What are sexual problems?
A sexual problem means that sex is not satisfying or positive for you. In women, common sexual problems include feeling little or no interest in sex, having problems getting aroused, or having trouble with orgasm. For some women, pain during intercourse is a problem.
Most women have a sexual problem at one time or another. For some women, the problem is ongoing. But your symptoms are only a sexual problem if they bother you or cause problems in your relationship.
There is no "normal" level of sexual response, because it is different for every woman. You may also find that what is normal at one stage of your life changes at another stage or age. For example, it's common for an exhausted mother of a baby to have little interest in sex. And it's common for both women and men to have less intense sex drives as they age. This is linked in part to hormone changes in the body.
What are some causes of sexual problems in women?
Female sexuality is complex. At its core is a need for closeness and intimacy. Women also have physical needs. When there is a problem in either the emotional or physical part of your life, you can have sexual problems.
Some common causes include:
Emotional causes, such as stress, relationship problems, depression or anxiety, a memory of sexual trauma, and unhappiness with your body.
Physical causes, such as hormone problems, pain from an injury or other problem, and certain conditions such as diabetes or arthritis.
Aging, which can cause changes in the vagina, such as dryness and stiffening.
Certain medicines that can cause sexual problems. These include medicines for depression, blood pressure, and diabetes.
What are the symptoms?
Sexual problems can include:
Having less desire for sex.
Having trouble feeling aroused.
Not being able to have an orgasm.
Having pain during intercourse.
How are sexual problems in women diagnosed?
Women often recognize a sexual problem when they notice a change in desire or sexual satisfaction. When this happens, it helps to look at what is and isn't working in the body and in life. For example:
Are you ill, or do you take a medicine that can lower your sexual desire or response?
Are you stressed or often very tired?
Do you have a caring, respectful connection with a partner?
Do you and your partner have the time and privacy to relax together?
Do you have painful memories about sex or intimacy?
Your doctor can help you decide what to do. He or she will ask questions, do a physical exam, and talk to you about possible causes.
Some women find it hard to talk to their doctor about sexual problems at first. Sometimes it helps to write out what you want to say beforehand. For example, you could say something like "For the past few months, I haven't enjoyed sex as much as I used to." Or you could say "Ever since I started taking that medicine, I haven't felt like having sex."
Wednesday, April 29, 2009
Sexual Health: Sexual Problems in Men
A sexual problem, or sexual dysfunction, refers to a problem during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle has four phases: excitement, plateau, orgasm, and resolution.
While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.
What Causes Sexual Problems?
Sexual dysfunction can be a result of a physical or psychological problem.
Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.
Who Is Affected by Sexual Problems?
Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.
How Do Sexual Problems Affect Men?
The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.
What Are Ejaculation Disorders?
There are different types of ejaculation disorders, including:
Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.
Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.
Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.
In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.
Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.
While research suggests that sexual dysfunction is common (43% of women and 31% of men report some degree of difficulty), it is a topic that many people are hesitant to discuss. Fortunately, most cases of sexual dysfunction are treatable, so it is important to share your concerns with your partner and doctor.
What Causes Sexual Problems?
Sexual dysfunction can be a result of a physical or psychological problem.
Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of certain medications, including some antidepressant drugs, can affect sexual desire and function.
Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, and the effects of a past sexual trauma.
Who Is Affected by Sexual Problems?
Both men and women are affected by sexual problems. Sexual problems occur in adults of all ages. Among those commonly affected are those in the geriatric population, which may be related to a decline in health associated with aging.
How Do Sexual Problems Affect Men?
The most common sexual problems in men are ejaculation disorders, erectile dysfunction, and inhibited sexual desire.
What Are Ejaculation Disorders?
There are different types of ejaculation disorders, including:
Premature ejaculation -- This refers to ejaculation that occurs before or soon after penetration.
Inhibited or retarded ejaculation -- This is when ejaculation is slow to occur.
Retrograde ejaculation -- This occurs when, at orgasm, the ejaculate is forced back into the bladder rather than through the urethra and out the end of the penis.
In some cases, premature and inhibited ejaculation are caused by a lack of attraction for a partner, past traumatic events and psychological factors, including a strict religious background that causes the person to view sex as sinful. Premature ejaculation, the most common form of sexual dysfunction in men, often is due to nervousness over how well he will perform during sex. Certain drugs, including some anti-depressants, may affect ejaculation, as can nerve damage to the spinal cord or back.
Retrograde ejaculation is common in males with diabetes who suffer from diabetic neuropathy (nerve damage). This is due to problems with the nerves in the bladder and the bladder neck that allow the ejaculate to flow backward and into the bladder. In other men, retrograde ejaculation occurs after operations on the bladder neck or prostate, or after certain abdominal operations. In addition, certain medications, particularly those used to treat mood disorders, may cause problems with ejaculation. This generally does not require treatment unless it impairs fertility.
Sex Therapy & Other Counseling
If the problem is one of lack of knowledge, your health care provider or a sex therapist can teach you (and your partner) about the sexual response cycle and the elements of sexual stimulation. Armed with this new knowledge, many couples can go forward on their own.
Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems.
For some women these problems are fairly clear, including past sexual or other abuse, rape, or traumatic sexual encounters.
For others, the problems may be less clear-cut, involving unresolved emotional issues or dissatisfaction with other areas of life.
In either case, the therapist usually focuses on resetting the woman's attitudes toward sex.
The goal is to get rid of old attitudes that got in the way of enjoyable sex, establishing new attitudes that increase sexual responsiveness.
If the problem relates to your relationship, couples counseling is recommended. (You don't have to be married to go to a "marriage counselor.")
The couples therapist is trained and experienced at helping couples recognize, understand, and solve their problems.
First, the counselor explores the relationship to find the trouble spots.
The counselor will recommend exercises and activities that will improve the couple's communication and trust.
If that can be accomplished, often the sexual problem can be solved more easily.
Sex Therapy
A sex therapist may take couples therapy one step further by focusing on the couple's physical relationship. After identifying the couple's attitudes about sex and the sexual problem, the sex therapist recommends specific exercises to re-focus the couple's attention and expectations. Specific objectives may include any of the following:
Learning to relax and eliminate distractions
Learning to communicate in a positive way what you would like
Learning nonsexual touching techniques
Increasing or enhancing sexual stimulation
Minimizing pain during intercourse
Sex therapists often use what are called "sensate focus" exercises to treat sexual problems. The exercises start with nonsexual touching and encourage both partners to express how they like to be touched. The goal is to help both partners understand how to recognize and communicate their preferences.
Sex therapists can recommend exercises to help with vaginismus.
One successful technique is the use of Kegel exercises. Many women are familiar with these from their childbirth education classes. Kegel exercises involve voluntary contraction and relaxation of the muscles around the opening of the vagina. Women do this instinctively when they need to urinate at an inconvenient time.
Some women have been helped by using dilators to relax the vaginal spasms. A small dilator is placed in the vagina for 10 minutes, then removed. Larger dilators are used over time to train the vaginal muscles. Kegel exercises may improve the chance of success with this technique.
Group therapy or a support group may be very helpful for a woman. There she can discuss her problems with others who share them. Women often gain insight and practical solutions from these groups, as well as a greater confidence from knowing she is not alone. Couples groups also can be very helpful if both partners are willing. A sex therapist usually recommend such a group if he or she thinks it would be helpful.
Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems.
For some women these problems are fairly clear, including past sexual or other abuse, rape, or traumatic sexual encounters.
For others, the problems may be less clear-cut, involving unresolved emotional issues or dissatisfaction with other areas of life.
In either case, the therapist usually focuses on resetting the woman's attitudes toward sex.
The goal is to get rid of old attitudes that got in the way of enjoyable sex, establishing new attitudes that increase sexual responsiveness.
If the problem relates to your relationship, couples counseling is recommended. (You don't have to be married to go to a "marriage counselor.")
The couples therapist is trained and experienced at helping couples recognize, understand, and solve their problems.
First, the counselor explores the relationship to find the trouble spots.
The counselor will recommend exercises and activities that will improve the couple's communication and trust.
If that can be accomplished, often the sexual problem can be solved more easily.
Sex Therapy
A sex therapist may take couples therapy one step further by focusing on the couple's physical relationship. After identifying the couple's attitudes about sex and the sexual problem, the sex therapist recommends specific exercises to re-focus the couple's attention and expectations. Specific objectives may include any of the following:
Learning to relax and eliminate distractions
Learning to communicate in a positive way what you would like
Learning nonsexual touching techniques
Increasing or enhancing sexual stimulation
Minimizing pain during intercourse
Sex therapists often use what are called "sensate focus" exercises to treat sexual problems. The exercises start with nonsexual touching and encourage both partners to express how they like to be touched. The goal is to help both partners understand how to recognize and communicate their preferences.
Sex therapists can recommend exercises to help with vaginismus.
One successful technique is the use of Kegel exercises. Many women are familiar with these from their childbirth education classes. Kegel exercises involve voluntary contraction and relaxation of the muscles around the opening of the vagina. Women do this instinctively when they need to urinate at an inconvenient time.
Some women have been helped by using dilators to relax the vaginal spasms. A small dilator is placed in the vagina for 10 minutes, then removed. Larger dilators are used over time to train the vaginal muscles. Kegel exercises may improve the chance of success with this technique.
Group therapy or a support group may be very helpful for a woman. There she can discuss her problems with others who share them. Women often gain insight and practical solutions from these groups, as well as a greater confidence from knowing she is not alone. Couples groups also can be very helpful if both partners are willing. A sex therapist usually recommend such a group if he or she thinks it would be helpful.
Sex Therapy & Other Counseling
If the problem is one of lack of knowledge, your health care provider or a sex therapist can teach you (and your partner) about the sexual response cycle and the elements of sexual stimulation. Armed with this new knowledge, many couples can go forward on their own.
Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems.
For some women these problems are fairly clear, including past sexual or other abuse, rape, or traumatic sexual encounters.
For others, the problems may be less clear-cut, involving unresolved emotional issues or dissatisfaction with other areas of life.
In either case, the therapist usually focuses on resetting the woman's attitudes toward sex.
The goal is to get rid of old attitudes that got in the way of enjoyable sex, establishing new attitudes that increase sexual responsiveness.
If the problem relates to your relationship, couples counseling is recommended. (You don't have to be married to go to a "marriage counselor.")
The couples therapist is trained and experienced at helping couples recognize, understand, and solve their problems.
First, the counselor explores the relationship to find the trouble spots.
The counselor will recommend exercises and activities that will improve the couple's communication and trust.
If that can be accomplished, often the sexual problem can be solved more easily.
Sex Therapy
A sex therapist may take couples therapy one step further by focusing on the couple's physical relationship. After identifying the couple's attitudes about sex and the sexual problem, the sex therapist recommends specific exercises to re-focus the couple's attention and expectations. Specific objectives may include any of the following:
Learning to relax and eliminate distractions
Learning to communicate in a positive way what you would like
Learning nonsexual touching techniques
Increasing or enhancing sexual stimulation
Minimizing pain during intercourse
Sex therapists often use what are called "sensate focus" exercises to treat sexual problems. The exercises start with nonsexual touching and encourage both partners to express how they like to be touched. The goal is to help both partners understand how to recognize and communicate their preferences.
Sex therapists can recommend exercises to help with vaginismus.
One successful technique is the use of Kegel exercises. Many women are familiar with these from their childbirth education classes. Kegel exercises involve voluntary contraction and relaxation of the muscles around the opening of the vagina. Women do this instinctively when they need to urinate at an inconvenient time.
Some women have been helped by using dilators to relax the vaginal spasms. A small dilator is placed in the vagina for 10 minutes, then removed. Larger dilators are used over time to train the vaginal muscles. Kegel exercises may improve the chance of success with this technique.
Group therapy or a support group may be very helpful for a woman. There she can discuss her problems with others who share them. Women often gain insight and practical solutions from these groups, as well as a greater confidence from knowing she is not alone. Couples groups also can be very helpful if both partners are willing. A sex therapist usually recommend such a group if he or she thinks it would be helpful.
Psychotherapy can help a woman identify problems in her life that may be expressed as sexual problems.
For some women these problems are fairly clear, including past sexual or other abuse, rape, or traumatic sexual encounters.
For others, the problems may be less clear-cut, involving unresolved emotional issues or dissatisfaction with other areas of life.
In either case, the therapist usually focuses on resetting the woman's attitudes toward sex.
The goal is to get rid of old attitudes that got in the way of enjoyable sex, establishing new attitudes that increase sexual responsiveness.
If the problem relates to your relationship, couples counseling is recommended. (You don't have to be married to go to a "marriage counselor.")
The couples therapist is trained and experienced at helping couples recognize, understand, and solve their problems.
First, the counselor explores the relationship to find the trouble spots.
The counselor will recommend exercises and activities that will improve the couple's communication and trust.
If that can be accomplished, often the sexual problem can be solved more easily.
Sex Therapy
A sex therapist may take couples therapy one step further by focusing on the couple's physical relationship. After identifying the couple's attitudes about sex and the sexual problem, the sex therapist recommends specific exercises to re-focus the couple's attention and expectations. Specific objectives may include any of the following:
Learning to relax and eliminate distractions
Learning to communicate in a positive way what you would like
Learning nonsexual touching techniques
Increasing or enhancing sexual stimulation
Minimizing pain during intercourse
Sex therapists often use what are called "sensate focus" exercises to treat sexual problems. The exercises start with nonsexual touching and encourage both partners to express how they like to be touched. The goal is to help both partners understand how to recognize and communicate their preferences.
Sex therapists can recommend exercises to help with vaginismus.
One successful technique is the use of Kegel exercises. Many women are familiar with these from their childbirth education classes. Kegel exercises involve voluntary contraction and relaxation of the muscles around the opening of the vagina. Women do this instinctively when they need to urinate at an inconvenient time.
Some women have been helped by using dilators to relax the vaginal spasms. A small dilator is placed in the vagina for 10 minutes, then removed. Larger dilators are used over time to train the vaginal muscles. Kegel exercises may improve the chance of success with this technique.
Group therapy or a support group may be very helpful for a woman. There she can discuss her problems with others who share them. Women often gain insight and practical solutions from these groups, as well as a greater confidence from knowing she is not alone. Couples groups also can be very helpful if both partners are willing. A sex therapist usually recommend such a group if he or she thinks it would be helpful.
Young men experiment with Viagra
ATLANTA - Hundreds of patients asking Dr. Scott Parry for Viagra at his Atlanta clinic are young, healthy and virile.
They don't suffer from diabetes, hypertension or any other medical cause of impotence.
Some complain about performance anxiety. Others say that their marriage is in need of a spark. Partygoers are looking for something to offset the effects of alcohol.
They're part of a new wave of men in their 20s, 30s and 40s who look nothing like Viagra's first spokesman five years ago: former presidential candidate Bob Dole, who famously used the term "erectile dysfunction," or ED. Instead, they mirror the drug manufacturer's new spokesman, home-run slugger Rafael Palmeiro, who has used Viagra but is reported to have said he didn't need it.
"Mr. Blue" - a slang term for the drug - has exploded into a multibillion-dollar industry, with nine Viagra tablets dispensed every second around the globe.
Men with ED aren't the only ones fueling the business. Curious men and others looking for that edge in the bedroom can buy the pills from a doctor, off the Internet or around Atlanta nightclubs, sealed in tiny zip-top bags.
"Some young men will come in for a cold or pain in the leg and say, 'By the way, I was wondering about this Viagra, and my wife and I have been having some problems,' or 'I could use something to build my confidence,'" said Dr. Shangbo Guan, a specialist in internal medicine who is seeing an increase in the number of younger men asking for Viagra.
Experts say that some of these men suffer from unrealistic expectations about performance or are masking more deep-rooted problems, such as relationship conflict, poor self-image or drug addiction.
"There seems to be growing interest in having a 24/7 erection and performing sexually without looking at the context or meaning," said Dr. Gail Wyatt, a sex therapist, professor of psychiatry at UCLA and the author of No More Clueless Sex.
At other times it is even more superficial: Men simply want to be impressed with how they function.
"Everybody has insecurity, and here's this one thing they take and they can feel they have this power and they look good," said Virginia Erhardt, a sex therapist.
Viagra manufacturer Pfizer and other companies selling impotence drugs vehemently deny targeting healthy men and say the drugs are intended only for men with ED.
With as many as 30 million American men suffering from at least partial ED, according to the National Institutes of Health, there is no need to go outside that pool of potential customers, the drug-makers say. They estimate that only one in every 10 men with ED seeks treatment.
The incidence of ED increases with age, and it is unclear how many men under 40 have it. Government and private sector estimates of the number of 40-year-old men suffering from ED range from 5percent to 39 percent. Men 40 and younger account for at least 8 percent of the prescriptions for Viagra, according to Pfizer. No age breakdown is available for Levitra or Cialis, a newcomer to the market already dubbed "the weekender," because it can stay in the bloodstream for 36 hours. Unregulated Internet sales are not tracked.
But all three drug companies say that young, healthy users represent a small slice of the business - even "peripheral," according to Pfizer spokesman Daniel Watts.
Doctors and people on the party circuit argue that they are seeing anecdotal evidence to the contrary. While most who use the drugs need them, there's clearly interest among growing numbers to see if they can find thrill in a pill.
Guan said that only about 10 percent of the men asking him for ED medication appear not to need it, but the buzz about the pills is getting around, and he's seeing it in his office.
There's a reason the impotence drugs are intended only for men who clearly need them. While considered relatively safe, the trio of impotence drugs can lead to serious complications when taken with nitrates, often used to control chest pain, and other medications. Possible side effects include flushing, muscle aches and even bluish vision. Urologists warn that some men who don't need the medication might develop a psychological dependency. And the long-term effects are still unknown.
Use of the drugs by men without ED also seems completely unnecessary. The drugs work by increasing blood flow to the penis, allowing for an erection if stimulated. It is not a hormone or an aphrodisiac.
"You should never take any medication that's not necessary," said Dr. Deena Davis, a urologist at St. Joseph's Hospital in Atlanta. "Men think they will have this great erection, but if you are fine without it, there is no reason to take it.... I think some men look at it like a miracle pill, and then there"s word of mouth about this buddy who lasted 20 days."
With impotence pills easily available through the Internet, Parry, a primary-care physician, typically grants requests for them so he can supervise their use and educate his patients about the risks. He is also afraid some men may not use a condom if denied a prescription for Viagra.
"In an era of safe sex, the condom takes away some of the sensation, and if you want to encourage safe sex, Viagra can help that," Parry explained.
Some doctors also worry that the new Cialis may be particularly attractive to young party revelers because it stays in the bloodstream for so long. "You take it at lunch on Friday and you are good all weekend," said Dr. Bruce Stein, an Atlanta urologist.
A Cialis spokeswoman, however, explained that the long-acting drug is meant to let couples "take advantage of the romantic moment as it happens and have less time pressure."
Some doctors also say that mixing impotence drugs with mind-altering drugs, such as Ecstasy or crystal methamphetamine, is on the rise - and a potentially deadly combination. Wyatt, the UCLA sex therapist, said that Viagra has become a staple at popular "rave" parties in the gay community, known as "circuit parties."
"If you are in party mode and if everything is sped up, you may not take time to talk about sexually transmitted diseases," Wyatt said.
In fact, a study of 844 men at a San Francisco STD clinic found that Viagra users had had an average of 5.4 sexual partners during the past two months, compared with 3.5 partners for non-Viagra users. The study also found that more than half the men using Viagra had obtained it through a friend, not a doctor.
Pfizer spokesman Watts said that Viagra is not to blame.
"This is not about Viagra," he said. "It is about individuals taking responsibility for their actions - practicing safe sex and taking appropriate actions."
Many experts blame highly sexualized images in magazines, pornography and such TV shows as Sex and the City for giving young men the impression that women desire marathon sex.
"Sex is everywhere," said Davis, the St. Joseph's Hospital urologist. "Men see sex and sexual performance as part of the definition of what a great catch a guy is.... I think this is fed to them by the outside world for the most part. Not their partners."
Relationship gurus say that many of the roots of impotence are psychological and need not medication but counseling, or at least a different mind-set. They recommend drug-free solutions: tenderness, love and communication.
"Women don't want a minute-and-a-half, but they sure don't want four hours," said Erhardt, the Atlanta sex therapist. "Most women would like four hours of lovemaking that includes hugging and kissing and cuddling - but four hours of intercourse? Give me a break."
Wyatt said that many men are developing a warped - and casual - view of sex.
"Viagra is not the way to a good sex life," she said. "The way to a good sex life is to make a friend of the person you're with ... and look at sex as an added ingredient."
They don't suffer from diabetes, hypertension or any other medical cause of impotence.
Some complain about performance anxiety. Others say that their marriage is in need of a spark. Partygoers are looking for something to offset the effects of alcohol.
They're part of a new wave of men in their 20s, 30s and 40s who look nothing like Viagra's first spokesman five years ago: former presidential candidate Bob Dole, who famously used the term "erectile dysfunction," or ED. Instead, they mirror the drug manufacturer's new spokesman, home-run slugger Rafael Palmeiro, who has used Viagra but is reported to have said he didn't need it.
"Mr. Blue" - a slang term for the drug - has exploded into a multibillion-dollar industry, with nine Viagra tablets dispensed every second around the globe.
Men with ED aren't the only ones fueling the business. Curious men and others looking for that edge in the bedroom can buy the pills from a doctor, off the Internet or around Atlanta nightclubs, sealed in tiny zip-top bags.
"Some young men will come in for a cold or pain in the leg and say, 'By the way, I was wondering about this Viagra, and my wife and I have been having some problems,' or 'I could use something to build my confidence,'" said Dr. Shangbo Guan, a specialist in internal medicine who is seeing an increase in the number of younger men asking for Viagra.
Experts say that some of these men suffer from unrealistic expectations about performance or are masking more deep-rooted problems, such as relationship conflict, poor self-image or drug addiction.
"There seems to be growing interest in having a 24/7 erection and performing sexually without looking at the context or meaning," said Dr. Gail Wyatt, a sex therapist, professor of psychiatry at UCLA and the author of No More Clueless Sex.
At other times it is even more superficial: Men simply want to be impressed with how they function.
"Everybody has insecurity, and here's this one thing they take and they can feel they have this power and they look good," said Virginia Erhardt, a sex therapist.
Viagra manufacturer Pfizer and other companies selling impotence drugs vehemently deny targeting healthy men and say the drugs are intended only for men with ED.
With as many as 30 million American men suffering from at least partial ED, according to the National Institutes of Health, there is no need to go outside that pool of potential customers, the drug-makers say. They estimate that only one in every 10 men with ED seeks treatment.
The incidence of ED increases with age, and it is unclear how many men under 40 have it. Government and private sector estimates of the number of 40-year-old men suffering from ED range from 5percent to 39 percent. Men 40 and younger account for at least 8 percent of the prescriptions for Viagra, according to Pfizer. No age breakdown is available for Levitra or Cialis, a newcomer to the market already dubbed "the weekender," because it can stay in the bloodstream for 36 hours. Unregulated Internet sales are not tracked.
But all three drug companies say that young, healthy users represent a small slice of the business - even "peripheral," according to Pfizer spokesman Daniel Watts.
Doctors and people on the party circuit argue that they are seeing anecdotal evidence to the contrary. While most who use the drugs need them, there's clearly interest among growing numbers to see if they can find thrill in a pill.
Guan said that only about 10 percent of the men asking him for ED medication appear not to need it, but the buzz about the pills is getting around, and he's seeing it in his office.
There's a reason the impotence drugs are intended only for men who clearly need them. While considered relatively safe, the trio of impotence drugs can lead to serious complications when taken with nitrates, often used to control chest pain, and other medications. Possible side effects include flushing, muscle aches and even bluish vision. Urologists warn that some men who don't need the medication might develop a psychological dependency. And the long-term effects are still unknown.
Use of the drugs by men without ED also seems completely unnecessary. The drugs work by increasing blood flow to the penis, allowing for an erection if stimulated. It is not a hormone or an aphrodisiac.
"You should never take any medication that's not necessary," said Dr. Deena Davis, a urologist at St. Joseph's Hospital in Atlanta. "Men think they will have this great erection, but if you are fine without it, there is no reason to take it.... I think some men look at it like a miracle pill, and then there"s word of mouth about this buddy who lasted 20 days."
With impotence pills easily available through the Internet, Parry, a primary-care physician, typically grants requests for them so he can supervise their use and educate his patients about the risks. He is also afraid some men may not use a condom if denied a prescription for Viagra.
"In an era of safe sex, the condom takes away some of the sensation, and if you want to encourage safe sex, Viagra can help that," Parry explained.
Some doctors also worry that the new Cialis may be particularly attractive to young party revelers because it stays in the bloodstream for so long. "You take it at lunch on Friday and you are good all weekend," said Dr. Bruce Stein, an Atlanta urologist.
A Cialis spokeswoman, however, explained that the long-acting drug is meant to let couples "take advantage of the romantic moment as it happens and have less time pressure."
Some doctors also say that mixing impotence drugs with mind-altering drugs, such as Ecstasy or crystal methamphetamine, is on the rise - and a potentially deadly combination. Wyatt, the UCLA sex therapist, said that Viagra has become a staple at popular "rave" parties in the gay community, known as "circuit parties."
"If you are in party mode and if everything is sped up, you may not take time to talk about sexually transmitted diseases," Wyatt said.
In fact, a study of 844 men at a San Francisco STD clinic found that Viagra users had had an average of 5.4 sexual partners during the past two months, compared with 3.5 partners for non-Viagra users. The study also found that more than half the men using Viagra had obtained it through a friend, not a doctor.
Pfizer spokesman Watts said that Viagra is not to blame.
"This is not about Viagra," he said. "It is about individuals taking responsibility for their actions - practicing safe sex and taking appropriate actions."
Many experts blame highly sexualized images in magazines, pornography and such TV shows as Sex and the City for giving young men the impression that women desire marathon sex.
"Sex is everywhere," said Davis, the St. Joseph's Hospital urologist. "Men see sex and sexual performance as part of the definition of what a great catch a guy is.... I think this is fed to them by the outside world for the most part. Not their partners."
Relationship gurus say that many of the roots of impotence are psychological and need not medication but counseling, or at least a different mind-set. They recommend drug-free solutions: tenderness, love and communication.
"Women don't want a minute-and-a-half, but they sure don't want four hours," said Erhardt, the Atlanta sex therapist. "Most women would like four hours of lovemaking that includes hugging and kissing and cuddling - but four hours of intercourse? Give me a break."
Wyatt said that many men are developing a warped - and casual - view of sex.
"Viagra is not the way to a good sex life," she said. "The way to a good sex life is to make a friend of the person you're with ... and look at sex as an added ingredient."
Viagra Improves Sex for Some Women
Viagra can do wonders for men. But a new study shows it also improves sex for some postmenopausal women.
The findings come from a research team led by sexual-function gurus Jennifer R. Berman, MD, and Laura A. Berman, PhD. The placebo-controlled study, funded by Viagra maker Pfizer Inc., evaluated 202 postmenopausal women diagnosed with female sexual arousal disorder (FSAD). This disorder is defined as distress from an inability to attain or maintain sexual excitement.
Half the women were treated with Viagra; the other half got inactive placebo pills. Many of the women who got the placebo reported improved genital sensation. Some even reported more sexual satisfaction. But both of these improvements were much more common among women who took Viagra.
The little blue pill didn't work for women who, in addition to FSAD, also had something called hypoactive sexual desire disorder or HSDD. While many women with FSAD have difficulties with genital blood flow -- suggesting a physical problem that Viagra can help -- women with HSDD may be more likely to have an underlying emotional or relationship problem leading to lack of sexual desire.
"Unresolved emotional or relational issues should be addressed before beginning medical therapies," Berman and colleagues stress. Their report appears in the December 2003 issue of The Journal of Urology.
Viagra, Genital Sensation, and Sexual Satisfaction
Women were included in the study if they were postmenopausal or if they had a hysterectomy. Their ages ranged from 30 to 71 with an average age of about 51.
The Berman team focused on the women's answers to two questions after taking Viagra or placebo:
After taking the study medication, the sensation/feeling in my genital (vagina, labia, clitoris) area during intercourse or stimulation seemed to be: (a) more than before, (b) less than before, or (c) unchanged.
After taking the study medication, intercourse and/or foreplay was (a) pleasant and satisfying; better than before taking the study medication; (b) unpleasant; worse than before the study medication; (c) unchanged; no difference; or (d) pleasant but still not like it used to be or I would like it to be.
Among placebo recipients, 44% reported improvement in the first question and 28% reported improvement in the second question.
Among all Viagra recipients, 57% reported improvement in the first question and 42% reported improvement in the second question.
But among Viagra recipients with sexual arousal disorder who did not have HSDD, the results were more striking: 69% reported improvement in the first question. This group was eight times more likely to report improvement than women without HSDD who got placebo.
Similarly, among Viagra recipients with sexual arousal disorder who did not have HSDD 50% reported improvement in the second question. This group was 11 times more likely to report improvement than non-HSDD women who got placebo.
The authors note that women who respond to Viagra may need to have normal levels of estrogen and testosterone. For many postmenopausal women, that may mean menopausal replacement therapy. In the present study, the women had normal hormone levels or were receiving menopausal replacement therapy.
The findings come from a research team led by sexual-function gurus Jennifer R. Berman, MD, and Laura A. Berman, PhD. The placebo-controlled study, funded by Viagra maker Pfizer Inc., evaluated 202 postmenopausal women diagnosed with female sexual arousal disorder (FSAD). This disorder is defined as distress from an inability to attain or maintain sexual excitement.
Half the women were treated with Viagra; the other half got inactive placebo pills. Many of the women who got the placebo reported improved genital sensation. Some even reported more sexual satisfaction. But both of these improvements were much more common among women who took Viagra.
The little blue pill didn't work for women who, in addition to FSAD, also had something called hypoactive sexual desire disorder or HSDD. While many women with FSAD have difficulties with genital blood flow -- suggesting a physical problem that Viagra can help -- women with HSDD may be more likely to have an underlying emotional or relationship problem leading to lack of sexual desire.
"Unresolved emotional or relational issues should be addressed before beginning medical therapies," Berman and colleagues stress. Their report appears in the December 2003 issue of The Journal of Urology.
Viagra, Genital Sensation, and Sexual Satisfaction
Women were included in the study if they were postmenopausal or if they had a hysterectomy. Their ages ranged from 30 to 71 with an average age of about 51.
The Berman team focused on the women's answers to two questions after taking Viagra or placebo:
After taking the study medication, the sensation/feeling in my genital (vagina, labia, clitoris) area during intercourse or stimulation seemed to be: (a) more than before, (b) less than before, or (c) unchanged.
After taking the study medication, intercourse and/or foreplay was (a) pleasant and satisfying; better than before taking the study medication; (b) unpleasant; worse than before the study medication; (c) unchanged; no difference; or (d) pleasant but still not like it used to be or I would like it to be.
Among placebo recipients, 44% reported improvement in the first question and 28% reported improvement in the second question.
Among all Viagra recipients, 57% reported improvement in the first question and 42% reported improvement in the second question.
But among Viagra recipients with sexual arousal disorder who did not have HSDD, the results were more striking: 69% reported improvement in the first question. This group was eight times more likely to report improvement than women without HSDD who got placebo.
Similarly, among Viagra recipients with sexual arousal disorder who did not have HSDD 50% reported improvement in the second question. This group was 11 times more likely to report improvement than non-HSDD women who got placebo.
The authors note that women who respond to Viagra may need to have normal levels of estrogen and testosterone. For many postmenopausal women, that may mean menopausal replacement therapy. In the present study, the women had normal hormone levels or were receiving menopausal replacement therapy.
Female sexuality
Female sexuality is an extraordinarily complex process. The physician needs to be aware of the patient's sexuality and whether or not there are sexual concerns. Physiologic changes over the lifespan can interact with sexual performance as can a variety of disease processes. Partner and relationship issues must also be taken into account. Physicians need to include a sexual history as part of their general history and should not be judgmental of their patients' sexual practices. Sexual disorders in women are defined and delineated by those issues causing personal distress. Again, one person's distress may be quite normal to another. The important aspects of care consist of listening, educating, and providing support to the patient. There is increasing interest but a continued need for data in the use of testosterone in women with decreased libido. The use of sildenafil for female sexual dysfunction remains controversial as a benefit. Overall, there is a need for the development of well-organized, randomized, controlled studies on appropriate assessment and intervention for sexual dysfunction in women.
Better Sex With Viagra
About Viagra
Viagra is a prescription medicine used to treat erection problems. Since it first became available in 1998, Viagra has been helping to improve the sex life of men and their partner's and has been used by over 20 million men world-wide. Amazingly, 9 tablets are dispensed every second worldwide. More studies have been carried out on Viagra than any other treatment for erection problems.
Viagra is Effective
Viagra works for 8 out of 10 men if taken correctly, so it is important to follow some simple advice on getting better sex with Viagra. Viagra improves erections with most men no matter how long they have had erection problems, no matter the cause, how often they have it or how old they are. It is no wonder Viagra is the most prescribed treatment for erection problems .
How Viagra Works
Viagra works by increasing blood flow where you need it. It does this by inhibiting an enzyme called PDE 5, which prevents the breakdown of an important chemical messenger cGMP. This allows the chemical messenger cGMP that instructs the arteries controlling blood flow to the penis to accumulate at increased levels, so the natural process of an erection can occur.
With Viagra, you must be sexually excited to get an erection. If you take Viagra and are not sexually stimulated, nothing will happen. You won't get an erection just by taking the pill. Viagra is not an aphrodisiac or a hormone. It's a medicine that treats a physical erection problem.
Once you take it Viagra can work for most men within 30 minutes. Viagra works for at least 4 hours and peaks at 1 hour, so you can choose your moment.
Viagra Safety
Safety is of paramount importance when considering any medication. Viagra has been tested in more than 110 controlled studies and has been used by over 20 million men worldwide. Through these studies and real-world experience Viagra has been shown to have a proven safety profile and to be well tolerated. Viagra has been prescribed by more than 600,000 doctors and is the only treatment for erections problems with a proven safety profile that extends more than 4 years. If you have any concerns over safety discuss them with your doctor and always discuss your medical history with them.
No medicine is for everyone so please read through the important safety information.
Ensuring Viagra is right for you
There are very clear guidelines about who can take Viagra and who can't. And there's only one way to know for sure if VIAGRA is right for you - you must visit your doctor for a physical exam and a face-to-face conversation about your own particular problems. Do not use an Internet service that offers an online diagnosis.
It's important to tell your doctor about any medicines you may be taking, both prescription and non-prescription. A medicine you are taking for another health problem might be causing your ED, but never stop taking any medicine before talking to your doctor.
Your doctor will advise whether Viagra is right for you.
If Viagra is right for you, be sure to ask about the FREE Viagra starter pack *
Viagra is there when you need it most
Viagra is at its highest concentration in your body in 1 hour. This matches studies of men's sexual habits that show the amount of time that passes between a couple contemplating sex and actual intercourse is just under one hour, whether a man has an erection problem or not. But don't worry if your timing is a little off, Viagra lasts for up to 4 hours and allows for prompt onset of action.
Viagra is a prescription medicine used to treat erection problems. Since it first became available in 1998, Viagra has been helping to improve the sex life of men and their partner's and has been used by over 20 million men world-wide. Amazingly, 9 tablets are dispensed every second worldwide. More studies have been carried out on Viagra than any other treatment for erection problems.
Viagra is Effective
Viagra works for 8 out of 10 men if taken correctly, so it is important to follow some simple advice on getting better sex with Viagra. Viagra improves erections with most men no matter how long they have had erection problems, no matter the cause, how often they have it or how old they are. It is no wonder Viagra is the most prescribed treatment for erection problems .
How Viagra Works
Viagra works by increasing blood flow where you need it. It does this by inhibiting an enzyme called PDE 5, which prevents the breakdown of an important chemical messenger cGMP. This allows the chemical messenger cGMP that instructs the arteries controlling blood flow to the penis to accumulate at increased levels, so the natural process of an erection can occur.
With Viagra, you must be sexually excited to get an erection. If you take Viagra and are not sexually stimulated, nothing will happen. You won't get an erection just by taking the pill. Viagra is not an aphrodisiac or a hormone. It's a medicine that treats a physical erection problem.
Once you take it Viagra can work for most men within 30 minutes. Viagra works for at least 4 hours and peaks at 1 hour, so you can choose your moment.
Viagra Safety
Safety is of paramount importance when considering any medication. Viagra has been tested in more than 110 controlled studies and has been used by over 20 million men worldwide. Through these studies and real-world experience Viagra has been shown to have a proven safety profile and to be well tolerated. Viagra has been prescribed by more than 600,000 doctors and is the only treatment for erections problems with a proven safety profile that extends more than 4 years. If you have any concerns over safety discuss them with your doctor and always discuss your medical history with them.
No medicine is for everyone so please read through the important safety information.
Ensuring Viagra is right for you
There are very clear guidelines about who can take Viagra and who can't. And there's only one way to know for sure if VIAGRA is right for you - you must visit your doctor for a physical exam and a face-to-face conversation about your own particular problems. Do not use an Internet service that offers an online diagnosis.
It's important to tell your doctor about any medicines you may be taking, both prescription and non-prescription. A medicine you are taking for another health problem might be causing your ED, but never stop taking any medicine before talking to your doctor.
Your doctor will advise whether Viagra is right for you.
If Viagra is right for you, be sure to ask about the FREE Viagra starter pack *
Viagra is there when you need it most
Viagra is at its highest concentration in your body in 1 hour. This matches studies of men's sexual habits that show the amount of time that passes between a couple contemplating sex and actual intercourse is just under one hour, whether a man has an erection problem or not. But don't worry if your timing is a little off, Viagra lasts for up to 4 hours and allows for prompt onset of action.
Better Sex for Gay men
Generally, we're not taught how to be a fantastic lover, we learn through experience. At GMFA we get the chance to talk to lots of gay men about their experiences and the things that can make for great sex. We've gathered some of their best advice here, as well as some tips that help keep the sex you have safe.We've also taken the time to really learn about how the arse works and how you can increase your pleasure and reduce your pain when you're getting fucked. We can guarantee that the section on your arse will teach you things that they never taught you in sex education at school.
We know that not everybody is going to like the same thing, but whether you've just come out or you've been around the block a few times, we hope that there will be something here that you can use.
The more confident and informed you are in sexual situations, the easier it is for you to stay in control of the sex you're having.
Sex and Sexual Health
HIV remains the most serious sexually transmitted infection (STI) for gay men, so you’ll find lots of info about it here, but we’ll also answer your questions on other STIs and give you information and advice on how to make your sex life healthier, happier and hornier.The website has been built with London gay men in mind, and so the clinics and services we mention are mainly based in London. We hope that most of the information will be useful to gay men around the world.
If you can’t find the answer to your questions here, or if you have any other comments, then let us know by using the ‘Feedback on this page’ button underneath the menu on the left.
The information provided on the Sex & Sexual Health website is deisgned to support, not replace the relationship that exists between you and your doctor. This website is run by GMFA and funded by GMFA and the Pan London HIV Prevention Partnership.
Sunday, April 26, 2009
The Female Condom
What is the Female Condom?The FC female condom has been available in Europe since 1992 and was approved by the US Food and Drug Administration (FDA) in 1993. It is available in many countries, at least in limited quantities, throughout the world. This female condom carries various brand names in different countries including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv’ and Care.
The FC female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. At each end there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.
There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide.
In 2005 the makers of the FC female condom announced a new product called FC2. This has the same design as the original version but is made of nitrile, which may make it cheaper to produce. The FC2 began large-scale production in 2007. The United Nations Population Fund (UNFPA) is already procuring the FC2. The FDA approved the FC2 in December 2008 and the World Health Organisation has stated that the product is acceptable for bulk procurement by UN agencies.
The VA w.o.w. Condom Feminine
The VA w.o.w. Condom Feminine (or VA for short) has been distributed as part of HIV prevention efforts in South Africa since 2004. More recently it has become available in Brazil, Indonesia and through government clinics in Portugal. Having gained the “CE mark” for European marketing, its manufacturer plans to expand its availability in European shops and clinics. One more trial is needed before the product can gain FDA approval for sale in the USA.
Like most male condoms, the VA is made of latex. When not stretched it is much shorter than the FC – around 9 cm (3.5 inches) – though it is highly elastic. It has a rounded triangular frame at the open end and a sponge inside the closed end, which helps to anchor it inside the vagina.
The VA is lubricated and does not contain spermicide. Oil-based lubricants should not be used with this female condom as they can damage latex.
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