Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Understanding male sexual health: More men now reporting low sex drive, Peyronie’s disease, finds study

Scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation.

Myupchar July 20, 2020 22:17:59 IST

This article is a repost which originally appeared on Firstpost.

Edited for content

Male infertility is a topic that is rarely discussed. However, doctors have seen an increase in the number of male patients coming to sexual health clinics to seek help in recent years. Doctors have seen that different sexual health problems are being reported by men which were not prevalent before, also indicating more awareness and openness regarding male sexual health.

Different male sexual health problems

A study published in the journal International Journal of Impotence Research on 1 July 2020 stated that there has been a switch in the sexual problems which males complain about now.

The scientists accumulated complete data of 2,013 patients who were continuously evaluated by a sexual medicine expert between the years 2006 to 2019. The scientists found that 824 patients were assessed for erectile dysfunction, 369 patients were diagnosed with curvature of the penis (Peyronie’s disease), 322 patients had premature ejaculation, 204 suffered from low sex drive and the remaining 294 had other sexual dysfunctions.

In this study, the scientists found that earlier, more men were diagnosed with erectile dysfunction and premature ejaculation. However, more recently, men have been diagnosed with low sexual desire and Peyronie’s disease.

With the successful treatment options for erectile dysfunction such as Viagra and Cialis and awareness, men have been reporting more about other sexual dysfunctions as well.

Cap-Score: A test to find out sperm quality

Male infertility is one of the major reasons behind the increasing numbers of in-vitro fertilization (IVF) cases throughout the world. Earlier tests like semen analysis, also called seminogram, were done to find out the quality and ability of sperm to fertilize. However, due to the lack of an appropriate diagnostic test for evaluating the fertilizing ability of men, most of the infertility cases get classified as idiopathic or unexplained.

In a recent research article in the journal Reproductive BioMedicine Online, scientists from various universities in the US used Cap-Score to test the sperm capacitation of males.

Sperm capacitation is a natural process where the spermatozoa (motile male sex cell) changes its shape to be able to penetrate and fertilize the female egg. The Cap-Score is a test which determines the percentage of sperm that undergoes capacitation in a certain amount of time. Usually, 35 percent of sperms of a man with normal fertility would undergo capacitation.

In this study, the scientists took the sperm samples from 292 patients and tested their ability to reproduce with the help of traditional sperm analysis test and Cap-Score. Out of these patients, 128 couples became pregnant after three cycles of Intrauterine Insemination (placing sperm inside a woman’s uterus to facilitate fertilisation).

The scientists found that those with high Cap-Score were able to fertilize more efficiently and resulted in a higher number of pregnancies. The scientists also found that men who constantly questioned their fertility showed impaired or reduced capacitation ability.

Benefits of Cap-Score over traditional sperm analysis

Scientists found that traditional semen analysis is unable to identify impairments in fertilising ability, which typically leads to a diagnosis of idiopathic infertility. The scientists found that unlike the traditional semen analysis, capacitation is a better test which helps in determining whether or not there would be a successful generation of pregnancy.

Both these studies indicate that with better awareness of male sexual health issues, men choosing to report as well as get treatment for these diseases, and with the widespread adoption of better sperm analysis tests like the Cap-Score by the medical community, male sexual dysfunction and infertility can be better addressed globally.

For more information, read our article on Low Sperm Count.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.

13 Questions About Erections: What It Is, How It Works, What to Do

What Is an Erection? A First-Timer’s Guide to Getting Hard

Medically reviewed by Jennifer Litner, LMFT, CST — Written by Adrienne Santos-Longhurst on December 15, 2020

This article is a repost which originally appeared on Healthline

Edited for content. Some of the recommendations below may not be recommended by the forum- e.g.- watching porn

Got questions about erections? Like why do they happen, and usually at the most random times?

Or what the heck is dribbling out of it? And what’s up with raging semis?

Keep reading, because we’re answering all of your burning questions here. (Not that your boner should burn, BTW.)

So, what exactly is it?

An erection — or boner, wood, or chubby, if you prefer — is a hardening of the penis.

Most of the time, the penis is flaccid and just hangs around minding its own business.

During an erection, it becomes temporarily engorged with blood and enlarged. This makes it feel stiff and causes it to stand up and away from the body.

Why does it happen?

Sexual arousal is often the reason, which is caused by seeing, feeling, or even thinking of something that turns you on.

Erections can also happen for no particular reason. There’s actually a name for these random boners: spontaneous erections.

So if you get a stiffy while watching a documentary on slugs, it’s just a penis doing what a penis does and it’s NBD.

It’s also normal to wake up with morning wood, whether you’ve had a sex dream or not.

How does it work?

To know how an erection works, we need to start with a little lesson on penis anatomy.

There are two chambers that run the length of your penis called the corpora cavernosa. Each contains a maze of blood vessels that create sponge-like spaces.

When those blood vessels relax and open, blood rushes through and fills them, causing the penis to engorge, creating an erection.

A membrane around the corpora cavernosa helps trap the blood so your D stays hard.

Erections aren’t just about the penis, though. Your brain plays a role, too.

When you get aroused, your brain sends signals to your penis that cause the muscles in it to relax and let the blood in.

Does everyone get them?

Everyone with a penis does.

That said, certain lifestyle factors can make it difficult for you to get an erection, like being tired, stressed, or intoxicated.

Certain medications and medical conditions can also cause erectile dysfunction.

Does it hurt?

It shouldn’t. Mostly boners just make you super aware of your D when you don’t generally really feel it or think about it otherwise.

However, there are some instances when an erection might be uncomfortable.

Pee boners are an example of this. They happen because your penis is designed to not let you wet yourself. It’s quite marvelous, really. Try to pee when you’re still hard and you’ll feel the burn.

Excessive or especially vigorous masturbation can also cause some discomfort down there. So, if your pain starts after you’ve been especially heavy-handed lately, giving your penis a rest should help.

Otherwise, an underlying medical condition or injury can cause painful erections. If you have penis pain, a trip to a healthcare provider is in order.

What if stuff starts coming out? Is that normal?

Totally normal — assuming that what’s coming out isn’t bloody, green, or yellow, or has a dank stank to it. (Those are all signs of an STI or other infection.)

Barring those things, what you’re seeing is either ejaculate or pre-ejaculate — or precum, as most people call it.

Ejaculation typically happens during orgasm. This is when your arousal builds and leads to an intense, feels-so-good release that’s accompanied by ejaculate shooting from your penis.

That said, it’s possible to orgasm without ejaculating. It’s also possible to ejaculate without having an O.

That thin, slippery fluid that dribbles out of your D when you’re hard before ejaculation is called precum. It happens to anyone with a penis and is no biggie.

An FYI about precum: It can contain a small amount of sperm and therefore can cause pregnancy.

What’s the point of all this?

The point of an erection is so you can partake in penetrative sex.

Granted, you don’t need to have penetrative sex if you don’t want to, but in order to be able to get it in there — whether there is a vagina or anus — you need to at least be a bit hard.

Penetration without an erection is kind of like pushing rope.

How do you make it go away?

The penis is designed to lose an erection once you’ve ejaculated, so that’s one way.

Other than ejaculating, you may be able to able to make it go away by eliminating the source of stimulation, like:

  • shifting positions (or your boner) so your jeans or thighs aren’t rubbing it
  • thinking about something else, preferably something nonsexual
  • distracting yourself by reading anything in sight or counting backward

You can also just wait it out and hide it in the meantime by holding something over it, like your bag or jacket. If your shirt is long enough, you can try untucking it (the shirt, not the boner).

For a menacing rager that pops up at a particularly inopportune time, hightailing it to the nearest exit or washroom might be your best bet.

How often are you supposed to get one?

There’s no hard and fast rule when it comes to how many erections a person should get.

People with penises have an average of 11 erections per day and three to five more each night, but everyone is different.

There are numerous factors that can affect how often you get hard, like your age, hormone levels, and lifestyle.

If you’re concerned about your ability to get or maintain an erection, talk to a healthcare provider. Same if you feel like you’re hard more often than not or have an erection that persists for more than 2 hours straight.

Is there anything you can do to prevent it from happening?

Not really.

Erections are a normal part of having a penis. They’re bound to happen whether you want them to or not.

Using some of the methods we gave to stop an erection might also help you prevent one, but it’s not a sure thing, especially if you have an especially sensitive penis.

What if you want to make it happen?

Now we’re talkin’!

The key to getting an erection is being relaxed and allowing yourself to get aroused.

Here are some things that can help things along:

  • Fantasize about something you find sexually stimulating.
  • Look at images you find arousing.
  • Watch porn.
  • Read erotica.
  • Touch yourself anywhere it feels good, not just your penis.
  • Try a sex toy.

How do you know if you’re doing it right?

As long as it’s not causing you — or anyone — pain or distress, then it’s all good.

Sexual arousal should feel good. Erections shouldn’t be a source of discomfort or guilt.

If you’re concerned about your erections or are struggling with negative feelings about your sexuality, you may find it helpful to talk to a professional.

You can speak to your primary care provider or find a sexual health professional in your area through the American Association of Sexuality Educators, Counselors and Therapists (AASECT) directory.

What’s the bottom line?

Erections are natural and just part of owning a penis. As inconvenient as they may be when they come up spontaneously, the ability to have them is a sign of health.

Their main purpose may be to facilitate penetrative sex, but no pressure. Your erection, your choice.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Penis health: Conditions, safety, lifestyle, and care

What to know about penis health

Medically reviewed by Kevin Martinez, M.D. — Written by Jenna Fletcher on April 2, 2020

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

Edited for content

A healthy penis should be free of lesions, warts, and abnormal discharge. In general, the penis should be roughly the same color as the surrounding skin, though it may be a shade darker or lighter.

Also, a person should not experience any pain in their penis when urinating or engaging in sexual activity.

A sudden change in the appearance, sensation, or function of the penis may signal an underlying issue that requires medical attention.

This article describes certain lifestyle factors and health conditions that can affect penis health. It also outlines some possible symptoms of poor penis health and provides tips on penis care.

Lifestyle factors that affect penis health

Lifestyle factors that can affect penis health include sexual relationships, weight management, and alcohol use.

The sections below outline some common lifestyle factors that can affect penis health.

Sexual relationships

Sexually transmitted infections (STIs) can negatively affect penis health. Some of the most common STIs include:

  • human papillomavirus (HPV)
  • chlamydia
  • gonorrhea
  • herpes

The Centers for Disease Control and Prevention (CDC) recommend that people practice safe sex in order to reduce their risk of contracting an STI. This involves using barrier methods during sexual activity and getting vaccinated against hepatitis B and HPV.

The following can also help reduce the risk of spreading and contracting STIs:

  • limiting the number of sexual partners
  • maintaining a monogamous sexual relationship
  • abstaining from sexual activity

Often, people who contract an STI do not experience any symptoms. This is why it is important for people who are sexually active to attend regular sexual health screenings.

Weight management

Obesity can negatively affect many aspects of a person’s health, including penis function.

People with obesity may be more likely to experience erectile dysfunction, or impotence. This occurs when a person is unable to develop or maintain an erection during sexual activity.

According to the Obesity Action Coalition, obesity can contribute to erectile dysfunction by:

  • decreasing testosterone levels
  • causing inflammation throughout the body
  • damaging the blood vessels, including those that supply blood to the penis

However, one 2018 study suggests that the relationship between obesity and sexual health is not completely clear. Although obesity may contribute to erectile dysfunction, other factors may also give rise to poor sexual health. These include:

  • anxiety
  • stress
  • self-esteem issues

Diet

Eating a healthful, balanced diet can help prevent obesity and related sexual health problems.

A 2017 animal study investigated the potential link between diet, obesity, and erectile function. In this study, one group of rats consumed a calorie-rich diet, while a second group consumed a standard diet.

The rats that consumed the calorie-rich diet were more likely to develop obesity, and they also showed significantly poorer erectile function.

The types of food a person eats could also affect their penis health. For example, one 2016 study found that a diet rich in flavonoids was associated with a reduced risk of erectile dysfunction in men below the age of 70.

Flavonoids are chemicals that occur naturally in a range of vegetables, fruits, and grains. Some examples of flavonoid-rich foods include:

  • root vegetables
  • legumes
  • berries
  • grapes
  • citrus fruits
  • teas
  • chocolate

Exercise

Exercise is important in helping a person maintain a moderate weight. This means that it also helps reduce the risk of obesity-related sexual health concerns.

Exercise may also benefit sexual health more directly. For example, one 2015 study investigated whether or not regular walking exercise could help improve erectile dysfunction in men who had recently had a heart attack.

Those who took part in the regular walking program reported a 71% decrease in erectile dysfunction symptoms. Those who did not take part in the program reported a 9% increase in erectile dysfunction symptoms.

The researchers conclude that regular exercise may help reduce symptoms of erectile dysfunction.

A 2011 meta-analysis investigated the effects of aerobic exercise on erectile dysfunction. The researchers analyzed five studies involving a total of 385 participants.

All the studies showed improvements in erectile dysfunction following aerobic activity. The researchers conclude that men with erectile dysfunction may benefit from aerobic training, though further studies are necessary to confirm this.

Alcohol and tobacco use

Drinking a lot of alcohol can negatively impact many aspects of a person’s health.

According to the CDC, excessive drinking can interfere with male hormone production, potentially contributing to impotence and infertility.

Alcohol also increases the likelihood that a person will engage in risky sexual behavior. Such behavior puts a person at increased risk of contracting or transmitting an STI.

Tobacco smoking can also have a negative effect on penis health. According to the Truth Initiative, smoking may play a role in the following sexual health issues:

  • erectile dysfunction
  • infertility
  • decreased libido

Health conditions that may affect penis health

There are several health conditions that can directly affect penis health. Some of the more common ones include:

  • STIs, such as chlamydia, herpes, or genital warts
  • phimosis, which occurs when the foreskin cannot extend over the head of the penis
  • balanitis, which is inflammation of the head or foreskin of the penis

Other conditions not directly related to the penis can also affect its health. Many of these conditions may cause erectile dysfunction or issues with fertility. These include:

  • obesity
  • diabetes
  • high blood pressure
  • stress
  • certain heart conditions

When to see a doctor

Anyone who is sexually active should check for symptoms of STIs regularly. They should look for:

  • rashes, sores, or blisters on the penis
  • burning or itching sensations in the penis
  • abnormal discharge from the penis
  • a foul odor coming from the penis or groin area
  • pelvic pain
  • pain when urinating or passing stools

Anyone who thinks that they may have an STI should visit their doctor for a diagnosis and appropriate treatment.

Importantly, many people who contract an STI will not experience any symptoms. Regular sexual health screenings will help detect STIs that a person may not have noticed otherwise.

Anyone who thinks that they may have erectile dysfunction should also see their doctor, who will work to diagnose the cause.

How to care for the penis

A person should clean their penis at least once per day using a mild soap. Using abrasive or heavily scented soaps could irritate the skin of the penis.

A person should wash all parts of the penis, including:

  • the pubic hair
  • the scrotum
  • the area between the legs and scrotum
  • the penis shaft
  • the area underneath the foreskin, if uncircumcised

Tips for a healthy penis

The tips below can help a person keep their penis healthy:

  • using a barrier method during sex
  • limiting the number of sexual partners they have
  • undergoing a sexual health screening at least once per year if in a monogamous relationship
  • undergoing a sexual health screening as often as every 3–6 months if having sex with multiple partners
  • keeping the penis and genital area clean
  • limiting alcohol consumption
  • avoiding the use of tobacco products
  • exercising regularly
  • eating a healthful, balanced diet

Summary

A person can take several steps to maintain the health of their penis. This includes exercising regularly and eating a healthful diet. A person may also wish to avoid having unprotected sex, drinking a lot of alcohol, and using tobacco products.

To maintain a healthy penis, a person should thoroughly wash the penis at least once per day. Those who are sexually active should also go for sexual health screenings at least once per year and perform regular self-checks at home.

If a person has any concerns about their penis, they should talk to a doctor as soon as possible. The doctor will work to diagnose the cause of the issue and provide appropriate treatments.

 

Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Types of penises: Shape, size, circumcision, and more

What to know about types of penises

Medically reviewed by Joseph Brito III, MD — Written by Mathieu Rees on November 23, 2020

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

Edited for content

The penis is a male organ with functions that include reproduction and urination. As with any body part, no two people have the same penis.

The penis has two main features. The body, or shaft, connects the penis to the abdomen. At the opposite end of the shaft is the glans, or head.

This article lists some common types of penises, categorized primarily by measurement, and provides some related information.

Length

Penises come in different lengths when flaccid or erect.

Estimates about average penis length can vary. For example, one 2014 study looked at the penis size of United States males. It found that the average erect length was around 5.6 inches.

However, another article suggests there are issues with many penis length studies, including the fact that participants self-report measurements.

These studies use self-reported data and are therefore subject to bias, which likely fuels the widespread belief that the average penis size is closer to 6 inches. In reality, the average is likely to be lower

Girth

Penises also have different girths or circumferences.

A 2014 study into the penis size of U.S. males found that the average erect girth was around 4.8 inches.

However, as with penis length, a person should note that many penis girth studies use self-reported measurements, which are known to be fairly unreliable.

Curvature

Some penises are completely straight when erect. However, many have a bend or curvature. There are three main types of curved penis. These include penises that:

  • curve upwards from its base
  • curve downwards from its base
  • curve to the left or right

Additionally, some people may have multiple kinds of curvature. For instance, some penises may curve to the left and upwards.

Penile curvatures are common and typically benign. They are rarely painful and do not usually make penetrative sex more difficult.

However, abnormal penile curvature can sometimes be a symptom of Peyronie’s disease. One review lists the following as possible symptoms:

  • a thickened area, or plaque, in the penile shaft
  • curvature of the penis during erection
  • pain in the penis
  • erectile dysfunction

Scientists are not sure what causes Peyronie’s disease.

One common explanation is that the condition results from mild, recurring trauma to the penis. This can occur during intercourse or masturbation.

Peyronie’s disease can also be due to a rupture in the penis, known as a penile fracture. Genetic factors may also contribute to the development of this condition.

Anybody who suspects they may have Peyronie’s disease should seek medical advice. Sometimes, people with the condition who experience no other issues, such as pain, could still use their penis for sexual activity without needing medical treatment.

In some cases, doctors may recommend surgery to remove the plaque or reduce the curvature in the penis.

The base to head ratio

For some people, the circumference of the base of their penile shaft is the same as the circumference of their penile head.

For others, this ratio is different. Some may have a penile head with more girth than the base of their shaft, or vice versa.

Circumcised and uncircumcised

A person with a penis is born with a retractable layer of skin that covers the penile head, commonly referred to as the foreskin.

Many people around the world have their foreskin surgically removed, in a process known as male circumcision.

A trained person may carry out male circumcision on children and adults, often for cultural or religious reasons. Doctors can also perform them in medical treatments.

Circumcised penises do not have a foreskin, which means that the glans is always visible. Uncircumcised penises have a foreskin, which often covers the glans, especially when the penis is flaccid.

Some infants can be born without a foreskin, which is a condition called hypospadias. Here, the opening of the penis is not found at the tip. Surgery is usually required to correct this issue.

Uncircumcised men can also develop phimosis, where the foreskin cannot retract over the hood of the glans. This can lead to irritation and infection. People with the condition generally require medical circumcision.

Because circumcision is a surgical process, it can sometimes lead to health issues, including:

  • infection
  • necrosis of the penile head
  • cut to the penile head or urethra
  • penile loss

However, people should note that this procedure is very common. Infections following circumcision, one of the most common possible complications, affect just 0.5% of people.

Summary

Many internet sources misinform and perpetuate myths about penises. In reality, they are highly varied, just like other body parts.

Anyone who has concerns about their penis can seek medical advice from a trained professional.

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months []; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus []. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic []. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

This Secret Muscle in Your Penis Makes You Seem Smaller Than You Are

And more eye-opening insights from a leading urologist’s new book.

By Piet Hoebeke
Nov 18, 2020

This article is a repost which originally appeared on Men’s Health

Edited for content

The following is an excerpt from Members Club: A User’s Guide to the Penis, a new book by urologist Piet Hoebeke, M.D., Ph.D.


Funnily enough, the average penis in humans is far longer than strictly necessary. Gorillas and chimpanzees do it with a lot less and they still manage to fertilize their females. When erect, a grown gorilla has a penis length of four centimeters, and a chimpanzee erection measures eight centimeters. With an average length of over 13 centimeters, humans outshine their close relatives.

What do we have to thank for the over-proportional size? Usually, natural selection does away with characteristics that don’t serve a function–for example, the body hair that humans for the most part have lost. Things that aren’t needed are done away with, because making excess tissue wastes energy.

So why does man have such a long penis?

The answer is because, alongside natural selection, there is another mechanism at play: sexual selection. Natural selection ensures that a species adapts optimally to its environment, sexual selection supplies the characteristics to give a species the greatest chance of mating. Therefore, sexual selection exaggerates some characteristics without natural selection undoing them. Think of the long, colorful tails of birds of paradise or peacocks. For one reason or another, female birds like a long tail, so a male with a long tail has more chance of reproducing, even if such an impractical attachment increases the risk of him being caught by a predator.

In the animal kingdom, we see an endless range of tactics for attracting potential partners. The huge chest muscles of male gorillas are another example. The male gorilla has an imposing presence, even though he only has a small penis. Homo sapiens generally flaunt a smaller muscular structure, but they have the largest penis of all primates, in terms of both proportion to body height and absolute length. This points to sexual selection.

Exactly how this came about in evolution, we don’t know. There were no scientists around at the time observing primitive humans. We suspect the civilization process played a role in it. For a long time, man was a predator; a hunter-gatherer searching for food in the wild. Physical fitness was necessary to survive. At a certain time–or, even, over a period of time–humans became farmers. We took nature into our own hands and brute strength slowly lost importance. With farming, it wasn’t about who could run fastest or jump furthest; it was who could produce the most from his land. The physical characteristics needed to impress females became less prominent. Perhaps that is why, as compensation, the penis grew bigger.

Coitus was a brief affair in primitive humans. There was no foreplay: humans lived in a threatening environment and men were well aware that others could be close by on the look-out for a woman who was ready for sex. The faster they could deposit their sperm, the better. And how did women know that a man was ready for sex? Attraction is a game of smell, pheromones, blushing cheeks and deep breathing, but the most important sign of arousal is the erection. Because sex had to take place so quickly, a large penis facilitated a quick selection.

Over time, humans started wearing clothes and that created a nice paradox: the very fact that humans were covering up their body made the penis more prominent. For that we have a muscle to thank that has since lost its function.

Most mammals have a layer of muscle under the skin. Horses, for example, can use it to twitch their skin to get rid of flies. Primitive humans could do that too. Now we only have the remains of such a muscle in the human body, for example in the groin, where we have the fascia of Scarpa. We also still have one of these superficial muscles in the neck, a small muscle in the hand, and a muscle in the skin of the scrotum and penis: the dartos muscle.

Most people with a penis have no idea that there is a muscle around their sex organ, because you can only see it if you look at the penis skin under a microscope. Men don’t walk around displaying biceps in their penis, and the dartos muscle doesn’t let you twitch your penis, either. So what does it do?

Not a single male mammal walks around waving its penis, apart from when a male feels a great desire to mate. In most mammals, the dartos muscle neatly tucks the flaccid penis inside the body. When Homo sapiens walked around naked, their penis was also hidden from view. When you’re climbing over sharp rocks or running through thorny bushes, you want to keep your genitalia as close as possible to the body. Only with sexual arousal did the dartos muscle relax and the penis come out.

The muscle also runs as far as the skin of the scrotum, where it helps with the temperature regulation of the testicles. Each testicle is connected to a vas deferens which is also surrounded by a muscle. When the testicles get too warm, the vasa deferentia let the testicles hang down; if it suddenly gets cold, they tuck the testicles in. At the same time, the dartos muscle contracts the skin of the scrotum. That’s why your penis looks small if you swim in cold water.

As people started to wear clothes, the purpose of this muscle diminished. Clothing took on its protective role, and men with a strong dartos muscle no longer had an evolutionary advantage from this. Natural selection did its work, but a redundant body part doesn’t disappear in 20 or even 100 generations. In 10,000 years there have been around 330 generations, but the dartos muscle is still there.

It’ll keep the penis company for a while longer, but it just does less than before. The penis and scrotum are no longer drastically drawn inside the body of modern man; at most they shrivel up a little.

Some men might be sorry that the dartos muscle is an involuntary muscle, over which they have no control. I can imagine that some would jump at the chance to make their penis look longer in a communal changing room. But, alas, the dartos muscle only relaxes at higher temperatures or in the case of moderate arousal. In the case of strong sexual arousal, the dartos muscle contracts again, to prepare for ejaculation.

An erect penis doesn’t decrease in size because of this, but the testicles are pressed closer to the body. Two penises can be exactly the same length when erect, but the man with an active dartos muscle will appear to have the smallest penis when flaccid. He might think to himself about the other man: Blimey, he’s well hung! But what he could perhaps think is: Poor thing, he’s got a bit of a lazy dartos muscle there!

Therein lies the second paradox that burdens the male member. As I mentioned earlier, compared to other animals, men have an oversized penis. Because it also hangs outside the body, it catches the eye even more. So what do men do? They compare. And then all too quickly they come to the conclusion: Oh no, mine is too small.

Funnily enough, many men–and women–don’t even know how long the average penis is.

 

Medications that cause erectile dysfunction

What medications may cause erectile dysfunction?

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Medically reviewed by Matt Coward, MD, FACS — Written by Rachel Nall, MSN, CRNA on November 11, 2020

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

Several factors can cause or contribute to erectile dysfunction. One example is the medications a person takes. Medicines that affect sex drive, blood flow, and sexual organ function may increase the incidence of erectile dysfunction.

Erectile dysfunction (ED) is the inability to achieve or maintain an erection. It is a common condition that affects males of all ages and varying levels of health and fitness.

This article lists some medications that may cause or contribute to ED, and outlines some treatment options. Finally, we offer some tips to help prevent ED.

Medications that may cause ED
Certain medications may contribute to ED, although they are not usually the sole cause of the condition.

A person who suspects their ED may be due to a particular medication should talk to their doctor. Where possible, a healthcare professional may recommend changing the dosage or switching medicines.

A person should not stop taking their medications unless their doctor tells them to do so.

Some medications that may contribute to ED are below.

Anti-hypertensives

Anti-hypertensives are prescription medications to help lower blood pressure. They may contribute to ED, though doctors have not yet established why this is the case.

Examples include:

  • beta-blockers, such as metoprolol and atenolol
  • clonidine
  • spironolactone
  • some diuretics, such as hydrochlorothiazide and furosemide

Immunosuppressants

Immunosuppressants reduce the activity of the immune system. A person may take them to help control an autoimmune condition or prevent organ rejection following an organ transplant procedure.

One potential side effect of immunosuppressants is impaired sexual function.

Examples include:

  • sirolimus
  • everolimus
  • tacrolimus
  • cyclosporine

Anti-androgens

Androgens are hormones associated with male characteristics. Anti-androgens block some aspect of these hormones. Doctors may prescribe them for several conditions, such as heartburn or prostate cancer.

Examples of anti-androgens include:

  • ketoconazole
  • flutamide
  • bicalutamide
  • nilutamide
  • enzalutamide

GnRH agonists

Gonadotropin-releasing hormone (GnRH) agonists are a class of medications that doctors sometimes prescribe to treat prostate cancer. They may reduce sexual desire in men.

Examples include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)

Corticosteroids

Corticosteroids are drugs that mimic the effects of certain hormones inside the body. People typically take them to help reduce inflammation.

These drugs can also reduce testosterone levels. This may lead to decreased sexual desire and sexual function in some men.

Examples of corticosteroids include:

  • prednisone
  • prednisolone
  • hydrocortisone

Antidepressants

Antidepressants are medications that doctors may prescribe to treat or prevent the recurrence of clinical depression.

Some antidepressants may inhibit sexual desire, which may affect sexual performance. Others may also delay ejaculation.

Examples of antidepressants that may cause ED include:

  • selective serotonin reuptake inhibitors (Lexapro, Prozac)
  • noradrenaline reuptake inhibitors (Wellbutrin, Zyban)
  • tricyclic antidepressants (Pamelor)

Antipsychotics

Antipsychotics are drugs primarily prescribed for the treatment of psychosis. They may inhibit sexual desire, which may then affect sexual performance.

Examples include:

  • aripiprazole (Ability)
  • olanzapine (Zyprexa)
  • risperidone (Risperdal)

Anti-epileptics

Anti-epileptics are medications that doctors prescribe to help prevent epileptic seizures. They may affect a man’s ability to orgasm.

Examples include:

  • gabapentin (Neurontin)
  • topiramate (Topamax)

Recreational drugs

Aside from medications, some recreational drugs can also affect sexual arousal and performance. Examples include:

  • alcohol
  • hallucinogens
  • narcotics, such as heroin
  • stimulants, such as cocaine and methamphetamines

Drugs to treat opioid addiction may also lead to erectile dysfunction. These drugs include methadone and buprenorphine.

What is ED?

ED is the medical term for when a person has difficulty achieving or maintaining an erection. While this may occur periodically for all males, those with ED experience more frequent and routine episodes.

The ability to achieve and maintain an erection is dependant on several factors, including:

  • sexual arousal
  • sufficient blood flow to the penis
  • nerve sensation

An issue with any of the above factors may lead to ED.

Treatments for ED

A doctor may recommend treatments that can enhance sexual performance while allowing a person to continue taking potentially life-saving or life-extending medications. Some examples are below.

Self-care

Often, ED treatments begin with making changes to a person’s routine. These include:

  • adopting healthful eating habits
  • increasing daily exercise
  • maintaining a healthful weight
  • limiting or avoiding alcohol
  • quitting smoking
  • avoiding using recreational drugs
  • sleeping well

Males who experience mental health issues, such as stress, anxiety, or depression, may also benefit from seeing a mental health professional. These conditions can negatively impact sexual desire and sexual function. As a result, successful treatment may help manage ED.

Medications

A doctor may prescribe one of the following medications to help treat ED.

Phosphodiesterase type-5 inhibitors

Phosphodiesterase type-5 (PDE 5) inhibitors are medications that relax and widen the blood vessels to promote blood flow. The American Urological Association (AUA) recommend that males take PDE 5 inhibitors 1–2 hours before having sex.

Examples of PDE 5 inhibitors include:

  • tadalafil (Cialis)
  • vardenafil (Levitra)
  • avanafil (Stendra)
  • sildenafil citrate (Viagra)

PDE 5 inhibitors are not suitable for people taking nitrates.

Injections

A vasodilator is a medication that helps widen the blood vessels, increasing blood flow.

One potential ED treatment involves injecting the vasodilator directly into the penis or urethra.

Testosterone therapy

According to the AUA, the vast majority of ED cases are due to reduced blood flow to the penis. They add that low testosterone levels may affect a person’s sex drive, but are rarely the cause of ED.

If low testosterone levels contribute to ED, a doctor may consider testosterone therapy (TT). This technique involves regularly administering testosterone in one of the following forms:

  • an injectable medication
  • a gel
  • a patch applied to the skin.

However, the AUA state that TT does not improve erections in males with normal testosterone levels or in those with low testosterone levels who experience ED as their only symptom.

Devices

A vacuum erection device (VED) consists of a plastic tube and a pump. The plastic tube fits over the penis, forming a seal against the body’s skin. Using the pump creates a vacuum around the penis, which causes an erection.

Once the penis is erect, the person slips an elastic ring onto the base of the penis. This retains the blood inside the penis for up to 30 minutes.

According to the AUA, around 75% of males who receive proper training on using a VED can achieve an erection when using these devices.

Surgical treatments

If lifestyle measures and medical treatments are ineffective, doctors may recommend surgical options for ED. These are outlined below.

Penile implant procedure

The main surgical option for ED is inserting a penile implant. This device sits permanently inside the penis, making it rigid enough for a person to have sex.

There are two types of penile implant:

  • Semi-rigid implant: Bendable silicone rods that a person can bend downward for urinating or upward for sex.
  • Inflatable implant: Fluid-filled cylinders attached to a rod inside the scrotum. Using the pump forces fluid into the cylinders, causing the penis to enlarge and stiffen.

Vascular surgery

Vascular surgery for ED helps improve blood flow to the penis. Doctors usually reserve this procedure for younger males with good vascular with ED due to pelvic trauma.

24 Ways You or Your Penis-Having Partner Can Increase Penile Sensitivity

24 Ways You or Your Penis-Having Partner Can Increase Penile Sensitivity

Medically reviewed by Jennifer Litner, LMFT, CST — Written by Adrienne Santos-Longhurst on October 14, 2020

This article is a repost which originally appeared on Healthline

Edited for content

For many folks, sexual satisfaction is all about the feels, so if you or your penis-having partner are experiencing decreased sensitivity down there, it could really mess with your ability to get off.

There are a few things that can cause a decrease in penile sensation, from the way a person masturbates to lifestyle habits and hormone imbalances. The good news: There are ways to get back that lovin’ feeling.

Quick distinction: Less sensation vs. numbness

To be clear, there’s a big difference between less sensation and numbness.

Having less sensation — which is what we’re focusing on in this article — means you don’t feel as much sensation in your peen as you did before.

A numb penis is a whole other ball of wax and refers to not being able to feel any normal sensation when your penis is touched.

If it’s related to your technique

Yep, how you pleasure yourself might be affecting your penile sensation.

What does this have to do with it?

The way you masturbate can lead to decreased sensitivity. Some people call this “death grip syndrome.”

The gist is that people who masturbate using a very specific technique or tight grip can become desensitized to other types of pleasure over time.

When this happens, coming or even getting any pleasure without the exact move or pressure becomes difficult.

If you’re feeling all the feels just fine when you masturbate but find that partner sex is where the sensation is lacking, there are a couple potential reasons.

A thinner or smaller-than-average penis, or even too much lube (natural wetness or synthetic), can mean less friction — and ultimately sensation — during intercourse.

What can you do to help address this?

Just switching up your technique should do the trick and help you recondition your sensitivity.

If death grip is the issue, depending on how you’re used to masturbating, this might mean loosening your grip, stroking at a slower pace, or both.

You could also mix things up with a sex toy made for penis play, like the Super Sucker UR3 Masturbator, which you can buy online, or TENGA Zero Flip Hole Masturbator, which is also available online. And don’t forget the lube!

If intercourse is the issue, some positions make for a tighter fit and therefore more friction.

Here’s a little secret: Tweaking any position so your partner can keep their legs tight together during sex should work.

Plus, if anal sex is what you’re both into, the anus is by nature a tighter squeeze. Just be sure to use a lot of lube if you take it to the backside.

And speaking of a lot of lube: If an abundance of wetness is making sex feel a bit like a Slip ’N Slide, a quick wipe with some tissue should fix it.

If it’s related to your lifestyle

Certain lifestyle habits can be to blame for your peen’s lessened sensitivity.

What does this have to do with it?

Do you bicycle a lot? Do you masturbate frequently? These things can cause the sensitivity in your peen to tank if you do them often.

When it comes to masturbation, how often you do it matters if you’re doing it a lot, according to research that has linked hyperstimulation to decreased penile sensitivity.

As for bicycling, bicycle seats put pressure on the perineum — the space between your balls and anus. It presses on blood vessels and nerves that provide feeling to the penis.

Sitting in a hard or uncomfortable chair for long periods can do the same.

What can you do to help address this?

Masturbation is healthy, but if the frequency of your handy treats is causing a problem, taking a break for a week or two can help get your penis feeling back to itself.

If you sit or bicycle for long periods, take regular breaks. Consider swapping out your bike seat or usual chair for something more comfortable.

If it’s related to your testosterone levels

Testosterone is the male sex hormone responsible for libido, not to mention a bunch of other functions.

If your testosterone (T) level drops, you might feel less responsive to sexual stimulation and have trouble getting aroused.

T levels decrease as you age. Damage to your danglers — aka testicles — can also affect T, as well as certain conditions, substances, and cancer treatment.

Your doctor can diagnose low T with a simple blood test and treat it using testosterone replacement therapy (TRT). Lifestyle changes, like regular exercise, maintaining a moderate weight, and getting more sleep can also help.

If it’s related to an underlying condition or medication

Certain medical conditions and medications can affect sensation in the penis.

What does this have to do with it?

Diabetes and multiple sclerosis (MS) are just a couple conditions that can damage nerves and affect sensation in different body parts, including the penis.

Medications used to treat Parkinson’s disease can also reduce penile sensation as a side effect.

Ensuring that any underlying condition is well managed might help bring the feels back.

If medication’s the culprit, your doctor may be able to adjust your dose or change your medication.

If it’s related to your mental health

Sexual pleasure isn’t just about your D. Your brain plays a big role, too.

What does this have to do with it?

If you’re dealing with anxiety, stress, depression, or any other mental health issue, getting in the mood can be near impossible. And even if you really want to get down to business, your penis may not be as receptive.

What can you do to help address this?

It really depends on what’s going on mentally.

Taking some time to unwind before sexy time can help if you’re feeling stressed or anxious.

A hot bath or shower can help your mind and muscles relax. The warm water also increases circulation, which can help increase sensitivity and make your skin more responsive to touch.

If you’re regularly struggling with feelings of anxiety or depression, or having trouble coping with stress, reach out for help.

Talk to a friend or loved one, see a healthcare provider, or find a local mental health provider through the Anxiety and Depression Association of America (ADAA).

Things to keep in mind if you’re struggling

Not to be punny, but try to not beat yourself silly over this.

We get how frustrating it must be to not be able to enjoy the sensation you want or expect during sexual activity.

Here are some things to keep in mind if you’re struggling.

It’s probably not permanent

Chances are your lessened penile sensation can be improved.

As we’ve already covered, changes in technique, getting in the right frame of mind, or some lifestyle tweaks may be all that’s needed to get your penis feeling right again.

A healthcare provider can help with any underlying medical or mental health issues and recommend the right treatments.

Go easy on yourself

We’re not just talking about choking your chicken either! Stressing about this and putting pressure on yourself will only make things worse in the pleasure department.

Give yourself time to relax and get in the mood before play, and permission to stop and try another time if you’re not feeling it.

Don’t be embarrassed to ask for help

Penis health and sexual health are just as important as other aspects of your health.

If there’s something going on with your penis or your ability to enjoy sexual activity, a professional can help.

Good penis health is in your hands

You can’t control everything, but there are things you can do to help keep your penis healthy:

  • Eat a healthy diet, including foods shown to boost penis health by lowering inflammation and improving T levels and circulation.
  • Get regular exercise to improve mood and T levels, manage your weight, and lower your risk for erectile dysfunction and other conditions.
  • Learn to relax and find healthy ways to cope with stress to improve your T levels, mood, sleep, and overall health.
Things to keep in mind if your partner is struggling

If it’s your partner who’s struggling with lessened sensitivity down there, don’t worry. Chances are there’s a good reason for it, and it’s probably not what you think.

Here are some things to keep in mind if it’s getting to you.

Don’t take it personally

Your first instinct may be to blame yourself if your partner isn’t enjoying sex. Try to not do this.

Sounds harsh, but: Not your penis, not your problem.

As a loving partner, of course you want them to feel good. But unless you’ve damaged their penis by taking a hammer to it, their lessened penile sensitivity isn’t your fault, so don’t make it about you.

I repeat, don’t make it about you

Seriously, it’s not your penis!

As frustrated as you might be, keep it to yourself

Not trying to dismiss your feelings or anything, but as frustrated as you may be that your partner isn’t feeling it even when you pull out your best moves, it’s probably a lot more frustrating for them.

That said, if your partner’s lack of sensation results in a marathon shag sesh that causes chafing to your nether regions, of course you have the right to take a break or stop. It’s your body, after all. Just be mindful of how you say it.

Ask what your partner needs from you

EVERYONE should be asking what their partner needs when it comes to sex and relationships. It’s the key to making both great.

Do they need a little time to relax before action moves to the peen? Do they need more foreplay that focuses on other pleasure spots to help them get in the mood? Do they want to just stop altogether? Don’t be afraid to ask.

The bottom line

If you’ve lost some of that lovin’ feeling down below, your lifestyle and pleasure routine — solo or partnered — may provide some clues. If not, your doctor or other healthcare provider can help.

In the meantime, be patient and kind with yourself, and consider some of your other pleasure zones for satisfaction.

 

The 10 tips to keep your penis healthy from more sex to exercising it

TIP TOP The 10 tips to keep your penis healthy from more sex to exercising it

Gemma Mullin, Digital Health Reporter
1 Mar 2020, 9:21

This article is a repost which originally appeared on THE SUN

Edited for content

WHEN it comes to talking about matters down below, it can be a pretty sensitive topic.

Most of us prefer to keep discussions about our privates, well, private.

But keeping your todger in good working order is important – especially as you get older.

Research shows that looking after your member can reduce your risk of erectile dysfunction and prostate cancer.

It’ll also help you enjoy a long and happy sex life well into the future.

Not sure where to start?

Here, male sexual health expert Kerri Middleton, from Bathmate, reveals her top tips to keep your penis healthy…

1. Workout

You’ll be pleased to know that the number one tip is to use the tool you’ve been gifted with.

A study by Harvard University found that blokes who ejaculate more frequently — upwards of 21 times per month — have a 33 per cent lower risk of developing prostate cancer.

Men who have sex at least once a week are less likely to suffer erectile dysfunction than those who roll in the hay less often.

A Finnish study has shown that the more you use it, the better your erections will be.

And don’t worry if you’re going through a dry patch – masturbation counts, too.

But it’s not just your penis that you need to work out to keep performing at your best – it’s your entire body.

Plenty of evidence links a sedentary lifestyle with erectile dysfunction, so if you want to improve staying power be sure to enjoy plenty of aerobic exercise.

Running and swimming are the best for penile health.

2. Let go of stress

Leave your stress at work and minimise stressful situations in your home life to keep your member strong.

Excess adrenaline is released into the bloodstream when you’re in a state of worry, causing your blood vessels — including the ones in your penis — to contract.

There are plenty of methods you can use to ease tension and unwind, from meditation to laughter or pumping iron, all of which can help with performance.

3. Cut down on booze

One way many people choose to relieve stress after a hard day’s work is hitting the bottle.

However, if you want to enjoy a healthy sex life long into the future, alcohol can seriously scupper your desire.

Binge and heavy drinking causes nerve and liver damage and can affect the careful balance of male sex hormones.

Even in the short term, alcohol curbs sensitivity and decreases reaction time, leaving you less able to perform.

4. Ditch cigarettes

It’s no secret that cigarettes harm your blood vessels and have a negative impact on your heart health.

Remember that your heart is the ultimate titan, pumping blood throughout your body — including your penis.

Nicotine also makes your blood vessels contract and can stifle blood flow down below.

5. Drink plenty of water

Water keeps everything flowing, especially the plasma and blood cells that make your member stand to attention.

If you’re dehydrated, the blood simply doesn’t flow as well as it should.

So, if you’re worried, up your daily intake of straight H2O to the recommended amount of eight glasses per day.

6. DON’T skip coffee

It’s a little-known fact that coffee consumption and healthy erections are linked.

Drinking coffee is said to speed up the metabolism and get the heart rate going in a healthy way, contributing to blood flow and a healthy member.

Caffeine also causes the arteries in your penis to relax, promoting blood flow to the nether regions.

A study found that drinking two to three cups a day has a particularly positive effect on blokes who are carrying a few extra pounds.

Keeping your penis in good health shouldn’t be a strain.

All of the components required to lead a healthy lifestyle contribute to blood flow, sperm count and testosterone levels and help fight disease.

Get into a mindset where looking after yourself is a priority, and the rest will follow.

7. Get a good night’s sleep

It’s all too easy in our busy society to allow sleep to fall by the wayside.

Between working, playing, relaxing and chatting, there’s barely enough hours in the day.

Still, rest is one of the most vital components of a healthy lifestyle.

Not getting enough sleep is connected to several health issues that contribute to downstairs disappointment such as high blood pressure, diabetes and obesity.

8. Eat well

We all know how important diet is to our overall health, but not many men realise how vital it is to eat the right diet for your penis.

The fuel you put in your body won’t only help erections – it also improves sperm count, sex drive and even affects your risk of prostate cancer.

The foods to avoid:

  • Anything deep-fried
  • Processed meats like bacon
  • Soy
  • Fizzy drinks
  • Sugar
  • Refined carbohydrates like white bread and breakfast cereals

The best foods to eat include tomatoes, salmon, olive oil and oysters.

Another type of food associated with male sexual health is anything spicy.

A French study has found that men who consume more spicy foods have higher testosterone levels than those who shy away from them.

Serrano peppers increase testosterone levels by reducing the amount the kidneys flush out while capsaicin releases chemicals that increase your heart rate, mimic arousal and kickstart your libido.

9. Check cholesterol levels

Not being able to get it up becomes more of an issue the older you get — but it doesn’t have to.

The reason age is tied into loss of erectile function is because as we age, we tend to put less effort into leading a healthy lifestyle.

High cholesterol narrows the blood vessels, which is the leading cause of erectile dysfunction.

Keeping fit, eating healthily and avoiding cigarettes and alcohol are the ideal ways to lower cholesterol.

10. Keep blood pressure in check

Like high cholesterol, high blood pressure is a sign of poor heart health.

It can cause thickening of the arteries, which restricts blood flow and can cause problems with your penis.

Losing weight and enjoying regular cardiovascular exercise, along with avoiding refined carbs and salty food, will naturally lower your blood pressure.

Penis Enlargement: Just Another Form of Vanity? (from The Ultimate Guide To Male Enhancement)

Penis Enlargement: Just Another Form of Vanity? (from The Ultimate Guide To Male Enhancement)

The following is a chapter taken from the book: The Ultimate Guide To Male Enhancement.

Penis Enlargement: Just Another Form of Vanity?

The following was taken directly from a “Question and Answer” exchange:

Question

To me there is a bit of irony in your profession and your view on sex, if you truly feel the way you do about sex, then why do you do what you do… if you feel men don’t need a bigger penis or learn how to use it better, then why do you teach men both of these things? I feel like your point of view on sex and what you do for a living just don’t match.

I understand where you’re coming from, and I completely agree. Sex has been skewed in America by the media and, yes, I fell for it; I admit that. But, even with that said, it’s nice to have a good-sized penis and know how to use it…don’t you think so? It’s like a man wanting to be fit or get muscles, so they go to the gym. If a woman wants to have a fit body, with firmer legs and ass, they go to gym to do so. I feel men getting or wanting a bigger penis is no different. Why can women pay to get bigger boobs and ass and us as men have to stay with the penis size we were born with?

As I earlier said, I totally agree with your view on sex today, but do you think it’s wrong for me or anyone for that matter to want a bigger penis and learn how to use it like a porn star and learn how to please most women? I think sex is a beautiful thing. Even though I agree I am one of those you speak of falling for the idea of having to be like a porn star to be great in bed, I don’t think it’s a bad thing to want to be one.

That’s one of the things I wanted ever since I was in my early teens and just decided to do something about it now. Though I hurt myself bad, I thought you’d be the one to 1) help me heal as fast as possible 2) help me get the perfect size and stamina I always wanted. It’s like asking you to train me at the gym to get the body I always wanted. As I said before, I don’t anything wrong with wanting that and/or wanting to please most women in the bedroom. I think you and I both know that a 5 1/2-inch penis that’s not thick at all on most girls won’t cut it.

Answer

It’s about perspective. Do you engage in self-improvement activities because you enjoy the challenge and benefits, or do you do it because you feel inferior and because you’re plagued by feelings of emotional inferiority? There’s nothing wrong with sex. It’s one of life’s greatest pleasures, but it’s important you put sex in the proper context of your life.

The TRUE irony about all of this is men who suffer from self-doubt often suffer from those sexual issues (or have them compounded) BECAUSE of the doubt itself! For those men, male enhancement can give them the confidence they need to make changes in other areas of their life. It allows them to get their foot in the door, so to speak. I still wish to help you with your training, but I also want you to feel emotionally whole, which is much more important than the mere pursuit of enlargement.

Imagine having the confidence about not worrying either way what someone else thinks and if they like it then more power to you. Having TRUE confidence can be much more impressive than merely having a large penis. You can have both, which covers the question you had mentioned in your first sentence. THIS is the part of my teaching I’ve been focusing more on, and I expect soon the coaching will focus exclusively on these and other more challenging projects.

Let’s get down to the essence of what I’m trying to talk to you about – the ego. While people’s youths have typically been defined as the time for the exploration of the ego, modern culture has perverted this into this monstrous idea where not only do you have to be perfect in order to be somebody, but you should be better than others, in order to rank above them. I can expand on this further and get into the sexual improprieties you’re expected to partake in, but surely you get the picture. You may be at an age where many young men strut around, show off and engage in reckless relationships and activities.

You feel deprived in some way, not only due to what you perceive to be a disability of some sort, but also due to how you’re expected to perform. By all means, as a human, on some level you’re going to feel cheated, but your particular situation presents you with a challenge, should you get through it.

You’ll become the type of person

1. Others will admire for their inner strength (surely, you’ve met people who may not have been physically attractive but exuded a presence or aura which seemed irresistible), and

2. You’ll be so emotionally strong you won’t be as prone to falling prey to emotional traps. That’s going to take YOU going inside yourself and confronting your fears and seeing them for what they are. Until you do that, issues will continue to pop up, and you’ll have one worry after another to keep you busy. Some men spend their entire lives caught in those types of traps.

Confidence is when you’re happy with yourself enough such that what others may think or say about you in a negative fashion isn’t able to truly affect you. This isn’t to say your feelings won’t be hurt, but you’ll understand the real issue is with the person making specific demands of you, not you. It’s all about the ego.

Working on going beyond the ego is a work in progress. Depending on where you’re at emotionally, some people need ego-strengthening to get them out of feelings of suicide. Confronting your fears and why you have them in the first place will help you get started. Valuing yourself above your physical/material attributes will also help.

Please allow me to be very clear when I say wanting to please others is NOT what I was referring to exactly. There’s nothing inherently wrong with that or wanting to be bigger, etc.; however, the problem arises when you think you have to do these things in order to be complete. This is especially true when those feelings of being incomplete are so powerful, they cause life-crippling effects. This is due to ego-driven FEAR, and it’s this particular issue I’m trying to help you get over.

What is stopping you from being able to perform? It’s the very thing we’re attempting to help you with, as described. Now, what if we rephrased your writing to something like: Imagine being free of the fear to be the best a potential sexual partner has ever had. Imagine being free enough to be able to let go of any anxieties enough so you can tap into passion, while you’re with someone. The sex is so intense and natural, and all you feel is pleasure – no hang ups, no worries – just pure enjoyment.

The Ultimate Guide to Male Enhancement