Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

Q&A: Can COVID-19 cause erectile dysfunction? | Expert Opinion

One of the less-publicized reported repercussions of COVID-19 infection has been male sexual health, specifically erectile dysfunction (ED).

Erections require blood flow to the penis, so erectile dysfunction often results from conditions that restrict blood flow or damage nerves and arteries.

by Joceline S. Fuchs, For the Inquirer

Published Feb 19, 2021

This article is a repost which originally appeared on The Philadelphia Inquirer

Edited for content

More than 850,000 Pennsylvanians have tested positive for COVID-19, and while the vast majority of those infected are recovering, long-term effects of the disease are still largely unknown. While pulmonary, cardiac and neurologic complications from COVID-19 are widely recognized, one of the less publicized reported repercussions of infection has been on male sexual health, specifically erectile dysfunction (ED).

More men are experiencing and seeking medical care for sexual dysfunction during the pandemic, with the greatest increase seen in younger men in their 40s and 50s.

A July study published in the Journal of Endocrinological Investigation examined the effects of COVID-19 on male sexual and reproductive health. The study identified a correlation between COVID-19 and ED, likely caused by many factors, ranging from physiological changes to changes in the way we interact with others.

One of the hallmarks of a COVID-19 infection is an exaggerated inflammatory response. The resulting storm of pro-inflammatory signals, called cytokines, causes inflammation of the lining of blood vessels. (https://marchfss.com/) The hyperinflammatory state triggered by COVID-19 infection can cause vascular damage, ultimately disrupting blood flow — the key component of getting and maintaining an erection.

ED has long been recognized as an excellent marker for physiological well-being. Specifically, ED functions as the “canary in a coal mine” for cardiovascular disease, often predating symptomatic heart disease up to several years in advance. People with preexisting medical conditions are at higher risk for serious COVID-19 infection, but the converse is also true: COVID-19 infection can worsen preexisting medical conditions, such as heart disease and diabetes.

In addition, many of the medications used to treat common heart conditions can have a negative effect on erectile dysfunction. The decline in overall health in COVID-19 survivors and the medications used to manage this can both result in ED.

Also, mental and emotional health plays a large role in men’s sexual health. Being in the right mindset is a vital component of achieving an erection and having a satisfactory sexual experience. There is no doubt that there has been a negative mental and emotional toll from the pandemic regardless of personal COVID-19 infection. The impact of social isolation, worry for family and self during the pandemic, and economic toll from quarantine is demonstrated with increasing rates of stress, anxiety and depression. All of these feelings can be detrimental to sexual function.

With COVID-19 having such a sweeping effect on our daily lives, finding ways to improve quality of life has become more important than ever. ED is more common than most men realize — it is recognized in more than 50% of men over the age of 50 — and may be occurring at even higher rates during the pandemic.

If you are experiencing ED, you should speak to your doctor or urologist to be evaluated and discuss treatment options. And remember that one of the best ways to lower your risk of long-term complications from COVID-19 is to prevent infection in the first place by getting vaccinated when you can, observing social distancing, masking, and using good hand hygiene.

Joceline S. Fuchs is a board-certified urologist with MidLantic Urology in Abington.

Surprising Facts About Erectile Dysfunction Or Impotence

Surprising Facts About Erectile Dysfunction Or Impotence

by George K.

This article is a repost which originally appeared on scubby

Edited for content

Erectile dysfunction, as taboo as you might assume it to be, is actually a much more prevalent and recurring disorder in the male population. That, whether of old, or of today. From https://www.numan.com/erectile-dysfunction, understand the basic facts from fiction of what ED truly is, and isn’t.

Common Erectile Dysfunction Yes’s And No’s

  1. Is Erectile Dysfunction Really Dangerous?

As it is, the answer is “no”. Erectile dysfunction is not a severe kind of ailment. In fact, most cases show that it is a very common (albeit frustrating) disorder that a majority of the male population experiences, at least once in each one’s lifetime.

To look at this through the lenses of practicality, erectile dysfunction transpires in 50 of men who are 50 years of age. 70% for those who are 60 years of age. And 80% for those who are beyond 70 years of age. It is also important to note that men as young as 25 to 40 may go through ED as well.

In the aspect of “danger” in terms of a health hazard, most erectile dysfunction cases are the contrary. They are disturbances, annoyances, to say the least, during coitus. But as long as you have been diagnosed and are declared “healthy” (i.e. clear of cardiovascular and/or nervous system diseases), then you will probably be able to trace ED back to simpler causes such as stress, lack of sleep, and the like.

  1. Is Erectile Dysfunction Permanent?

No, it is not. At least, with erectile dysfunction that is linked to environmental causes instead of to physical ailments and/or reasons rooted to ageing. ED is generally tied into how stressed or stress-free your bodily systems are.

The adrenal glands ramp up the production of cortisol whenever your central nervous system’s stress sensors are on the alert. One would think that this would revert to ramping up the reproductive system’s capacity to maintain an erection. Ironically, this isn’t so.

Instead, your body will go into a kind of slump post the cortisol-secretion. Almost immediately, in fact. Translated, it equates to a weaker prowess in achieving an erection in sexual intercourse. Cortisol narrows and tightens arteries, which is a direct impedance of blood flow towards the penile region.

Going back to the question proposed, ED will not be permanent. That is, provided you see to following-through with work-life balance, physical and mental health balance, as well as regular visits to your ED treatment medical practitioner.

  1. Is Erectile Dysfunction Treatable?

Yes. It is. This is where going for a diagnosis will be advantageous to you. As early as now (if you have gone through erectile dysfunction as of recent), you can ask your doctor about its possible causes, in parallel to your current health status.

Through a proper diagnosis, a series of bodily disorders can be ruled out, and it will be easier for your doctor to identify the major cause of ED. Afterwards, you can inquire about erectile dysfunction treatments.

Besides the medication itself which you are to partake of on a regular basis (and never beyond the recommended dosage, might we add), your doctor will provide you with a schedule and a fixed period for taking said medication.

First, for observing how your bodily systems will respond to the ED medication. And second, for observing how often and how long you may need to stay on the ED treatment.

 

Medications that cause erectile dysfunction

What medications may cause erectile dysfunction?

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

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

This article is a repost which originally appeared on MEDICALNEWSTODAY

Edited for content

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

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

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

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

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

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

Some medications that may contribute to ED are below.

Anti-hypertensives

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

Examples include:

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

Immunosuppressants

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

One potential side effect of immunosuppressants is impaired sexual function.

Examples include:

  • sirolimus
  • everolimus
  • tacrolimus
  • cyclosporine

Anti-androgens

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

Examples of anti-androgens include:

  • ketoconazole
  • flutamide
  • bicalutamide
  • nilutamide
  • enzalutamide

GnRH agonists

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

Examples include:

  • leuprolide (Lupron)
  • goserelin (Zoladex)

Corticosteroids

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

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

Examples of corticosteroids include:

  • prednisone
  • prednisolone
  • hydrocortisone

Antidepressants

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

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

Examples of antidepressants that may cause ED include:

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

Antipsychotics

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

Examples include:

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

Anti-epileptics

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

Examples include:

  • gabapentin (Neurontin)
  • topiramate (Topamax)

Recreational drugs

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

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

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

What is ED?

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

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

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

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

Treatments for ED

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

Self-care

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

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

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

Medications

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

Phosphodiesterase type-5 inhibitors

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

Examples of PDE 5 inhibitors include:

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

PDE 5 inhibitors are not suitable for people taking nitrates.

Injections

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

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

Testosterone therapy

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

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

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

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

Devices

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

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

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

Surgical treatments

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

Penile implant procedure

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

There are two types of penile implant:

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

Vascular surgery

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

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.

#SexColumn: Men can lose their sex drive too

#SexColumn: Men can lose their sex drive too

Sep 25, 2020

By Sharon Gordon

This article is a repost which originally appeared on IOL

Edited for content

Every joke I’ve ever heard about lack of libido or not wanting to have sex has had a woman as the brunt. In reality many women report that their partners are more often than not the cause for a drop in sexual activity.

Men can also feel asexual, not enjoy sex and find themselves in a slump. The difference is nobody will admit to it or discuss it.

So let’s talk about the top 10 things that can kill your sex drive and your penis. Doctors often refer to ED (erectile dysfunction) as the first signs of early death. I don’t want to be alarmist but the penis and its ability to be erect is a fantastic gauge for health.

ED is the first sign that you may have one of the big three chronic conditions; hypertension, cardiac problems or diabetes. They are easy to diagnose and treatable and yet many men ignore the signs because they are reluctant to admit that their erections are not what they used to be.

One of the big drug companies talk about the 5 finger erection. Hold your hand out in front of you, fingers outstretched, thumb facing up and pinkie finger to the floor. It is the perfect explanation of erections through the ages. The thumb indicates the strength and height of a young adolescent male and the pinkie that of an older male. No cause for concern, as long as the penis is still hard.

It’s when the penis can no longer obtain an erection that you should see your doctor. A real doctor, not some quack that is going to just prescribe ways to achieve and erection. You should be treating the cause and not just the symptom.

There are other reasons why your erection isn’t what it should be. I’ve already alluded to diabetes. Sugar affects testosterone production, making it harder to get an erection. So slow down on eating all those sweets and chocolates.

Inadequate sleep also affects testosterone levels and in turn your erection. I know that this year has shot stress levels through the roof, affecting everything from sleep to nutrition. Be aware of it and if necessary get help. Exercise and mediation can help but drugs may be necessary in acute cases.

Which brings me to exercise. Too much exercise, especially running and cycling could be doing more harm than good. British Columbia University did a study that alleges that more than 64km per week can drop testosterone levels by 17%.

I wonder if erections were stronger during the lockdown when alcohol was not available for sale. Alcohol consumption has a major impact on erections and inability to orgasm. Alcohol also affects testosterone levels.

I keep going on about the hormone testosterone. This is the libido driving hormone and without it your sex drive will tank. Men often lack enough testosterone. It is a simple blood test and is very easily treated. So if you feel something is off, get it tested. I know so many men who would rather bite the bullet than spend an hour at the doctor and get it sorted.

If you are spending too much time indoors you ay also be lowering testosterone production. You do need Vitamin D for production to happen. So why not take yourself out for a day in the outdoors. I have recently discovered that in and around Johannesburg there is plenty to do.

I have some bad news for the lactose intolerant and vegans. Harvard Medical School alleges a direct connection between Soy intake and erectile dysfunction. So if you have recently changed your diet to soy based foods and have been experiencing erectile issues, try cutting out the soy.

Every one of these causes can be addressed and I am by no means suggesting that these are the only causes for your penis not working as well as it should. My absolute opinion is that if it’s not working as well as it should seek medical assistance. There is no reason to be ashamed or embarrassed. Most women have their breasts and vaginas examined annually to ensure continued sexual health and men should get into the habit of doing the same.

In the interim, while you are sorting out the causes there are some adult toys that can help out in the play department. Penis pumps can help draw blood into the penis and thus help with a better erection. Once blood is in the penis use a simple cock ring to keep the blood there for the duration of play. Remove it before it becomes uncomfortable and no longer than 20 minutes.

For a little extra vooma, use a vibrating cock ring. You will maintain your erection and become a vibrator in one go. If your erection doesn’t work at all anymore, you can use a hollow strap on. The penis is placed inside the strap on and is then used to pleasure your partner the same way an erection would. Also remember that your mouth and hands can offer just as much pleasure when used correctly.

6 all-natural sex tips for men

6 all-natural sex tips for men

Posted September 15, 2020, 10:30 am
Matthew Solan
Executive Editor, Harvard Men’s Health Watch

This article is a repost which originally appeared on Harvard Health

Edited for content

If you believe those upbeat, seductive advertisements, men only need to pop a pill to awaken their dormant sex life. Whether the problem is erectile dysfunction (ED) — the inability to maintain an erection for sex — or low libido, ED medications appear to be the quickest and easiest solution.

While these drugs work for most men, they are not right for everyone. ED drugs are relatively safe, but can cause possible side effects such as headaches, indigestion, and back pain. Plus, some men may not want their sex life dependent on regular medication, or simply can’t take them because of high or low blood pressure, or other health conditions.

Fortunately, there are some proven natural ways for men to manage their ED and increase vitality. Bonus: these strategies also can enhance your overall health and quality of life, both in and out of the bedroom.

Six ways to boost your sex life without medications

  1. Get moving. Research has shown that regular exercise is one of the best medicines for ED. One study of almost 32,000 men ages 53 to 90 found that frequent vigorous exercise equal to running at least three hours per week or playing tennis five hours per week was associated with a 30% lower risk of ED compared with little or no exercise. It doesn’t really matter how you move — even walking is great — as long as you keep moving.
  2. Eat right. Go bullish on fruit, vegetables, whole grains, and fish, while downplaying red and processed meat and refined grains. This type of diet lessened the likelihood of ED in the Massachusetts Male Aging Study. Another tip: chronic deficiencies in vitamin B12 — found in clams, salmon, trout, beef, fortified cereals, and yogurt — may harm the spinal cord, potentially short-circuiting nerves responsible for sensation, as well as for relaying messages to arteries in the penis. Multivitamins and fortified foods are the best bets for those who absorb B12 poorly, including many older adults and anyone with atrophic gastritis, a condition that may affect nearly one in three people ages 50 and older. Also, make sure you get enough vitamin D, which is found in fortified milk or yogurt, eggs, cheese, and canned tuna. A study in the journal Atherosclerosis found that men with vitamin D deficiency have a 30% greater risk for ED.
  3. Check your vascular health. Signs that put you on the road to poor vascular health include soaring blood pressure, blood sugar, LDL (bad) cholesterol, triglycerides; low HDL (good) cholesterol; and a widening waist. Check with your doctor to determine whether your vascular system — and thus your heart, brain, and penis — is in good shape, or needs a tune-up through lifestyle changes and, if necessary, medications.
  4. Measure up. A trim waistline is one good defense — a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist.
  5. Slim down. Tip the scales at a healthy weight. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat tinkers with several hormones that may feed into the problem, too. Need more reasons? Slimming down helps with tips 3 and 4.
  6. See your dentist. A study in The Journal of Sexual Medicine found an association between gum disease and risk for ED. Gum disease causes chronic inflammation, which is believed to damage the endothelial cells that line blood vessels, including those in your penis.

8 Penis-Friendly Foods to Boost T-Levels, Sperm Count, and More

The best way to boost penis health? Food.

Medically reviewed by Katherine Marengo, LDN, RD — Written by Tiffany LaForge — Updated on October 23, 2018

This article is a repost which originally appeared on HealthLine

Edited for content

We often eat with our hearts and stomachs in mind, but how often do we consider how foods affect extremely specific body parts?

First things first though: no matter what we eat, the benefits are holistic — it goes where our bodies need it.

But, let’s say, if you know, that apples and carrots are good for your prostate and penis health, wouldn’t you be inclined to eat these foods more often?

That’s the goal of our below-the-belt food list.

Instead of eating as if your penis needs special attention, fill your day with foods that optimize your whole body, and in turn, help your blood bring the nutrients, vitamins, and minerals your penis needs to function. (Erectile dysfunction in younger men is rising and about 1 in 9 men will develop prostate cancer in their lifetime.)

On the plus side, enhancing your diet just might help with other concerns, such as heart disease, hormonal imbalances, fat burn, and more.

From prostate cancer, low T-levels, ED, and possibly infertility, these foods are here to help.

1. Spinach to boost testosterone levels

Spinach worked for Popeye, and it’ll help you, too.

Spinach is a super source of folate, a known blood flow-booster. Folic acid plays a critical role in male sexual function and a deficiency in folic acid has been linked to erectile dysfunction.

Cooked spinach contains 66 percent of your daily folic acid requirement per cup, making it one of the most folate-rich foods around. Additionally, spinach contains a fair amount of magnesium, which also helps improve and stimulate blood flow and has been shown to boost testosterone levels.

Spinach for penile health

  • A good source of folic acid which may help prevent erectile dysfunction.
  • Contains magnesium which has been shown to boost testosterone.
  • Pro-tip: Try our favorite spinach recipes for your next date night.

2. A daily cup of coffee for better sex

Your morning cup of java can be a below-the-belt pick-me-up, too!

Studies have found that drinking two to three cups of coffee a day may prevent erectile dysfunction. This is thanks to coffee’s most beloved ingredient: caffeine.

Caffeine is shown to improve blood flow by relaxing penile arteries and muscles, leading to stronger erections. Cheers!

Caffeine for penile health

  • Caffeine has been shown to prevent erectile dysfunction.
  • Improves blood flow by relaxing penile arteries and muscles.
  • Pro-tip: Not a fan of coffee? You can get your daily caffeine fix from Yerba Mate or matcha instead.

3. Apple peels to prevent prostate cancer

Apples have some great all-around health benefits, but one of their lesser known advantages pertains to penis health.

Apple peels, in particular, contain the active compound ursolic acid. This compound has been shown in cell studies to stop the growth of prostate cancer cells by “starving” the cells. Still, you should always follow a medical professional’s treatment plan when faced with prostate cancer.

Eat more fruits and veggies Grapes, berries, and turmeric also have similar effects. Studies suggest that men who consume more fruits and vegetables in general have better odds at beating prostate cancer.

Apples for penile health

  • Contain an active compound that may starve prostate cancer cells.
  • Men who consume more fruits and vegetables have a better prostate cancer survival rate.
  • Pro-tip: The cancer-fighting compound is contained in the peel so be sure to eat your apples with the skin on. You can also make dried apple chips or apple peel tea.

4. Supercharge your libido with avocados

The Aztecs were on to something when they named the avocado tree the “testicle tree.”

An excellent source of healthy fats, potassium, and vitamins, avocados are great for getting you in the mood.

This toast-topper favorite has vitamin E and zinc, both of which have positive effects on male sex drive and fertility. Zinc has been suggested to increase levels of free testosterone in the body, while vitamin E may improve sperm quality.

Avocados for penile health

  • Contain zinc which increases testosterone levels.
  • Are a good source of vitamin E which improves sperm quality.
  • Pro-tip: Out of ideas beyond guacamole and toast? Find inspiration with our 23 delicious ways to eat an avocado.

5. Chili peppers to spice up the bedroom

Can you handle the heat? Studies have found that men who consume spicy foods have higher-than-average testosterone levels.

While this doesn’t mean spicy food gives you testosterone, the chemical capsaicin has been shown to have bedroom advantages.

Found in hot sauce and chili peppers, capsaicin triggers the release of endorphins — the “feel good” hormone — and can rev up the libido.

Chili peppers for penile health

  • Men who eat spicy foods have higher-than-average T-levels.
  • Capsaicin found in chili peppers triggers the release of endorphins.
  • Pro-tip: There’s more health benefits to spicy foods than a healthy libido. Read about our top five here.

6. Carrots keep your sperm healthy

Looking to improve your sperm count? Science says to eat more carrots.

This fertility superfood may improve both sperm count and motility (the movement and swimming of sperm).

Research suggests this is due to the chemical carotenoids found in carrots, which is also responsible for giving the vegetable its orange color.

Carrots for penile health

  • Research finds that carrots can improve male fertility.
  • Carotenoids found in carrots may improve sperm quality and motility.
  • Pro-tip: Another vegetable high in carotenoids is sweet potatoes, which makes our list of the 14 healthiest vegetables on earth alongside carrots.

7. Oats for a bigger O

Oatmeal might not come to mind when you think of the world’s sexiest foods — but maybe it should!

Oats can be beneficial for reaching orgasm and Avena Sativa (wild oats) is considered an aphrodisiac. The amino acid L-arginine found in oats has also been shown to treat erectile dysfunction.

Like Viagra, L-arginine helps penile blood vessels relax, which is essential to maintaining an erection and reaching orgasm.

Oats for penile health

  • Wild oats are a known aphrodisiac.
  • Amino acids found in oats relax blood vessels and can help with erectile dysfunction.
  • Pro-tip: New to oats? Try our quick and easy 10-minute overnight oats, made three ways.

8. Tomatoes are a penile health trifecta

Want all the benefits in one punch? Start with tomatoes.

Tomatoes include several of the benefits listed above and can be eaten in a variety of ways.

Research shows lycopene-rich foods, like tomatoes, may help prevent prostate cancer.

Tomatoes might also be beneficial to male fertility and sperm quality — as tomatoes seem to significantly improve sperm concentration, motility, and morphology.

Tomatoes for penile health

  • Help prevent prostate cancer.
  • Are beneficial to male fertility and improve sperm concentration, motility, and morphology.
  • Pro-tip: Too busy to make your own marinara? You don’t just have to cook with tomatoes. Try drinking tomato juice for a quick and healthy way to get your daily lycopene.

Looking for more ways to ensure below-the-belt health? Check out our best tips to prevent prostate cancer and non-penile advice on improving your sex life.

After all, your health is more than one body part.

Penis Health: 38 Things to Know About Maintenance, Safety, and More

Penis Health: 38 Things to Know About Maintenance, Safety, and More

Everything You Need to Know About Penis Health

Medically reviewed by Stacy Sampson, DO on March 26, 2019 — Written by Sian Ferguson

This article is a repost which originally appeared on HealthLine

Edited for content

What this means

When most people think about penis health, they think about sexually transmitted infections (STIs) and erectile dysfunction (ED).

While these conditions can certainly affect the health of your penis, penile health is about so much more than that.

There are many different things that can affect the health of your penis, including your hygiene practices, lifestyle changes, and any underlying health conditions.

Here’s what you need to know to keep your penis in tip-top shape.

What affects penis health?

Many different things can affect penis health. And by “penis health,” we mean:

  • your ability to urinate comfortably
  • your ability to get or maintain an erection
  • your fertility

Penis health also includes avoiding certain health conditions, such as penile cancer and STIs.

The following factors can affect the health of your penis:

Hormone levels

ED can be caused by hormone imbalances, such as a low testosterone level. Low testosterone levels can be caused by a number of different factors, which we’ll discuss in this article.

Age

As you age, you’re more likely to experience sexual dysfunctions like ED. This is partly because your testosterone level will naturally decline over time.

Health conditions

High blood pressure, diabetes mellitus, and certain neurological conditions can cause ED. Psychological conditions such as anxiety and depression can also exacerbate ED.

Sex

If you want to have sex without a condom, ensure that both you and your partners are tested regularly for STIs, or remain in a monogamous relationship with someone free of STIs.

Otherwise, correctly using a condom every time you have sex is the only way to reduce your risk.

Rough sex can also harm your penis. For example, pulling back the foreskin abruptly can tear it. Accidentally bending your erect penis can cause a traumatic penis fracture.

Medication

Some forms of medication can increase your chances of ED. Speak to a doctor or other healthcare provider if you think your medication is causing ED or other sexual dysfunction.

Hygiene

Practicing good hygiene is essential for your health. Wash your penis and groin area often to keep it clean.

Poor hygiene can cause a build-up of smegma, an oily, malodorous, and irritating substance that is known to occur below the foreskin.

If smegma builds up, it can cause inflammation to the adjacent skin. This can be uncomfortable and can be a cause [of] balanitis, a condition where the head of the penis becomes red and inflamed.

Even with a circumcised penis, less than ideal hygiene can lead to penile irritation and inflammation, including balanitis.

General tips

Penis health needs a holistic approach. In other words, taking care of all aspects of your general health is important for the health of your penis. This is especially important since a range of different health conditions can affect your fertility and penile health.

Stay hydrated

Hydration is important for your overall health, as well as the health of your penis. There might be a link between dehydration and ED, so try to get about two liters of water a day.

Eat a balanced diet

A balanced diet is key in helping you reduce your chances of developing diabetes and heart disease, both of which can cause ED.

One 2016 study conducted among 25,096 subjects looked at the relationship between ED and flavonoids, which are mostly found in vegetables and fruit.

Researchers found that the subjects who regularly consumed flavonoids were less likely to develop ED.

Certain foods may also boost your testosterone levels and improve your fertility. This includes:

  • spinach
  • spicy foods with capsaicin
  • avocado

Get regular exercise

Moderate physical activity can reduce your chances of ED.

One 2015 study looked at people with ED and a recent myocardial infarction, commonly referred to as a heart attack. It found that a home-based walking program can reduce ED.

Try exercising at least a few times a week — even a brisk walk every so often can improve your penile health.

Practice pelvic floor exercises

Pelvic floor exercises are often associated with vaginal health, but they can be helpful for everyone.

These exercises can improve your ability to get and maintain an erection, as well as prevent dribble after urination.

A small 2005 study on 55 people with ED found that pelvic exercises helped 40 percent of participants regain normal erectile function.

An additional 35.5 percent reported that, although they hadn’t completely regained normal function, their overall erectile function did improve.

You can do basic Kegel exercises by squeezing the muscles you use to urinate. Squeeze for five seconds, relax, and repeat for 10 rounds. Eventually, work your way up to 20 reps. Do this two or three times per day.

Maintain a healthy weight

Maintaining a healthy weight can reduce your chances of diabetes, high cholesterol, and heart disease, all of which affect your penile health.

Practice stress management

Practicing stress management is great for your overall health and the health of your penis.

Stress and anxiety can affect your sexual performance and fertility. Stress also increases your chances of developing cardiovascular disease, which can lead to ED.

Stress management techniques include:

  • deep breathing
  • spending time with loved ones
  • journaling
  • meditation

Practice sleep hygiene

Sleep is important for your vascular health, which affects your ability to become erect.

There seems to be a link between obstructive sleep apnea and ED, possibly because sleep deprivation can lead to low testosterone and other hormonal imbalances.

Avoid tobacco

Smoking cigarettes is strongly associated with ED.

A 2013 study showed that this possibly is because smoking disrupts your heart’s autonomic function, which in turn leads to ED.

Smoking can also decrease your fertility.

Drink alcohol in moderation, if at all

As with tobacco, excessive drinking can cause a number of health problems, which can in turn affect your penis health.

How to wash your penis

You can wash your pubic area using warm water and unscented, mild soap. Don’t use harsh soaps or scrub the area too hard, as the sensitive skin in the area can be irritated.

Make sure you:

  1. Wash your pubic mound and the skin around the base of the penis, as well as the skin between your thighs and your pubic mound. Sweat can collect here.
  2. Wash the shaft of your penis.
  3. If you have a foreskin, gently pull it back and wash it. This helps to prevent smegma build-up, which can lead to conditions like balanitis.
  4. Wash your scrotum and the skin around it.
  5. Wash your perineum (the piece of skin between your scrotum and anus).
  6. Wash near your anus and between your butt cheeks.

It’s best to wash your penis every time you bathe.

As you wash yourself, examine the skin around your groin for STI symptoms. This includes:

  • unusual discharge
  • rashes
  • blisters
  • warts

How to groom your pubic hair

Some people like grooming their pubic hair, while others don’t. Whether you groom your pubic hair or not is your decision.

If you’d like to remove or trim your pubic hair, keep your skin type in mind. This will help you avoid razor burn and other discomfort.

Shaving

Shaving is a painless way to remove hair. It’s important to take certain precautions to avoid getting a rash.

Shave in the same direction that your hair grows. Use shaving cream while shaving and apply cortisone cream after to reduce irritation.

Never share razors with anybody else, and disinfect yours before use. If you use disposable razors, replace them every so often.

Waxing or threading

Waxing involves applying warm wax to the skin and pulling the hair out from their follicles.

Threading involves twisting thread around the hairs and pulling them out by the root.

Waxing and threading can be uncomfortable — it all depends on your individual pain tolerance.

If done incorrectly, these removal methods can cause swelling and rash.

You can reduce your risk for discomfort by visiting a professional waxer or threader.

Chemical hair removal

Hair removal cream breaks down the proteins in hair so that it can be washed away and removed.

While it can be an effective way to remove hair, some people find that hair removal creams irritate their skin.

You shouldn’t use these creams if you have sensitive skin or chemical allergies.

If you do use hair removal cream, don’t apply it directly to your penis.

Trimming

If you don’t want to remove the hair entirely, you can trim it with a pair of scissors or electric trimmer.

Be sure to disinfect scissors before and after use. You should only use these scissors for grooming — using them for other tasks can spread germs.

How to prevent STIs

There are a number of ways to prevent STIs.

Get vaccinated

The Centers for Disease Control and Prevention (CDC)Trusted Source recommend that everyone gets vaccinated for human papillomavirus (HPV) around age 11 or 12.

Doing so at a young age — before you’re sexually active — ensures that you’re protected against HPV before you’re exposed to the virus.

But if you weren’t vaccinated as a child, you may still benefit from getting vaccinated as an adult. Talk to a doctor or other healthcare provider to learn more.

Get tested after every new partner

Many STIs are asymptomatic, which means that you won’t have any noticeable symptoms.

For this reason, it’s important to get tested before having sex with a new partner. Both you and your partners should get tested.

If you or a partner has an infection, you might be able to take certain precautions to prevent it from spreading between you.

For example, if you have HIV, your partner can take Truvada (pre-exposure prophylaxis, also known as PrEP) to help prevent them from contracting it.

Use a condom every time you have sex

Using a condom every time you have sex — oral, vaginal, or anal — is the best way to help prevent the spread of certain STIs.

If you don’t want to use a condom, ensure that both you and your partners don’t have any STIs.

If you suspect you’ve contracted an STI, try not to panic. Most are treatable, and it’s nothing to be ashamed of. Talk to a healthcare provider. They’ll help you find the cause of your symptoms and advise you on any next steps.

Common questions

At this point, you might have more questions about penis health. Here are some common concerns that many people have.

Does it matter if you’re circumcised?

Circumcision has its pros and cons. Whether you’re circumcised or not, it’s important to wash regularly.

If you have a foreskin, pull it back gently and clean it to avoid a smegma build-up. Circumcised penises are more likely to get chafed or irritated, so use loose-fitting, cotton underwear always.

Circumcision doesn’t affect fertility, but uncircumcised penises are more susceptible to STIs, as well as conditions like balanitis.

Practicing good hygiene and safe sex can reduce your chances of getting these conditions.

Does it matter if you’re a “grower” or a “shower”?

So far, there isn’t any scientific information that shows whether being a “grower” or a “shower” is better or healthier. Both are totally okay — so embrace whatever category your penis may fall into!

Is it normal for your penis to have a bend or a curve?

It’s normal for your penis to curve slightly, but if you have a significant bend and pain in your penis when it’s erect, you could have Peyronie’s disease.

This condition can cause some discomfort. It’s often caused by a traumatic injury.

If you’re concerned that you may have Peyronie’s, see a doctor or other healthcare provider.

Is “use it or lose it” true?

Many people believe that sex is a “use it or lose it” thing — that if you stop having sex, you’ll end up struggling to have sex.

While it’s true that frequent sex has many health benefits and can boost your sex drive, there’s no evidence that chastity can permanently or seriously damage your penis.

Is there such a thing as too much or too little ejaculate?

If you’re noticing that you are ejaculating a lower volume of semen than usual, it’s called perceived ejaculate volume reduction (PEVR).

This could be caused by a number of things, including depression, diabetes, and certain testicular conditions. It could also be a side effect of medication.

How can you maintain penis sensitivity as you age?

The tissue on your penis might lose sensitivity as you age. This could be caused by friction, so wear loose cotton underwear instead of tight, rough underwear.

How can you maintain your ability to get an erection?

Taking steps to reduce your risk of heart disease and diabetes — both of which can cause ED — can help you maintain your ability to get an erection.

What can you do to promote fertility?

Certain foods can promote fertility. For example, spinach contains magnesium, which can boost your testosterone levels.

Tomatoes and carrots can increase your sperm count and motility.

Other than that, healthy lifestyle choices help maintain fertility.

As outlined above, avoiding tobacco smoking and alcohol, eating a balanced diet, and exercising are all important for penis health.

Is it OK if your pee changes colors?

Your urine could change colors depending on how hydrated you are:

  • Clear urine could mean you’re overhydrated.
  • Yellow to amber urine is considered normal.
  • Orange or brown urine could mean you’re dehydrated.

Some colors might also be a cause for concern.

For example, bloody, cloudy, blue, or green urine could indicate that you have an infection or another health condition.

See a doctor if you’re experiencing unusual changes in color or consistency.

What if you start peeing more than usual?

Frequent urination could be a sign of:

  • urinary tract infection (UTI)
  • diabetes
  • interstitial cystitis

If you’re peeing a lot more than usual and you think something is wrong, contact a doctor. This is especially important if you’re experiencing a burning sensation during urination.

Is it normal for your penis to smell?

Your groin might naturally smell a little like sweat, as it’s common to sweat in that area. This smell can be reduced through daily washing.

However, the smell shouldn’t be pungent. An unpleasant-smelling penis could indicate that you have a condition such as:

  • UTI
  • yeast infection
  • balanitis
  • gonorrhea
  • chlamydia

If the smell doesn’t clear with careful washing, see a doctor for diagnosis.

What if your penis is sore or inflamed?

If your penis is sore or inflamed, it could be a sign of certain penis conditions. This includes:

  • balanitis
  • phimosis, a condition where the foreskin can’t be pulled back over the head of the penis
  • penile cancer, which is rare but serious

No matter the cause, pain and inflammation can be uncomfortable, so see a healthcare provider. They can help you find relief.

Is it possible to break or fracture you penis?

Although the penis doesn’t have bones in it, the term “penis fracture” is often used to refer to a penis injury where the lining inside becomes torn. This is often caused by rough sex.

If you fracture your penis, it will turn black and blue, flatten, and it may make a popping noise. This is considered a medical emergency and requires immediate attention.

When to see a doctor or other healthcare provider

Ideally, you should see a doctor once a year for a penile check-up.

Otherwise, you should seek medical attention if you experience:

  • bruises on the penis
  • yellow, green, or otherwise unusual penile discharge
  • swelling or inflammation of the penis
  • blisters, rashes, warts, or sores on or near your penis
  • burning, pain, or bleeding when you urinate or ejaculate
  • pain during sex
  • pain during an erection
  • difficulty getting or maintaining an erection

Check your groin for signs of infections and other conditions regularly.

If you have any concerns, don’t hesitate to speak to a healthcare provider. They can help set your mind at ease and advise you on any next steps.

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.

The Dangers and Risks of Penis Enlargement | Non Surgical

The Dangers and Risks of Penis Enlargement | Non Surgical

We’ve partnered with TotalMan and will be presenting regular video features from this comprehensive site!

In this video, TotalMan discusses the dangers and risks of non surgical penis enlargement.

If you are someone that would like a bigger penis however you also want all the dangers and risks laid out so you know what to look out for, then this video is for you.

Unlike every other company or business promoting their products I’m going to tell you all about what can go wrong with non surgical penis enlargement.

So you’re someone that would love having a bigger penis. Wouldn’t we all!

So, you go online you look up penis enlargement from products to programs and pills and potions.

There is an array of so called “solutions”.

Now it’s fair enough that most companies are trying to sell you their stuff so why would they say anything about what could go wrong.

If they did that, it could mean you might not buy their stuff.

They don’t want that. So technically, they’re not lying, they’re just not telling you the whole truth.

Me on the other hand, hahaha, to hell with that. I have a conscience and I would like to sleep better at night knowing I told you everything I could.

Enjoy.
Stay safe.
Gain abundantly.
And…#DBYD … Don’t Break Your D!


 
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Study: ED questionnaire lacks crucial questions

Study: ED questionnaire lacks crucial questions

By Jeni Williams

* This article is a repost which originally appeared on UrologyTimes

Chicago-A patient-reported outcomes survey that is widely used to determine whether men are experiencing erectile dysfunction (ED) fails to ask three critical questions that could uncover whether men truly have ED and the extent to which they face challenges, researchers say.

In a presentation at the AUA annual meeting in Chicago, one research methodologist said there are three obvious problems to using the six-question version of the International Index of Erectile Function (IIEF-6) to assess erectile function:

• Men who respond that they are not sexually active are not asked why—and their answer significantly lowers their survey score. Yet for many men, lack of sexual activity is not due to a loss of sexual function.

• Men are not asked whether they are using erectile aids.

• Because men do not report use of erectile aids, physicians miss an opportunity to ask patients to rate their level of sexual function with these aids.

“Too often, a man who says he is not having sex is automatically defined as having ED when that may not be true. If someone is not having sexual activity, you cannot assume that person has ED. You must ask additional questions,” Andrew Vickers, PhD, attending research methodologist, Memorial Sloan Kettering Cancer Center, told Urology Times.

Once men share the answer to this question, it’s important to adjust survey results to reflect the reason men are not having sex. Only in doing so can health care professionals gain valid insight into a man’s sexual health, Dr. Vickers said.

The study was conducted by researchers at the University of Michigan Medical School, Ann Arbor and Memorial Sloan Kettering Cancer Center under the direction of Karandeep Singh, MD, MMSc, assistant professor of learning health sciences and assistant professor of medicine for the University of Michigan Medical School. The study was supported in part by funding from the National Institutes of Health/National Cancer Institute, Blue Cross and Blue Shield of Michigan, and the National Institute of Diabetes and Digestive and Kidney Disease.

Men with prostate cancer who had undergone radical prostatectomy were asked to complete the existing version of IIEF-6 as well as adjusted versions that added a question about the use of erectile aids, instructed men to respond to the survey based on their level of erectile function without use of aids, and asked men who reported not having intercourse to share the reason why. EPIC sexual function scores were analyzed for men who reported no sexual activity on the IIEF-6.

A total of 24,732 surveys were completed by 6,780 men as part of their routine care. The results show the extent to which the IIEF-6 provides limited insight around erectile function in some men who have undergone radical prostatectomy.

Study: ED questionnaire lacks crucial questions: Page 2 of 2

Among the 16,573 surveys that included data around the use of erectile aids, 15% reported the use of erectile aids, predominantly injections (89%). A simple modeling analysis showed that before a question around the use of erectile aids was introduced, some men would report their level of erectile function using the aids; others would assess their erectile function without the use of aids.

Among men who stated they were not having sexual intercourse, 46% gave reasons other than ED for the absence of sexual activity, including lack of a partner, sexual orientation, sexual preference, and health problems of the female partner. In men who were having sexual intercourse, doubling the first three questions on the survey resulted in almost perfect scores compared with the full IIEF-6.

In the 251 men who reported not having sexual activity, 13% reported they continued to have erections sufficient for sexual activity. Meanwhile, 5.6% reported scores of at least 65 on the EPIC sexual function domain.

Adjusting the survey to provide more detailed and informative insight into the erectile function of men who have undergone radical prostatectomy “is an easy fix,” Dr. Vickers said.

“The problem is not in calculating a group average. The problem is in working with individual patients,” he added.

It’s also important to ensure patients understand what is meant by the word “intercourse,” Dr. Vickers said.

“Some men think ‘sex’ means ‘intercourse’ [only],” he said.