Sexual Fitness for Men: The Hardness Factor

Last Editorial Review: 8/19/2005

WebMD Live Events Transcript

"The harder the erection, the healthier the man." Is the penis a barometer of a man's health? Steven Lamm, MD, says that great sex can only come with great health and that once men understand the connection between health and virility, they will take better care of themselves. For men who want to achieve peak sexual health -- and the partners who love them -- Lamm shared his advice for health and hardness on July 13, 2005.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome to WebMD live, Dr. Lamm. Thank you for joining us today.

Thanks for the opportunity.

Doctor, the link between overall health and a man's sexual health seems obvious but it's so often overlooked by men. Why?

I think that most men have actually not connected those dots. They actually have the misconception or misperception that somehow they can abuse their body but somehow the one organ that they value the most, their genitals, will somehow not be affected by the abuse. I think in general men abuse their bodies and they are not very proactive.

We are trying to capture a gender, trying to capture the male species because from all the recent data and all the recent research, it appears as though we are an endangered species. We are dying of diseases that we need not be dying from, such as diabetes, excessive obesity and the metabolic syndrome as it's called, hypertension, sleep apnea syndrome, depression and suicide. We know about the longevity of males vs. females and we know that men are dying at a younger age for a variety of reasons. There is one thing for certain -- men are not proactive.

The whole reason and purpose of writing the book was, and is primarily, to make it very clear to men that there is a very, very important relationship between their overall health, their overall lifestyle, and their sexual performance. I think it's ultimately going to be the best and strongest hook we can possibly have to change a man's perspective about his health.

I think that the data with reference to the overall health issue and sexual performance has not really been known for as long as you might think. It actually started with the introduction of the revolution in male sexuality with the introduction of Viagra, when the data started becoming clear that the majority of men who suffer erectile problems actually have a biologic basis for it. Prior to the introduction of Viagra and then Levitra and Cialis, the pervasive thought was that 80% of erectile problems or issues were psychological and only 20% were organic or structural or vascular. That has completely been flipped around to the fact that we really do appreciate that it's the comorbidity -- the diabetes, smoking, obesity -- that is actually the basis for the changes in erection function.

That's another point that I'm trying to make in our book, which is that we have to move away a little bit from the idea of erectile dysfunction just as we moved away from the term impotency because it's not politically correct and it implies things about the person that we don't need to imply. We're raising the new issue of erection quality, called EQ. That's an easier concept for the average young man and the average woman to understand.

Erections change over time, they change with every decade of a man's life, as every other organ changes. That organ has to age and be affected by illness and vascular disease and stress as any other organ. So we're actually trying to educate the public in understanding that erection quality changes and the knowledge and awareness of what these changes are can be very helpful for a man and certainly very helpful for a woman.

How do you measure the quality of an erection?

That's an extremely good question! In the past, we basically had a questionnaire. This is a questionnaire that is standardized and it's a whole host of questions. There's a long form and a short form to the questionnaire. Men would basically be put in a room and we ask them: How confident are you in your erection? How confident are you that you can complete a sexual encounter? It contained a whole host of different questions -- questions about their libido and about their interest in sex, and that was basically it. There were no objective or very few objective ways of measuring the erection.

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. Rosselló. 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. Rosselló 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.

I think you achieved it. How about explaining for our audience just exactly what The Hardness Factor program is.

In publishing, and in the real world, people like to have something that they can measure and some progress that they can make. In some of the other books that I have written we sort of didn't give them a program, we basically just said here are the facts and this is what you need to do. We wanted to make it easy for men and we wanted to be able to say to them, if you follow what we're suggesting, you will be able to have a noticeable change in your sexual performance over a period of let's say six weeks. And you might even see a change within four to five days if you really are paying attention. What we wanted to do was to launch men into a new lifestyle. It takes six weeks to change people's habits; we know that in areas of addiction and other areas.

What we really did was create this six-week program in which we gradually seduced men to change what they are doing. This really is seduction -- it should have been called the Trojan Horse to tell you the truth. What we're basically saying is: Guys, this is not that difficult. If you're starting at ground zero, or before ground zero, maybe you just need to start walking, maybe just reduce the amount of food you're eating by a small amount, maybe we need to change what you're actually eating.

We sort of created this sensuous eating program because we appreciated, at least I appreciated, that the senses one uses in the bedroom to be a great lover are the same senses that you actually use while you're eating. You need to be able to have a sense of smell and taste and texture and you have to have visual capacity. Those are the same senses that you're using when you're eating, so why not take advantage and prime those senses? I asked Waldy Malouf if he would come up with some really healthy recipes that were a bit spicier and that would challenge a man's palate and he could transfer those senses in another venue. He really came up with just unbelievable kinds of foods. I had the privilege of cooking with him so that we could show the world that even somebody, such as myself, who is really not a cook in anyway (my wife will attest to that) can actually do some of these preparations.

We're trying to make it easy for guys. We're saying over the six-week period: reduce your calorie intake a little bit or start doing some stretching, because sex is a physical act. You have to be physically fit in order to perform at the highest level. It doesn't require a lot of energy expenditure, believe it or not, to actually have sex, but there is a certain amount of endurance and physical fitness that's required. So we wanted to say to the man: if you want to go play tennis in six weeks, don't you think you need to put your body in a certain kind of physical shape in order to play tennis? You're just not going to decide you're going to play singles after you have been sedentary.

So we're making it simple for the guys and I think that there will be an appreciable, measurable change in their own sense of their sexual performance. What does that really mean? It's a concept that I think will be extremely clear to men -- a man knows and a man appreciates the confidence that he may or may not have with reference to the ability to achieve an erection, to maintain an erection and to maintain rigidity of the erection throughout the sexual encounter. They know how comfortable and how confident they really are. I am confident that over a period of six weeks, eight weeks, 12 weeks, they will clearly see an enhancement in their performance by following some extremely simple, logical and healthy interventions.

I forgot, by the way, to incorporate the supplements that we wrote about in the book and they are very simple. We're talking about products such as Pycnogenol, which is an antioxidant that's been around for 30 or 40 years and there's more evident basis for this product than any I have seen. There is also arginine, which is an amino acid which facilitates the production of a gas called nitrous oxide -- responsible for the blood vessels to dilate and open up. Omega-3s which you know you get from the big fish; I wish they didn't also have mercury in them, but omega-3s are extremely important for the integrity of blood vessels and platelets. We talked about some funny supplements. Tthere's a Pinnacle product called horny goat weed, an herb from China that seems to make men a little more "randy" -- there may be a testosterone-like effect for those that have a libido issue as a result of either a drop in their testosterone or stress or depression. There are a few supplements that I think can facilitate the process.

But my real message is that a relatively simple lifestyle change can make an enormous difference in the preservation of the erectile performance.

"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."

I'm 42 and I want to know if there are exercises to improve blood flow and strengthen erection. Another concern of mine is the loss of sensation around the head of my penis during intercourse that keeps me from being able to ejaculate. Does this have anything to do with hardness?

I think as you can see and as you have read, here is a relatively young man, 42 years old. In my office I'll see men 32 years old with very, very similar concerns and questions. These men are really part of the silent majority, which is they don't really have an opportunity to share their concerns with anybody. They certainly don't talk about it to other men because other men are not interested, nor are they knowledgeable with reference to what to do about it. Men talk to each other about sexual encounters, not about sexual performance. They may actually be even kind of rebuffed by their family doctor who also may not be particularly interested or feel awkward about the subject. So this kind of forum I think is extremely important. For this man, his sexual performance is a major contributor to the quality of his life and probably the quality of his partner's life. So we now have a condition that affects two people, not just one person.

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.

If that doesn't work, then an actual penile implant can be inserted. They are very sophisticated right now and there are thousands and thousands of men who have had a terrific result with these implants.

So, basically I can say that 100% of men who really, really want an erection can achieve an erection.

"If you don't sleep, you're not going to perform or function cognitively or sexually in my opinion."

Well, given that your goal is to get men to take care of their overall health and to deal with any underlying issues, and that it's almost as if sexual health is a reward for taking good care of yourself, what role do you see for medications like Cialis and Levitra and Viagra? How do they fit in with your program? Bluntly, we all tend to think, I don't want to do the hard work, I'm just going to pop a pill and it will make everything work like magic.

You're making this too easy for me! The Hardness Factor is primarily, as you said, a health book to try to get men to take better care of themselves so that they can maintain or enhance their erections. If they elect not to read this book and they elect to live a lifestyle which is injurious to their blood vessels, they are going to need at some point in their life a restoration -- a rescue medication. I view Viagra, Levitra and Cialis as rescue medicines.

Now, these medicines are extremely effective and extremely safe, however they are not treating the underlying comorbidity that is responsible for the problem. They are not lowering cholesterol, not lowering blood pressure effectively, not affecting testosterone levels and not treating depression. They are an effective band-aid but they are not treating any underlying problem.

I think it's extremely important for men who have erectile problems to appreciate that they can get help and that the medications are very effective and very safe. But they need to go to the doctor, at any age, so a program can be established -- a program of weight loss, control of blood pressure or smoke cessation in conjunction with these powerful and effective and safe medicines.

You talk about something in your book called the "4-Day Insurance Policy." It even says: Open only in case of emergency. The Hardness Factor 4-Day Insurance Policy enhances hardness in only four days. You look at it as an emergency kind of program, but I looked at it and thought perhaps this would give someone a sample of what they can do if they actually stuck with the program long term.

I think you're right. I realize that you can't alter a serious biologic problem in four or five days -- you can hardly do it over six weeks. But we wanted to really stress to men that even over a four- or five-day period, you can alter your biology. You can make your blood vessels more reactive, more responsive than you can imagine.

The example was if a man came to my office on Monday and said to me, "I've got to play basketball on Friday night with my teenage son and I would rather not kill myself on Friday, you know, do you have any suggestions?" I can't make him necessarily a better basketball player by Friday, but I could say to him, "Between now and Friday, let's start doing some stretching exercises, some running in place, you know, let's get a little bit more limber, let's avoid that six-pack of beer over the next four or five days."

We can actually start to get you functioning at a higher level over a very short period of time. For example, the supplements, they are going to start working right away.

If you're severely impaired you already are in the restoration business rather than in the maintenance or enhancement business. You're going to really have to go to the doctor and unfortunately you're going to need medications. But if you're otherwise just the typical American male who is not really taking good care of himself, we are very confident that even over a four- or five-day period you can see a noticeable change which will of course, only increase and be augmented over a period of six weeks. It's a tease but it's basically saying come on guys, let's start making some changes.

What are some of those changes?

First thing is reduce your portions -- start having less to eat. Let's reduce the fat in your diet. When you eat fat, what you're basically doing is stunning your blood vessels. If you stun the blood vessels, they can't open and close and they can't be as elastic as they would be under normal circumstances. If you draw blood on somebody who has had a big meal, the blood is milky, it's opaque. That's due to the triglycerides that are circulating. You want to try to reduce the total amount of fat and sugar in the diet.

You want to start to use some of the antioxidants, the Pycnogenol, the arginine, the omega-3s. And niacin is a fantastic substance that raises your good cholesterol and lowers your bad cholesterol.

Have some green tea, probably the healthiest drink I know of. Start doing some of the exercises that we talked about, the cobra, the stuff that starts just exciting your muscles a little bit.

I think that with a little bit of the supplements, with a reduction in your calorie intake, with a better selection of foods, certainly if you're smoking, what an opportunity to stop because that's going to make the greatest impact. Also get some sleep -- sleep is as necessary as food and water but men just don't think that they need it. If you don't sleep, you're not going to perform or function cognitively or sexually in my opinion.

That's an example of what you can quickly do over a four- or five-day period.

What can a woman do to help her husband or her partner? What can anyone do to help their partner get more into this program and get more out of this program?

I think that women really are the victors in this gender battle and women are clearly the caretakers and the leading force around health care and around a lot of other things. I really think that men are becoming irrelevant in our society and unless they can respond to a book of this nature, we can only prove that they are irrelevant. If you can't get them motivated to change with reference to this subject, men really have a bad problem.

I think that women can basically appreciate that sexuality and an erection is a very, very important aspect of a man's being. She has to really understand that very, very clearly. And, she must appreciate that there is a link between the man's health and the quality of his erection. That can be a motivating force when the woman says, "Look, I have noticed that there is kind of a change in either your interest in sex or in the actual hardness of your penis and I'm concerned about your health. I read Dr. Lamm's book and I think this can be fixed. Sex is as important for me as it is for you, so I'd like to make an appointment with the doctor for you and I'd like you to read the book. I'd like you to start to make some changes."

I think that a woman can really direct the man. We knew in the long run that the success of this book would be based on whether we can get enough young women to buy this book, to read this book, and to make changes in their men. We also knew that it would be very important for young men to read this book as well, but women are critical in this venture to get men to change. I think that they are. Women do kind of find the book interesting because you want to know your enemy, you want to know your enemy and you want to know things about erections, just as men want to know about female hot spots. I think this is very important for women.

My husband has had difficulty getting an erection only when having sex with me. He blames it on noises, his head won't get in the game or my lack of interest. Yet he masturbates every morning and has no problem doing himself. Is this a symptom of erectile dysfunction or is it personal? We're so frustrated we hardly try anymore so we won't hurt each other's feelings.

"It appears as though the men who have more regular sex seem to be healthier and seem to live longer."

This is a very sad email to me because this is what you see over and over again, in which any kind of interference in a normal sexual relationship between two partners results in an estrangement and a distancing and anger. This is a condition that affects more than one person, as you can see, and unless this young lady can effect a change in her relationship and a better understanding of sexuality, I would be skeptical whether this relationship will last. My suggestions are the following:

  • I would suggest that the man stop masturbating on a daily basis because, not that masturbation is in itself harmful, but it's harmful for this relationship because it diminishes the man's drive and interest in having sex with his partner. It's probably a statement of anger or resentment or some underlying psychological issue.
  • I think that the main problem is a relationship problem. They are clearly not communicating effectively. Silence, in this particular case, or avoidance, is not going to solve this problem; it's going to make this problem a lot worse, in my opinion. I would suggest that they go for couples' therapy, go to their family doctor.
  • She can go to her gynecologist to find out if there are any issues affecting her. We didn't talk about the whole gamut of female sexual problems that I would be privileged to speak about at a future opportunity.

This couple needs a lot of help and my wish is that they go and get it. I hope they go to the doctor. I know that the erectile issue, if there is any, can easily be dealt with but I think it's the relationship that's having the problem.

Sometimes that's the hardest thing to sort out, whether it's a physical problem or relationship problem.

It's interesting. We call this The Hardness Factor , we didn't call it The Intimacy Solution if you notice. Relationships are much more complicated, much more difficult to deal with than --believe it or not -- erections. The erections are easy; it's the relationships that are so difficult.

Has there ever been a study done comparing men who have had an active sex life, five or more times a week, and those who have sex about one to two times a month, to see if there's any correlation between activity and erectile dysfunction over an extended period of time?

Good question and good news. It appears as though the men who have more regular sex seem to be healthier and seem to live longer. That may be a product of a fact that they are capable of having sex more often and so they are healthier by definition. But there is a study in Wales that showed the men having regular sex actually lived significantly longer than the men who were having it much less frequently. There's the good news -- good sex may actually cause good health and the reverse may be true as well.

So your statement that the penis is the barometer of a man's health has been proven true?

I don't think it's been proven, but it's still my hypothesis and I'm hoping that the statement itself is so provocative that it will get men to appreciate that the performance and functioning of their penis reflects enormously on their overall state and if a man wants to have a high functioning penis, it's very important for him to function at a very high health level. As one of the editors of Harper Collins said, and I'm really appreciative of all their enormous efforts in support of this book, "Dr. Lamm, you're going to make good health sexy." That's really what my goal is.

Good goal! We're all about good health here at WebMD.

Can certain foods really help your sex life?

Here's the way I put it -- I think that certain foods can really harm your sex life, that's for certain.

Excessive alcohol, excessive fat and just excessive calories probably are very, very destructive. On the other hand, if you enrich your diet with foods of color -- green, orange, red, fruits, vegetables, fiber -- I think you are actually going to enhance the quality of your health and subsequently, the quality of your sex life. So my answer is yes.

I don't think you want to think in terms of "aphrodisiacs" -- foods that somehow enhance your interest in sex. Clearly over the last century people have written about certain foods that have a very phallic appearance, whether they are artichokes or oysters or celery or cucumbers. Those just happen to be healthy foods and some have substances that may be healthy for you but not necessarily aphrodisiac.

If there is one food that may be actually somewhat sexually stimulating it would probably be chocolate, but I would not overdo it.

I'm sure there are plenty of women who would agree with you about chocolate as an aphrodisiac food -- lots of women.

"I really hope that with some of the simple lifestyle changes that I have introduced in this book, we can start a new era of awareness of men's health."

Will your program work for men of all ages?

The answer is absolutely. It will work for all men of all ages at all times -- it's a health book. I think that the younger the man, the less damage has occurred, the greater capacity for restoration and for enhancement. As a man gets older, his blood vessels get stiffer, there's more plaque and more work will be required. I'm hoping to stay preserved into my 90s.

Certainly maintaining a proper weight is a big portion of this program, correct?

Absolutely. I think that when we look at the cause for disease in our country, the two leading causes are obesity and smoking. Obesity is a much more complex condition than smoking and even more difficult to attack. I think that should be one of the primary missions of our society -- to try to reduce the body mass index and body fat levels and increase physical activity. These are the simplest interventions that can save our country millions and millions of dollars.

Doctor Lamm, we're almost out of time. Before we wrap things up for today, do you have any final comments for us?

The statements I would really like to make, I think you have given me an opportunity to do so already with the nature of the questions and the emails.

What I want to be able to say in this book is that men really are relevant in our society and they really do need to understand that when there are issues that affect a man, they can respond. A book of this nature can alter, hopefully, a man's perception of his sexuality and his overall health, and give him the knowledge that he can really make a difference for not only himself but for his partner and his family. I really hope that with some of the simple lifestyle changes that I have introduced in this book, we can start a new era of awareness of men's health.

Thank you so much for joining us, Dr. Lamm.

For more information, please read The Hardness Factor by Steven Lamm and visit his web site at

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