For a country that is often characterized as sex-obsessed, many Americans are surprisingly naive and ill-informed about certain basic aspects of sexual health. While it may well be true that as a people we spend a lot of time thinking about sex, it seems that we don’t always get all the facts straight.
A case in point, of course, is erectile function, which until the advent of Viagra and the other popular impotence drugs that followed was the subject of considerable misinformation. Not the least of the many myths surrounding impotence was the widespread belief that psychological factors were the primary cause of erection problems.
1. Blood Flow Is Key
We now know that the vast majority of difficulties in getting and keeping an erection can be blamed on insufficient blood supply to the penis. However, psychological factors do account for some erection problems, particularly among younger men, but it is estimated that only about 20 percent of impotence can be attributed to mental and emotional issues.
A recent article posted on the website of UC San Diego Health System shines a spotlight on some of the misunderstandings and myths surrounding aspects of impotence and other issues of male sexual health. Offering valuable insights on some of these matters is Mike Hsieh, M.D., director of UC San Diego’s Male Fertility and Sexual Health Program.
2. ED and Cardiovascular Disease
Dr. Hsieh points out that many men aren’t really aware that erection problems are an early sign of cardiovascular disease and, as such, an important warning that a heart attack or stroke might be in their future if they fail to take remedial action. The blood vessels that supply the penis are significantly smaller than those that carry life-sustaining oxygen to the heart and brain. However, if those smaller vessels are beginning to clog up, it’s usually only a matter of time before similar problems occur in bigger blood vessels.
Taking quick action to make wiser lifestyle choices in many cases can reduce the severity of impotence symptoms and prevent a heart attack or stroke. Major risk factors for both erection problems and cardiovascular disease, says Dr. Hsieh, are obesity, diabetes, a sedentary lifestyle, high blood pressure, and smoking.
3. ¨Manopause¨ and Its Effects
Although its changes might be somewhat more subtle, according to Dr. Hsieh, almost all men will undergo andropause, the male equivalent of menopause that is sometimes jokingly referred to as ¨manopause.¨ As in women, this series of changes is linked to an age-related decline in sex hormone production. Its symptoms in men vary, says Dr. Hsieh. ¨Some men experience irritability, fatigue, weight gain, low sex drive and erectile dysfunction. Some don’t.”
4. Effects of Cancer Treatment
Most men — and women as well — are unaware that almost all forms of cancer treatment can have sexual side effects, according to Dr. Hsieh. Because chemotherapy by design targets cells with robust replication rates, it can damage not only cancer cells, which are its primary target, but also hair follicle cells and sperm cells. As a result, sperm production is often profoundly affected.
Radiation therapy or surgery in the pelvic region can damage delicate nerves or alter the blood supply to sexual organs, and the very stress of cancer’s presence can cause hormonal imbalances, which in some cases may interfere with sexual function and fertility.
Dr. Hsieh says that UCSD Health System recommends ¨fertility preservation for all men and women who have been diagnosed with cancer and want to have children.¨ For women, this process generally involves harvesting a number of their eggs and freezing them for future use. In men, the process involves freezing sperm or testicular tissue.
5. Vasectomies 95% Reversible
Dr. Hsieh has some good news for men who may have had vasectomies but later decided that they wanted to father another child. A man continues to produce sperm even after the vasectomy procedure, and if a decision is made to reverse the process within 10 years after the vasectomy, chances are good that the tube that was either cut or clamped during the procedure can be successfully reconnected, he says.
Dr. Hsieh, who is an expert on the vasectomy reversal procedure, explains that it is done under a microscope with sutures as fine as eyelashes. Vasectomy reversal is expensive — $8,000 to $9,000 — and it’s not generally covered by insurance.
6. Side Effect of Testosterone Supplementation
Athletes and bodybuilders who take testosterone supplements as part of their efforts to bulk up and increase strength run the risk of shutting down sperm production, obviously an unwelcome side effect for men who want to start or grow a family. Noting that ¨giving a man testosterone is like giving him birth control,¨ Dr. Hsieh explains that the brain is constantly monitoring testosterone levels, and if it detects adequate levels of the hormone, it directs the testicles to stop sperm production.
In some cases, the damage can be permanent, says Dr. Hsieh. Some men who have taken performance-enhancing drugs over an extended period of time may find that sperm production never returns to normal levels once they’ve stopped using the performance enhancers.
7. Incidence of Infertility
Contrary to popular belief, says Dr. Hsieh, men are just as likely to have fertility issues as women, and the older a man gets the more likely he is to experience decreased sperm production and quality. ¨A 50-year-old man is not as fertile as a 30-year-old. That’s the take-home message.¨ For a man who is contemplating fathering a child at an advanced age, this means that not only may he have difficulty impregnating his partner, but a child born of such a union has a higher risk of genetic problems, due largely to the degraded quality of the father’s sperm.
Although advancing age has negative effects on sperm production and sperm quality, it is hardly the only cause of infertility, says Dr. Hsieh. Other factors that can lower sperm counts, impair sperm motility, or cause dysfunctional sperm shape include hormonal imbalances, genetic problems, and anatomical blockages.
8. Impotence and Aging
Among the most firmly entrenched misconceptions about erection problems is the belief that they are an inevitable consequence of advancing age. While it certainly is true that the incidence of impotence increases among older men, that is more a reflection of the consequences of bad lifestyle choices they have made and followed over a number of years. Men who eat a healthy diet, stay active, drink alcohol in moderation, and don’t smoke can remain sexually active well into their golden years. By contrast, men in their 30s and 40s who fail to take care of their overall health may very well find themselves facing erection problems at a relatively early age.
Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.
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