Marvin first noticed a problem after he and Caroline had been together for five years. “Almost overnight I stopped getting erections. It started out, it would just go soft quickly. Then, in the space of about two months, nothing.” Until this happened Marvin and Caroline had been enjoying, in her words, “a very full sex life.”

Marvin went to his doctor, and tests revealed no physical problem. The erection difficulty continued, and after several months Marvin’s physician recommended that he go to a sex therapy clinic at a nearby university. Their experience is just one example of sex therapy. Other therapists proceed with treatment differently.

Marvin and Caroline entered a structured, medical school-based sex therapy program which lasted for three months. Follow-up visits were available after they completed treatment. Each week, they had a session with their two therapists, a man and a woman. (The male-female sex therapy team is based on the ideas of Masters and Johnson. But recent research suggests that a single therapist—male or female—may be just as effective. And certainly, many successful therapists work alone.)

Thorough tests had found no physical cause for Marvin’s erection problem, so that part of the process was finished. Marvin and Caroline filled out questionnaires. They answered questions about their past and present sexual habits and about how they felt about certain types of sexual behavior. Then they were interviewed separately and the therapists discussed their answers in detail. In addition, the therapists obtained even more medical and personal information.

Some interesting facts emerged during the couple’s discussions with the therapists. Marvin realized his body was sending him a message: He was very uncomfortable about on-the-job developments, and said he was under a lot of stress. “My problem coincided almost exactly with a job change I wasn’t happy about.”

Upset about his work situation, Marvin had begun drinking heavily. He had been a social drinker for many years, without suffering any apparent ill effects. But as his unhappiness at work increased, his alcohol consumption did likewise. Obviously, adding large amounts of alcohol to this already-pressured situation just made his erection problem worse. But it wasn’t until he entered sex therapy that Marvin realized the extent of his self-sabotage.

Therapy helped him make these connections. But it did more for the couple. It improved their communication.

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If you are a regular bike rider and are experiencing numbness in your penis after a ride, you can halt—and reverse—any potential damage. One option is the recumbent bike. With its wide chair, all the rider’s body weight is supported by the sit bones, the bony protrusions of the pelvis. There are also new saddles available that take all pressure off the cavernosal artery. Some models have a wide hole running down the middle; others have a shorter nose. Both will protect you while you get the benefits of riding.

Taking care of the physical component of your life is vital if you want fulfilling sex, as is understanding the emotional underpinnings of your relationship. There is, however, one more part to the sexual fulfillment puzzle that you must be aware of if you are going to have the best sex of your life.

*135\138\8*

For five years, Jake had been taking long-lasting sublingual nitroglycerin daily. He knew he would be taking the pills for the rest of his life. But, overall, he was in fine health. His job kept him physically active, he was careful about his diet, and he avoided as much stress as he could. But he did have one very significant blight in his life—his life-saving medication was contributing to the gradual loss of firm erections. When he heard about a Viagra trial being conducted at a local clinic, he immediately volunteered.

Unfortunately, he wasn’t a suitable candidate. The study coordinator informed him that since he was using a nitrate medication and couldn’t switch to another medicine, he had to be barred from the study. Jake fit the sole exclusionary criterion for Viagra: anyone taking a nitrate-based drug cannot use Viagra. In combination with nitrates, the ED pill can produce a host of serious adverse effects in some individuals.

Luckily, a nurse told him that other oral medications were being developed and tested, and eventually he ended up in my office as part of the Vasomax trials. He was enormously relieved to find out that Vasomax has no known negative interaction with drugs, including the one he was taking.

Jake had a very positive response to Vasomax. He told me, “Having a heart condition doesn’t limit me in any way. I feel—and act—ten years younger. This is the best thing that could have happened to me.”

The fact that Jake took good care of himself helped him a lot. And the same holds true for all men. That’s why I developed my virility-enhancement program to make you look, feel, and perform better.

*107\183\8*

Currently, the Human Genome Project at the National Institutes of Health is unraveling the human genetic blueprint. In just a few years, researchers will be able to look at a man’s genetic background and then choose—or even design—a drug that will correct a drooping penis or boost a waning libido.

With the dawn of the new world of sexual medicine, a more immediate question has arisen. Should a man take the pill to improve erections if he doesn’t think he has ED? The issue can easily be sidestepped by saying that if a man takes the pill and his erections improve, then he had ED after all. The drug is restoring a state which would exist “naturally” if the man were free of ED. However, another way to view the issue is to ask whether the pill should be used by men with no erectile problems, as a recreational pleasure-enhancer. Who decides —the patient or the doctor?

Ultimately, they will share the decision. Making sex better denotes a hallmark in the history of modern medicine. Not so long ago, even a harmless activity like masturbation was regarded by the medical community as the first step on the road to madness. Today we can openly address sexual problems—which is the first step toward solving them. With the ED medications, we are on the next rung of the ladder. Medical science is beginning, right now, to turn erectile dysfunction into an archaic reference that will, in the near future, be as small a worry as smallpox is today.

*78\183\8*

Here are some important things to keep in mind when it comes to drugs and erection problems:

• Many different drugs can cause erection problems, including drugs too new to have been identified as problem causers yet.

• Different men have different degrees of sensitivity. A certain drug may not affect Joe but will leave Bill puzzled because he can’t get an erection.

• Drugs interact with each other. You can take drug A • alone with no erection problem. You can take drug B alone with no erection problem. But if you take A and B together you may find yourself unable to get an erection.

• A man’s tolerance for a certain medication may change over a period of time. Sometimes a man will take a drug for years, with no side effects. Then, suddenly, the drug will ruin his sex life. Drugs can be sneaky this way.

Cast a Critical Eye on Medications

It sounds incredible, but doctors have identified a common prescription eye medication, timolol maleate eye drops (Timoptic), as the possible culprit in some erection problems. A very small percentage of men using this drug experience erection problems and lack of sexual desire.

How many men may have had such problems and not reported it? Nobody knows. But the lesson is clear: If you develop an erection problem after taking any medication—pills, shots, ointment, eye drops—don’t keep it a secret. Tell your doctor, and find out if changing the dosage or the drug could restore potency.

*48\184\8*

Diarrhea should be considered abnormal when it is different from your usual bowel movement pattern. Even though it may come as a relief after many years of constipation, the experience of new diarrhea should be taken seriously. If it continues for more than three or four days or if it returns frequently, medical advice should be sought. Any degree of diarrhea that begins to interfere with the normal activities of your life or shows mucus or blood must be checked immediately.

One of the common causes of diarrhea is infection. Various viruses (“stomach flu”) and bacteria can infect your bowel and cause diarrhea. Usually you will have other evidence of infection, such as fever and abdominal pain. The diarrhea is usually short-lived and does not recur.

An older person also may suffer from inflammatory bowel disease, even though it is more common in younger people. The diarrhea is often combined with mucus and blood, and you may have other symptoms as well, such as fever. It usually persists, unlike infectious diarrhea, until properly diagnosed and treated.

Malabsorption may appear initially as loose bowel movements. It may take some time before you become aware of weight loss, which is usually associated with poor absorption and digestion of food.

If you have traveled a great deal or lived under unhygienic conditions, you may suffer from parasites, which can cause diarrhea. The diarrhea often contains red blood.

An often overlooked cause of diarrhea in older individuals is lactose intolerance, the result of a lack of the lactase enzyme that normally breaks up lactose, the sugar found in milk. Therefore, milk products are not properly digested and the sugar is fermented by the bacteria in the intestine. The symptoms include bloating, gas, abdominal cramps, and frequent loose bowel movements. You may notice that your symptoms often follow meals in which milk products are eaten. Remember, although you avoid milk, yogurt, and cheese, many packaged foods, including bread, contain milk.

Some people with lactose intolerance may spontaneously improve periodically and may be able to tolerate small amounts of milk products. However, after a bout of stomach flu, you may no longer be able to endure milk products and once again develop bowel symptoms.

If you overuse laxatives, you may develop diarrhea that alternates with constipation. This kind of diarrhea can be a result of excess laxative use and is very common in older people. You should avoid laxatives and seek advice from your physician.

With a bowel obstruction, sometimes the only material that can pass through the blockage is liquid stool, which appears as diarrhea. Medication may relieve the diarrhea but this only exaggerates the obstruction and is dangerous. Diarrhea that alternates with constipation should always be investigated thoroughly.

Because many possible reasons for diarrhea exist, there is no single effective treatment. The most important step is to find the underlying cause, and unless the diarrhea is clearly the result of a temporary problem such as flu, which can be expected to improve within a few days, diarrhea should not be treated with constipating agents except under medical supervision.

The short-term therapy consists of decreasing food intake and eating a primarily liquid diet. Soups, juices, and tea are recommended during the treatment of the kind of diarrhea that often occurs with bowel infections. If you are in the habit of taking laxatives, you should consult your physician about stopping them. If the diarrhea continues despite discontinuing laxatives, your physician should investigate the cause. This should be done without delay if the diarrhea persists.

*80\166\2*

As we age, less sleep may be required for the mind and body to work properly. For most individuals a sleep pattern is established early in life, and this usually continues into the later years. You may be used to going to bed at a certain hour, perhaps with your spouse or after a favorite television program. You expect to sleep until morning. On the other hand, some of your sleep requirements may be met by afternoon naps, which you may not think of as “sleep.”

Sleeping medications only temporarily improve sleep patterns. Most medications work when first taken, but gradually their effect wears off. This may lead you to take larger doses and stronger sleeping pills. Your physician may prescribe tranquilizers instead of sleeping pills in the hope of calming you into sleep. Tolerance to these drugs also diminishes and they lose their soporific effect. They often accumulate in the body and may lead to mental confusion, memory impairment, and dizziness. When stopped they often cause withdrawal reactions, making it difficult for you to discontinue them.

If you are taking sleeping pills, you should gradually try to discontinue them. Patterns of sleep can be relearned. You could try going to sleep much later than you usually do. A warm drink such as milk may be helpful in soothing your mind and body. Reading a book or listening to music can also have a calming effect. If sleep does not come easily, get out of bed and read, knit, or do something else, rather than lie in bed anxiously waiting to fall asleep.

You may have difficulty sleeping because of a medical problem. Arthritic pain, the need to go to the bathroom frequently, or shortness of breath can interfere with your sleep. But taking a sleeping pill will not help, and it may even aggravate some of your other symptoms. Sleep disturbance is a common symptom in people who suffer from depression. The problem may be one of falling asleep or of sleeping fitfully and waking up too early in the morning. Tranquilizers and sleeping pills usually make the depression worse.

When your sleep pattern has changed suddenly, your physician should pursue the cause. You should avoid taking a sleeping pill as a solution. Most people can enjoy a restful sleep without the use of tranquilizers and sleeping pills.

*73\166\2*

This procedure is done in the fasting state. Usually, the mouth and the back of the throat are treated with a local anesthetic. Many physicians use small doses of tranquilizers to make you feel less tense during the examination. This test should not be omitted on the basis of age alone. It can be done even on the very ill, and it may make the difference between an accurate and a “presumptive” diagnosis.

A full investigation of the gastrointestinal tract may include a rectal examination followed by a sigmoidoscopy and perhaps barium enema and barium swallow X-rays. Colonoscopy and gastroscopy may be required if the diagnosis is elusive. A set of gallbladder X-rays or echograms may confirm that symptoms are not arising in the biliary system rather than from the intestines.

*64\166\2*

You may wonder why your physician repeats X-rays. An X-ray not only is useful to make a diagnosis but also may be necessary to follow the outcome of treatment. For example, a chest X-ray, probably the most common, gives a picture of the heart and lungs. It can be used to diagnose heart failure or pneumonia and will probably be repeated on a number of occasions to make sure that the therapy has been successful.

Contrast X-rays require that a chemical substance be swallowed, injected, or given as an enema. The substances used for the “contrast” appear on the X-ray and are excreted or metabolized by the body later. They usually do not have side effects, unless you are allergic to iodine, which is contained in some of these substances. If you have had a reaction to iodine during an X-ray procedure in the past, inform your physician whenever an X-ray is ordered.

*57\166\2*

All the hypnotics are habit forming. Because their effects diminish in time, the sleep disorder may become aggravated. It is more important to discover the cause for the sleep disturbance and deal with it at its source, rather than changing hypnotics or increasing their dosage. They all can cause mental confusion.

Medications for emotional disturbances are frequently prescribed for older people. The use of minor tranquilizers, such as diazepam, has reached almost epidemic proportions. Although they occasionally may be helpful, for the most part they are taken excessively. Major tranquilizers are used for serious mental illness or in cases of severe agitation. The most common drugs of this group are the phenothiazines. Although they have a calming effect, they sometimes increase mental symptoms, and they can cause or aggravate the symptoms of Parkinson’s disease. They can also cause the blood pressure to fall, and some people develop abnormalities in liver function, which is reversible when the medication is stopped.

Antidepressant medications are beneficial for depressive illnesses, but they must be used with great discretion. Usually, a small dose is given and gradually increased in order to avoid side effects such as mental confusion and irregular heart rhythms. Some people complain of an excessively dry mouth, and this often occurs with phenothiazines as well.

Diabetes mellitus, a common ailment, improves with dietary changes. However, some people require insulin. This is more likely if the illness was acquired at an earlier age and if you are not overweight. The main problem with the use of insulin is excessive dosage, which may result in a hypoglycemic (low blood sugar) reaction. You will learn how to adjust your insulin dosage according to your diet and amount of exercise.

Some people benefit from hypoglycemic tablets, which increase the feeling of well-being and decrease the symptoms of diabetes. The two main families are the sulfonylureas and biguanides. Chlorpropamide, tolbutamide, glyburide, and glipizide are examples of commonly used hypoglycemic pills. Controversy has arisen over whether these medications should be used because some researchers think that they may increase the tendency to certain types of heart disease. This has not been verified, and their use appears to be safe and their effect beneficial in many individuals.

Your physician cannot be expected to know the details of every medication, and he will frequently consult his desk references for information. You can help your physician by knowing your own medications. You should know the family to which they belong and the reason they were prescribed. If possible, you should know the generic name and the dosage. Review your medications periodically with your physician. It is worthwhile bringing them in their containers to your doctor for a thorough review on each visit if you take many medications or from time to time if your medical conditions and medications are stable. It is your responsibility, as well as your physician’s, to use medications accurately and carefully to obtain the maximum benefit.

*49\166\2*