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

So with reference to this man, are there exercises that he can do? Any exercise which increases his cardiac output, the ability of his heart to pump blood, will be extremely helpful. That's No. 1. So if he started a swimming program or a jumping-rope program or a running or biking program, although I wouldn't bike excessively because you can theoretically injure some of the nerves that are actually going to the penis, so for this gentleman I don't think I would select biking as the aerobic exercise of choice. I think that he can do some squats, being careful not to use a lot of weights or maybe even no weights at all so that he is not injuring his knees. If he does exercises that involve the lower part of his body, involving the quadriceps and ham strings and lower back, you're going to promote blood flow to the pelvic region.

If he is able to exercise and lose weight at the same time, he's going to free up some testosterone which will now enhance his sexual performance and his libido.

On the last issue that he talked about, which was the question of the numbness that he is experiencing with sexual encounters, the gentleman may actually have a problem in the nerves of his lumbar spine. He may have a narrowing of the lumbar canal called lumbar stenosis which may be causing some compression of nerves during the sexual act. I think that it would be a good idea for him to see his local doctor and to pursue this.

There are now a large number of physicians who are now part of the Society for Sexual Medicine that have a particular interest.

Is the foreskin for an uncircumcised man supposed to freely move over the shaft of an erect penis or is it OK if it just comes behind the glans head? I feel that my erections are limited because of the fact that the foreskin constricts on a place on the erect shaft. Is there a solution other than surgery?

Once again, a very good question. There is a condition known as phimosis in which the skin really does not move freely and it can affect the quality of his erections. I think the best thing he can do is see the urologist. There is a very simple procedure to free up the skin from the glans and I think he will be more comfortable.

I am a 65-year-old man with a bad impotence problem. I have tried both Viagra and Cialis with poor results. Do you have any suggestions to improve my ability to achieve an erection? By the way, I do get erections when I'm asleep and occasionally even have wet dreams.

I think the good news is that clearly he is capable of having an erection. The issue is going to be what is the quality of that erection and is the rigidity firm enough for real penetration? But it is an extremely good sign that he is actually having these nocturnal erections. I am a little surprised that he is not responding to the Viagra or the Cialis or Levitra.

This man needs to be certain that:

  • He is using a sufficient dose. In other words, of Viagra I would use 100 milligrams, of Cialis I would use 20 milligrams, and of Levitra, which is a very potent agent, it might be very effective with 10-20 milligrams.
  • I would attempt to use it multiple times, especially with Viagra, before I deemed it as a failure. We know for example that men might not respond to the first few doses of Viagra, but after five or six doses, they may start to get a very, very good response. We know with a drug such as Levitra, a very potent agent, they generally will respond the first time and they will continue to respond with each subsequent time. So if the man has failed with Viagra, I would certainly consider Levitra and see what happens.

I think the other thing that people need to appreciate is that if you took, for example, the Viagra with a full meal, you might be diminishing its effect. With Levitra and with Cialis they are more food independent so you can eat your meal and then take the medicine and it would still be effective.

Also, a lot of men are rushing the act, which is that they take the medicine and they can't wait to start. Even though some of these medicines may work within 30 minutes and each of the pharmaceutical companies tries to do studies showing that their drug works very, very quickly, my best suggestion is to wait. Wait at least one to one and a half hours on a relatively empty meal before initiating and engaging in sexual encounters.

A lot of men don't appreciate that you actually need sexual stimulation for these drugs to work. Taking the medicine is not going to induce an erection. What the medicines do is facilitate an erection in an appropriate setting, so stimulation is absolutely necessary in order for the erection to occur. As men get older they actually need more sensory and physical stimulation in order to achieve an erection. You need to recruit more senses -- tactile, physical, mental imagery in order to achieve an erection, and a lot of men don't get enough stimulation.

This is something that I think is extremely important for women. They think because the man does not achieve an erection instantaneously as they come to bed or in a certain encounter that somehow it means they are not sexually appealing and the man is probably not interested, and that is not true. What this is really saying is I need more stimulation in order to achieve a proper erection.

So there are a lot of things this man can do:

  • Improve the way he is using the medications.
  • Appreciate that a lot more stimulation is necessary.
  • Have his testosterone checked because when the testosterone levels are very low, the oral medications may not work as effectively.
  • Try it at a different time of the day. I find that men are more potent in the morning, so an encounter early in the morning may be more effective for a variety of circadian rhythm explanations and biologic reasons.

By the way, any underlying medical condition needs to be corrected as well. Whether it's high blood pressure, high cholesterol, a mood disorder such as depression or some other medicine that may be having an adverse effect on the medication, a beta blocker or something like that -- they have to be corrected as well. If all of these changes do not work, then another intervention would be the injection of a vasoactive medicine directly into the penis. I know it sounds barbaric but it's actually painless and this can be extremely effective. This may be something that the man and his partner find perfectly acceptable.

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