Senior Sex: How to Maintain or Improve Intimacy

Sex in the Senior Years

By Mark Stibich, PhD | Updated on August 13, 2023
Medically reviewed by Isaac O. Opole, MD, PhD

This article is a repost which originally appeared on verywell health

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

Key takeaways:

‧ People in their 70s and 80s and beyond can continue to enjoy sex.

‧ Striving for optimal physical and mental health can allow one to continue to enjoy sex in older age.

‧ Issues you cannot resolve on your own should be brought to the attention of a qualified medical professional.

Many people in their 70s and 80s are not only sexually active, but satisfied with their senior sex lives.1 Though the frequency or ability to perform sexually may decline with age due to physiological changes, these don’t necessarily affect how a person experiences or enjoys sex.

Aging-related problems like erectile dysfunction (ED), vaginal dryness, or urinary incontinence can affect sex. But their impact can also be minimized by using medication, managing chronic conditions, seeking individual or couples counseling, and changing sexual practices.2

This article explores the sex lives of adults 65 and over and the problems that can interfere with sex as the body ages. It also discusses the various treatment options and ways to maintain—or even jumpstart—your senior sex life.

Sexual Activity in Older Adults

Studies suggest that men are almost twice as likely as women to still have sex or masturbate in their later years. A British study found close to 60% of men ages 70 to 80 and 31% of men ages 80 to 90 are still sexually active. In women, those figures drop to 34% and 14%, respectively.3

This lower rate of sexual activity in older women may be due to a lack of opportunity rather than a lack of desire. Research shows that older women are less likely to have partners (due in large part to the fact that they often outlive their partners). This is sometimes referred to as “the partner gap.”1

Sexual Health Problems in Older Men

It is common for men to experience sexual problems after age 40. Reasons include a natural decline in testosterone levels, heart disease, and prostate problems. The inability to achieve or sustain an erection or reach orgasm or ejaculation are common concerns.4

Erectile Dysfunction

Erectile dysfunction (ED), formerly known as impotence, is the inability to achieve or maintain an erection firm enough for sexual penetration and long enough to achieve orgasm.

While ED is more common in older men, aging itself does not cause the problem. ED is related to conditions, sometimes several at once, that directly or indirectly interfere with erections.

Risk factors include high blood pressure, diabetic nerve damage, smoking, obesity, Peyronie’s disease, depression, and even certain medications. An accurate diagnosis is needed to ensure the right treatment.5

ED drugs like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) are often the first-line treatments for ED. Lifestyle changes and counseling can also help. For some men, hormonal therapy, penis pumps, and penile implants may be recommended.
Is There a Female Viagra?

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a non-cancerous enlarged prostate and one of the most common health problems in older males.6 BPH can cause symptoms like difficulty urinating, frequent urination, or waking up in the middle of the night to urinate (nocturia).

On top of this, BPH can cause sexual problems like low libido (low sex drive) and delayed ejaculation (difficulty reaching orgasm).

Among the treatment options, testosterone therapy may help restore libido. There are also certain drugs used off-label that may help with delayed ejaculation, including cabergoline (originally marketed as Dostinex) and Wellbutrin (bupropion).7

Because some BPH medications can also cause sexual dysfunction, a change in the dose may help resolve these concerns.8

Sexual Health Problems in Older Women

More than a third of older women experience sexual problems. These are typically due to menopause, when estrogen levels steeply decline. Hormonal changes can lessen sexual desire and make it harder to become aroused.9

Sexual organs also change as a person gets older. A woman’s vagina will shorten and narrow. The vaginal walls become thinner and less flexible, tearing more easily. Vaginal lubrication decreases, making vaginal intercourse more painful.10

Hypoactive Sexual Desire Disorder

Hypoactive sexual desire disorder (HSDD) is diagnosed when an absence of sexual fantasies, thoughts, and desires causes personal distress. It is a problem that is common among many older women.

A medication known as Addyi (flibanserin) is used to treat HSDD in women. It is currently only approved for premenopausal women, but research shows that it can also improve libido in older women as well.11

Vaginal Dryness

Vaginal dryness is uncomfortable and can make sex painful. Over-the-counter (OTC) remedies that can help relieve irritation and itching from vaginal dryness include lubricants such as K-Y Jelly or vaginal suppositories like Replens.

If OTC remedies don’t help, your doctor may prescribe estrogen cream as well as estrogen-containing vaginal rings and vaginal suppositories.

There are also plant-based products, like black cohosh, that have estrogen-like effects. These should be used with caution in women who have had or are at risk of breast cancer.12

Pain With Sex

Painful intercourse is more likely in older women as vaginal tissue tends to thin and tear easily after menopause. Standard treatments for vaginal dryness can often help ease pain during sex.

If that is not effective, prescription drugs like Osphena (ospemifene) and Intrarosa (prasterone) can treat thinning vaginal tissues and help relieve moderate to severe vaginal dryness.12

Pelvic Organ Prolapse

The pelvic floor muscles and tissues hold the bladder, uterus, cervix, vagina, and rectum in place. Pelvic organ prolapse (POP) occurs when the pelvic floor weakens, causing the pelvic organs to drop and bulge (prolapse) in the vagina. This can cause pelvic pain and pressure, pain with sex, and urinary incontinence.13

POP is often treated with pelvic floor physical therapy to strengthen the supporting muscles. In some cases, surgery may be needed.14

Other Health Concerns

Chronic medical conditions become more common as a person ages. Many of these can interfere with an older person’s sex life.
Arthritis and Chronic Pain

Arthritis and other chronic pain conditions are common among older adults and can make sex very difficult. Depending on the cause, doctors may recommend physical therapy to strengthen muscles and improve flexibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs), both over-the-counter and prescription, can be taken before sex to help ease the pain. Opioid drugs, while effective as a pain reliever, can cause a drop in testosterone and contribute to ED.15

If the pain only occurs in certain sexual positions, let your partner know and try different positions. Bolstering your bodies with pillows and cushions can also help.

Diabetes

In the United States, almost one-third of adults over 65 have diabetes. Approximately half of these are undiagnosed.16

Diabetes can cause sexual dysfunction in both men and women. This can be due to circulation problems, medication side effects, or nerve damage. Problems include:17

‧  Low libido
‧ Difficulty with arousal
‧ Erectile dysfunction
‧ Painful intercourse
‧ Reduced genital sensation
‧ Urinary tract infections
‧ Yeast infections

The best way to reduce the impact of diabetes is to gain control of your blood sugar. Speak with your doctor if you have difficulty managing your blood sugar, and be sure to mention any sexual health problems you may be having. It’s important for your doctor to know.

Heart Disease

Older age is the greatest risk factor for heart disease.18 Heart disease causes problems as arteries start to narrow and harden (referred to as atherosclerosis). This reduces blood flow throughout the body, including the pelvis and genitals, resulting in sexual dysfunction in both men and women.

Heart disease is one of the leading causes of erectile dysfunction in men. It can also cause women to have difficulty achieving orgasm due to the decreased blood flow to the genitals.

There is no one way to resolve these issues, but there is evidence that statin drugs used to reduce the risk of heart disease can improve erectile dysfunction in some men.19 Some studies suggest that similar approaches may improve sexual function in women with heart disease.20

People with heart disease may also be nervous about sex due to fear of a heart attack. While sexual activity is generally safe, talk to your health provider if you are concerned.21

Obesity

Today, more than 40% of adults over 65 meet the definition of obesity.22 Research shows that women who are obese are more likely to experience sexual dysfunction than non-obese women.23 In addition, obesity increases the odds of erectile dysfunction in men.20

These issues may be directly related to higher rates of diabetes among people who are obese as well as reduced blood circulation due to atherosclerosis.24

Weight loss, achieved with a healthy diet and routine exercise, is considered the best strategy to overcome obesity. It may also improve a person’s self-image and sense of well-being while making sex easier to navigate.

Urinary Incontinence

Urinary incontinence is the loss of bladder control. This becomes more common with age, especially in women.

Incontinence can be embarrassing and make sex awkward. Women who experience stress incontinence may be afraid to orgasm. Extra pressure on the abdomen during intercourse can also cause urinary leakage.

If you have incontinence, empty your bladder before sex. Changing sexual positions can help prevent urinary leakage by avoiding the compression of the bladder. Pelvic floor exercises can also help strengthen the muscles that aid with urine control.

Medications

Some medications used in older adults can cause sexual dysfunction in both men and women. These include:25

‧  Antidepressants
‧  Antihistamines
‧  Chemotherapy
‧  Diuretics (“water pills”)
‧  High blood pressure medicines
‧  Opioid painkillers

If you are having sexual difficulties, let your doctor know and advise them of any drugs you are taking, including over-the-counter, prescription, or recreational.

Lifestyle and Mental Health

Lifestyle and mental health issues can also contribute to sexual problems in older adults. These issues can be just as difficult—and sometimes even more difficult—to overcome than physical ones. If you are faced with any of these issues, there are things you can do to turn them around.
Alcohol

For some people, drinking a glass of wine helps them relax and get in the mood. However, too much alcohol can end up impairing sexual function. According to the National Institute on Drug Abuse, alcohol is the most-used drug among older adults, with 65% of people 65 and older reporting high-risk drinking.26

Alcohol can impair a man’s ability to get an erection, cause premature ejaculation, or delay orgasm.27 In women, too much alcohol can make it difficult to climax.2

Reducing the amount you drink can help, but if you are unable to control your alcohol use, speak to your doctor about treatment options.

Depression

In the United States, between 5% and 10% of adults over 65 are estimated to be depressed.28 This can lead to many health concerns, including sexual dysfunction.29

In people with depression, neurotransmitters—chemical messengers that send signals between the brain and body—are out of balance. This can affect sexual desire, arousal, and orgasm. Ironically, medications used to treat depression can have the same effects.

While the benefits of antidepressants often outweigh the risks, therapy and counseling may offer a reasonable option for those with mild depression.

Stress

Stress can be a contributing factor to sexual dysfunction. Financial worries and health concerns are just some of the common stresses affecting older adults.

To relieve stress (and the effect it has on your sex life), consider stress management techniques like mindful breathing, tai chi, yoga, and meditation. Research shows practicing mindfulness and meditation can ease the effects of stress and improve overall feelings of well-being.30 This alone may help improve sex.

In addition, seek professional assistance from financial advisors, health advocates, and social workers to help better deal with the other stresses in your life.

Relationship Issues

Lack of sexual intimacy is often related to relationship problems. If you are and your partner are not connecting emotionally, it can lessen your desire to be intimate.

On the flip side, studies show that older couples who engage in sexual intercourse with their partner are likely to share a closer relationship. Moreover, closeness to one’s partner has been shown to increase overall well-being.31

While this issue is not unique to older couples, many people find talking to a marriage counselor can help them work through relationship issues and rekindle sexual feelings and attraction.

Self-Image

With age can come weight gain and other body changes that may affect one’s sense of physical attractiveness. Self-consciousness can spill over into the bedroom and affect a person’s confidence during sex.

A 2019 study among older women found that those who were self-conscious about their bodies reported less sexual satisfaction. By contrast, those who had greater self-acceptance of their bodies irrespective of weight or aging-related changes had a more satisfying sex life.32

Self-acceptance is ultimately the key. Working with a therapist, either alone or as a couple, can help you discuss your feelings openly and find a way to embrace a more positive self-image.

How to Maintain a Healthy Sex Life

The benefits of maintaining your sex life as you age are physical and emotional. Being sexually active is associated with a lower risk of medical conditions and a longer life. It’s also associated with a greater sense of happiness and overall well-being.3

If your sex life has become stagnant and you’d like to rev it back up, here are a few things you can do.

Communicate

Good sex begins with good communication. Couples who have been together a long time often think they know what the other is thinking. But no one is a mind reader.

Talk to your partner about any concerns you have. You may feel as though your mate is no longer attracted to you because sex has become infrequent, when in fact they are experiencing a decline in sexual interest.

In addition, as sex organs change with age, what felt good before may no longer feel good or may even be painful. Be open with your partner about these changes.

Communicating about sex can be challenging at any age, however. If you and your partner struggle to talk about sex, consider seeing a sex therapist.

Redefine Sex

Sex, as you get older, may need to change. But different can still be good, if not better. With an empty nest and possibly retirement, there’s more time and privacy to explore.

Research shows older adults have a broader definition of sexual activity than younger adults.33 In other words, they better understand that there is more to sex than just intercourse. Foreplay on its own can be quite satisfying.

Be creative and willing to try new things.

Rethink Intimacy

Sex isn’t just physical. It’s an emotional expression of intimacy. As you grow older, sexual intimacy changes. What this means to you and your partner may need to be redefined.

Emotional intimacy can be expressed through non-sexual physical touch. Examples of non-sexual physical touch include:

‧  Back rubs
‧  Cuddling
‧  Holding hands
‧  Hugging
‧  Placing your hand on your partner’s shoulder or arm
‧  Playful nudges
‧  Sitting next to each other
‧  Touching feet under the table

Another non-sexual way to build emotional intimacy is spending quality time together. Things you can do:

‧  Go out on dates with other couples.
‧  Look through old photos and reminisce.
‧  Play cards, board games, or word games.
‧  Read aloud to each other.
‧  Play music together.
‧  Travel, explore new places.
‧  Visit with friends or family.

Just Do It

Instead of waiting for the desire to strike, experts recommend that older adults just go for it. This is because sex has physical and emotional benefits. Orgasms release oxytocin, a hormone that induces a state of calm and improves sleep.

Even if you’re not in the mood, having sex can set the stage for more sex in the future. This is especially true for women. Having sex regularly helps increase natural lubrication and vaginal elasticity. It may also improve erections in men.

Summary

Older age can lead to sexual problems in different ways. Age alone increases the risk of erectile dysfunction, delayed ejaculation, low libido, vaginal dryness, and pelvic organ prolapse. Medical conditions like arthritis, diabetes, heart disease, obesity, and incontinence can also directly or indirectly interfere with sex.

Lifestyle and emotional issues that can impair sexual function in all ages can become even more profound in adults 65 years and older. These include stress, depression, negative self-image, relationship problems, and alcohol abuse.

By working with a doctor or therapist, you can overcome many of these concerns and improve not only your quality of life but your sex life as well. Keeping open lines of communication and embracing change as a natural part of life can also help keep your sex life fresh as you approach your later years.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. University of Michigan Institute for Healthcare Policy and Innovation. Let’s talk about sex.

2. National Institute on Aging. Sexuality in later life.

3. Lee DM, Nazroo J, O’Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: findings from the English longitudinal study of ageing. Arch Sex Behav. 2015;45(1):133-144. doi:10.1007/s10508-014-0465-1

4. Shigehara K, Kato Y, Iijima M, et al. Risk factors affecting decreased libido among middle-aged to elderly men; Nocturnal voiding is an independent risk factor of decreased libido. Sex Med. 2021 Oct;9(5):100426. doi:10.1016/j.esxm.2021.100426

5. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of erectile dysfunction.

6. National Institute on Aging. Prostate problems.

7. Abdel-Hamid IA, Elsaied MA, Mostafa T. The drug treatment of delayed ejaculation. Transl Androl Urol. 2016;5(4):576-591. doi:10.21037/tau.2016.05.05

8. National Cancer Institute. Understanding prostate changes: a health guide for men.

9. Harvard Health Publishing. Yes, you can have better sex in midlife and in the years beyond.

10. Szymański J, Słabuszewska-Jóźwiak A, Jakiel G. Vaginal aging—What we know and what we do not know. Int J Environ Res Public Health. 2021 May;18(9):4935. doi:10.3390/ijerph18094935

11. Portman DJ, Brown L, Yuan J, Kissling R, Kingsberg SA. Flibanserin in postmenopausal women with hypoactive sexual desire disorder: Results of the PLUMERIA study. J Sex Med. 2017;14(6):834-842. doi:10.1016/j.jsxm.2017.03.258

12. Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018;10:387-395. doi:10.2147/IJWH.S158913

13. Department of Health and Human Services: Office on Women’s Health. Pelvic organ prolapse.

14. Duralde ER, Rowen TS. Urinary incontinence and associated female sexual dysfunction. Sex Med Rev. 2017;5(4):470-485. doi:10.1016/j.sxmr.2017.07.001

15. Marudhai S, Patel M, Valaiyaduppu Subas S, et al. Long-term opioids linked to hypogonadism and the role of testosterone supplementation therapy. Cureus. 2020;12(10):e10813. doi:10.7759/cureus.10813

16. Kalvani RR, Golden SH, Cefalu WT. Diabetes and aging: unique considerations and goals of care. Diabetes Care. 2017 Apr;40(4):440–3. doi:10.2337/dci17-0005

17. American Diabetes Association. Sex and diabetes.

18. Steenman M, Lande G. Cardiac aging and heart disease in humans. Biophys Rev. 2017 Apr;9(2):131–7. doi:10.1007/s12551-017-0255-9

19. Kosti JB, Dobrzynski JM. Statins and erectile dysfunction. World J Mens Health. 2019 Jan;37(1):1–3. doi:10.5534/wjmh.180015

20. Nascimento ER, Maia ACO, Pereira V, Soares-Filho G, Nardi AE, Silva AC. Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence. Clinics (Sao Paulo). 2013 Nov;68(11):1462–8. doi:10.6061/clinics/2013(11)13

21. Penn Medicine. Sex and your heart: What to know about intimacy and heart disease.

22. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief. 2020;360.

23. Mozafari M, Khajavikhan J, Jaafarpour M, et al. Association of body weight and female sexual dysfunction: a case control study. Iran Red Crescent Med J. 2015;17(1):e24685. doi:10.5812/ircmj.24685

24. Ho JH, Adam S, Azmi S, et al. Male sexual dysfunction in obesity: the role of sex hormones and small fibre neuropathy. PLoS One. 2019;14(9):e0221992. doi:10.1371/journal.pone.0221992

25. Conaglen H, Conaglen J. Drug-induced sexual dysfunction in men and women. Aust Prescr. 2013;36(1):42-45. doi:10.18773/austprescr.2013.021

26. National Institute on Drug Abuse. Substance use in older adults DrugFacts.

27. Prabhakaran DK, Nisha A, Varghese PJ. Prevalence and correlates of sexual dysfunction in male patients with alcohol dependence syndrome: a cross-sectional study. Indian J Psychiatry. 2018;60(1):71-77. doi:10.4103/psychiatry.IndianJPsychiatry_42_17

28. Cheruvu VK, Chiyaka ET. Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: findings from a nationally representative sample. BMC Geriatr. 2019;19(1):192. doi:10.1186/s12877-019-1203-2

29. National Institute of Aging. Depression and older adults.

30. Goyal M, Singh S, Sibinga EM, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(3):357–68. doi:10.1001/jamainternmed.2013.13018

31. Smith L, Yang L, Veronese N, Soysal P, Stubbs B, Jackson SE. Sexual activity is associated with greater enjoyment of life in older adults. Sex Med. 2019 Mar;7(1):11–8. doi:10.1016/j.esxm.2018.11.001

32. Gillen MM, Markey CH. A review of research linking body image and sexual well-being. Body Image. 2019;31:294-301. doi:10.1016/j.bodyim.2018.12.004

33. Hinchliff S, Tetley J, Lee D, Nazroo J. Older adults’ experiences of sexual difficulties: Qualitative findings from the English longitudinal study on ageing (ELSA). J Sex Res. 2018;55(2):152-163. doi:10.1080/00224499.2016.1269308

 

 

 

 

 

 

Pumping Edition of Ask The Experts

Pumping Edition of Ask the Experts

Big Al, of MaleEnhancementCoach.com, answers questions about pumping.

If you have questions you’d like answered in an Ask the Experts article, please PM Big Al

Q. Is there a specific erection level you should use when entering the pump? When I go in erect, I don’t get in as good of a workout as when I go in a bit flaccid.

Al: If you don;t have any serious stamina concerns and are utilizing the device with enlargement in mind, you can enter the device at about 70% erect or so- then proceed to induce a full erection once you’re in the device.

If one has ED or has serious stamina issues. then enter the device with as much of an erection as can be comfortably managed.

 

Q. What are your favorite pumping routines?

Al: The following are two pages of data I recommend on this subject:

‧ A New Bathpump Routine

‧ The Advantages of Pulse Penis Pumping

 

Q. Are there things you can do during the pump session itself to make the workout more challenging?

Al: There are various intensity techniques which can be used by the advanced. Pulling (jacking) the device slightly can generate even more pressure in slight bursts. Some use this as a means of self-pleasuring.

Another very advanced technique is to give a pull and then a quick pump to remove a slight bit of pressure. The singular pump combined with a pull creates a greater negative pressure deficit.

The above can also be performed with a well-timed Kegel instead of a pull.

These techniques work best with a manual pump or BathMate type device.

*                *                *

Do you want Al to answer your questions?  Please check out MaleEnhancementCoach.com

Caffeine and Erectile Dysfunction

By Lindsay Curtis Updated on May 01, 2023
Medically reviewed by Jamin Brahmbhatt, MD

This article is a repost which originally appeared on verywellhealth

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

Key Points

‧ Moderate doses of caffeine may improve sexual function.

‧ Caffeine consumption can have a positive effect on emotional health.

‧ Caffeine sensitivity usually increases with age.

Coffee before sex may do more than just wake up the brain. Some research suggests that males who drink two to three cups of coffee a day have lower odds of developing erectile dysfunction, possibly because coffee may stimulate blood flow to the penis.

This article explains how coffee affects sexual performance and reproductive health.

How Coffee Improves Sex

In addition to providing a boost of energy, drinking coffee can make sex better in a variety of ways. Coffee is rich in antioxidants, which can protect blood vessels, aid circulation, and possibly improve blood flow to the penis, helping men get and maintain erections.

Erectile Function

Men who drink two to three cups of coffee per day may have an easier time getting and maintaining an erection.

In fact, one study found that men who consumed between 85-170 milligrams of caffeine per day were 42% less likely to experience erectile dysfunction, which is the inability to get or maintain an erection that is firm enough for sexual activity.

Those who consumed between 171-303 milligrams of caffeine a day were 39% less likely to report ED compared to those who didn’t consume caffeine.

This may be due to caffeine relaxing the arteries and smooth muscle in the penis, allowing more blood flow and improving erectile function. It may also be because caffeine intake may boost testosterone levels, and having low levels may contribute to ED. Research shows that men who regularly consume caffeinated coffee have higher levels of testosterone than those who do not consume it.

However, a more recent study found no association between caffeine intake and ED.

ED Prevalence

ED is very common. Though the risk of ED increases with age, young men can also experience the condition. Estimates on the prevalence of ED vary, but it is estimated that one out of every 10 men will experience the condition at some point during their life.

Improved Libido

It’s possible that caffeine can ramp up your sex drive. Caffeine is a stimulant, which is a drug that can increase energy and alertness by speeding up your brain and body. This increased energy may also give your sex drive a boost.

In addition to boosting energy levels, caffeine may also increase testosterone levels in men. Research shows that men who regularly consume caffeinated coffee have higher levels of testosterone than those who do not consume it.

One study found that consuming more than 4 milligrams of coffee prior to exercising boosts testosterone levels in athletes. An older study showed that chewing caffeine gum may elevate testosterone levels by up to 14%.

Caffeine’s possible ability to increase testosterone levels may also boost sex drive, as low levels have been linked with low libido.

However, scientists haven’t published research on the effect of coffee on libido in humans.

Decreased Stress

Caffeine may lower anxiety and elevate mood, which could make a coffee drinker happier and more relaxed during sex.

Researchers believe that caffeine can reduce anxiety by blocking receptors of the chemical adenosine, which can prevent the brain from causing a stress response.  However, this may only be the case for low to moderate coffee drinkers. Heavy caffeine intake can actually cause higher anxiety levels.

Side Effects

Though coffee may offer some health benefits, it’s important to drink it in moderation. Too much caffeine can cause a host of unwanted side effects, including:

‧ Anxiety
‧ Jitters
‧ Headache
‧ Insomnia
‧ Increased heart rate
‧ Upset stomach
‧ Dependency

The Food and Drug Administration recommends consuming no more than 400 milligrams (about four to five cups of coffee) per day to avoid side effects.

Caffeine Sensitivity

If you have caffeine sensitivity, even a small amount of caffeine can make you feel unwell. There are varying degrees of caffeine sensitivity: one person may be unaffected, while another won’t be able to sleep hours after consuming it. Caffeine sensitivity tends to increase with age, so you may find you need less coffee as you get older.

How Much Coffee Before Sex?

Coffee boosts energy levels, improves physical endurance, and increases neurotransmitters associated with elevated mood, which can all serve to help improve your sex life.

However, you don’t need to drink an excessive amount of coffee before sex to enjoy the benefits. One or two cups 45 minutes prior to sexual activity may help improve ED, boost testosterone, and give you the energy you need for a positive sexual experience.

Do Energy Drinks Help Sexual Performance?

While caffeine consumed in coffee is generally well tolerated by most people, energy drinks can have a number of negative effects, and there is no evidence to show that energy drinks can help with sexual performance. In fact, long-term consumption of energy drinks is associated with an increased risk of developing cardiovascular problems, sleep disorders, dental problems, obesity, and calcium deficiency.

Summary

Coffee may be a natural way to help improve your sex life. More research is needed to say for sure, but it appears that drinking coffee can reduce your chances of erectile dysfunction and increase your libido. Coffee may also reduce anxiety and stress, thus making sex more relaxing and enjoyable.

You don’t need to drink much coffee to benefit from its effects. One or two cups 45 minutes before sex should be enough. Avoid drinking more than four or five cups a day, since excess caffeine can lead to unwanted side effects like insomnia and anxiety.

Though some people do find coffee to be helpful, be sure to talk to your healthcare provider if you have ED or other concerns about your sexual performance.

Frequently Asked Questions

Does drinking coffee before sex improve testosterone?

Research suggests that coffee may temporarily boost testosterone levels, which may be beneficial before sex.  Drinking coffee can also result in the relaxation of the cavernous smooth muscle found in the penis and improve blood supply through penile arteries to enhance blood flow to the penis.

What is the link between coffee and testosterone?

Coffee may help boost testosterone levels in men. One study found that men who consumed caffeine five times a day had higher levels of testosterone than men who did not consume it. Researchers concluded that caffeine may act as an aromatase inhibitor (blocking estrogen), which may boost testosterone production. Another study found that caffeine may improve exercise and training outcomes due to its ability to moderately boost testosterone levels.

Does caffeine improve ED?

Moderate levels of caffeine consumption may help improve erectile dysfunction. Research shows that men who consume between 85-170 milligrams of caffeine are 42% less likely to experience erectile dysfunction compared to those who don’t consume caffeine.

Do the symptoms of caffeine sensitivity increase with age?

Yes, caffeine sensitivity increases with age. Young people metabolize caffeine much more quickly than older adults. One study found that it takes seniors 33% longer to metabolize caffeine compared to younger adults.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Lopez DS, Wang R, Tsilidis KK, et al. Role of caffeine intake on erectile dysfunction in US men: results from NHANES 2001-2004. PLOS ONE. 2015;10(4):e0123547. doi:10.1371/journal.pone.0123547

Maggi, M., Rastrelli, G., & Corona, G. (2020). Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction. Asian Journal of Andrology, 22(3), 265. https://doi.org/10.4103/aja.aja_61_19

Wedick NM, Mantzoros CS, Ding EL, et al. The effects of caffeinated and decaffeinated coffee on sex hormone-binding globulin and endogenous sex hormone levels: a randomized controlled trial. Nutr J. 2012;11(1):86. doi:10.1186/1475-2891-11-86

Lopez DS, Liu L, Rimm EB, et al. Coffee intake and incidence of erectile dysfunction. Am J Epidemiol. 2018;187(5):951-959. doi:10.1093/aje/kwx304

Cleveland Clinic. Erectile dysfunction.

Anwar, S., Verma, P., & Dutt, R. (2022). Role of caffeine in inducing anxiety by reducing brain serotonin synthesis blocking adenosine receptors (A1, A2A, A2B, and A3). Current Traditional Medicine, 8(4). https://doi.org/10.2174/2215083808666220321145436

Richards, G., & Smith, A. (2015). Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. Journal of Psychopharmacology, 29(12), 1236–1247. https://doi.org/10.1177/0269881115612404

Food and Drug Administration. Spilling the beans: how much caffeine is too much?

Landry TM, Saunders MJ, Akers JD, Womack CJ. Caffeine added to coffee does not alter the acute testosterone response to exercise in resistance trained males. J Sports Med Phys Fitness. 2019;59(9):1435-1441. doi:10.23736/S0022-4707.19.09183-7

Lopez DS, Liu L, Rimm EB, et al. Coffee intake and incidence of erectile dysfunction. Am J Epidemiol. 2018;187(5):951-959. doi:10.1093/aje/kwx304

Beaven CM, Hopkins WG, Hansen KT, Wood MR, Cronin JB, Lowe TE. Dose effect of caffeine on testosterone and cortisol responses to resistance exercise. Int J Sport Nutr Exerc Metab. 2008;18(2):131-141. doi:10.1123/ijsnem.18.2.131

Polasek TM, Patel F, Jensen BP, Sorich MJ, Wiese MD, Doogue MP. Predicted metabolic drug clearance with increasing adult age. Br J Clin Pharmacol. 2013;75(4):1019-1028. doi:10.1111/j.1365-2125.2012.04446.x

 

 

Common and Uncommon Threats to Men’s Sexual Health

3 Common—and 4 Uncommon—Risks to Men’s Sexual Health

You might know some of these threats to your sexual well-being. Others might surprise you.

Author: Kurtis Bright
Published: March 22, 2023

This article is a repost which originally appeared on Giddy

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

Key Points

‧ Sexual health information is more abundant and easier to access than ever.

‧ Ironically, men are at a greater risk of diseases caused by excess and poor lifestyle choices than ever.

‧ ED is a notorious side effect of common ailments like diabetes and poor cardiovascular health.

Sexual health information is everywhere these days, both quality info and the not-so-high-quality kind that’s widespread on social media platforms. Even with all this access to so much information, though, certain lesser-known threats to our sexual health and fertility may slip under the radar.

At the same time, the seriousness of certain sexual health risks that “everyone knows about” may go ignored.

Here are three of the more common risks to men’s sexual health and fertility, as well as a handful of risks that aren’t always recognized as threats.

What are the biggest risks to men’s sexual health?

When we talk about threats to sexual health, we’re often talking about systemic problems. That is to say, if you’re having a problem with how your penis works, it’s not necessarily about your penis.

In modern society, we tend to view medicine as slapping on a bandage or taking a pill to alleviate the most obvious symptom we can see. In reality, lots of problems you might have in other parts of your body can affect how your penis functions.

“Sexual health is health,” said Justin Dubin, M.D., a urologist and men’s health specialist with Memorial Healthcare System in South Florida. “So sexual health problems, in general, can be a warning sign or a result of other health issues: diabetes, heart issues, infections, depression, anxiety, testosterone issues, obesity, other lifestyle issues—you name it. Having ED is the canary in the coal mine.”

Common sexual health issues

Three of the most common issues that can affect sexual health are cardiovascular disease, obesity and diabetes. They work against us in different ways.

Cardiovascular disease

Heart disease and vascular problems are strongly associated with erectile dysfunction (ED). A vital component of getting an erection is good blood flow to the penis, and issues such as atherosclerosis and high blood pressure hamper it.

Obesity

Obesity is a big risk factor for ED. One study indicated 79 percent of men who presented with ED were clinically obese, and obesity hampers your heart’s ability to pump blood. Plus, it’s a comorbidity for another risk factor, diabetes.

Diabetes

Diabetes causes a condition called diabetic neuropathy, which affects nerve endings and can result in numbness, tingling and loss of sensation. Along with blood flow, nerves are crucial for the penis to receive the signals from the brain and nervous system to get erect.

“You need to have good nerves in your penis,” Dubin said. “People [with diabetes] who have bad sensation in their feet or fingers or their eyesight, well, the nerves in the penis are very small as well, and poorly controlled diabetes can cause ED.”
Less common risks to sexual health

Four of the less obvious issues that can affect your sexual health include smoking, sexually transmitted infections (STIs), Peyronie’s disease and mental health.

Smoking

The dangers associated with smoking often focus on the lungs and heart, and rightly so. However, a lesser-known effect of smoking is that it’s associated with ED.

“Smoking and ED are linked to overall cardiovascular health,” said Neel Parekh, M.D., a men’s fertility and sexual health specialist with Cleveland Clinic. “It’s associated with cardiovascular disease, so that’s another reason why it can make it more difficult to achieve an erection. It can even affect fertility; smoking has a negative effect on how well the sperm swim.”

Indeed, according to some studies, smoking has a negative impact on semen parameters. Luckily, other studies show that quitting can greatly improve them in a short amount of time.

STIs

When it comes to fertility, another little-known issue some guys may encounter is that sexually transmitted infections can affect your sperm. An STI can travel up the urinary tract and cause problems in the rest of your reproductive system in ways that may affect you long after you’ve taken your antibiotics and the symptoms have gone away.

“Chlamydia and different bacterial infections can lead to epididymitis—the inflammation of the epididymis—which is where sperm is stored,” Parekh said. “These STDs can cause scarring of the epididymis or vas deferens and cause blockages for guys, preventing sperm from traveling through.”

Peyronie’s disease

Another issue that can fly under the radar is Peyronie’s disease. It’s a buildup of fibrous plaque or scarring in the penis that may result in a lump or new curvature that wasn’t there before. It’s thought to affect 1 in 10 men and may come on suddenly due to overenthusiastic sexual activity or over time through buildup. It can also cause erections to be painful during the acute phase.

“Peyronie’s disease is another uncommon disease that some guys will let go unchecked,” Parekh said. “A painful lump in the penis can lead to worsening curvature to the point where they can’t penetrate. Some guys will kind of ignore it for a while; maybe they’re embarrassed by it and they don’t want to tell anybody.”

Mental health

It’s an old trope: The biggest sex organ in the body is the brain. If your emotional state isn’t good, it can have a profound impact on sexual function.

Don’t forget that some antidepressants have a negative effect on sexual function, too, so it’s important to talk with your healthcare provider and make sure you address both mental health and sexual health.

“Mental health is health, too, just like sexual health,” Dubin said. “Depression, anxiety and medications that treat depression and anxiety can cause ED. I always quote the great Robin Williams: ‘God gave man a brain and a penis, and only enough blood to control one at a time.’ So if you’re up in your head, your penis is just not going to work. It’s just not.”

Conclusions

A wide variety of health issues can affect your sexual health and fertility. But perhaps the main takeaway should be that instead of trying to list all the possible factors that could specifically affect your penis, try to remember that the penis is just one part of the intricate and complex machine that is your body. Mess with one part of the network and it’s likely to have downstream effects. Take care of your body, and it’ll take care of you.

If your overall health is solid but erectile dysfunction is an issue, even intermittently, a wearable device free of the side effects of popular medications can restore sexual function. Eddie® is an FDA-registered Class II medical device designed to treat erectile dysfunction and improve male sexual performance. Its urologist-designed shape and fast-acting results allow you to treat your ED with more control. With Eddie, you don’t need to wait for a pill to kick in, use an awkward pump or subject yourself to painful injections.

In 2021 clinical trials, 95 percent of men who used Eddie reported a positive effect on their sex life.

How Men Can Take Care of Their Sexual Health

What Men Can Do to Ensure Their Sexual Health Is Strong

Mental and physical care are both critical to a man’s libido and reproductive well-being.

Author: Helen Massy
Published: March 06, 2023

This article is a repost which originally appeared on Giddy

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

Key Points

‧ Maintaining good sexual health is important for men.

‧ Mental health will have a large impact on sexual well-being.

‧ 20-30% of men in their 20s and 30s experience some form of ED.

Sexual health is an essential part of every man’s life. As well as protecting yourself from sexually transmitted infections (STIs) and diseases (STDs) or preventing unwanted pregnancies, sexual health is about having safer, satisfying sex and a positive and respectful approach to sexuality and relationships.

Understanding how to look after your sexual health benefits both you and your partner.

The best place to start is by getting to know your body and your reproductive system, and what’s normal and what’s not normal. This way, you can quickly identify any problems and seek medical support to address them.

There are multiple aspects to men’s sexual health, including physical health and mental health. Lifestyle factors influence all of these elements, either in a positive or negative way.

Men’s health and sexual health

A few of the essential aspects of a male’s sexual health are desire, erections and endurance, explained James J. Elist, M.D., a urologist in Beverly Hills, California, who specializes in impotence and male sexual dysfunction.

Being sexually healthy enables a man to fully participate in and enjoy sexual activity.

The body can’t just rely on physical health to create desire, erections and endurance, though. Physiology, mental health and emotional health can affect both libido and sexual function.

Male sexual health isn’t just about the ability to enjoy sex. It’s also about preventing STIs/STDs and identifying any problems with fertility. It’s about understanding how to prevent unwanted pregnancies and ensuring sex is consensual, respectful and safe for both partners.

Mental health and men’s sexual health

Mental health can directly impact sexual health and vice versa.

“Low libido, erectile dysfunction [ED] and premature ejaculation can all be exacerbated by negative mental health experiences, whether that’s traumatic experiences, relationship or professional workplace stress, depression or anxiety,” Elist said.

He explained that those negative mental health experiences can lead to worsened sexual performance, which in turn leads to more strains on mental health, driven by decreased self-confidence and self-worth as a result of poor performance in bed.

This leads to a negative cycle in which one feeds into the other.

“As such, it’s important to seek solutions early on to prevent any issues from worsening. Taking care of one’s mental health through therapy, meditation, etcetera can often improve sexual health issues as well,” Elist said.

If you find your mental health is affecting your sexual health, or problems with sex or sexuality are affecting your mental health, you can explore a number of options with your healthcare provider to address either issue.

Physical health and men’s sexual health

“It all begins with male libido,” Elist said of the connection between physical health and sexual health. “A man must have the desire to engage in sexual activity in the first place.”

Unfortunately, he said, as guys get older, libido tends to decrease as testosterone decreases. Obviously, for a man to be able to perform sexually, he must be able to achieve and maintain an erection. You can take steps to address this issue.

“As with testosterone and libido, erectile function also relies on staying healthy, particularly maintaining cardiovascular health, avoiding cigarettes and exercising frequently to get the blood pumping,” Elist said.

Once a man achieves an erection, he must maintain the erection and be able to last long enough to enjoy a sexually satisfying experience for both himself and his partner.

“Often, premature ejaculation can get in the way, which is why it’s important to limit stress and practice pelvic floor exercises if that’s an issue an individual deals with,” he said.

There is no need to suffer in silence if you have any problems with your libido, erection, ejaculation or performance. Seek help from your healthcare provider if you are experiencing problems, as many treatment options are available to help you feel comfortable and satisfied when having sex.

What’s a ‘normal’ sex drive?

Sex drive varies depending on a man’s age. Elist explained what happens to libido across the stages of life:

‧ In his early 20s, an individual can desire sex almost daily.

‧ Starting in his mid-30s, an individual’s testosterone levels begin to decrease by approximately 1 percent per year.

‧ Upon reaching his 60s, sexual desire may lessen even further for many men.

While there’s no “normal” level of sex drive for men, Elist stressed it is normal for levels to decrease over time.

“However, that trend can be partially mitigated and offset through regular exercise, eating healthy and maintaining a consistent sleep schedule,” he said.

Sexual health and reproductive health

“There are various issues that can impact an individual’s reproductive health and fertility, from stress to smoking to excessive testosterone use,” Elist explained.

To look after reproductive health, men should undertake a testicular self-exam routinely to ensure that there are no signs of lumps or tumors. Cancer is obviously a concern here, but fertility comes into the picture, too.

Testicular self-exams and examinations by a physician can help men identify the presence of a varicocele, a dilated vein inside the scrotum that can increase the temperature of the testicles and negatively affect sperm development, according to Elist.

Sperm counts decrease by an estimated 40 percent for every degree the testicles rise in temperature.

Elist also highlighted that the excessive use of testosterone or androgens could damage the testicles. Tobacco and frequent marijuana use can also decrease sperm count. All of these factors should be considered if a man is experiencing fertility issues.

Your healthcare provider can use various tests to help establish fertility problems, including the following:

‧ STI/STD testing
‧ Semen analysis
‧ Urinalysis
‧ Hormone testing
‧ Ultrasound scans
‧ Testicular biopsies

Complications and related conditions

The most common male sexual dysfunctions men should be aware of, according to Elist, include:

‧ Low testosterone
‧ Low libido
‧ Erectile dysfunction
‧ Premature ejaculation

ED is an issue that impacts more than half of all men at some point in their lives.

“While many think erectile dysfunction is an issue that only affects older men, it can actually impact 20 percent to 30 percent of men in their 20s and 30s,” Elist said.

Premature ejaculation is an issue that impacts nearly 40 percent of all men.

“It is characterized by sexual activity that often lasts one minute or less and sexual experiences which cause stress and frustration,” Elist explained.

You can address premature ejaculation issues with a combination of solutions that could include meditation, pelvic floor exercises, supplements, lidocaine sprays or prescription SSRIs, or selective serotonin reuptake inhibitors.

“Other issues, such as delayed ejaculation, retrograde ejaculation and Peyronie’s disease, are less common, but if an individual is experiencing any of those issues, then it’s important to discuss them with a urologist,” he added.

 

How Does Exercise Help Men Sexually?

How Exercise Improves Men’s Sexual Health

Being active is good for everyone, but there are benefits specific to males.

Author: Laura Williams Bustos, ACSM EP-C
Published: February 21, 2023

This article is a repost which originally appeared on Giddy

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

Key Points

‧ Everyone can benefit from exercise.

‧ Men have specific reasons for maintaining fitness as they age.

‧ Exercise may help to prevent erectile dysfunction.

Men, women, children and anyone else can reap the benefits of exercise. From helping prevent weight gain to reducing the risk of major chronic diseases such as heart disease and diabetes, exercise is something for which everyone should make time.

But there are reasons men, specifically, should consider including physical activity in their day-to-day lives. These reasons include sexual health benefits as well as reducing the risk of sex-specific issues such as erectile dysfunction (ED) and prostate cancer.

Men’s exercises

The ins and outs of exercise are similar for all adults. The Centers for Disease Control and Prevention (CDC) outlines that all healthy adults should aim to accumulate at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking, every week. In addition, adults should perform at least two days of strength-building exercises, which target major muscle groups.

If you’re not currently exercising, this may sound overwhelming, but it breaks down to about 30 minutes of exercise per day, five days per week. And if strength-building exercises are performed in a circuit format, with little rest between exercises or sets, they can actually double as the recommended moderate-intensity cardio, too.

While there are lots of ways to meet this goal, a sample schedule may include:

  • Monday. A 15-minute morning walk plus a 15-minute evening walk.
  • Tuesday. Thirty minutes of strength training exercises performed as a circuit. For example, perform 10 repetitions each of bodyweight squats, pushups, walking lunges, dumbbell overhead shoulder presses, dumbbell row, triceps chair dips, dumbbell biceps curls and sit-ups. Then repeat the series two more times without rest between exercises or rounds.
  • Wednesday. Thirty minutes of pickup basketball or playing soccer at the park with your kids.
  • Thursday. Thirty minutes of strength training exercises performed as a circuit.
  • Friday. A 15-minute morning walk plus a 15-minute evening walk.

It’s important to remember that exercise preference plays a key role because if you can choose exercises you enjoy and can do confidently, you’re more likely to continue doing them.

For instance, a study published in 2018 by researchers from Virginia Commonwealth University found men were significantly more likely than women to enjoy weightlifting, while they were less likely to enjoy moderate-intensity cardio. So even if the CDC’s guidelines suggest doing “moderate-intensity cardio” for 150 minutes per week, it’s important to find options—like playing sports or strength training—that are most appealing to help you meet those overarching goals.

“Regular exercise decreases the risk of all diseases and mortality from all causes,” said Kirk Parsley, M.D., a sleep expert and retired Navy SEAL based in San Diego as well as a medical team member for LegacyExpeditions.net Triple 7 Expedition. “It also helps men maintain blood flow throughout the body, enhancing muscularity and reducing the severity of male pattern baldness. Blood flow to the skin and genitals also makes sexual dysfunction less likely and improves sensation during sex. Maintaining cognitive function through balanced neurochemistry and blood flow is one of the major benefits of regular exercise and, in many cases, can counteract the risk of inherited genetic diseases.”

Risks and benefits

When started slowly, conscientiously and progressively, an exercise program carries very few risks and offers a slew of potential benefits.

“If a man is completely untrained—has never exercised regularly in his life—and he is over 30-ish, he should be evaluated by a physician for serious cardiovascular risk as well as musculoskeletal stability and movement prior to starting an exercise program,” Parsley explained. “For example, if a man has always been overweight, has never played sports or wasn’t active growing up, he may well have some biomechanical deficits that would make certain exercises more dangerous than would be worth the risk. However, generally speaking, men are no more or less likely to get any specific injury from exercise. The exercise dictates the risk.”

If you haven’t exercised in some time, schedule a quick health screening with your doctor to make sure there aren’t any specific exercises to avoid. Then consider enlisting a trainer for a few sessions to help you perfect your form and start a safe, well-designed program.

Certain exercises pose a higher level of risk because performing them incorrectly (or doing too much too soon) can place undue stress on the joints. If you’re new to exercise, it’s best to ensure you’re doing each movement correctly.

“Dead lifts are risky for low back injuries, running is risky for knee and hip injuries, [and] swimming, boxing or any racket sport has a higher risk of shoulder injuries,” Parsley said.

Even if the risk of an injury is slightly elevated due to the specific movement, the risk can be mitigated by perfecting proper form and gradually increasing workout intensity.

“If you start by exercising at a moderate pace, tempo and intensity, and gradually add short bursts of higher-intensity exercise progressively over months to years, you can do any exercise without unreasonable risk-to-reward benefits,” Parsley said.

And about those rewards? They’re extensive. The National Library of Medicine’s MedlinePlus information resource highlights the following:

  • Boosts mental health and mood
  • Enhances sexual health
  • Helps keep cognitive health sharp with age
  • Helps manage blood sugar and reduces the risk of developing type 2 diabetes
  • Improves sleep
  • Increases the likelihood of living longer (and living better as you age)
  • May help you quit smoking
  • Reduces the risk of cardiovascular disease
  • Reduces the risk of falls
  • Reduces the risk of some cancers, including colon, breast, lung and prostate

It’s important to note that while these benefits apply to men and women, a few of them should be of particular interest to men.

“Regular exercise lowers the risk of diabetes and high cholesterol, as well as lowers the risk of high blood pressure, which is elevated, in particular, in this gender,” said Rathna Nuti, M.D., an orthopedic physician at DFW Sports Medicine in North Texas.

Exercise and sexual health

One of the reasons exercise is so beneficial for men lies in how it can benefit sexual health. Arguably, this could be one of the biggest motivating factors for starting and maintaining an exercise program.

Benefits to sexual health are not emphasized as often as some of the other reasons to exercise, such as reducing the risk of heart disease. However, the increased blood flow that helps reduce the risk of heart disease is actually the same reason exercise can improve sexual health.

“Regular exercise impacts men’s sexual health by increasing the circulation of blood flow to various areas of the body, which helps ensure a healthy circulatory system,” Nuti explained. “A strong, smooth blood flow is key for arousal, which helps with erections and increases libido in men. Men who exercise more often are less likely to suffer from sexual dysfunction.”

“Sexual health is hugely impacted by fitness, for endurance, strength, the ability to move in certain ways, hold certain positions and carry your partner’s weight,” Parsley added. “However, high-intensity interval training [HIIT], a certain form of exercise, has been shown to increase testosterone levels, as can weightlifting or competitive sports. Testosterone has an impact on sexual desire, sexual confidence and oftentimes erection quality and duration. Cardiovascular fitness is not only beneficial to sexual performance, but the reverse is true, too. Poor cardiovascular fitness is often associated with greater difficulty getting and maintaining an erection.”

Exercise and ED

As Parsley and Nuti both pointed out, the impact exercise has on blood flow and circulation can positively influence the ability to get and maintain an erection. Believe it or not, studies have investigated the kinds of exercise that make a difference.

A study published in 2018 in the journal Sexual Medicine observed the impact and results of multiple exercise interventions to improve ED and concluded 160 minutes of moderate- to vigorous-intensity exercise performed each week for six months would help decrease erectile problems in men with ED. The study authors recommended 40 minutes of this kind of training four days per week.

If you currently aren’t exercising and the thought of carving out two and a half hours per week from your schedule for exercise seems daunting, remember that something is better than nothing. You can work your way up to the goal of 150 to 160 minutes of exercise each week by starting with 10 to 15 minutes of exercise per day.

Consider all the ways it can benefit your health, including your sexual health, and you’ll soon realize that once the habit is formed, it’s going to be worth the effort and time. The trick is simply finding the form of exercise that you enjoy.

Osteoporosis and Sex: How Osteoporosis Can Affect Sexual Health

By Cristina Mutchler Published on December 19, 2022

Medically reviewed by Marissa Sansone, MD

This article is a repost which originally appeared on verywell health.

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

Our takes:

‧ Osteoporosis can and does affect men- especially if hormone levels are off.

‧ Men with ED are often considered at higher risk of developing osteoporosis.

‧ Medication and lifestyle changes can have a substantial effect on the development of osteoporosis.

Osteoporosis is linked to hormone levels in the body, which can affect sexual health. Specifically, a natural lowering of the sex hormones estrogen and testosterone as we age can contribute to bone thinning and weakness.

During this time, it’s not uncommon to find yourself dealing with sexual health issues like erectile dysfunction, discomfort during sex, or a reduced sex drive.

This article discusses how osteoporosis is connected to sexual health, tips on treatment options, and when to see a healthcare provider.

What Is the Connection Between Sexual Problems and Osteoporosis?

Sexual health problems, such as erectile dysfunction (ED) and vaginal dryness, can often coexist with osteoporosis. Researchers think this connection is due to the key role that sex hormones play in bone health.

One study found that osteoporosis was three times more common in males with ED than those without the condition.

Other research suggests that experiencing sexual health issues like vaginal dryness after menopause is linked to osteoporosis.

Symptoms and Gender Differences

Osteoporosis is more common in people who have lower levels of sex hormones in their bodies, as estrogen and testosterone play an important role in providing bone protection.3 For women, this typically happens when menopause is reached, as the ovaries are producing less estrogen. Similarly, as men age, testosterone production is reduced.

Both genders appear to be affected differently regarding how osteoporosis may impact their sexual health. More research has been published on a link between erectile dysfunction in men with osteoporosis, while fewer studies have shown a connection between female sexual dysfunction, menopause, and osteoporosis.

It’s estimated that about 10 million adults age 50 and older in the United States have osteoporosis—and the condition is roughly four times as common in women as it is in men.

Men

Although men don’t develop osteoporosis nearly as often as women, research suggests that men with ED have a higher risk of osteoporosis. While many factors can play a role in developing ED, experts believe that lowered testosterone levels are a likely culprit in the case of osteoporosis.

Erectile dysfunction symptoms can include:

‧  Inability to achieve or trouble achieving an erection
‧  Loss of erection before sexual intercourse is over
‧  Difficulty performing during sex
‧  Premature or delayed ejaculation

In one study, the group with the highest risk for osteoporosis was men aged 40 to 59 with ED.9 Researchers recommend that all men with osteoporosis be evaluated for ED—and that men already diagnosed with ED be evaluated for bone density issues like osteoporosis.

Women

Significantly more women experience osteoporosis than men and may also be likely to experience sexual dysfunction issues. Researchers believe this is mostly because of the significant decline in estrogen and testosterone levels around the menopause phase.

For example, it’s common to experience symptoms such as:

‧  Vaginal dryness
‧  Pain during intercourse
‧  Lack of sexual arousal

Experts worldwide have been looking into solutions for treating osteoporosis and sexual dysfunction in women who have reached menopause. Some of the potential therapies being studied include:

‧  Treating with estrogen and testosterone therapy
‧  Using the prescription synthetic steroid drug Tibolone
‧  Prescribing drugs used to treat ED for men and women
‧  Trying selective estrogen receptor modulator drugs (SERMs) hormone therapies for breast cancer for vaginal dryness relief and increased sexual drive

More evidence is needed before these treatments may be considered, approved, and recommended for those usages in the United States.

How Are Sexual Problems With Osteoporosis Treated?

People experiencing sexual dysfunction issues alongside osteoporosis will want to check with a healthcare provider before adjusting their routine or medications. Ensuring your osteoporosis treatment plan is on track is a good place to start.

Treatment options for osteoporosis include:

‧  Prescription medications, known as bisphosphonates, are often prescribed to help decrease bone loss.
‧  Hormone therapy can help boost estrogen and/or testosterone levels, preserving bone density.
‧  Lifestyle modifications, such as diet changes to include specific nutrients and adding resistance exercises to your workout routine, can help improve bone health.
‧  Surgical procedures, including vertebroplasty and kyphoplasty or spinal fusion, may be recommended to treat and prevent further bone fractures.
‧  Mental health therapies, like talk therapy or support groups, can support psychological well-being with an osteoporosis diagnosis.

A healthy sex life may also contribute to improved overall health. Potential treatment options for sexual dysfunction include:

‧  Erectile dysfunction (ED) treatment options can involve prescription medications, testosterone replacement therapy, counseling, and lifestyle changes.
‧  Female sexual dysfunction treatment options might include a testosterone patch for increased sex drive, lubricant for vaginal dryness, and avoiding sexual positions that cause discomfort.
‧  Talk therapy for people with osteoporosis and their partners may improve their overall sexual health.18 Research suggests combining this method with medication helps improve ED symptoms and sexual satisfaction.

Summary

There is a connection between osteoporosis and sexual health issues, such as erectile dysfunction (ED) and vaginal dryness. Experts think the lower levels of sex hormones as we age cause bone changes that lead to osteoporosis and increase the chances of sexual dysfunction problems. People with osteoporosis experiencing conditions like ED or painful sex should check with a healthcare provider to discuss treatment options.

Q&A: Why holiday stress can affect men’s sexual health and how to manage it

 

By Dr. Tim Sandle Published December 13, 2022

This article is a repost which originally appeared on DIGITAL JOURNAL.

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

Our takes:

‧ A number of men report lower sex drives during the holidays.

‧ It’s thought ED (Erectile Dysfunction) is becoming more common and also more openly discussed.

‧ Stress is believed to be the #1 culprit in ED.

Many men experience a much lower sex drive during the holiday season. Holiday stress, spending time with extended family (maybe in unfamiliar and less private surroundings), excessive drinking and overly-indulgent food – are all contributing factors to a lack of interest.

To discuss the many factors that affect the male libido, particularly during the holiday season, and how to address and manage them, Digital Journal sat down with Michael Werner, M.D, FACS, a board certified urologist and Medical Director and Founder of Maze Men’s Sexual & Reproductive Health in New York.

Digital Journal: We’ve been hearing more and more about erectile dysfunction (ED) lately. Is it becoming more common, or are people just more willing to talk about it?

Dr. Michael Werner: I think it safe to say it is a combination of both. Men are living longer, and with higher expectations of having a quality life, including a robust sex life, complete with a rigid erection. We have learned from research that ED is far more prevalent in younger men than we previously thought. For example, 20 percent of men in their 20s have some sort of erection problems. At the same time, it is pushed into the forefront through proliferation of online medication and support services, men’s magazines, and media in general.

This has all made the topic more approachable. Nationally, 1 out of 3 men have some sort of sexual function problem. It does takes men a much shorter time to come to terms with the fact that they have a sexual issue, and to seek treatment, even if it is just to access drugs on line.

DJ: Why is there is an increase in ED during the Holiday Season?

Werner: Stress is probably the #1 culprit here. Not only the stress of events and family get-togethers, but financial pressures of couples. In our practice we hear a lot of friction in couples worrying about how much money is being spent on holidays. Nothing kills sex like resentment or anger. Add to this, overeating, too much alcohol, and being overtired will all put a damper on any sex life.

DJ: Let’s talk about the stress – how can men best manage that when a lot of the holiday pressure seems out of their control?

Werner: Breathe! Taking care of yourself means minimizing stressful situations. You do not have to accept every invitation that comes along. It means stepping outdoors for a breath of fresh air or going for a walk when you have had enough of family dynamics. Better yet, go for a walk with your partner. Commiserating and talking about your stress with your partner, being open about your feelings, will often bring you closer together. Misery loves company! Laugh about the insanity around you.

It is important to maintain as much of your normal routine as possible. Work harder on getting to bed on time, exercise, avoid overeating and certainly avoid over drinking.

DJ: The holidays are known to increase symptoms of depression. Is this part of the equation as well?

Werner: Virtually all holidays have a lot of expectations around them. We have this ideal of what any holiday is supposed to look like. If our expectations are a Hallmark movie but reality more closely resembles Mad Magazine, we can get pretty frustrated. Holidays can also amplify feelings of loneliness or loss. Holidays are associated with memories and not all memories are pleasant. We encourage our patients to get involved in helping other people such as a soup kitchen or volunteering in their religious community.

DJ: You say we should avoid overeating and drinking too much. Isn’t that difficult during the holidays?

Werner: I really feel that for most people it’s not simply over-eating, it is that they are eating food in quantities they normally would not. Instead of one candy, it’s so easy to pop another candy, cookie, or holiday treat into your mouth as you walk by the kitchen counter. Pretty soon, the cookie tray is empty, and you are in a carb crash and feeling bloated.

Alcohol can be the same situation. It’s a party? Have another drink! The good news is that not drinking alcohol is very common in our culture now. Most people will respect your choice to not imbibe. If they don’t? You’re at the wrong party.

DJ: What steps can men take to improve sexual health during the holidays?

Werner: Eat well, sleep well, exercise well! The magic trio of good health applies to sex organs as well. But sexual health is not just body parts. Maintain physical intimacy. This is a good time to explore pleasure focused sex: massages, baths, and other non-penetrative activities. I think sometimes we don’t acknowledge that intercourse often requires a lot of energy and endurance for everyone! Buy each other a sex gift of some kind. Sexual health is emotional health and mental health as well.

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

What to know about depression and erectile dysfunction

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

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

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

Our takes:

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

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

‧ Medical professional assistance is available for treating ED.

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

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

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

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

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

Signs and symptoms of erectile dysfunction

The signs of ED include‧:

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

‧ inability to get an erection at any time

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

Can depression cause erectile dysfunction?

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

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

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

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

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

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

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

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

physical health conditions, such as:

‧ type 2 diabetes

‧ high blood pressure

‧ heart and blood vessel disease

‧ multiple sclerosis

‧ Peyronie’s disease (curvature of the penis)

‧ chronic kidney disease

‧ surgery for bladder cancer

‧ injury to the penis or pelvic area

certain medications, including:

‧ antidepressants, such as fluoxetine (Prozac)

‧ blood pressure drugs, such as atenolol (Tenormin)

‧ tranquilizers, such as diazepam (Valium)

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

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

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

‧ anxiety

‧ low self-esteem

‧ fear of sexual failure

‧ stress

‧ guilt about certain sexual activities

Treatment options

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

Medications for erectile dysfunction

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

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

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

‧ vardenafil (Levitra)

‧ avanafil (Stendra)

‧ tadalafil (Cialis)

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

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

Medication change for depression

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

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

‧ desvenlafaxine (Pristiq)

‧ trazodone

‧ vortioxetine (Trintellix)

‧ vilazodone

Lifestyle changes

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

‧ stopping smoking, if applicable

‧ eating a nutritious diet

‧ exercising regularly

‧ maintaining a moderate weight

‧ limiting or stopping recreational drug use, if applicable

Psychotherapy

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

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

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

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

When to contact a doctor

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

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

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

Suicide prevention

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

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

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

Click here for more links and local resources.

Summary

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

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

Sources:

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

Sexual Stamina: 10 Tips to Last Longer

Kristopher Bunting, MD

Updated on October 17, 2022

This article is a repost which originally appeared on healthnews.

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

Whether you have problems with premature ejaculation or you simply want sex to last longer, there are many ways to last longer in bed. Making sex last longer can involve maintaining an erection for longer, delaying ejaculation, and reducing the time to achieve another erection after ejaculating. There are a variety of ways to improve your sexual stamina and make sex more satisfying for both you and your partner.

Key takeaways:

‧ There are many ways to improve male sexual stamina, including medications and sexual techniques. Increased foreplay and emotional intimacy may also improve sexual performance.

‧ Medications for erectile dysfunction and premature ejaculation can improve stamina and sexual performance.

‧ Controlling sexual stimulation by using numbing sprays or gels, certain sexual positions, and other techniques can help men control when they orgasm.

How long should sex last?

Ideally, sex should last for as long as you want it to. Many people think of sex as penetration, but it can (and should) involve much more. Research shows that the average time until ejaculation during penetrative sex is between 5 and 6 minutes. For most people, achieving orgasm is the goal of sex. While 5 minutes of penetration (or less) will get many men where they want to get to, it takes longer for women to climax from penetration alone. So, how can you make sex last longer?

Foreplay

There is more to sex than just penetration and orgasm. Foreplay is important for mutual arousal; it gives you and your partner time to stimulate yourselves and each other. Take time to use all of your senses to get excited and prepare for the main event.

Kegel exercises

Kegel exercises can help both men and women strengthen pelvic floor muscles, improving continence and sexual function. A strong pelvic floor can help you control when you ejaculate.

Work on your relationship

Sex is both physical and mental. Both the body and the mind need to be stimulated and aroused to enjoy sex. Emotional intimacy plays a role in sexual arousal, especially in long-term relationships. Research has shown that emotional intimacy is linked to sexual desire. Furthermore, good communication in a relationship is linked to improved sexual satisfaction and decreased sexual dysfunction. Communicating sexual needs with your partner can improve sex and may help you last longer.

Medication

Medications used to treat erectile dysfunction (ED) and premature ejaculation (PE) can also improve sexual stamina. Commonly used antidepressants such as Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), and other drugs that raise serotonin levels in the brain can help delay ejaculation. While this can be an unwanted side effect for some, it can help people with PE have more control over when they orgasm.

ED medications can help some men recover more quickly after ejaculating and may improve sexual performance in men without erectile dysfunction. Viagra (sildenafil), Cialis (tadalafil), and other erectile dysfunction medications improve blood flow to the penis. This allows men with mild to moderate ED to have firmer, longer-lasting erections. Remember, these are prescription medications; you should not take them without first being evaluated by a doctor. They can have extremely dangerous interactions with other medications, including nitrates taken for chest pain or amyl nitrate and amyl nitrite (poppers) taken recreationally.

Reduce stimulation

Topical anesthetics are used to treat PE and can help men delay orgasms. A variety of topical numbing creams, sprays, and personal lubricants are available that reduce stimulation of the penis, including condoms with numbing lubricant. However, these can cause skin irritation and discomfort in some people, so check with your partner before using a topical anesthetic.

Other ways to reduce penile stimulation and delay orgasm include wearing a condom and using more lubrication. Wearing a condom not only helps prevent sexually transmitted diseases and unwanted pregnancy, but it can also decrease stimulation of the penis, especially thicker condoms. Using lubrication during sex can reduce friction and stimulation.

Techniques to delay orgasm

There are a variety of techniques that can be employed to help delay orgasm and ejaculation. Techniques recommended for people with PE include the squeeze technique (gently squeezing the head of the penis for several seconds) and the start and stop technique (stop penile stimulation for 30 seconds). Other techniques include pausing and taking a deep breath or shifting your focus away from sexual sensations during sex. In other words, slow down and take a moment to rest before you reach orgasm.

Masturbating before sex can help delay ejaculation, but timing is important. Practicing edging, bringing yourself to the brink of orgasm while masturbating, can help you learn how to recognize when you are about to orgasm and allow you to practice techniques to delay orgasm.

Try something different

There are many Tantric and Taoist sexual practices that can help control ejaculation and improve sexual pleasure for men and their partners. The “sets of nines” technique is an easy way to control mutual stimulation. It involves performing 9 sets of 9 controlled thrusts, beginning with 9 shallow thrusts, followed by 8 shallow thrusts and 1 deep thrust, then 7 shallow thrusts and 2 deep thrusts, and so on, ending with 9 deep thrusts. It is a simple technique, but it is very effective for controlling ejaculation and building up sexual excitement.

Certain sexual positions can help control ejaculation, especially positions that allow for grinding, as opposed to thrusting. Partner on top positions, the lotus position, and the Coital Alignment Technique can maintain constant stimulation for your partner while limiting stimulation to the penis from thrusting. Explore the Kama Sutra and other books for tips on which positions can help you control when you orgasm.

Get healthy

Overall health affects sexual function; eating a proper diet and getting enough exercise can improve your sexual health. Obesity, type 2 diabetes, high blood pressure, heart disease—all of these conditions can affect sexual function and they can all be improved or prevented through diet and exercise.

You can improve your sexual stamina

There are many ways for men to improve their sexual stamina. Foreplay, communication, and emotional intimacy can improve sex. Medications, condoms, and lubricants can delay orgasm and reduce stimulation. A variety of techniques can help men control when they orgasm, including techniques used for premature ejaculation and certain sexual positions. Give some of these a try and find out what works best for you.

Resources:

1. Urology Care Foundation. Premature Ejaculation.

2. The Journal of Sexual Medicine. Original Research—Ejaculation Disorders: A Multinational Population Survey of Intravaginal Ejaculation Latency Time.

3. International Society for Sexual Medicine. Women’s Orgasm Takes Longer During Partnered Sex.

4. Mayo Clinic. Kegel Exercises for Men: Understand the Benefits.

5. Journal of Social and Personal Relationships. The Associations of Intimacy and Sexuality in Daily Life.

6. The Journal of Sex Research. Couples’ Sexual Communication and Dimensions of Sexual Function: A Meta-Analysis.

7. Cleveland Clinic. Premature Ejaculation.

8. International Journal of Impotence Research. Sildenafil Does Not Improve Sexual Function in Men Without Erectile Dysfunction but Does Reduce the Postorgasmic Refractory Time.

9. Nature Reviews Urology. Sildenafil Improves Sexual Function in Men Without Erectile Dysfunction.

10. Mayo Clinic. Erectile Dysfunction: Viagra and Other Oral Medications.

11. Circulation. Drug Interactions With Phosphodiesterase-5 Inhibitors Used for the Treatment of Erectile Dysfunction or Pulmonary Hypertension.

12. Journal of Sex & Marital Therapy. The Coital Alignment Technique (CAT): An Overview of Studies.