NOVA Impotence Expert Q Amp A

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Please read the additional text of questions and answers were sent to live events as well as follows: Mr. Dr. Irwin Goldstein Q & A live event on May 12, 1998.

Hi, I came from NOVA at WGBH in Boston you live, Mr. You maybe interested in how can a male last longer. Ken Bader. In the studio with us tonight, Dr. Irwin Goldstein, the USA Today story on most subjects, and in one of the leading urology impotence. Food and Drug Administration (FDA) has since approved the oral medication Viagra spotlight has been turned condition that is estimated to affect up to 30 million American men. However, Viagra is the only treatment for erectile dysfunction is not. Are there any other options? For the next hour, Dr. Goldstein is a Boston University Medical Center, responds to questions sent from our Web listener. Should you need medical assistance, this event is comprised of general advice, please note that is not intended to substitute for visiting your own doctor. Dr. Goldstein, your participation, thank you.

Ken, thank you. Happy to be here.

Q: And our first question here. It comes from her 29-year-old woman right here in Massachusetts asks: "If women are likely to suffer impotence, what and how to diagnose it. Check out also maleerected organ photos?"

Women suffer from sexual health problems are not. Women, are having very similar physical problems related to blood flow, perhaps they will reduce the lubrication of the vagina, increased time to arousal and decreased sensation and decreased vaginal orgasm. We like people suffering from circulatory problems in their sexual dysfunction just mainly dealing with post-menopausal women with a history of diabetes and high cholesterol and smoking. We are the clitoris and vagina are now being developed and we will one day have an ultrasound study of blood flow to the record. We record and other aspects of vaginal pH and vaginal physiology. If available other drugs and now not limited to this, the main methods of our increasing blood flow to these women have an impaired blood flow was reduced because of the Viagra The. View increasing erection. And we have women in a series of anecdotal, and have used it have actually seen remarkable results. Pfizer, the women in four cities have been given different doses of either placebo or Viagra, has ongoing research in Europe. See last longer sex. And these studies are being conducted in the United States considered the end of this year. See hard erections.

Q: OK, another question from another female listener. She is 53 years old and she's from Washington, DC She writes: "I was talking about getting the Viagra allow them to better sex, they heard a lot of men suffer from impotence are already If it does not look like they can really have it better. You maybe interested in do penis enlargment pills work. sex? "

This is a very frequently asked questions. Viagra, or is useful in men with normal erectile function? And the answer is probably not useful. You can not get an erection really better than normal erection. View pills for penis enlargement. But there are caveats here. Some people claim to have a normal sexual activity, sexual activity has been, in fact, the erection of 50% to allow 2 to 3 minutes, say. Whereas they are having sexual activity, where they may have a normal erection during sexual activity. Gets a little confusing to the listener and it. So might go to a party, and John Hey, I'm sex three times a week, well, you are going to talk to my wife would say, might say, success is really nothing to compare it and that great and it was not. In the sexually active population that is less than a full erection, Viagra has been very successful.

Q: So, yes the bottom line, I?

Well, yes but it depends what you define as normal. People can be hard to have an erection lasting in the basement,, and then go to the second floor of the house, the attic of the house, and Viagra does not help him.

Q: We have a question from a gentleman of 69 years in Florida. You maybe interested in impotence cause. He says: "If so then you can also recover sexual function following radical prostectomy, how." He "placed a damper incontinence is serious foreplay and arousal," he said.

Unfortunately prostate cancer in men is a very common problem. Like a woman with breast cancer, prostate cancer or radical ... occurs at a rate of one in eight. One common treatment options for men with prostate cancer for long-term treatment is a radical prostate. And unfortunately, nerves and arteries bringing blood to the penis are often located next to the prostate. View effects of yohimbe. When the prostate is removed during surgery, and nerve injury can be to the penis and sometimes pipes. We are radical in patients with prostate, is a good success with Viagra. Check out also impotence treatment. But Viagra is not successful, we treated pellets, and infusion therapy and very, very great success has been, and we also have great success with the implant. If you have prostate cancer, treatment. You, impotence, if you are concerned that the results present the best treatment to re-establish sexual function after prostate treatment. You maybe interested in male enhancement side effects.

Q: Where is the question of the gentleman from Florida for 62 years. He writes: "In the treatment of erectile dysfunction correct, it is difficult to reach orgasm and ejaculate yet, what is to inhibit orgasm and / or ejaculation why is it?" He said, "They are still often There is no chance to. It's like it's hit or miss thing, "he said. He said, "I do not either Viagra or a vacuum pump, you'll know you are not able to function properly.", Is added

They are what we think is great to listen to in general. People erection and ejaculation and orgasm are considered the same thing like, and in fact, they are physiologically very different. Impotence is the inability to get an erection. Orgasm is a phenomenon that occurs in sensory stimulation to the skin of the penis is passed to the part of the brain. And ejaculation release of fluid from the end of the penis and the activity of the resulting feeling is more reflective. A number of reasons that you do not have orgasm, it can be the medicine. It senses changes in the penis, can be from aging. Should receive medical attention for it to determine whether the reason you are. See gt6 for erectile dysfunction. In many cases, the use of a vibrator, add a little rise to the brain senses that it leads to orgasm and ejaculate. Sometimes, the vagina does not provide a standard for the orgasm sensation only.

Q: So, Viagra has no effect on -

Well, you know, it's an interesting question. You not only enhanced by Viagra orgasm, intercourse satisfaction, overall satisfaction and the erection of an independent, New England Journal paper has been released it appears, with statistically knows Viagra. Viagra did not work only had normal sex. Because the things you want to increase your desire, this is good. You must have your own desires in nature. Because Viagra has a different treatment for male sexual disorders yet.

Q: ask a 70-year old man from New Jersey "? What about drug interactions with Viagra, for example, it is compatible with Prozac"

Do not take Viagra now we know that there are very few reasons. Viagra should you have problems with eye disease called retinitis pigmentosa means you do not. And it's a rare vision problems. Called nitroglycerin tablets and has a version such as nitroglycerin or. You maybe interested in vimax cock growth south africa. Nitroglycerin, nitrate and fast acting. There is acting and long acting nitrate medium. These two short terms, it is reasonable to use Viagra. Now you, of which Prozac is one, there is a need to use Viagra to overcome the problem of drugs, the most common drug problem in fact is high blood pressure medication and heart medication . Let's say that is an issue but just Prozac. Absolutely, please use Viagra to overcome the side effects of other drugs. If there is any drug that you need to stay on their medications. You maybe interested in increase male sex drive. It decreases if there are side effects of erectile function, please use Viagra or other treatments to regain their erectile function.

Q: Dr. Goldstein, here's a question from the gentleman from New York 64 years. See causes impotence. He says: "The life of an adult all my erection I do not to be embarrassed of me, bent down upwards." He says, "He and I were wrong urological this about once told the doctor, said he does not have a full erection and I just. It was so firm, but I did not believe him, he failed to persuade. This general terms, have you heard of it until now? "

Yes, it is a fairly common condition. It is actually known as congenital penile curvature. There are two ways to have a penile curvature. You get it, it is usually because one sexual injury. And most common, and its partners to obtain a superior position. You are also born with a curvature, it can be essential with this gentleman. Check out also night erections. Bend it down significantly, and we've seen when the patient is at least 90 degrees of flexion, especially sexual intercourse at a particular location is difficult. And it is part of the urinary system penis, urethra, is a congenital problem with erection is shorter than the chamber. Because, as erects penis whole, of course you only when erects it, but looking at it in a relaxed state, but it's not like tethering, and to produce erections, the urethra, the room erection system does not stretch as bent. Check out also samurai x pill review. Surgical correction, usually as an outpatient in fact, is not complicated, it's a solution for many men. Check out also best erection supplement.

Q: We have another question here: "Dr. Goldstein, you know what you have heard of this product will be introduced topical cream I. View penile enhancer?"

In fact, says Viagra, pellet, the first line treatment for erectile the user is a little easier to handle than vacuum devices and injectable or implant, or an example that has a host of others have been developed . Other drugs have been developed there, we now have an era of topical creams. There are companies that generate data for a series of topical creams. View natural remedies for ed. Of us working on here at Boston University. We are actually in topical creams have little more than 100 people. Check out also new ed treatments. And it looks like a very exciting alternative to oral medication. In an oral pill has been anyone not satisfied to meet the needs of their topical cream. Little notes, the very first question we had was in the female sexual dysfunction topical cream is widely used to treat. I am woman, I think a bit more confidence to use local materials to enhance the delivery of blood flow to the clitoris and / or vaginal than oral pill probably. So it is for the future. It is, I do not know, in the early 2000s and has been released when it is very widely effective.

Q: I have been looking for Viagra in the form of a wafer to achieve their "Wall Street Journal," I read on. Is it true?

And a half hours late to raise this kind of thing one time and get your medicine at this time. We are many years from today, in retrospect, is let's say in 2005, phosphodiesterase type 5 inhibitor sildenafil has an incidence of perhaps better, perhaps 3 or 4 and similar drugs such as One, maybe five, six, pharmaceutical companies, there is action, delivered better than Viagra. But we always will remember for the Viagra's ability to stimulate the entire country. This erectile dysfunction, saying that most talked about subject in America, open your story. I am almost 20 years and has never been in this area, you need to share with you, this drug until it was at least talked about subject in the United States. So we we discussed over time and remember that this will allow Viagra to have a better way to manage it alone.

Q: I'm writing to ask colleagues from Ohio 50 years "? Treatment is not effective in men with diabetes and erectile dysfunction nerve damage and / or circulatory problems,"

Well, unfortunately, diabetes is a disease that has a great ability to get in terms of penile erection is not. It may not have erectile problems in patients with diabetes is very common. And we have a visit to the doctor, it is recommended to be managed in a way that is very similar to nondiabetic patients. Managed by treatment of choice such like Viagra, history, physical examination, laboratory testing, maybe you'll get. They should not, and would involve a pellet or injection, a second-line treatments fail or if they fail, if recommended, such as third-line treatment of such implants it. We have circulatory problems, nerve damage and in Viagra, and that success in diabetic patients.

Q: male listeners aged 39, from Virginia wrote: "What alcohol consumption causes a reduction in hardness of erection?"

It's a great question. It depends on the degree to which alcohol is consumed. In the Massachusetts Male Aging Study, which is a large male was evaluated for predicting what erectile function, randomized, community-based sample and, in addition to the frequency of erectile function is present, which have prevalence, alcohol consumption and alcohol use and excessive use of ethanol is quite apply in this case was not actually in the statistical indicators of erectile dysfunction did not. In the majority of male erection problems is actually a minor use of ethanol, a vascular disease proved to be the basic underlying dysfunction, perhaps there are many reports of prevention. Because of the message, I guess, not the least drink, too, and you can still maintain erectile function. Check out also what causes ed.

Q: This is an interesting question from a 45-year-old man from New Hampshire. Check out also best homeopatic medicens for rock hard penis in india. He writes: "I have no problem achieving an erection, I also had problems or to sustain it, I do not have to reach orgasm trouble, is this a sign of erectile dysfunction ? "

It is a question similar to the one we just had to answer. Orgasm, ejaculation and erectile function is an independent real sexual men. Of course, other sexual function is what we call libido is the drive. Delayed orgasm, there are several reasons for men to have an orgasm, or decreased. See male inhansment. A common and most, I would think, but simply, and sensory changes in aging. Orgasm is a sensation because of events eventually spread to parts of the brain wave propagation brings us the pleasure of orgasm, to be released is called, is a specific part of the brain senses in an amount sufficient must be reached. If you do not reach this ultimate event in the brain feel you do not experience orgasm. In addition, the drugs prevent orgasm. As such, like Prozac, for example drugs, drugs for depression that we use for men with premature ejaculation to delay their orgasm ejaculation reflex in practice. I recommend strongly to verify your doctor. One of the best treatments we have now is to increase the amount of stimulus into an important part of the brain that orgasm is happening, and vibration therapy. See how to increase men s libido.

Q: Where is the question from 31 year old woman in Ohio. She writes: "My husband is 31 and we are suffering from impotence about half a year is to achieve an erection when he is in loss for why this happened, but can not be maintained, He is to achieve an orgasm. View rock hard pills... when he still does not achieve an erection, ejaculation by masturbation. "Her question," Are you any explanation you can why these problems Have you? "is

This is the one that talks about various topics and a number of great questions. So we 're going to be a short period as possible. The fact that he has erection problems are consistent for six months, which actually meet the definition of erectile dysfunction. We have not included men with impotence overnight activity. The second problem is that this question is addressed to orgasm. You maybe interested in herbs for sex drive. Ejaculation without erection Clearly, there is likely to occur properly in men. Check out also how to last longer having sex. You are really great quality, well maybe not a great quality, but can have an orgasm and ejaculation erection quality if not more convincing, at least you get to have sexual release it You can. So they are not related. His side of the young people only 31 are, in large, this is a disease of aging, and debate and engaging activities erection, blood vessels secondary to high cholesterol and diabetes, smoking and of age. We found that it is the fact that the same blood vessel damage due to more young impotence, blood vessel damage that is due to trauma. And I think you'll be able to talk to the other side of this we just ever. It is this man or not bicyclist, a man karate, but if you think you are so described that may or been kicked to the crotch of his fall or on the fence post, his have fallen into some of the concrete in the crotch. I have this strong person, in particular, the urologist can take professional tests, we recommend that you consult.

Q: I am an interesting situation, written by 43 year old male from Florida where the listener. See erectile dysfunction drugs. He says: "Recently, I like the number one sea level have difficulty experienced sexual arousal, such as moving from a 3800 foot elevation, geographic relocation, what effect gained approximately 20 pounds two few, # 3, and have.. increased stress associated with are involved in this? "three interesting situations.

Well have the stress of weight gain, geographic location, and there is great reason to have a problem with arousal. View rock hard weekend ingredients. Arousal is related to how that feels very, how do I, how comfortable - it's as much psychological as an indicator of mental health as being something. So look to psychologists to get more control over their situation or actually just waiting for this one, your psychological stress may be useful. View cure for ed. Awakening for the poor that are related to hormones, and of course there are other reasons. It is therefore examined for the hormone, which is another possibility for this individual. The most common reason for waking you have erection problems is erectile problems. If you can not run, you know, if so, which greatly reduces the awakening of your situation.

Q: Question from a 34 year old resident of Indiana. He is a man. And he asks: "What role frequently (once daily) masturbation, and he does not play in the inability of humans to achieve an erection and a half later in life said, I often to masturbate, and are starting to realize and less rigid erection. See libido enhancing. "

It's a great question, during the onset of the frequency of masturbation and erectile problems as far as I know of no relationship at all. You can argue that is suitable for most frequent erections erection. Syndrome, "If you do not use it, you lose it" kind of like the opposite. And that you have erectile problems, they are consistent and if they have lasting six months, it is the doctor to see why. We may have some other problems just as described above. Several trauma crotch area. Another possibility is to check whether or not to restore the erection itself slows the frequency of masturbation only. Sometimes if you are young, not a good time to have erection problems, however, young men have erection problems is worth seeing a doctor about.

Q: Dr. Goldstein, here is another question from the Midwest. 64-year-old man wrote:. . . "I had my implants two years ago, 1 / 2 when it was really stimulating, turned out to be beyond the erection erectile tissue is established by the implant, it is possible that a total surprise Viagra is, or will further strengthen erections. See pills penis? confident that I know to leave the head of the penis erectile implant is slightly relaxed you are. Viagra may also help them? "

This is absolutely great question, it is mentioned to have a valuable role in treating all types of sexual terms just Viagra. I was yesterday, and I had a walk in the same patient at all in the office I put him on Viagra, he and today is called, and he his Viagra than without implants in his person and Viagra he's had implants and much better erections. Since Viagra is able to stimulate the remaining tissue in the penis of a man there with the implant still see it. Expand the only answer, because we are sort of using Viagra in conjunction with the men inject themselves now, and we are using Viagra in conjunction with the men using a pellet. And we are using Viagra to men with psychological treatment. Indeed, I called and the young men and bypass surgery for blocked arteries that procedure, I have started using Viagra as a sleeping pill for these patients. Why would I use it as a sleeping pill? Because it has actually strengthened the value of your erection. And we have discovered that men enjoy. And we are as to facilitate the erection of the night pill to sleep by giving Viagra in a way that, in patients with path operations, bypass, ego better than them, better results with the implant and satisfaction from You can see that you have given.

Q: Writing Male 60 years old in Massachusetts where "tablets of 50 milligram Viagra is, if there is no effect, but it will not check in urology doctors and first I would 100 mg, Is it safe to try two pills?

Well, generally when you change the dose of medication, please consult your doctor. You are not experiencing side effects after taking tablets of 50 mg you, if you can not get erection again, so it would do and give them to perform a doctor, it can increase capacity by irrational is not . But, of course, again, is it any drug would be wise to check your doctor.

Q: 28 year old male listener from New Jersey wrote: "Dr. Goldstein, the erection of a normal length of time is also what is the length of the erect penis is something normal?"

They are two good questions. Well, the usual duration of erection should be related to the stimulus. You will find exciting and want to have sex with their partners, sex for 30 minutes or 45 minutes and you want to have time, or both engaged in this relationship and The erection that long if there is a partner you should be able to maintain. Length of the average erect penis in the United States is the length of the 5 1 / 2 inches. Related to the length of the penis, called several attractive anthropometric study of the length of the penis is now part of the body, and was there. Interestingly, the length of the erect penis what if there is a racial difference, but differs in that it is possible to predict the length of your erect penis. Body parts to estimate the length of the erect penis Interestingly, the length of the arm. Either smoking or high blood pressure, tobacco, and if you have diabetes or high cholesterol and smoking, in fact, have been compared with those who do not actually have a small penis you. Because they are about the length of the penis erect now understand that we are part of an interesting observation.

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Q: Here's an excellent practical question from a 66-year-old gentleman in North Carolina. You maybe interested in premature ejaculation supplements. He asks: "What all is involved for a man to do in order to receive a prescription for Viagra? Can I just go to the doctor and ask for it, and he'll give me a prescription? I'm a 66-year-old male with no medical problems."

An individual who believes he meets the definition of impotence or in the medical world, we use erectile dysfunction, here is what you would have to have to meet the definition. A consistent, for a period of usually around six months, problem with erection quality, usually obtaining and maintaining the erection that effects satisfactory sexual intercourse, or satisfactory sexual activity. So if you meet that definition of a consistent problem with the quality of erection that affects satisfaction during sexual activity, please see a local doctor. You need to see an internist or a primary care doctor. Check out also sexual erection. If you'd like you could see a urologist. You would undergo a history, a physical examination and some laboratory tests and most likely after education and attempts to modify your lifestyle, end up with a prescription for Viagra.

Q: This question follows right out of that answer. It's from a 58-year-old male listener in Florida. He says: "How do you find a competent urologist?" "In the last three years I have gone to two, both asked questions and neither gave me any physical exam. View what to do about premature ejaculation. The first was part of an impotence clinic. He suggested I masturbate. The second gave me a pill made of some African tree bark. I've since read it doesn't work. And then suggested having his nurse show me how to inject myself. Right or wrong I didn't go back to learn how to do this. The doctors on the show all seemed to look at a possible physical cause before prescribing any treatment. Thank you."

Well, I appreciate your call, and I apologize for your unfortunate experience with my colleagues. Check out also stiffonehebak. The only thing I can say to you, I guess, is that your evaluation happened prior to the Viagra era. Now were you to go to either a competent urologist or internist or primary care doctors you would be managed, not with the oral pill from tree bark, which again, has never been shown to work, but now with a drug, which has been shown to be safe and effective for the treatment of impotence, and that is, of course, Viagra. Should Viagra fail you would then be considered for second line therapies, which would be injections or vacuum devices or pellets, and third line therapies would be penile implant devices. First line therapies now are the oral pill, Viagra, potentially psychologic therapy, and you should be able to find many physicians to help you with this management.

Q: Here's an interesting situation from a female listener. She's 67 years old and she lives in Georgia. She writes: "My husband had a penile prosthesis inserted a few months ago, and has experienced some disappointment. He had been experiencing gradually increasing impotence for several years and was more than anxious to have this done. Is it possible that because of his dysfunction we both sort of put sex out of our minds, or does it just take a long time to adjust to this method. See passion rx and cali plus? He has coronary heart disease and takes a great deal of medication. Check out also what male enhancements really work. He is 65 and although he has problems, is very active."

I need to know much more information. Penile implants have a excellent success rate, about 80 percent in men who have impotence. We've been using penile implants since the early 1970s and considering it's now the late 1990s, it's almost 25 years of experience. View sexual performance pills. The design of the devices have improved greatly and there is usually in four to five people great satisfaction, as was seen on the show. Check out also pill enhancement. I need to know a little bit more of why your partner has this disappointment. Maybe there's something that could be done that's simple that can enhance that disappointment so that there's satisfaction. We're now even using Viagra in men with penile implants to enhance their satisfaction. View female increase libido. So we need more information.

Q: A 47-year-old gentleman from North Carolina writes: "When I have an erection only the left half of the penis seems to inflate. I am able to achieve orgasm, but there is discomfort in the penis on the side that is inflated, similar to too much pressure. Is there a reason and a solution?"

Without seeing you, the left half inflates and the right side doesn't. The one thing that comes to my mind is a condition called Peyronie's Disease, and I'm surprised despite all these questions we've had today, I haven't heard from one patient who has had Peyronie's Disease. This condition involves thickening of the wall of the erection chamber. And of course, things that inflate and increase in volume require elastic or elastic properties of the wall. So if the wall is scarred and can't inflate then that would be a condition called Peyronie's Disease. Peyronie's Disease is also associated with pain and you described this pain. Peyronie's Disease is a condition which occurs generally from trauma during intercourse, primarily from partner superior intercourse. And one would need to see a doctor and discuss this with him for appropriate management.

Q: From North Carolina comes this gentleman's question. He says: "I'm a 35-year-old man who has visited a vascular specialist to determine if I had any vascular reason I have problems obtaining an erection. The specialist determined I had no vascular problem. He did not suggest anything to help me have an erection." He asks, "How normal is this, and do you think Viagra would help since I suspect my problem is more mental?" He adds, "My wife wants me to see another doctor."

Well, this is a tough question because it's a little more specialized. Check out also how to fight premature ejaculation. I don't know what tests your vascular specialist did to rule out or rule in that you had a vascular problem. A man who is 35 years old who has erection problems statistically is more likely to have a blood vessel vascular problem, if he's going to have a physical problem. Of course there could be psychologic problems. Viagra would be an excellent treatment for any man, whether young or old, who meets the definition of impotence, which is a consistent problem obtaining and maintaining an erection for satisfactory sexual activity. It sounds like you would meet that definition and Viagra may be useful for you. Should you wish to be considered for potential curative surgery, if the problem is physical and related to blood vessel blockage, I guess another consulting doctor would be indicated here.

Q: Here's an interesting question from a gentleman 47 years old in Michigan. He writes: "What is the relationship to sexual dysfunction, if any, to protracted sexual inactivity or abstinence?"

We answered this question in a roundabout way earlier. Protracted sexual activity, actually has a name, and we call it Widower's Syndrome...

Q: Inactivity.

Yeah, inactivity, protracted inactivity. We use the word, Widower's Syndrome. And that is someone, for example, who is happily married and unfortunately, the partner passes on. And this man takes many years until he has enough energy to find a new partner and is essentially inactive for a protracted period of time. And we go back to the concept of, if you don't use it you will lose it. You maybe interested in how to increase your sex stamina. We have strong scientific beliefs in this statement that having an erection is good for an erection. For men who have impotence and believe that it's related to protracted inactivity, having Viagra would be a useful tool. You maybe interested in herbs that increase libido. But perhaps taking Viagra as a sleeping pill. We're going to look into it that way in the future. Taking it as a sleeping pill would enhance the nighttime erections, so these wouldn't be sexual erections. So the protracted inactivity could actually be generated or reversed, if you like, by taking the pill at night, and enhancing the duration of the natural erections that you get when you sleep. You get about three hours of erection if you sleep eight hours. View natural enhancers. It's about four or five or six episodes, each lasting about 30 minutes to 45 minutes. And Viagra has the capability of enhancing that. When you speak to men who take Viagra, one of the universal findings and statements by them is that they wake up with erections like they were 18 years of age again. And that's because it enhances the nighttime erections.

Q: From Connecticut comes this question from a 45-year-old male listener: "Does hernia scar tissue from an operation cause any type of blood flow dysfunction?"

No. From Connecticut, I can say to you emphatically, hernia scar tissue does not impair blood flow function. View long lasting erections. There are cases where people say having had a hernia leads to erection problems. There's very little reason for hernia to impact on erectile function in a negative way, but I would strongly encourage you to get tests, since you are young, and find out what the basis for the erection problem is. You maybe interested in man up male enhancement. Again, if you have impotence and wish to get managed by Viagra that would be a good choice for you.

Q: A 47-year-old listener from Michigan writes: "My wife has almost no sexual desire. She has had diabetes for 28 years and is on Prozac and Valium. Check out also penis enlarge pills. What is the more likely cause of the sexual problem, the diabetes or the medications and what would be the best treatment. View natural penis enhancers?"

Boy, that's a great question and one day we will have all of the research on what causes female sexual dysfunction. You maybe interested in mens erection. At the present time where the research is a little scarce what my opinion would be in this case is that the diabetes is doing what it does in men. It's blocking blood vessels, injuring nerves and affecting tissues of the female genitals. See do male enhancements work. Prozac, as it does in men, inhibits erectile function, would inhibit vaginal and clitoral function. In her, low desire may be reflective, possibly of diminished circulation to the vagina and/or clitoris during sexual activity. View whats an erection. And we are now finding that Viagra can help in these cases. Now there's a caveat here. Viagra is not FDA-approved for the treatment of female sexual dysfunction at the present time. We are prescribing Viagra at Boston University for such women under controlled environment and controlled circumstances to assess the effect. Hopefully, in a short period of time, Viagra will be assessed by a large drug company, like Pfizer for the safe and effective treatment of female sexual disorders such as your wife.

Q: No shortage of questions tonight, Dr. Goldstein. This one comes from right here in Massachusetts, a 41-year-old male. Check out also my penis wont get hard. He writes: "The day after I take Viagra I feel hung over. I have a headache and feel slightly sick." He asks, "Do the other drugs that are coming onto the market have similar side effects? How do these other drugs cause an erection?" He adds, "I was left impotent as a result of surgery to remove a tumor from my rectum one year ago. I tried the injection therapy and that worked fine. But," he adds, "It is not very appealing. Not my idea of foreplay."

Well, lots of information in this question but let's do the best we can. If you're having side effects from Viagra, my suggestion is, if you're using the 100 milligram tablet, cut back to the 50 milligram tablet, and you may not have your headache and feel sick. And you would still have the advantage of using an oral pill and not having the need to inject. See testerone levels in men. The new drugs coming on the market are drugs that will be shown by the FDA one day, hopefully, to be safe and effective for the treatment of impotence. The next drug, which appears likely to be submitted to the FDA is a drug that blocks how stress affects the penis. View instant erection gels. Stress acts on the penis through specific receptors called alpha receptors, and these drugs are alpha blockers. There's also another drug which stimulates the erection center in the brain and you take that as a tablet underneath your tongue, what we call sublingual. They're not going to be available for at least a year, so we have to get something active in you right now. The first advice is to cut back on the dose of Viagra, and the second advice may be to go back to the injections. While it may not be appealing, it obviously did work in you and you may have to do that.

Q: Dr. Goldstein, here's another question that I suspect is on a lot of people's minds. It comes from a 58-year-old male listener in Virginia. He says: "Does a vasectomy cause any of the symptoms of male impotence as one grows older?" He says his sex life and functions were fine before 50 but have gradually diminished. Again, he's 58 years old now. And then he asks, "Would a reversal be possible and would it help me function?"

For some reason we get people who always think that a vasectomy is related to impotence. See sexual herbal supplements. There is no relationship that I can report from multiple studies studying thousands of men who under control situations didn't have a vasectomy, or under situations had a vasectomy and looking at things like erectile problems. People are also concerned of vasectomy in prostate cancer, and there's absolutely no relationship between vasectomy and prostate cancer. Having a reversal could happen, but if you are hoping it reverses your impotence, it won't. A 58-year-old male would most likely have erection problems from vascular disease, such as cigarette smoking or diabetes or high cholesterol. See ways to increase libido. I would suggest you seek your doctor. And if you like, undergo testing. But specifically, you could simply try Viagra and see if it restores your potency, even though you have had a vasectomy.

Q: A 49-year-old woman listener in Massachusetts writes: "My husband has had a problem with not being able to get as hard as he used to. See pre mature ejaculation. He gets an erection but it is easily bendable and reduces my pleasure drastically. He also takes much longer to have an orgasm. He is 46 years old and this has been going on for a few years." She asks, "Would Viagra be a good option for him?"

Wow, this is a great question because someone asked earlier, do normal people, would benefit from Viagra. Now since you are sexually active and really he is at least hard enough to penetrate in you, some people may think that "he's normal." When obviously, as you state, he's not as hard. He has longer to achieve orgasm. There are sexual dysfunctions going on here. Yes, by all means, he would be an excellent candidate for Viagra. He is actually the ideal, in fact, candidate for Viagra. Since he's in his 40s and has erection problems, you might want to have him undergo testing to see if there are early vascular conditions. Because if there are, perhaps maybe he could get a cardiac stress test and see if other vascular conditions are abnormal such as the blood circulation to his heart, which would be very important to know.

Q: Here's a listener from North Carolina. He's a gentleman and he asks this question: "Can I use the vacuum therapy and Viagra at the same time. You maybe interested in can you get hard?" Here's a bit of background he provides. "I am 58 years old with a radical prostate removal because of cancer. The cancer was contained in the prostate. I have not had good success with the injection. I could not get it stiff enough for penetration. I was using 1.0 strength with the injection." He says, "The vacuum method does not get it stiff enough for good penetration."

Your question is can vacuum constriction devices be made better by taking Viagra? Well, the data is not in since Viagra is so new. Check out also erectile dysfunction causes and treatment. But we are presently using Viagra alone, we're using Viagra with pellet therapy, using Viagra with shot therapy, using Viagra with implant therapy, and Viagra with vacuum constriction device therapy. And we're now even using Viagra to enhance erections at night. View enhancement pills. So we are just discovering the magical ways Viagra can help men and their sexual dysfunctions. And of course, we're now using Viagra in women. So we're now seeing how Viagra works in all of this. I would encourage you to try all therapies to help your situation. Injections are not functioning and the vacuum device is not perfect. So maybe Viagra will turn the corner. Of course, the other option is you can undergo a penile implant, should you desire to enhance your sexual function.

Q: A quick question from a 47-year-old fellow in Massachusetts. He asks: "Is there any connection between circumcision and impotence?"

We often get that question as we do with the vasectomy. In this particular situation I unfortunately have seen a case where an odd complication happened during circumcision that actually did cause the erection problems. So this is a little different than vasectomy. Although for the most cases, circumcisions are entirely benign and rarely are the reasons for erection problems. Since you are in your 40s and having an erection problem, I would strongly encourage you to seek a local doctor and get an evaluation.

Q: Here is the last question we have time for tonight, and it's a very good one. It comes from a 32-year-old gentleman in South Carolina. He asks: "I would like to know, what are the preventive actions to take against impotence?" A very good question.

Spectacular question. The ones that are obvious are don't ride a bicycle. Don't smash your crotch in karate. Don't fall on fence posts. So preventing trauma and respecting the perineum. That would be my favorite. The most obvious, obviously, is to prevent the ravages of aging by taking control of your blood pressure. Keeping your weight down. Not having diabetes or at least if you have diabetes to get the maximum control you can. To avoid using drugs unless you have an obvious medical problem, because oftentimes drugs influence erectile performance. And the final answer, as it concerns preventative, is the concept of using Viagra to enhance the duration of nighttime erections. We have substantial evidence that would show that men who start becoming impotent start losing their night erections. That's one of the first things they see. We're hoping that if we get men at this early level where they're now starting to see just the beginnings of night erections that they used to get, easily and routinely, that they're now not getting, is to start taking drugs like Viagra or other ones as they become available, to enhance night erections. We hope to actually prevent impotence with all these measures.

Q: Dr. Goldstein, this has been a most enlightening and fascinating hour. Thank you very much for being here.

Ken, really, thank you for the opportunity to be here, and I thank all of the people for their great questions. You maybe interested in penis enhansment. They really were a typical day in the office.

Well, on behalf of Dr. Irwin Goldstein and the staff of NOVA, I'm Ken Bader in Boston, thanking you for joining us and wishing you a very good night.

Additional Q&As

Q: (from a 38-year-old Oregon woman) My fiance, who is 37 years old, has trouble maintaining an erection for more than a minute or two. You maybe interested in penile enhancements. Commonly, he ejaculates *after* his erection has faded. When we do succeed in having intercourse, he ejaculates (and loses his erection) with very little stimulation. In any case, ejaculation for him rarely FEELS like an orgasm. He is not sure when this trouble started, because before meeting me last year, he had not had a sexual partner for 10 years. You maybe interested in medical stores in india at punjab where vimax penis pills are available. When my fiance sought medical treatment, the urologist took urine and blood samples and later told him that he was physically "OK." He prescribed an anti-depressant (Paxil), which only made my fiance giddy. What do you recommend? How can we find a doctor in our geographic area who is knowledgable and up-to-date in this field? Also, is there any research into what can cause or prevent male orgasm? It seems that erection, orgasm, and ejaculation are three separate, though related, functions. View my penis wont stay hard. In our case, none of them seem to be working properly. Thank you for any help you can give us!

Your fiance has a common erectile quality problem - inability to maintain the erectile rigidity. You maybe interested in how to increase libido. Because the problem is consistent and affects his satisfaction with sexual intercourse he has met the criteria for having "erectile dysfunction." The usual evaluation would consist of a history, physical examination, and laboratory tests, followed by education, modification of lifestyle etc, and initiation of first line therapy such as sildenafil citrate (Viagra). However, if your fiance wishes, because he is young, he would be considered a candidate for more sophisticated erectile function testing to gain a better understanding of the nature of the dysfunction and to see if he can be cured of his impairment. He should consider seeing a urologist who specializes in this field for more detailed advice. Perhaps calling the American Foundation for Urologic Diseases in Baltimore can help you locate this physician. You fiance could then be assessed for all the sexual dysfunction issues such as erection, orgasm and ejaculation.

Q: (from a 53-year-old Texas man) I am on blood pressure and diabetes pills and cannot get an erection. You maybe interested in penis enhancer. My doctor said Viagra would not work for me.

Actually sildenafil may work quite well for you. It is indicated for men with erectile dysfunction who have a physical basis for the impairment - a likely scenario in your case. See penis erection pills. The only contraindication for use of sildenafil is concomitant use of nitrates - pill for treatment of chest pain (angina). If sildenafil does not work, you could try a vacuum device or try intraurethral pellets, self-injections or a penile implant.

Q: (from a 59-year-old California man) My dysfunction started with diabetes and is now further complicated by Peyronie's. It has been several years since I have been able to have a normal erection. I have tried the injection in the Drs. office...it proved quite painful due to the bend in the penis. See cause of erectile dysfunction. I have been given Viagra to try. If the pill helps with the erection there will still be a severe 90-degree turn in the shaft of the penis, caused by scar tissue (Peyronie's) Is there a surgery available to remove the scar tissue, allowing the shaft to remain straight - and still responsive to the Viagra? I have been told that there is damage to the one side and I will need a graft to fill in space once scar tissue is removed. Check out also how to treat erectile dysfunction. (At this time my diabetes is controlled with pills and diet. ) I do have fears of undergoing surgery with a potential for infection due to diabetes.

Your problem is unfortunately common and consists of two problems - 1) erectile dysfunction and 2) penile curvature from Peyronie's disease. Management should be linked to close communication with your urologist.

Specifically to manage the impotence, treatment may be initiated with simple things first. New first-line therapies include sildenafil or vacuum constrictive devices. If these fail, second line therapies include self-injection or intra-urethral pellets. Such treatment focus on erection quality is designed to identify if the enhanced erectile function and improved rigidity wouold allow for functional sexual intercourse despite the penile curvature. If so - then no attnetion need be given to the penile curvature - which woudl be simpler.

If attention is needed to correct the penile curvature, basded on the above observation, there are traditional simpler medical therapies including vitamin E. Surgical procedures to achieve penile straightening include: 1) excision of the scar tissue and replacement by graft, 2) "a tuck" procedure or 3) insertion of a penile implant can achieve two purposes - penile rigidity and penile straightening. It is important to discuss all these issues with a urologist. There are important risks ad benefits with each treatment. Perhaps calling the American Foundation for Urologic Diseases in Baltimore can help you locate this physician.

Q: (from a 50-year-old California man) At $10 per tablet, Viagra is expensive. What good reasons can you offer for *not* sparing myself the expense of an office visit and simply getting a small supply from Mexico? Are there real dangers to this? I feel capable of reading and understanding the PDR. All drugs have contraindications to beware. What are those of Viagra?

Sildenafil citrate (Viagra) has been approved as safe and effective for the treatment of male erectile dysfunction. If you have compaints consistent with erectile dysfunction, you should see a physician. Erectile dysfunction may be caused by prostate cancer, unrecognized diabetes, hypertension, renal failure, hypogonadism, depression, other psychologic conditions, aortic aneurysm, lumbo-sacral disc disease, use of medications, etc. The evaluation consists of a history (medical, sexual, psychosocial), physical examination and laboratory tests. If needed a psychologic assessment may be added. Education and modification of lifestyle issues or changes in medication may be instituted under physician care. If appropriate, Viagra may be initiated. There are few contraindications other than concomitant use of nitrates.

Q: (from a 32-year-old California woman) Dr. Goldstein, My partner and I have a wonderful sex life, however, we rarely engage in intercourse. When we try to have intercourse either he loses the erection while putting on a condom (I have tried many distractions during the process) or he will lose the erection during penetration. You maybe interested in wonder how to. Once in a great while he will lose the erection while I give him oral sex. See erection gif. When he does maintain his erection thru penetration he often orgasms very quickly and says that it was too intense and he couldn't control it. Is this considered sexual dysfunction?? Or impotence?? Most often we engage in great oral sex instead...When I try to discuss it with him (in a non-threatening way, and when we're not having sex) he says "making a big deal about it only makes it worse." Could it be entirely psychological or combination of problems??

It is difficult to make diagnoses on patients based on the minimal information contained in the e-mail. View how to increase libido in men. Based on the above, it sounds that he has both erectile dysfunction (failure to maintain) and premature ejaculation. They may be independent or related sexual dysfunction phenomena. I would STRONGLY encourgage him to seek medical help - we can usually make such a great difference in these cases. Both conditions can be very easily managed.

Q: (from a 60-year-old Florida man) I was an active alcoholic between the ages of 15 and 51. See male erections. I have not used any addictive drugs in the last nine years. During the last three years I have used testosterone cream and 25 MG 2x/day DHEA supplements in an unsuccessful effort to overcome impotence. Furthermore, I am concerned about the possible cancer threat with their continued use. I have three questions:

  1. In your opinion, is my concern about cancer valid?
  2. Will Viagra be effective in someone who obviously has impaired adrenal function?
  3. What are your recommendations for treating impotence due to alcoholism?

I really enjoyed your show on NOVA.

In your opinion, is my concern about cancer valid? Yes, yes and yes. Prostate cancer is very common - about one in eight men will develop prostate cancer and prostate cancer is a leading cause of death in men your age. Testosterone definitely helps prostate cancer cells grow. One should get a PSA (prostate specific antigen) blood test every three to six months if one is being treated by testosterone.

Will Viagra be effective in someone who obviously has impaired adrenal function? There are several rare disorders of the adrenal gland - but if you have one - this should be managed by an endocrine specialist. If impotence persists despite appropriate treatment of the adrenal condition, then Viagra may be added.

What are your recommendations for treating impotence due to alcoholism? Alcoholism may cause impotence by a number of mechanisms especially from psychologic and nerve-related damages to the penile erection process. Assuming appropriate counseling has been tried, medical treatment may involve the use of Viagra.

Q: (from a 47-year-old Florida man) I have read books which provide instruction on how to exercise the PC muscle in order to better ejaculation control, and in fact, achieve orgasm without ejaculation. The benefits touted are the ability to maintain an erection after orgasm, more frequent orgasms, better erections, etc.

  1. Is there any benefit for a man to engage on a regular program of PC muscle training of 100 contractions a day?
  2. Does the prevention of ejaculation during orgasm increase the ability to maintain an erection, and allow for more frequent orgasms?
  3. I've noticed that by practicing extended contraction of the PC muscle, it will sometimes automatically go into spasm. Is there any benefit to this? Any negative effect on a man's anatomy?

Is there any benefit for a man to engage on a regular program of PC muscle training of 100 contractions a day? There is much anecdotal information on this topic, but not good scientific knowledge. In my opinion, there is only a minimal effect on ejaculation in an otherwise normal male.

Does the prevention of ejaculation during orgasm increase the ability to a maintain an erection, and allow for more frequent orgasms? The prevention of ejaculation during orgasm is extremely difficult to perform during normal intercourse. See vimax cock growth, where can i get this in s.a. If one could prevent ejaculation, this would definitely enhance the intensity of a subsequent orgasm.

I've noticed that by practicing extended contraction of the PC muscle, it will sometimes automatically go into spasm. Is there any benefit to this? Any negative effect on a man's anatomy? There is probably no harm to inducing a spasm in this or any muscle. Check out also ed natural remedies.

Q: (from a 50-year-old California man) Dear Dr. Goldstein, My experience suggests that a male can experience the physical phenomenon of ejaculation without always experiencing the mental/physical phenomenon of orgasm. Thus, my question concerns the relationship of these, both neurologically and psychologically. I'd also be curious to know if non-human ie animals, experience orgasm, or if their brain structures somehow don't allow this.

Orgasm is a sensory phenomenon which occurs in the septum of the thalamus. After receiving appropriate sensory information from the penis and genitals, a disproportionate amount of neurotransmitter is released into surrounding thalamic tissue. View erection n ejeculation view. This causes a depolarizing wave to affect a wider area in the thalamus. Pleasurable sensation is passed to appropriate cortical sensory areas of the brain (orgasm) - while the spreading wave causes activation of ejaculation pathways. It is possible to ejaculate with only a minimal orgasm. Check out also all natural herbs.

It is unclear if orgasm occurs in lower animals.

Q: (from a 46-year-old Pennsylvania male) With all the publicity associated with Viagra, several friends and I have discussed the product and our relative sexual function. You maybe interested in last long. We are all in our mid to late 40's, none of us suffer from hypertension or diabetes, we are not on medications. We are all married with children. We are perfectly functional, by that I mean we get erections and would never think of ourselves as impotent. But we have all aged. Our sex drive-libido is not as high. We all realize it comes with aging. What is much more of a disappointment is the diminished firmness of our erections. We all feel it is very noticeable and it is NOT in our heads. You maybe interested in how to keep a erection longer. It doesn't get as hard as it used to. We can't help but wonder if Viagra enhances blood flow to the penis for someone who doesn't get any erection, would Viagra have the potential to improve blood flow for someone whose blood flow has decreased with aging but is not impotent per se.

If you (or any of your friends) meet the definition of erectile dysfunction, that is, you have a consistent (for at least six months) inability to obtain or maintain and erection of sufficient quality for satisfactory sexual intercourse, then you may wish to undergo evaluation and treatment by a local MD.

There is such a condition as mild erectile dysfunction - you don't need to wait until the dysfunction is severe. Check out also natural ed remedies.

Q: (from a 26-year-old man in France) I'm 26 and I have not had many sexual experiments. Unfortunately it seems that every time I try with a new girl, I fail to obtain a real erection, though I have no problem obtaining a hard and stable erection via masturbation. Check out also low testosterone.

So I wonder if the overwhelming experiment of having pre-sex pleasures with a girl could handicap my capacity of having a real erection afterwards. Is it possible that too much excitation causes temporary impotence because of some organic reason. View herbal sexual enhancement?

And finally, of course, would Viagra help?

Is it possible that too much excitation causes temporary impotence because of some organic reason. View herbal sexual enhancement? Too much excitement may lead to release of adrenaline and early loss of your erections. Try and relax under circumstances with a new girlfriend or seek professional counseling from a sex therapist.

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