Sexual Fitness for Men: The Hardness Factor (cont.)

For a while physicians were using a device where they would place the device around the penis at night and see whether the penis actually expanded during certain forms of sleep known as REM sleep, where it is normal and appropriate for a man to have an erection even though it's not really a sexual erection since the man is paralyzed at the time during the sleep. So he is obviously not doing anything with the erection, but it's a biologic, physiologic marker of the capacity to have an erection.

A few years ago I encountered a very well-known physician in Spain. His name is Dr. Rossell. He has been a well-known urologist in Europe for many years with a very, very strong interest in what we call andrology and sexual medicine. Dr. Rossell has done more penile implants than probably any other doctor in Europe. He came up with a device, which is an FDA-approved device, called a Digital Inflection Rigidometer (DIR). It's a handheld device that you program for each patient with a head which is disposable. You give it to the gentleman and ask him to go home and to induce an erection the old-fashioned way. Then you press the device up against the penis for five seconds -- it's painless. It records what we call the axial rigidity of the penis.

We now know that you need 500 grams of axial rigidity to penetrate during intercourse. For comparison, a 15-year-old man might have a rigidity of 2,000. With every decade those numbers start to decline and they will decline precipitously in smokers and in diabetics and people with underlying medical problems. What will happen is, you might on your best day be 700, which should be good enough for penetration. You have a bad day -- the stock market goes down, you're worried about your child, something happens at work -- and now the biologic forces drive the rigidity down to 400 and you're just not able to perform. So we now can actually measure the rigidity and for me as a physician, what it basically did was it gave me some insight into the changing performance of men with disease process. It also gives me an opportunity to study the effect of medications, whether it is testosterone or Cialis or Levitra on the rigidity of the penis.

"I think that my whole goal now is to ensure that every man have an erection every day of his life."

Is this loss of axial rigidity through the years inevitable? Is there anything a man can do to improve his odds?

Yes, and once again a terrific question. It is not inevitable and it is not necessarily associated with aging. It is simply very common because we basically subject our bodies to a lot of injury as a result of life -- whether it's excessive eating and smoking and sleep problems, maybe even some medications that we might be taking for other causes. But there is no doubt that a man who preserves his body -- and hopefully he can preserve his body as well as he preserves his car with rotating the tires and changing the filters and doing whatever else you need to do to keep your car going -- if you do the same for the body, you can preserve yourself and you can function at extremely high levels into your 80s.

I think that my whole goal now is to ensure that every man have an erection every day of his life. I say that kind of in a joking way and it's not intended to mean that he needs to be having sex every day in his life, it means that he should be biologically healthy enough to have an erection every day of his life because that would imply the integrity of his blood vessels, his nerves, his hormones and his brain. That's what the goal really is, and I think that it's a good goal because I think it's one that is achievable, believe it or not. I think it's also one that can be a very powerful motivating and driving force for the average man. I cannot imagine a more powerful force as a man than to be able to say, if I stop smoking, if I start exercising, if I reduce my caloric intake and try to reduce body fat, that the collateral benefit will be an enhanced erection. It's a pretty powerful message to young people.

It should be a powerful message to all men.

I agree with you. When we wrote the book we wanted to be certain that men didn't misinterpret this as being for men who were already severely affected by erectile problems, but rather we wanted to get the attention of 16-year-olds and 30-year-olds. I'm happy to say that two of my boys, one in San Diego who is 28 and the other 21, have stopped smoking as a result of this book and maybe the realization that it's just not a good thing, but it certainly it precipitated their stopping.

I have to tell you that sharing the book with some of the men in my life of a variety of ages and letting them take a look at it, and all of the funny jokes in there, has gotten them thinking about the connection between their overall health and what they may be able to do in bed.

That's exactly what I love hearing about. We did create humor because I do know how to deal with men. I understand that men do find that this can be an intimidating subject and to address it with humor is something that makes it easier for men.

We have this world-class cartoonist from the New Yorker -- Jonny Cohen. And a world-class chef from the Beacon Restaurant in New York -- Waldy Malouf. Together we did the best we could in really creating a book that would hopefully be enduring and would really just not be a sex book, but rather be a health manual that can change a generation of men and get them to take better care of themselves. That's what our real goal is.

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