comes to family planning issues.”
When it comes to examining why a couple is having trouble conceiving, Dr. Dubin notes, “Women are often the only ones to see a doctor for a fertility workup. Guys need to know that if their partner is getting evaluated for fertility, they should too. Not only does it take some pressure off your partner, there is a chance that getting evaluated by a urologist can help you achieve your family planning goals. It’s time we shift the focus of fertility away from women and back to the couple as a whole,” he declares, adding with encouragement, “Guys, see a doctor!”
Women aren’t the only ones who face stigmas surrounding infertility. “Most men don’t like seeing a doctor, especially when it comes to discussing topics like fertility that they often associate with masculinity,” says Dubin. “Fortunately, the fertility workup is fairly straightforward. Typically, when you see your doctor there are three components to a male fertility workup.” He explains that it starts with semen analysis. “A semen analysis is a test in which you provide a semen sample. It is the gold standard for a male fertility evaluation. Basically, we look at the amount and quality of the sperm in your sample to assess your fertility status.” For men still intimidated by the process, Dr. Dubin offers, “Based on both your comfort level and access to facilities, the sample can be collected either at home or in a lab.”
Next, Dr. Dubin explains that blood work is useful. “Like female fertility, there are certain sex hormones that play a role in male fertility and sperm creation. Testosterone is an example of a common hormone we look at.” Men should also get a physical exam, and give their doctors a detailed medical history, while they’re at it. “Male fertility can be impacted by so many different things that it is important for your doctor to hear your story,” Dr. Dubin says. “In addition to a good history, getting a physical exam helps with the big picture of what is going on.”
When it comes to male fertility, it’s not as simple as playing with the cards you were dealt. “Male fertility is interesting because lifestyle choices can actually make a big difference on some men’s fertility. When it comes to overall health, it is important to remember: what’s good for your heart is good for your parts. Men who smoke cigarettes, are overweight, inactive, and eat poorly are more likely to have low testosterone and fertility issues. Eating healthy, exercising, and losing weight can help improve fertility.” While low testosterone can play a role in the struggle toward conception, Dr. Dubin reveals, “One important medication that can compromise your fertility is taking testosterone. If you are considering having kids at any point, I would not recommend starting without talking with a doctor.”
While we may have assumed this one was an old wives’ tale, Dr. Dubin clarifies, “If you are actively trying to conceive, you should avoid exposure to wet heat, [like] saunas and hot tubs. The heat can create a less favorable environment for sperm and temporarily cause a decline in sperm numbers.” Last but not least, let’s talk lube. “If you are a couple who uses lubrication during intercourse, the kind of lubricant that you use can make a difference. Most lubricants do not provide favorable environments for sperm and can potentially compromise fertility. When it comes to lubricants that are good for family planning, we recommend using Pre-Seed.”
Because of the sensitive nature of fertility — especially when it is proving to be an issue — Dr. Dubin stresses the importance of communication between couples. “Fertility is a sensitive topic for men to discuss as most guys associate it with their masculinity and what they consider makes them a man. At the same time, conception and family planning is a two-way street and if there are concerns about their sexual health or fertility status, it is important that their partner talks with them about it. Communication is key for couples struggling with fertility.” Offering one final tip to couples who may be having a hard time, Dr. Dubin says, “Focusing on the fact that this is a couple’s issue, not a male or female issue, should help relieve specific pressures and should motivate both partners to be active in the process and hopefully each get evaluated.” Teamwork makes the baby-dream work!
The following is taken from Chapter 14: Ways to Treat Premature Ejaculation from The Ultimate Guide To Male Enhancement.
Edited for content
Many men never experience the full potential of pleasure they can receive from their sexual encounters. This little–known mental/sexual exercise will take you to levels of pleasure and control you never thought possible.
Step 1:
First, you must find a time and a place in which you will be COMPLETELY undisturbed for 20–30 minutes.
Step 2:
Lie back naked on your bed (or another comfortable surface) and encircle your penis with your thumb, index, and middle finger. Place your middle finger on the sensitive spot directly behind your penis head (glans.) Rub your penis or visualize until it becomes erect.
Step 3:
While maintaining the pressure behind the glans with your middle finger, close your eyes and concentrate as deeply as possible on visualizing yourself performing with the utmost confidence and completely stress free, and in feeling a slight bit of pressure behind the sensitive spot behind the glans. It’s the EMOTIONAL feel of performing in this manner you’ll want to be able to duplicate in real live sexual scenarios.
At first, it will probably be difficult to concentrate deeply without a break in concentration for any length of time. This is where the mantra “practice makes perfect” comes into play. It will probably take a dozen sessions or more of 20–30 minutes before you are able to achieve the very deep level of concentration necessary for this exercise to work.
After you master the technique, your ability to concentrate and focus will become so strong, you will be able to bring yourself to orgasm merely by keeping pressure behind the glans with your middle finger and
concentrating on the feel of the movement! Some very light rubbing is acceptable. Some men have even reported multiple orgasms from following this technique!
Once you have mastered this technique, you will then be able to fully appreciate the pleasures of sex!
NOTE: Keep in mind some men will not be able to achieve orgasm without movement. If this describes your situation, once you come as close to climaxing as mere pressure and concentration will allow, you can jiggle your penis just enough to push you over the edge into climax.
Emotional Visualizations and Workout Schedule Challenges: Ask The Experts
Big Al, of MaleEnhancementCoach.com, answers questions about dealing with Emotional Visualization difficulties and busy schedule training.
If you have questions you’d like answered in an Ask the Experts article, please PM Big Al
Q. I’ve been having trouble with the Emotional Visualizations exercises for training.
They’re hard to do and I get frustrated doing it. What do you recommend?
Al: The Emotional Visualization exercises are for developing emotional mastery and a better kinesthetic sense. To summarize, BEFORE the session you should find a place to relax and to empty your mind of any thoughts. Optimally, your emotional state should be neutral, but if you could recall a positive emotional experience during sexual contact and can transfer some of that emotion into the session that would be optimal.
The difficulty comes from fighting the mind. The fighting in and of itself taps into “survival” emotions, which counters the process. A good analogy is to visualize your mind like a fist grasping at thoughts and mental dialog. When attempting the EVs picture yourself relaxing the fist- letting all of the thoughts dissipate. When the thoughts intrude (and they will) recenter yourself by focusing on your breathing, then picture yourself releasing again.
Go into it with acceptance- understanding that you’re going to be challenged. It may take 2-3 weeks of practice, but once you reach a threshold of viability you’ll find the process much easier and more rewarding.
Q. My schedule is very busy and I don’t always have time to do a full workout.
What are some ways someone in my situation can train?
Al: For best results, the exercises should be performed in one sitting. This is because the regimen is structured in a way where each exercise cascades into the next one.
As I see it, there are two possible solutions for getting in a full workout. The first would be to train first thing in the morning. The benefits are you’ll be taking advantage of high hormone levels upon awakening, and the motivation of having finished your session first thing in the day can carry over to the rest of the day. I recommend this option even if you have to wake up earlier.
If you don’t even have time for the above, maintenance exercises like JAI Stretches or light jelqs performed throughout the day can help to maintain conditioning. You might also consider a covert device like the Stealth or Phallosan.
* * *
By Beth Bradford/Sept. 25, 2022 9:00 pm EDT
This article is a repost which originally appeared on Health Digest.
Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.
Our Takeaways:
· Adults over 65 should engage in resistance training at least twice a week to stave off the effects of sarcopenia (age related muscle loss).
· Age related muscle loss is more pronounced in men.
· Increased inactivity combined with hormonal decline accelerates sarcopenia.
The Centers for Disease Control and Prevention recommends adults over 65 devote at least two days a week to strength training. That’s because our muscles lose both size and strength over the years, according to Better Health. The muscle fibers themselves get smaller and we have less of them. It takes longer for us to replace muscle tissue, and it’s often replaced with tougher tissue. Our nervous system also changes with age, which means that we lose muscle tone and the muscles themselves can’t contract as well. This can put us in a vicious cycle where our muscles get weak, we’re too tired to exercise, then we don’t want to exercise (via Healthline).
According to Cleveland Clinic, we begin losing muscle mass in our 30s, but muscle loss accelerates after the age of 65. In fact, this age-related decline in muscle mass is more pronounced in men, according to a 2014 article in Sports Health.
We need to keep muscle as we age to limit the risk of sarcopenia, which is the medical term for this age-related muscle decline, according to Cleveland Clinic. Sarcopenia is the main contributor to older adults falling and losing their quality of life. It prevents seniors from performing daily activities and living comfortably on their own. People who have sarcopenia have poor balance, walk slowly, and have problems climbing stairs.
Not only does sarcopenia reduce the quality of life, but it also reduces life span (via Healthline). Much of the muscle decline in older adults comes from reduced physical activity, less protein in the diet, inflammation from injury or illness, or stress from chronic diseases. As we age, we also have lower levels of hormones that maintain muscle mass and bone, such as testosterone and estrogen (via 2014 article in Sports Health). The good news is that we can make changes to slow and even reverse this muscle decline, according to Better Health.
Even if someone is already experiencing muscle loss, muscles can still respond well to strength training, according to a 2014 article in Sports Health. Adults up to 90 years old have even improved their strength. A 2022 review in Frontiers in Sports and Active Living found that strength training is best to combat sarcopenia. The researchers recommended methods like suspension training to activate core muscles. They also suggested low weights with low reps and short breaks for seniors.
Because poor nutrition can contribute to age-related muscle decline, Cleveland Clinic suggests adding 20 to 35 grams of protein to each meal to maintain muscle mass. However, the 2014 article said more research was needed on how nutrition affects sarcopenia specifically. Therefore, experts suggest for seniors to add vitamin D and long-chain polyunsaturated fatty acids to their diets in order to retain muscle.
September 19, 2022
Navid Leelani, DO, Scott D. Lundy MD, PhD
This article is a repost which originally appeared on Urology Times.
Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.
Our Takeaways:
· Telehealth is an increasingly popular method for obtaining medical services
· More studies need to be done in the areas of male sexual and reproductive medicine.
· Studies cite the prevalence of ED as high as 52%!
“With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness,” write Navid Leelani, DO, and Scott D. Lundy, MD, PhD.
With the intensified direct-to-consumer marketing of male sexual medicine treatments, the recent legislative changes in reproductive rights and their unknown long-term effect on assisted reproduction availability for infertile men, and the explosion of telehealth, the practice of male sexual medicine is evolving at a breakneck pace. Specialists in male sexual and reproductive medicine have been tasked with digesting the evolving literature and forming evidence-based treatment guidelines for men with erectile dysfunction, Peyronie disease, infertility, and a host of other conditions. Compared with other areas of urology and medicine in general, male sexual and reproductive medicine has a disappointingly small number of well-designed prospective studies, along with a significant gap in funding for male reproductive health compared with female reproductive health. Several manuscripts published in 2022 started to narrow this gap and provide valuable level 1 evidence supporting (or discounting) key areas within sexual medicine and infertility.
For men with severe male factor infertility and nonobstructive azoospermia, surgical intervention is often indicated to retrieve sperm. Testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (mTESE) are 2 commonly used approaches. A recent study by Jensen et al compared the efficacy of these 2 approaches in one of the few prospective randomized-controlled trials in male infertility.1 In the study, 49 patients were randomly assigned to mTESE with a sperm retrieval rate of 43%, and 51 patients were randomly assigned to TESA with a sperm retrieval rate of 22%. Men with failed TESA then went on to salvage mTESE with a combined sperm retrieval rate of 29%. Participants in the mTESE arm, however, had decreased postoperative testosterone levels, and 24% of participants experienced de novo hypogonadism at 6 months. Prior literature has suggested the testosterone drop is transient and that it will likely recover by 12 months. In summary, the study results showed that mTESE remains the gold standard for treatment of nonobstructive azoospermia, but patients should be counseled on the risk of de novo hypogonadism.
Despite this, mTESE success rates remain modest and are subject to the expertise and skill level of the laboratory and andrologist processing the tissue. Multiple hours can be spent trying to find the few viable sperm hidden among a sea of distractors. A recent study by Lee et al examined the power of artificial intelligence to detect human sperm in semen and mTESE samples using bright-field microscopy for nonobstructive azoospermic (NOA) patients.2 They first trained the program to identify sperm from semen samples of fertile patients. After validating the effectiveness of their algorithm, they retrained it to identify sperm in tissue from NOA patients that had been spiked with large amounts of sperm. When testing it on samples containing 3000 to 6000 sperm among other cell types, they achieved 84.0% positive predictive value and 72.7% sensitivity. Finally, without retraining their algorithm, they tested it on samples containing 10 to 200 sperm, replicating the “rare sperm” phenomenon seen in patients with NOA. Their model was able to detect 2969 sperm cells out of a total 3517 with an 84.4% PPV and 86.1% sensitivity. The clinical applications of artificial intelligence and machine learning in medicine continue to expand and have made their way to male infertility. Although this is not ready for immediate clinical use, it does highlight the need for further work to harness the power of technology to improve workflow of andrologists and in turn increase the success of infertility care for patients.
There has been a rapid rise in the need for male sexual health and reproductive specialists as the population ages and the number of comorbidities rise, although certain disease processes that fall within this specialty may be able to be addressed by a general urologist. In an analysis of the current educational landscape, Asanad et al call attention to the need for a structured educational curriculum in residency for male infertility.3 In a survey of urology residents, 54 of 72 respondents (75%) reported that male infertility comprises less than 10% of their training. Compared with residents who did not learn from infertility-trained faculty, residents who were exposed to infertility-trained faculty were 14.4 times more likely to feel confident performing infertility procedures (P < .001) and were more likely to feel confident performing fertility procedures after residency (P = .001).3 For trainees, their career depends on what they are exposed to. Smaller subdisciplines within urology may be more difficult to teach uniformly, and perhaps there are ways to improve the exposure to these areas for motivated residents (eg, visiting other programs).
Within male sexual health, one disease process that all urologists should be able to diagnose and initially manage is erectile dysfunction (ED). With studies citing the prevalence of ED as high as 52%, the demand for providers to manage ED remains sky high. Current treatment options include phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, vacuum erection devices, and penile prosthesis. A newcomer to the field is shock wave therapy, which uses controlled energy to induce angiogenesis.
The short-term effectiveness of focused shock wave therapy for patients with moderate ED was investigated in a double-blind, randomized, sham-controlled trial.4 In this study of 70 patients with moderate ED, 35 were randomly assigned to low-intensity shock wave therapy (LiST) and the other 35 were randomly assigned to sham therapy. After a 4 week washout from PDE5i, patients underwent LiST or sham twice weekly for 6 weeks. One month after treatment completion, 59% patients in the LiST group experienced an International Index of Erectile Function (IIEF) score improvement of at least 5 points, compared with 1 patient (2.9%) in the sham group (P < .001). This effect remained present at 3 months post treatment. Thus, the short-term data for LiST are compelling and suggest this may be a viable option in the management of vasculogenic ED for men with mild/moderate ED. Further studies are desperately needed to validate these findings, and urologists have an obligation to provide patients with an honest assessment of the data and only recommend treatments where the risks (including the financial burden) are outweighed by the benefits.
In stark contrast to focused therapy, radial shock wave therapy uses low-pressure radial shock waves to treat ED. In order to characterize its effectiveness, a randomized, double-blind, sham-controlled clinical trial enrolled 80 men with mild to moderate ED.5 Patients were treated weekly with either radial wave therapy or sham therapy for 6 weeks, and the primary outcome measured was change in the IIEF score between baseline and after treatment. Study results showed that there was no significant difference in IIEF scores between groups at 6 weeks or 10 weeks after randomization. Study results displayed the lack of evidence to support the use of radial wave therapy.
Despite the evidence of their ineffectiveness in managing ED, shock wave therapy and particularly radial wave therapy have been heavily marketed directly to consumers in the US. A recent article using a “secret-shopper” method found troubling marketing and practice trends in the US. The authors noted that patients often are not adequately educated on the different types of treatments and may not know if the administrator is a licensed medical professional.6 With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness.
Recent advancements in the field of male sexual health and reproduction present a bright future for the field with new diagnostic and therapeutic options on the horizon. However, it is apparent that demand still outpaces supply for men’s health specialty care. Urologists must work diligently to fill this void to not only increase access for patients to receive evidence-based care, but also to prevent men from falling to prey to practices looking to take advantage of this unmet demand and a vulnerable patient population.
References
1. Jensen CFS, Ohl DA, Fode M, et al. Microdissection testicular sperm extraction versus multiple needle-pass percutaneous testicular sperm aspiration in men with nonobstructive azoospermia: a randomized clinical trial. Eur Urol. Published online May 19, 2022. doi:10.1016/j.eururo.2022.04.030
2. Lee R, Witherspoon L, Robinson M, et al. Automated rare sperm identification from low-magnification microscopy images of dissociated microsurgical testicular sperm extraction samples using deep learning. Fertil Steril. 2022;118(1):90-99. doi:10.1016/j.fertnstert.2022.03.011
3. Asanad K, Nusbaum D, Fuchs G, Rodman JCS, Samplaski MK. The impact of male infertility faculty on urology residency training. Andrologia. 2022;54(8):e14457. doi:10.1111/and.14457
4. Kalyvianakis D, Mykoniatis I, Pyrgidis N, et al. The effect of low-intensity shock wave therapy on moderate erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial. J Urol. 2022;208(2):388-395. doi:10.1097/JU.0000000000002684
5. Sandoval-Salinas C, Saffon JP, Martínez JM, Corredor HA, Gallego A. Are radial pressure waves effective for the treatment of moderate or mild to moderate erectile dysfunction? A randomized sham therapy controlled clinical trial. J Sex Med. 2022;19(5):738-744. doi:10.1016/j.jsxm.2022.02.010
6. Weinberger JM, Shahinyan GK, Yang SC, et al. Shock wave therapy for erectile dysfunction: marketing and practice trends in major metropolitan areas in the United States. Urol Pract. 2022;9(3):212-219. doi:10.1097/UPJ.0000000000000299
A step-by-step guide for what to check, how to do it, and when to see your doctor.
By Elizabeth Millard Published: Aug 30, 2022
This article is a repost which originally appeared on Men’s Health.
Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.
Our Takeaways:
· Testicular cancer is most common among men 20-40 years of age.
· Testicular exams during a shower are optimal.
· Men should also examine their chests to ensure there’s no development of breast cancer.
Two-thirds of sexually active men agree it’s important to regularly perform below-the-belt self-exams—but 47 percent have no clue how to do one, according to a survey by Men’s Health parent company Hearst Media. No need to count yourself in the clueless half; below is your instruction manual on how to perform a sexual health exam in the privacy of your home—and why doing so is crucial for your health.
Because testicular cancer skews young—the disease is seen mainly in men between the ages of 20 and 40—self-exams should start as early as possible. Ideally, that would be in your teenage years, says Adam Ramin, MD, urologist and medical director of Urology Cancer Specialists in Los Angeles. Begin self-exams when there doesn’t seem to be a problem, so you can establish a baseline of what’s normal for you.
Doing a self-check while showering or bathing is easier because it relaxes the skin of your scrotum, says Boback Berookhim, MD, director of male fertility and microsurgery at Lenox Hill Hospital in New York. Plus, you’re already naked, so why not?
Move your penis out of the way and assess each testicle individually. Dr. Ramin says it should feel firm, similar to the webbing on your hand between the forefinger and thumb. Press gently to feel all parts of the testicle. As you feel behind the testicle, there may be a pea-sized lump; these are often benign, since cysts are common in that area, but if you find one, take note of its size and check with your doc if it’s painful or starts getting larger.
It’s common for one testicle to be slightly different in size or shape than the other. If you’re noticing a change in what constitutes normal for you, that should prompt a checkup.
The upper part of the testicles may have veins that look like a “bag of worms,” says Dr. Berookhim. Called “varicose seals,” these veins aren’t usually cause for concern, but if they start to enlarge or harden, get checked because that could affect fertility.
Look for skin changes, pimples, pustules, painful warts, or sores, all of which could be associated with a sexually transmitted infection.
If bringing the foreskin back causes pain or is difficult, see your doctor. This could be an indication of diabetes, says Dr. Ramin.
Your penis should be straight, so if there’s a slight bend that’s more pronounced during an erection it could be Peyronie’s disease. According to Dr. Ramin, this condition could occur when excess calcium forms plaque in your penile blood vessels, or be caused by scar tissue caused from an injury. If your penis is painful to touch, it’s best to get it checked.
Yes, men have breast tissue and can get breast cancer, so whenever you do a self-exam, check your chest as well. Gently but firmly press in a circular pattern around each nipple and outward, feeling for any small lumps. If you feel one, don’t put off getting checked; men have a higher mortality rate for breast cancer than women, which experts link to delayed diagnosis and treatment.
Once you step out of the shower, use a small mirror to inspect the underside of your penis and the inside of your thighs for sores or moles. Melanoma in the genital region is very rare, says Dr. Berookhim, but it does happen.
If you’re not detecting an issue, do a self-check every six months, suggests Dr. Ramin. But if you’ve had a problem or there’s an area you’re keeping an eye on, check more often.
End Of Cycle Peaking, Edging Improvement, and Supplementation: Ask The Experts
Big Al, of MaleEnhancementCoach.com, answers questions about peaking at the end of a training cycle, improving edging time, and supplements.
If you have questions you’d like answered in an Ask the Experts article, please PM Big Al
Q. You mention “peaking” at the end of a workout cycle being a goal. What exactly does this refer to?
Al: Peaking is the goal for the end of a cycle where you’re performing at maximum effort after several weeks of increases. A good analogy for this is when athletes train for a competition in a manner which ensures they perform their best on the date concerned. In your case, the final week of a cycle is where you wish to peak/plateau. Continued work much beyond this state leads to overtraining.
If you don’t hit a peak by the end of a cycle., it’s a good bet you’ve been UNDERtraining.
Q. I seem to be stuck at 10 minutes max time with edging.
The instructions say to stop three times before the point of no return but I can’t even get past two times. What is it that I can do to solve this problem?
Al: If you have to pause to get the extra time in, you can do so. If you can slow the rate and intensity of stimulation while still adding time per session that would be even better- though more difficult.
The initial goal of this exercise is to get to 20 minutes. At this point, a threshold should be reached where it becomes much easier to control your ejaculations. You should also have gotten more tolerance bu this time- though the correlation between endurance for MANUAL Stop and Starts and sexual activity may not be equal.
Q. What are some supplements you recommend for male enhancement improvement?
Al: For better EQ, L-Arginine is a good one. Yohimbe is excellent as an “herbal Viagra” and even has aphrodisiac-like qualities, but isn’t recommended for those with high blood pressure. Arnica is good to speed healing, while Butcher’s Broom (Ruscogenin) can aid in strengthening venous sufficiency. Vitamins A, E, and Zinc all help to maintain optimal hormonal profiles.
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