Depression and erectile dysfunction: The link, causes, and treatment

What to know about depression and erectile dysfunction

Medically reviewed by Nicole Washington, DO, MPH — By Mary West on November 14, 2022

This article is a repost which originally appeared on MEDICAL NEWS TODAY.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our takes:

‧ There are many potential causes of Erectile Dysfunction (ED).

‧ Anxiety and emotional stress appear to be common underlying factors.

‧ Medical professional assistance is available for treating ED.

Research has shown that there is a link between the two conditions. If a person has depression, they have a higher risk of developing erectile dysfunction (ED).

The above information comes from a 2018 review published in The Journal of Sexual Medicine.

Researchers do not fully understand the connection. However, theories suggest the underlying causes may include sexual performance anxiety or antidepressant side effects.

If a person with depression experiences ED, their doctor may prescribe a medication such as sildenafil (Viagra). Alternatively, they may recommend trying a different antidepressant.

Read on to learn about the symptoms of ED, how depression can cause it, treatment options, and more.

Signs and symptoms of erectile dysfunction

The signs of ED include‧:

‧ ability to get an erection only sometimes, despite a desire to have sex

‧ inability to get an erection at any time

‧ ability to get an erection, but being unable to sustain it throughout sex

Can depression cause erectile dysfunction?

Research from 2018 evaluates 49 studies to determine the relationship between depression and ED. It finds that a person with depression was 39% more likely to have ED than a person without depression.

Experts do not fully understand the factors that underlie how depression may cause ED. However, the current theories include:

‧ Behavioral: Depression involves negative thoughts and low mood. Either or both can lead to performance anxiety that hinders erectile function.

‧ Antidepressants: Many people with depression take antidepressant medications to manage their symptoms. However, these medications can cause low libido and inhibit the ability to have or maintain an erection.

‧ Low testosterone: The male hormone, testosterone, plays a key role in sexual performance. As such, low levels often correlate to ED. There is an association between depression and low testosterone levels in men.

The previously mentioned 2018 review also finds that people with ED are 192% more likely to have depression. This means that the link between depression likely goes both ways. For example, a person with depression may have ED for the reasons listed above. Similarly, a person with ED may also be more likely to experience depression.

Low self-esteem, self-consciousness about sexual performance, and other negative thoughts could contribute to depression in people with ED.
Other causes

There are a wide variety of factors besides depression that can cause ED. They include:

physical health conditions, such as:

‧ type 2 diabetes

‧ high blood pressure

‧ heart and blood vessel disease

‧ multiple sclerosis

‧ Peyronie’s disease (curvature of the penis)

‧ chronic kidney disease

‧ surgery for bladder cancer

‧ injury to the penis or pelvic area

certain medications, including:

‧ antidepressants, such as fluoxetine (Prozac)

‧ blood pressure drugs, such as atenolol (Tenormin)

‧ tranquilizers, such as diazepam (Valium)

‧ antiandrogens (medications that block the effects of testosterone), such as bicalutamide (Casodex)

‧ appetite suppressants, such as phentermine (Adipex-P)

Mental health factors can also increase a person’s likelihood of ED. In addition to depression, these include:

‧ anxiety

‧ low self-esteem

‧ fear of sexual failure

‧ stress

‧ guilt about certain sexual activities

Treatment options

Treatment for ED and depression includes medication, lifestyle changes, and psychotherapy. The treatment a healthcare professional recommends depends on the underlying cause of a person’s symptoms.

Medications for erectile dysfunction

Older research from 2001 explains when depression and ED occur simultaneously, treating one condition may improve the other. The findings indicate that treating ED with Viagra can alleviate the issue and lead to a notable reduction in depression.

Despite this, the research did not investigate how long the improvement lasts.

Doctors commonly prescribe Viagra for ED. It works by relaxing the muscle and increasing blood flow to the penis during sexual arousal. Other medications in the class include:

‧ vardenafil (Levitra)

‧ avanafil (Stendra)

‧ tadalafil (Cialis)

Additionally, if a person has low testosterone, a doctor may prescribe supplemental hormones.

Another treatment option that can trigger an erection is alprostadil. This comes in the form of an injection (Caverject) or a suppository (Muse).

Medication change for depression

A study from 2017 notes that sexual dysfunction is a common side effect of many antidepressants. For that reason, changing medication can help. Low libido and difficulty maintaining an erection are common side effects of antidepressants. However, some medications are less likely to have these effects.

The study’s authors recommend the following antidepressants for people who consider sexual functioning important:

‧ desvenlafaxine (Pristiq)

‧ trazodone

‧ vortioxetine (Trintellix)

‧ vilazodone

Lifestyle changes

Lifestyle changes may also reduce symptoms‧ of ED. These changes include:

‧ stopping smoking, if applicable

‧ eating a nutritious diet

‧ exercising regularly

‧ maintaining a moderate weight

‧ limiting or stopping recreational drug use, if applicable

Psychotherapy

The following psychotherapy interventions may help a person manage the emotional and psychological effects of depression and ED.

‧ Sex therapy: This involves counseling partners about their relationship or sex-related concerns.

‧ Cognitive behavioral therapy (CBT): This helps a person identify unhelpful thoughts and develop healthier ways of responding to challenges.

‧ Mindfulness therapy: This mental exercise consists of focusing on the present moment.

When to contact a doctor

If a person thinks they may have ED, it is a good idea to make an appointment with a doctor.

Additionally, people should seek medical attention if they have symptoms of depression. The sad feelings associated with depression last weeks and months, not days.

If they have suicidal thoughts, they should get immediate medical attention.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

Ask the tough question: “Are you considering suicide?”
Listen to the person without judgment.
Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
Stay with the person until professional help arrives.
Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Summary

People with depression are more likely to have ED, and ED is also associated with higher rates of depression. Symptoms of ED include being unable to attain and sustain an erection long enough to have sex.

If a person has both depression and ED, treating one condition is likely to improve the other. Medication and psychotherapy interventions, such as mindfulness, may help someone manage both conditions.

Sources:

Chokka, P. R., et al. (2017). Assessment and management of sexual dysfunction in the context of depression.
https://journals.sagepub.com/doi/10.1177/2045125317720642
Liu, Q., et al. (2018). Erectile dysfunction and depression: A systematic review and meta-analysis.
https://www.jsm.jsexmed.org/article/S1743-6095(18)31007-5/fulltext
Lue, T. (n.d.). Erectile dysfunction (ED).
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction
Overview – clinical depression. (2019).
https://www.nhs.uk/mental-health/conditions/clinical-depression/overview/
Seidman, S. N., et al. (2001). Treatment of erectile dysfunction in men with depressive symptoms: Results of a placebo-controlled trial with sildenafil citrate.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.10.1623
Walther, A., et al. (2019). Association of testosterone treatment with alleviation of depressive symptoms in men.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976

Male Hormonal Cycles

5 Things You Need to Know About the Male Hormonal Cycle

Anouare Abdou
November 8, 2022

This article is a repost which originally appeared on AskMen.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Early testing can help identify low testosterone.

‧ Unknown to many, men also have hormonal cycles.

‧ There is a correlation with optimal health and well being and optimal hormone levels.

‧ Testosterone is a stress resistance hormone.

When you hear the words “hormonal cycle,” the menstrual cycle might come to mind. You may be aware that women ovulate or have periods, for example. But men have cycles too — and it’s important to understand yours.

“Many men have little understanding of their hormonal cycle and are often dismissive of the impact it can have on both body and mind. Although most men know that hormones play a massive role in regulating sex drive and libido, the effects of the male hormonal cycles are often overlooked,” according to Dr Chia Tan, founder of Harley St M.D., a clinic that provides testosterone replacement therapy and a range of men’s health tests and treatments.

“Optimal testosterone and hormone levels help create the best version of ourselves. We feel youthful, energic, vibrant, and capable of making quick cognitive decisions. We recover quickly after exercising, keep belly fat at bay, and have a passionate libido as well as the ability to gain and maintain a strong erection,” says Ross Tomkins, co-founder of a men’s hormonal health clinic called Alphagenix.

From the impact of your lifestyle on your hormones to the effects of low testosterone, here are five things you need to know about the male hormonal cycle.

How Often Does the Male Hormone Cycle Reset?

While the average menstrual cycle lasts 28 days, the male hormonal cycle is actually built around the typical workday and resets within a 24-hour time span.

“Testosterone levels are elevated in the morning, reduce slightly in the afternoon, and are lowest late at night,” says Tan. “This basically means men tend to have more energy in the morning and afternoon, the natural time of the day when they would have been out hunting, which is when motivation, assertiveness and strength are needed the most.”

Can You Use Your Hormonal Cycle to Your Advantage?

You can therefore use that knowledge to your advantage. For example, Tomkins suggests working out or doing your most important work tasks first thing in the day to benefit from the surge of testosterone you experience in the morning. Your testosterone levels will start to decrease around lunchtime, so the period of time before that is prime time for being productive.

How Important is Testosterone?

You’ve gathered that testosterone plays a crucial role in your hormonal cycle. Its impact cannot be understated. Common signs of low testosterone levels include reduced sex drive and difficulty getting erections, fatigue, increased body fat, and mood swings, according to Tan.

Testosterone is not only responsible for your sex drive. It plays a big role in how you deal with stress and how efficient your metabolism is. “Testosterone is a stress hormone, it helps us resist stress. Low testosterone therefore often is linked with low mood, low motivation, and low vigor in life. Body fat distribution may change and one may find it harder to maintain lean muscle mass and easier to gain body fat due to a reduction in metabolism,” adds Tan.

Can Men Go Through Early Andropause?

You should also be aware of the fact that men experience the equivalent of menopause — andropause. And it can happen earlier than normal. For instance, Tomkins was diagnosed with low levels of testosterone in his early thirties, which led him to embark on a wellness journey.

Although men will always produce testosterone, they reach peak levels of the hormone in early adulthood. As they age, their testosterone levels decrease. “In some cases, these symptoms can be reported as early as in their late 30s or early 40s, but the majority of men may only start to notice it in their 50s or 60s,” says Tan.

How Does Lifestyle Affect Your Hormones?

Keep in mind that it’s not all luck and genetics. Your habits can have a huge impact on your hormonal cycle. “It’s really important to realize that this cycle is easily disrupted by poor lifestyle choices including poor diet, alcohol, smoking, no exercise and lack of quality sleep,” says Tomkins.

“If you recognize any symptoms I would start by looking at your diet, lifestyle and sleep. If these are all good, consider speaking to a specialist or at least taking a blood test to check biomarkers,” he recommends.

That being said, a blood test might not tell the full story, so trusting yourself and your awareness of your body is key. “Being within the normal range may not be sufficient for optimal well-being. The normal range determined by a laboratory takes no account of symptoms and is derived purely based on a statistical calculation of standard deviation and normal distribution curve,” says Tan.

What Can You Do to Address Low Testosterone?

If you do get diagnosed with low testosterone or embark on a journey to optimize your hormones, there are things you can do in conjunction with lifestyle changes.

Tomkins says that he now feels stronger and fitter than in his twenties after changing his diet and starting Testosterone replacement therapy (TRT). TRT is designed to bring back hormone levels to a healthy range by giving the body testosterone until symptoms start to reverse. “Restoring testosterone levels to an optimal level will significantly improve a man’s quality of life,” says Tan.

However, you’ll want to find experienced and knowledgeable doctors who will be able to diagnose you and create a personalized treatment plan. “Good TRT requires regular monitoring and tweaking, as all men are different,” adds Tan. “Everyone has a different height, body mass, and physical activity level, therefore treatment needs to be bespoke and individualized to make sure you get the best out of it.”

Men Should Check Their Testosterone Levels by Age 30, Urologist Says

Men should know their testosterone levels by age 30 to prevent health issues like weight gain and muscle loss, says top urologist

Gabby Landsverk
Oct 11, 2022, 12:31 PM

This article is a repost which originally appeared on INSIDER.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Early testing can help identify low testosterone.

‧ Low testosterone levels can cause side effects ranging from low libido and mood to muscle loss.

‧ A urologist said more men should get tested so their doctors can see how their hormone levels change over time.

‧ There is some evidence that higher testosterone levels may prevent illness like prostate cancer, not increase the risk.

Testosterone is a crucial hormone for men’s health, and a top urologist says more men should know their levels earlier in life.

Low testosterone can cause loss of energy, muscle, and libido, and can contribute to chronic illnesses such as heart disease, diabetes, and obesity, according to research.

But diagnosing low testosterone can be tricky, because natural testosterone levels can vary.

If you don’t already know your baseline, and you start experiencing these symptoms, you may not be able to trust the results of a testosterone test, said Dr. Ananias C. Diokno, former chief medical officer and chair of urology at Beaumont Hospital, Royal Oak.

“If you ask men what their testosterone levels are, they’ll scratch their heads. They don’t know and doctors aren’t testing for this. You should know what your level is by the time you hit 30 to 35,” Diokno told Insider.

What we think of as ‘normal’ testosterone, and why it’s not a perfect barometer

Testing for low testosterone is simple, using a blood test.

In healthy men, testosterone levels can range between 260 nanograms per deciliter (ng/dL) and more than 900 ng/dL, depending on age.

Low testosterone is typically defined as less than 250-300 ng/dL, according to the Cleveland Clinic.

However, since natural testosterone levels can vary widely, Diokno said many men can be misdiagnosed for hormone deficiencies.

For example, a person with testosterone levels of 400 or 500 ng/dL won’t be diagnosed with low testosterone because it’s higher than the defined standard, but if his initial levels were 700 or higher, the drop is significant and may warrant treatment.

“Many practitioners close their minds. Someone may be having symptoms but according to the guidelines, does not have low testosterone. It’s frustrating among men and among doctors who can’t help them,” Diokno said.

One solution is more routine hormone testing so men can establish what a healthy baseline looks like for them, similar to other markers of health like cholesterol, blood pressure, and blood sugar, Diokno said.

Low testosterone can cause low energy, low libido, and loss of muscle

Over time, men’s testosterone levels dwindle as a common side effect of aging. However, younger men can also have low testosterone, causing them to experience similar symptoms to much older men.

Telltale symptoms of low testosterone can be mental, physical, and emotional, including:

‧ Decreased sex drive

‧ Brain fog

‧ Depression and mood changes

‧ Fatigue

‧ Difficulty building or maintaining muscle

“The lower the testosterone, the more symptoms,” Diokno said.

Testosterone therapy may not be as risky as previously believed

For men who have had sudden dips in hormone levels, testosterone therapy can help restore quality of life, energy, and libido, Diokno said.

Previously, testosterone therapy has been carefully regulated, in part because high testosterone has been linked to a higher risk of prostate cancer in some studies.

Diokno said the opposite may be true, according to some observational studies, and healthy testosterone levels may protect prostate health.

Loss of muscle linked to low testosterone can cause other problems, too, including a decreased metabolism that can lead to weight gain and associated health issues.

Available evidence suggests that testosterone therapy, done correctly and with medical supervision, is a safe and effective way to raise hormone levels, and more research is needed to see who could benefit, Diokno said.

“It’s a Pandora’s Box, I think there are many questions that are still unanswered,” he said.

Get a Stronger, Healthier Penis – Penis Health Plan

The Ultimate Training Plan for a Stronger, Healthier Penis

Power up your package and sexual performance.

By Jon Irwin

Published: Oct 25, 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:

· Exercises can be performed for better penile function.

· Regular, productive sexual activity is excellent for optimizing penile function.

· If you suffer from serious negative effects, please seek out medical professional assistance.

“Fitness Routine” usually conjures up whatever gets you more endurance or stronger muscles. But devoting a little time to a few routines and developing new habits can also result in a stronger, healthier penis. Think of it as Third Leg Day.

Peak-performing junk (penis, balls, prostate, and pelvis—the whole enchilada) puts bathroom breaks under your control and houses sperm that are both plentiful and swift. Whether you think your package is working great, struggling, or doing something in between, these tips will help you get your gear in gear.

How to optimize your package if you are basically fine

That means everything is working okay—you just want to keep it that way.

Raise the frequency

Men who had sex less than once a week had a higher risk of erectile dysfunction than guys who did it at least once a week, according to a study in The American Journal of Medicine, making it one of the most useful (and fun!) ways to keep your penis strong. Even better, DIY sex is good, too. If you’ve noticed that you have a hard time maintaining an erection or reaching orgasm without, say, watching certain videos on the Internet, then you might want to try an orgasm ban during sex, even for a day, says sex educator Lawrence A. Siegel. This shifts the focus away from the endpoint and toward pleasure in the moment.

Find the right stuff for your stuff

When jock itch is driving you nuts, bypass online advice to apply apple–cider vinegar, cocoa butter, or Vicks VapoRub—they can leave you more uncomfortable without helping—and start with an OTC antifungal cream (like Lotrimin). Then avoid repeat infections: Put those boxer briefs on carefully at the gym and treat athlete’s foot and sweaty shoes with an antifungal powder, says MH dermatology advisor Corey L. Hartman, M.D.

Wrap it

Rates of the most reportable sexually transmitted infections have surpassed prepandemic levels, according to the CDC. At last estimate, one in five people in the U. S. has an STI. If you’re convinced condoms are still nothing but barriers to pleasure, you haven’t checked out the market for a while. P. S. condoms are known for feeling as if there’s nothing there. Skyn condoms have a soft texture and are nonlatex.

How to optimize if you are sort of fine

“Sort of fine” meaning you have problems getting or keeping it up—and maybe bladder leakage. Things may also look slightly . . . off?

Add a daily workout

Treat your pelvic floor like the muscles it’s made of and do isometric contraction sets. These Kegels improve bladder control and “have been shown to allow men to control ejaculations and enhance orgasm,” says Jamin Brahmbhatt, M.D., an assistant professor of urology at UCF College of Medicine. Tighten the muscles that stop your pee midstream for 3 seconds, relax them for 3, and repeat 10 times. Aim for 3 sets a day.

Get that checked out

Pimples? Bumps? Rashes? Go to a doctor to figure out what’s going on. Yes, there are apps out there where you can take a photo of your stuff and get a diagnosis of what’s up, but MH urology advisor Elizabeth Kavaler, M.D., says that using an app to detect an STI is “totally crazy.” You can order an at-home STI test kit (LetsGetChecked.com, Everlywell), but if what you have isn’t an STI, the kit can’t tell you what the trouble actually is. Only a real live doctor can do that.

How to optimize if you are not fine

In other words, “not fine” is when you can’t maintain an erection. And the urge to urinate is all the time.

Bolster your bladder

If “drip” describes your latest bathroom trip, you may have benign prostatic hyperplasia, a usually innocuous yet annoying enlarged prostate gland. The good news is that there are many treatments after diagnosis. Talk to your doctor about saw-palmetto extract, a supplement that can reduce urinary symptoms for some men, says Dr. Kavaler. Prescription drugs and minimally invasive surgeries can also help.

Eliminate the negative

Having a hard time staying hard? Maybe it’s your attitude. Men with higher levels of suspicious jealousy concerning their mate tend to have higher levels of erectile dysfunction, according to research by Gavin Vance at Oakland University. One way to cut through the envy is with sensate-focus therapy, a technique that uses touch, like holding hands, to decrease anxiety and increase intimacy.

Seek treatment for ED

If you’ve ruled out pills due to side effects or preexisting conditions, consider injectables. Sounds scary, but intracavernosal injections do the same thing as pills—increase blood flow—and people who use them consistently have high satisfaction rates, according to a 2019 study. Just stay skeptical of shock-wave therapy, says Dr. Kavaler. Using high-frequency ultrasound to irritate the penis lining as a way to help new cells grow and increase blood flow is being investigated, but its marketing may be stronger than the evidence—at least right now.

This story originally appeared in the November 2022 issue of Men’s Health.

Reference: Recent advances in the understanding and management of erectile dysfunction: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348436/

Sexual Stamina: 10 Tips to Last Longer

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.

How long should sex last?

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?

Foreplay

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

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.

Work on your relationship

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.

Medication

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.

Reduce stimulation

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.

Techniques to delay orgasm

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.

Try something different

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.

You can improve your sexual stamina

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.

 

How to Perform the Master Your Orgasms Exercise (from The Ultimate Guide To Male Enhancement)

The following is taken from Chapter 14: Ways to Treat Premature Ejaculation from The Ultimate Guide To Male Enhancement.

Edited for content

How to Perform the Master Your Orgasms Exercise

Many men never experience the full potential of pleasure they can receive from their sexual encounters. This littleknown 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 2030 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.

Mastering Your Orgasms Takes Time

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 2030 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.

The Ultimate Guide to Male Enhancement

Male sexual health and reproductive medicine: All that glitters is not gold

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

Men’s health: Employers must tackle low testosterone levels

by Helen Lake

Low testosterone is sapping the energy levels of two million men in the UK. Helen Lake discusses some of the issues and misconceptions surrounding low testosterone, as well as outlining the actions that employers can take to support their staff who are suffering with this hard-to-spot condition.

27th Jul 2022

This article is a repost which originally appeared on HRZone.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· A large percentage of men suffer from emotional concerns in silence.

· 40% of men aged 45 or older have clinically low levels of testosterone.

· Testosterone Replacement Therapy (TRT) should be considered a tactic of last resort for men with hormonal issues.

It’s estimated that around two million men in Britain suffer from low testosterone levels, making it a very real issue for a large proportion of the UK workforce.

For those working men suffering with it, symptoms can include low energy levels, poor concentration, memory loss and side effects that are often misdiagnosed as depression. Longer term, men living with a testosterone deficiency are more susceptible to serious health issues including cardiac arrest, infertility and osteoporosis.

Recent research by Peppy found that 39% of employees experience disruption due to men waiting until a health problem becomes severe before talking to their HR team.

With low testosterone impacting a man’s general wellbeing, as well as his performance at work – increasingly, there are calls for greater workplace support and awareness around male testosterone deficiency.

Men’s Health Awareness Week recently took place, but we shouldn’t only focus on men’s health during this time. At any point in the year, organisations should examine what can be done to raise the bar for men’s health, including their ‘t-levels’.

Who is impacted by low testosterone?

The research also revealed that an estimated 40% of men aged 45 and older have low testosterone. But, since this is an issue unique to men, it’s likely that the true figures are much higher than are reported.

Testosterone is the male hormone produced that boosts bone strength, powers sex drive, and helps to maintain muscle mass.

An estimated 40% of men aged 45 and older have low testosterone, with the true figure thought to be much higher.

It is mostly produced in the testicles, with production rising rapidly during puberty, triggering a whole host of teenage side-effects in young males and peaking around the 20s.

Levels begin to decline naturally in men by around 2% a year from their mid-30s. By their 40s, the more common symptoms – such as mood swings, low energy, loss of muscle mass, and poor concentration – are more likely to occur.

The imbalance of such a crucial part of a man’s hormonal make-up can have wide-ranging implications, both for him and his workplace.

A wide range of symptoms

While concerns around the impact menopause can have upon women in the workforce have taken deserved precedence in recent years, the issue of low testosterone in men of a working age is a cause for increasing concern among medical professionals.

And it should be for employers, too.

The ‘andropause’, as it’s been dubbed, may not present with as severe a set of symptoms as those experienced by some women during menopause, but the gradual decline in testosterone levels can have a devastating impact on the long-term health of men.

At the heart of the problem, is the fact that low testosterone isn’t always correctly diagnosed. Symptoms are commonly attributed to ‘working too hard’ or just getting older, and are often mistaken for depression – or else not identified at all.

The gradual decline in testosterone levels can have a devastating impact on the long-term health of men.

The symptoms of low testosterone vary between individuals. In some cases, low levels of testosterone do not appear to cause many symptoms for reasons that are not clear.

Impacts on men’s mental health and emotional wellbeing include poor sleep quality, mood swings and irritability – making it an issue employees and employers need to be aware of. Erectile dysfunction is another common sign, but is often viewed as an embarrassing issue that contributes to men suffering in silence.

In more severe cases, a decline in testosterone can affect sperm count and cause men to grow ‘moobs’ or man boobs, due to changes in the body’s fat distribution. The knock-on effect of low testosterone can therefore impact body image, self-confidence, and even family plans.

Most cases are caused by ageing, or through being overweight or type 2 diabetes – both of which are prevalent in the male population of the UK. In addition, low levels of testosterone can affect younger men as a result of stress, lack of sleep, poor diet and lack of exercise.

The impact on male mental health

For many men, low testosterone levels are the real culprit for that general feeling of low mood and exhaustion that so many experience.

But, when men are half as likely as women to visit their GP, many go years if not decades experiencing high levels of fatigue and decreased energy levels without finding out that it is hormone related and treatable.

In the UK today, one in eight men struggle with a common mental health problem such as anxiety or depression, and this is likely to be higher than is officially recorded. One in three men also attribute poor mental health to their job, making this a serious issue for workplaces.

In the UK today, one in eight men struggle with a common mental health problem such as anxiety or depression.

Directly or indirectly, the impact low testosterone levels can have on a man’s health and lifestyle – from loss of libido, to weight gain, to lack of quality sleep, to low mood – is very likely to trickle through to their mental and emotional wellbeing.

For organisations committed to improving their male workforce’s mental health, tackling testosterone must become part of the conversation.

How workplaces can tackle the problem

At present, accessing specific support is difficult for men suffering with low testosterone. Tests are only available on the NHS to those with severe symptoms, and these people must firstly have made an appointment with the GP and made it through the system, just in order to be diagnosed with low testosterone.

Workplaces are uniquely placed to give employees the practical and emotional support they need – and this starts with raising awareness.

Employees of all genders, ages and life stages should be made aware of the signs, symptoms and risks of low testosterone, so they know what to look out for in themselves, their colleagues and even their partners. Providing resources in the workplace for improved physical and mental health for employees should also be a priority.

Organisations should make the pathway to support as easy to access as possible by giving employees access to specialist men’s health support, including highly-trained urology specialist nurses, as well as nutritionists and fitness experts. Crucially for men, support should be available remotely and entirely confidentially to maximise uptake.

The help provided should include access to at-home hormone tests and personalised, expert advice on how to treat the side-effects of low testosterone.

Testosterone replacement therapy (TRT) should always be the last resort.

There is no ‘quick fix’ when it comes to low testosterone levels. Simple lifestyle changes like diet, exercise, sleep and work-life-balance can have a miraculous impact on an individual’s testosterone levels and should be explored first.

Testosterone replacement therapy (TRT) should always be the last resort, with any potential underlying medical cause excluded.

Leading employers are transforming men’s health

Forward-thinking employers and their employees are already reaping the rewards of connecting their people to a team of real, human experts.

With the right tools at their fingertips, individuals from leading consultancy firms, high street retailers and law firms are able to work alongside nutritionists, personal trainers, urology specialists and mental health experts – building the habits that can help to restore healthy testosterone levels.

Because eliminating the unwanted effects of low testosterone won’t just benefit the individual, but their workplace as well.

With the right holistic support and wellbeing initiatives, employees can spot the signs, identify the causes and take immediate, practical steps towards rebalancing their hormone levels, enabling them to bring their best selves to work each day.

Explained: Why men must not ignore sexual health problems

While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

IANS Updated Jul 24, 2022 | 06:43 AM IST

This article is a repost which originally appeared on TIMESNOW

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Men are usually hesitant to discuss sexual matters with others in a social setting.

· Professional consultations for sexual problems have more than doubled since 2020.

· Discussing sexual concerns can help to relieve stress and to discover potential solutions.

When was the last time you heard a man discussing his sexual wellness in a peer group or a social setting, or even with his loved ones? Chances are, you’ve never heard of such a thing. These conversations, while critical, just do not happen.
While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

Just like physical and mental well-being, men must take care of sexual wellness to lead a healthy and happy life. Thankfully, we’re on our way to speaking out loud about these issues as a society. Sexual wellness consultations increased by almost 139% in the year 2020 compared with the previous year.

1. Performance Pressure: Sexual health and effectiveness are taboo in society and specifically for men for various reasons. It is often assumed that sexual activity comes more naturally to men than women. While that is untrue, this notion gets even more troublesome when men aren’t able to perform in bed. Men suffer from performance anxiety a lot more than women, which is a leading cause of erectile dysfunction.

2. Erectile Dysfunction: The commonly used term for ED is impotence. The mere association of this word with men arouses discomfort in social circles and, more often than not, leads to a scarred image. But the problem is not as rare, just less talked about. As per the Massachusetts Male Aging Study, nearly half of the men in the age group of 40 to 70 face this issue due to reasons varying from arterial malfunction or other abnormalities that can be checked and treated. ED can be caused by endocrinological diseases such as prostate malfunction, hypogonadism or even diabetes. Trouble maintaining an erection could very well be caused by fibrosis or atrophy, which is a sufficiently organic process but could also be caused due to drugs or smoke. Another myth surrounding men’s sexual health is that ED is a psychological disorder. While the cause could be neurological, the issue definitely needs to be probed for clarity and subsequent treatment.

3. Low Libido: Libido comes naturally to all genders, given they’re in a suitable space in their head. Sexual pleasure is a recreational activity that does not need to be and ideally is not supposed to be imposed upon anyone. So, not being in the right mind space, like experiencing stress or anxiety, could lead to low libido. There could be very many reasons that need to get checked by an expert.

4. Premature Ejaculation: Generally, one out of three men has been known to complain about premature orgasm. This creates a lot of pressure upon men as they feel they’re somehow incapable of pleasing their women. This further causes a loss of self-confidence, adversely impacting their mental health and even leading to severe problems. Those days are gone when there wasn’t any scientific explanation for biological processes. Society has advanced a great deal to know for sure that there are underlying causes for many of the activities affecting sexual health. All the community collectively needs to do now is talk openly about sexual diseases and discomfort like other diseases. The bubble needs to burst now more than ever when we are experiencing a time when multiple genders exist in society.

Sexual pleasure, like any other need in life, is an individual’s responsibility. But acceptance in relationships plays a significant role in bringing that sort of communication out loud. This helps improve relationships and emotional health and leads to enhanced confidence and perspective in all aspects of life. Again, acceptance is the key in the end.

(Nilay Mehrotra, Founder & CEO of Kindly)

 

 

 

 

 

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