Nitroglycerin Gel for ED: Pros, Cons, & Practical Information

About Nitroglycerin Gel for Erectile Dysfunction

Medically reviewed by Matt Coward, MD, FACS — Written by Sara Lindberg on December 16, 2020

This article is a repost which originally appeared on Healthline

Edited for content

Erectile dysfunction (ED) may affect as many as 30 million men in the United States. People with ED experience an inability to get or keep an erection firm enough for sex.

You may be familiar with some of the more common treatments for ED, including lifestyle modifications, oral medications that include phosphodiesterase type 5 inhibitors (PED5 inhibitors), and penis pumps.

But a study published in the Journal of Sexual Medicine also looked at the use of nitroglycerin gel or cream as a topical treatment for ED. Although results look promising, it’s important to note that nitroglycerin gel or cream isn’t approved by the Food and Drug Administration (FDA) to treat ED.

Here’s what you need to know about nitroglycerin as a topical treatment for erectile dysfunction.

What is nitroglycerin?

Nitroglycerin is part of a class called vasodilators, which widen the blood vessels and improve blood flow to allow oxygen-rich blood to reach the heart.

It comes in a variety of forms, including sublingual (under-the-tongue), topical cream or gel, and as a transdermal patch. Nitroglycerin is most often used to prevent angina or attacks of chest pains.

Nitroglycerin for ED

“The idea of treating ED with topical nitroglycerin is not new and was first described in the 1980s,” says Dr. Joseph Brito, a urologist at Yale New Haven Health, Lawrence + Memorial Hospital. Brito is also a member of Healthline’s clinical review network.

In general, Brito says nitroglycerin works by dilating the blood vessels, which is why it’s traditionally used for patients with angina or chest pain due to poor cardiac vessel blood flow.

The concept is the same for ED, although Brito says it may have a dual mechanism of action:

  • It widens blood vessels helps blood flow.
  • It relaxes penile smooth muscle, which in turn compresses penile veins and impedes blood flow out of the penis, which causes rigidity.

How does nitroglycerin gel work?

According to Brito, nitroglycerin gel or cream differs from other ED treatments such as oral medications:

“[Topical nitroglycerin] acts as a nitrogen donor to increase local levels of nitric oxide, which works through molecular signaling (cGMP pathway) to cause this response,” he says.

On the other hand, Brito says PDE5 inhibitors (like tadalafil and sildenafil) work at a later step in the chain by inhibiting the breakdown of cGMP.

Nitroglycerin for ED doesn’t have enough research

That said, Brito points out that nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

Moreover, Brito points out that the American Urological Association guideline on erectile dysfunction published in 2018 didn’t include topical nitroglycerin as a suggested treatment for men with ED.

“Though this therapy was not specifically mentioned, the authors did state ‘the use of these treatments may preclude the use of other treatments known to be effective,’ and felt more research was needed,” he explains.

And there’s another factor to consider: Nitroglycerin cream on the outside of the penis might be transferred to your partner.

Why are people interested nitroglycerin gel for ED?

“Nitroglycerin may have some benefits over standard oral ED medications,” Brito says.

The onset of topical nitroglycerin is between 10 and 20 minutes, which Brito says is better than the quickest acting oral agents, with sildenafil taking at least 30 minutes.

In fact, the 2018 study published in the Journal of Sexual Medicine found that 44 percent of patients saw erection beginning within 5 minutes of application. Seventy percent of the men noticed an erection within 10 minutes.

The randomized, double-blind, placebo-controlled study included 232 men with ED who participated in two 4-week trials. One trial used a 0.2 percent glyceryl trinitrate topical gel before sex, and the other used a placebo gel.

“This may help with spontaneity, which can be an issue for couples using oral agents,” Brito explains.

Another benefit, Brito says, is that unlike other ED treatments like oral agents, nitroglycerin doesn’t need to pass through the gastrointestinal (GI) tract.

“Since absorption of oral agents like sildenafil is strongly affected by food intake, the medications are much more effective when taken on an empty stomach,” he says. This requires more planning and doesn’t always allow for spontaneity.

Where to buy nitroglycerin for ED

Nitroglycerin gel or cream is currently not approved by the FDA to treat ED.

If you have questions about this topical treatment, you need to talk with a doctor who knows your medical history. A prescription is needed for nitroglycerin.

How to take nitroglycerin gel for ED

Nitroglycerin use is managed by your doctor. Don’t use or apply this topical treatment without guidance.

According to the Journal of Sexual Medicine, the concentration studied was 0.2 percent, which Brito says likely explains why the effect was best for men with mild ED.

He also points out that other studies used concentrations of 0.2 to 0.8 percent for patients with more severe ED, who likely needing higher concentrations.

In general, Brito says people prescribed nitroglycerin by their doctor should apply a small amount (pea-sized) to the head of the penis.

Side effects and contraindications

Nitroglycerin is certainly not for everyone. According to a 2018 review, taking nitroglycerin-based medications with certain PDE5 inhibitors like Viagra is contraindicated. Using them together can result in a sudden and serious decrease in blood pressure and potentially death.

According to Brito, some drawbacks of topical nitroglycerin include possible transmission to the partner, which can lead to the partner sharing in side effects, especially low blood pressure. This can lead to headache and nasal congestion.

Other treatments for ED

There are several treatments available for ED, including:

  • oral medications that include PDE5 inhibitors such as sildenafil (Viagra) and tadalafil (Cialis). Other oral medications include vardenafil HCL (Levitra), and avanafil (Stendra)
  • erectile dysfunction pump (penis or vacuum pump)
  • penile injections
  • inflatable penile prosthesis
  • psychotherapy (talk therapy) for emotional or psychological issues related to ED
  • suppositories (Alprostadil)
  • counseling
  • diet modifications
  • exercise
  • stress reduction

The takeaway

Although some research points to the effectiveness of nitroglycerin gel or cream for improving the symptoms of ED, it’s currently not approved by the FDA as a treatment for erectile dysfunction.

If you have ED or think you may have ED, it’s important that you talk with a doctor about any treatment options. They can talk with you about the range of options, including lifestyle modifications, counseling, oral agents, penis pumps, surgery, and implants.

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.

10 Natural Ways to Boost Your Libido

Boost Your Libido with These 10 Natural Tips

Medically reviewed by University of Illinois — Written by Alexia Severson — Updated on May 11, 2019

This article is a repost which originally appeared on Healthline

Edited for content

The natural approach

Looking to spice up your sex life? There are a variety of things you can do in your everyday life that can help boost your libido and enhance your sex life.

1. Try eating certain fruits

Little evidence supports the effectiveness of certain foods, but there’s no harm in experimenting.

Figs, bananas, and avocados, for example, are considered libido-boosting foods, known as aphrodisiacs.

But these foods also provide important vitamins and minerals that can increase blood flow to the genitals and promote a healthy sex life.

2. Try eating chocolate

Throughout history, chocolate has been a symbol of desire. Not just because of its delicious taste, but because of its power to improve sexual pleasure.

According to one study, chocolate promotes the release of phenylethylamine and serotonin into your body. This can produce some aphrodisiac and mood-lifting effects.

According to another study, the effects of chocolate on sexuality are probably more psychological than biological.

3. Take your daily herbs

Next time you decide to sit down for a romantic dinner, add a little basil or garlic to your dish. The smell of basil stimulates the senses. Garlic contains high levels of allicin, and increases blood flow.

These effects may help men with erectile dysfunction.

Ginkgo bilobaTrusted Source, an extract derived from the leaf of the Chinese ginkgo tree, is another herb found to treat antidepressant-induced sexual dysfunction.

4. Take a tip from Africa

Yohimbine, an alkaloid found in the bark of the West African evergreen, has been known to work as a natural Viagra.

Some studies suggest that Yohimbine bark can help you maintain an erection. It will also enhance the quality of an erection. However, researchers say there is no natural equivalent to match Viagra.

5. Boost your self-confidence

The way you feel about your body affects the way you feel about sex. An unhealthy diet and lack of exercise may cause you to have a poor self-image. These things can discourage you from having and enjoying sex.

You can boost your self-esteem and your sex drive by shifting the focus from your flaws to your attributes. You can also focus on the pleasure experienced during sex.

6. Stick to one glass of wine

Two glasses of wine might be one too many. Drinking one glass of wine can put you at ease and increase your interest in becoming intimate. But too much alcohol can ruin your ability to perform by affecting erectile function. Too much alcohol can also inhibit your ability to orgasm.

7. Take time to meditate and relieve stress

No matter how healthy you are, being stressed out is going to affect your sex drive. Women are particularly susceptible to the effects stress can have on one’s sex life.

Men, on the other hand, sometimes use sex to relieve stress. And sometimes differences in the approach to sex may cause conflict.

To relieve stress, participate in sports activities, practice tai chi, or take a yoga class.

8. Get plenty of sleep

Those with a hectic lifestyle don’t always have the time to get the right amount of sleep. Being busy also makes it difficult to make time for sex.

People who balance work with caring for aging parents or young children are often left exhausted, which can lead to a reduced sex drive.

Boost your energy and sex drive by taking naps when you can and eating a healthy diet high in protein and low in carbohydrates.

9. Keep your relationship in check

After you’ve had an argument with your partner, chances are you’re not in the mood to have sex. For women, sensing emotional closeness is important to sexual intimacy. That means unresolved conflicts can affect your sexual relationship.

Communication is essential for building trust. It’s important to prevent resentments from building up.

Consult a doctor

Even if you’re taking a natural approach to boosting your sex drive, it still might be a good idea to talk with your doctor. They can help you identify underlying problems.

Your doctor may suggest some strategies for enhancing sexual health.

These may include communicating with your partner, making healthy lifestyle choices, and treating underlying medical conditions. Knowing the root of the problem affecting your sex life will make it easier to find a solution.

10. Trial and error

There are a variety of different approaches that may enhance your sex drive naturally. However, it’s important to remember that every couple is different. It may take a little experimentation to find out what works best for you.

If you do decide to turn to prescription drugs, remember that desire is at the core of sex. It’s important to remember that a little blue pill may not be the answer if emotional issues are affecting your libido.

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.

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.

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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.

 

Male Sexual Worries: Trends in the Post-Viagra Age

Male Sexual Worries: Trends in the Post-Viagra Age

This article is a repost which originally appeared on SciTechDaily

Edited for content

Trends in reasons for visiting a the San Raffaele sexual health clinic. Credit: This diagram appears with the permission of the authors and the International Journal of Impotence Research. The EAU thanks the authors, and the journal for their cooperation.

Scientists report a change in why men seek help for sexual problems, with fewer men complaining about impotence (erectile dysfunction) and premature ejaculation, and more men, especially younger men, complaining about low sexual desire and curvature of the penis (Peyronie’s disease).

Presenting the work at the European Association of Urology (virtual) Congress, after recent acceptance for publication, research leader Dr. Paolo Capogrosso (San Raffaele Hospital, Milan, Italy) said:

“Over a 10 year period we have seen a real change in what concerns men when they attend sexual health clinics. This is probably driven by greater openness, and men now accepting that many sexual problems can be treated, rather than being something they don’t want to talk about.”

The success of erectile dysfunction treatments such as Viagra and Cialis, and the availability of new treatments, means that men facing sexual problems have now have treatments for sexual problems which weren’t available a generation ago. Now researchers at San Raffaele Hospital in Milan have studied why men come to sexual health clinics, and how this has changed over a 10-year period.

In what is believed to be the first research of its kind, the scientists questioned 3244 male visitors to the San Raffaele Hospital Sexual Health Clinic in Milan over a 10 year period (2009 to 2019), and classified the main reason for the visit. They found that the number of patients visiting with erectile dysfunction problems increased from 2009 to 2013, then started to decrease.

There were comparatively few patients complaining of low sex drive or Peyronie’s disease in 2009, but complaints about both of these conditions grow from 2009 to the end of the study. In 2019 men were around 30% more likely to report Peyronie’s disease than in 2009, and around 32% more likely to report low sexual desire.

The amount of men complaining of premature ejaculation dropped by around 6% over the 10-year period. The average age of first attendance at the clinical also dropped, from a mean of 61 to 53 years.

“Erectile dysfunction is still the main reason for attending the clinic, but this number is dropping, whereas around 35% of men attending the clinic now complain of Peyronie’s disease, and that number has shown steady growth,” said Paolo Capogrosso. “Our patients are also getting younger, which may reflect a generational change in attitude to sexual problems.”

Dr. Capogrosso continued “We need to be clear about what these figures mean. They do not indicate any change in the prevalence of these conditions, what they show is why men came to the clinic. In other words, it shows what they are concerned about. The changes probably also reflect the availability of treatments; as treatments for sexual conditions have become available over the last few years, men are less likely to suffer in silence.”

These are results from a single centre, so they need to be confirmed by more inclusive studies. “Nevertheless there seems to be a growing awareness of conditions such as Peyronie’s disease, with articles appearing in the popular press*. In addition, we know that the awareness of this condition is increasing in the USA and elsewhere, so this may be a general trend,**” said Dr. Capogrosso.

Commenting, Dr Mikkel Fode (Associate Professor of Urology at University of Copenhagen), said:

“Although these data are somewhat preliminary as they stem from single institution they are interesting because they allow us to formulate several hypotheses. For example the drop in men presenting with erectile dysfunction may mean that family physicians are becoming more comfortable addressing this issue and that the patients are never referred to specialized centers. Likewise, the simultaneous drop in age at presentation and increase in Peyronie’s disease and low sex drive could indicate that both men and their partners are becoming more mindful to optimizing their sex lives. I will be very interesting to see if these trends are also present in other centers around the world.”

Dr. Fode was not involved in this work, this is an independent comment.

References:

* “Trends in reported male sexual dysfunction over the past decade: an evolving landscape” by Edoardo Pozzi, Paolo Capogrosso, Luca Boeri, Walter Cazzaniga, Rayan Matloob, Eugenio Ventimiglia, Davide Oreggia, Nicolò Schifano, Luigi Candela, Costantino Abbate, Francesco Montorsi and Andrea Salonia, 1 July 2020, International Journal of Impotence Research.

** “The Prevalence of Peyronie’s Disease in the United States: A Population-Based Study” by Mark Stuntz, Anna Perlaky, Franka des Vignes, Tassos Kyriakides and Dan Glass, 23 February 2016, PLOS ONE.
DOI: 10.1371/journal.pone.0150157
PMCID: PMC4764365

How Would You Answer ‘The Penis Question’?

How Would You Answer ‘The Penis Question’?

— Motivate patients by being an agitator, not an irritator

This article is a repost which originally appeared on MEDPAGE TODAY

Edited for content

“How do I make my penis bigger?”

As a urologist, I have fielded this question from men on countless occasions. Several years ago, when a middle-aged patient raised the question with me for perhaps the ten-thousandth time, I blurted out a simple answer for him, which could apply to nearly half of American men.

Mr. Boudreaux (not his real name) was obese, with a BMI of 30. He was taking seven medications a day, and suffered from diabetes and long-standing hypertension.

“Mr. Boudreaux,” I said, “if I could give you a pill that would give you more energy, improve your erections, increase your sex drive, decrease your blood pressure, improve your diabetes, decrease your risk of arthritis, decrease your risk of colon and prostate cancer, and make your penis one and a half inches longer, would you take the pill?”

Mr. Boudreaux’s face broke into a smile. He quickly responded, “Yes, please give me that prescription!”

“Mr. Boudreaux, it’s not a pill. It’s exercise!”

His smile faded. “But how would that make my penis bigger?”

I told Mr. Boudreaux that if he lost weight, all those things could happen, plus his panniculus would decrease and his penis would appear longer. He seemed game to try, so I arranged for him to see a nutritionist and start an exercise program.

His goal was to lose 2 pounds a week. Four months later at a follow-up appointment, Mr. Boudreaux reported that he had lost 30 pounds, his blood pressure had decreased enough to forego hypertension medication, and his HbA1c had significantly declined. And, yes, he reported gleefully that his penis had “grown” by nearly 2 inches!

As physicians, we routinely must propose very unpleasant options for patients’ health. Over the years I have always been disappointed that my advice on lifestyle changes has generally led to too few behavioral differences. This is especially true for obesity, which affects 42.4% of all Americans, according to the CDC.

A doctor’s usual advice to a hypertensive patient is to lose weight, exercise 20 minutes a day, take antihypertensive medication, and reduce dietary salt. The usual result in a 2-month follow-up appointment is no improvements in blood pressure, weight loss, or exercise habits.

Where, the doctor asks herself or himself, did I go wrong?

After years of pondering this question, it occurred to me that there is a distinction between irritation and agitation.

An irritator is a physician who prods patients to do something she wants them to do. The agitator, on the other hand, is an enlightened doctor who motivates patients to do something they want to do. An agitator, in essence, is as much of a coach as a director.

In my experience, irritation is not effective, at least not in the long run. But by gently agitating the patient through learning what he or she wants, the healthcare provider may unleash motivation more likely to result in improvement in compliance, health outcomes, and perhaps even a decrease in the cost of care.

How do we agitate patients to improve health habits? A Greek philosopher named Epictetus said nearly 2,000 years ago, “Nature hath given men one tongue but two ears, that we may hear from others twice as much as we speak.”

His advice applies forcefully to contemporary doctors. Most of us probably need to increase use of our ears. This is not easy for physicians to do, myself included.

I believe practiced and skilled listening lie at the core of success in shared decision-making, a growing trend in medicine over the last decade or two. Shared decision-making has been defined as “an approach where physicians and patients share the best available evidence when faced with the task of making decisions.”

In a popularly cited article on shared decision-making published in the Journal of General Internal Medicine, the authors proposed a three-step model. In step one, the provider presents the patient with a choice, commonly a stark one between changing behavior or paying a price in decline in health. Step two is a matter of discussing available options, and step three is helping the patient make a well-reasoned decision.

Take note of the third step. The ideal outcome, of course, is that a patient is more fully invested in a plan that fits his interests and motivations and thus feels it is as much his idea as the doctor’s. To achieve this goal, the physician must yield enough of the conversation to the patient to hear the patient’s motivators and align them to improved health. In the end, agitating can only happen effectively through active listening.

Bottom Line: There is seldom one way to manage a patient. It has been my experience that functioning more as an agitator than an irritator motivates patients to lead healthier lifestyles.

Neil Baum, MD, is a physician in New Orleans, corporate medical officer of Vanguard Communications, and co-editor of The Complete Business Guide for a Successful Medical Practice.

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.

 

PRP for Erectile Dysfunction: Research, Benefits, and Risks

Can PRP Treat Erectile Dysfunction? Research, Benefits, and Side Effects

Medically reviewed by Kevin O. Hwang, MD, MPH — Written by Daniel Yetman on March 6, 2020

This article is a repost which originally appeared on Healthline

Edited for content

What is PRP?

Platelet-rich plasma (PRP) is a component of blood that’s thought to promote healing and tissue generation. PRP therapy is used to treat tendon or muscle injuries, stimulate hair growth, and speed recovery from surgery.

It’s also used as an experimental or alternative treatment option for:

  • erectile dysfunction (ED)
  • Peyronie’s disease
  • penis enlargement
  • sexual performance

There’s currently little research on the effectiveness of PRP for ED. In this article, we’re going to break down what scientists have found so far. We’ll also look at alternative treatment options and potential side effects of PRP therapy.

How does it work?

Your blood is made of four different components: red blood cells, white blood cells, plasma, and platelets.

Plasma is the liquid part of your blood and makes up about half of its volume. Platelets are critical for helping your blood clot after an injury. They also contain proteins called growth factors that help speed up healing.

The theoretical benefit of PRP for ED is to make the tissue and blood vessels in the penis healthier.

To prepare PRP, a medical professional takes a small sample of your blood and spins it in a machine called a centrifuge. The centrifuge separates the plasma and platelets from the other parts of your blood.

The resulting PRP mixture has a much higher concentration of platelets than regular blood. Once the PRP is developed, it’s injected into your penis. This is called the Priapus Shot, or P-Shot.

The P-Shot is a quick procedure, and you’ll likely be able to leave the clinic in about an hour. You also don’t have to do anything to prepare in advance for the procedure.

What does the research say?

Many clinics offering PRP for ED claim that it’s effective, but there’s limited scientific evidence to support their claims. Using PRP for ED is experimental, and its effectiveness is still under review.

A 2020 review looked at all the research available to date on PRP therapy for male sexual dysfunction. The review looked at three animal studies and two human studies for ED. The studies didn’t report any major adverse reactions to PRP therapy.

The researchers concluded that PRP has the potential to be a useful treatment option for ED. However, it’s important to keep in mind that the studies had small sample sizes, and there weren’t adequate comparison groups.

More research is needed to understand the benefits of PRP treatment. The current evidence is mostly anecdotal.

How does PRP compare to other ED treatments?

At this time, it isn’t clear if undergoing PRP therapy will help improve symptoms of ED. Traditional treatment options might be a better alternative until more research is available.

Many people with ED have success with traditional treatment options, which usually target the underlying cause of ED. Your doctor can evaluate you for potential causes of ED, such as heart disease, high cholesterol, or diabetes, and recommend the best treatment option for you.

Common ED treatments include:

  • Medications. ED medications allow the blood vessels in the penis to relax and increase blood flow.
  • Lifestyle changes. Becoming more physically active, eating a healthier diet, and quitting smoking all have the potential to improve ED.
  • Talk therapy. Talk therapies might help improve ED if it’s a result of psychological causes, such as anxiety, stress, or relationship problems.
  • Targeting underlying conditions. ED is often caused by an underlying condition, such as high blood pressure, obesity, and heart disease. Treating these conditions has the potential to improve erection quality.
How much does PRP cost?

Few insurance plans currently cover PRP because it’s still considered an experimental treatment. The cost of the P-Shot can range widely among clinics. According to the Hormone Zone, the P-Shot procedure costs about $1,900. However, some clinics may charge up to $2,200 for treatment.

According to the 2018 Plastic Surgery Statistics Report, the average doctor fee for a PRP procedure was $683, not including facility and instrument cost.

Finding a doctor

If you’re interested in having PRP treatment for ED, talk to your doctor. They can answer your questions about PRP and refer you to a specialist who performs the treatment. Globally, there are at least 683 registered clinics that can administer PRP for ED.

PRP is usually performed by a doctor or surgeon. However, laws on who can perform the treatment may vary between countries.

When looking for somebody to perform PRP, check their medical credentials to make sure they’re licensed by a medical board before you make an appointment.

If possible, you may also want to speak to one of their previous clients to see if they were happy with their results.

Risks and side effects

The 2020 review mentioned earlier found no major adverse effects in the study participants. However, researchers can’t say whether or not PRP is a safe treatment for ED until more research comes out.

As of now, there have been few clinical trials, and the sample sizes have been too small to make any conclusions.

PRP is unlikely to cause an allergic reaction since the substance being injected is coming from your body. However, as with any type of injection, there’s always a risk of complications, such as:

  • infection
  • nerve damage
  • pain, including pain at the injection site
  • tissue damage
  • bruising
Takeaway

PRP therapy is still an experimental treatment. At this time, it isn’t clear if PRP can help treat ED. The procedure is relatively expensive and isn’t covered by most insurance companies.

Early research looks promising, but until studies with large sample sizes and control groups come out, you may want to stick with traditional ED treatments.

If you’re having trouble getting an erection, it’s a good idea to talk to your doctor. They can test you for underlying medical conditions that may be causing ED and recommend an appropriate treatment.

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.