Dating and Erectile Dysfunction (ED)....be honest upfront

Dating and Erectile Dysfunction (ED)

By Renee Bacher

WebMD Feature

Reviewed by Michael W. Smith, MD

Don't let erectile dysfunction derail your dating life. Learn how to manage your ED and talk about it with a new partner.

When to Have 'The Talk'

Have it “as soon as intimacy is contemplated,” says Keith Lloyd, MD, professor of urology at the University of Alabama at Birmingham School of Medicine. If you don’t perform well in bed, Lloyd says, let your date know up front and tell them the medical reason why.

Certified sex therapist Jane Brown, LPC, in private practice in Birmingham, AL, suggests that patients buy a copy of the book The New Male Sexuality, by Bernie Zilbergeld, PhD. Leave it on the coffee table as a conversation kick-starter for when your potential partner comes over, she says. When he or she looks at it, that’s your cue to say, “You know, I’m having this problem, and I’ve been reading this book to see if it could help me.”

The best-case scenario: The person offers to help with the problem. The worst-case scenario? They don’t. And you move on.

“If your date is not going to be sensitive to these issues, do you really want to continue with that person?” Brown asks.

Conquer Performance Anxiety

When you have ED, sometimes you can obsess about having an erection and lose sight of the big picture. Plus, ED problems can come and go, which can make you even more anxious.

“Once you’ve got a psychological overlay of wondering if you’re going to have a problem performing,” Brown says, “you’re almost guaranteed that you’re not going to get an erection. Even if your medical condition is under control, the psychological can override it.” 

Brown says that among her patients whose ED is caused by psychological factors, 90% improve when they take the focus off their erection and put it on pleasuring their partner.

“Getting them to believe that this works, however, is monumental,” she says. “But once they do, they forget about their penis and suddenly find themselves with an erection.”

Brown suggests that in addition to giving oral sex, couples simply explore each other’s erogenous zones, including the ears, neck, under the arms, and the nipples.

“I ask them to find out what they and their partner like. You and your partner are not mind-readers, nor should you have to be,” she says.

Meds and Timing

Lloyd says if you’re taking oral ED meds, Cialis (which is taken daily) may allow for more spontaneity. “Also, its long duration of action makes it a good choice for men who are dating,” he says. “However, Viagra and Levitra can be used discreetly, taken an hour or two before planned activity.”

Using products and injections to cause erections might be more of a challenge. The medicated urethral system for erections (MUSE), a small pellet inserted in the penis, can cause mild vaginal itching and burning in female partners. Be sure to let yours know if you're planning to use it, Lloyd says.

If oral treatments don't work, Lloyd says penile injections may be the next easiest solution. For patients with significant ED, who are dating, a penile implant is probably best, he says. 

It Isn't Personal

If you have trouble getting or keeping an erection with a date, assure her that you're attracted.

“Let her know it’s not her and you want this to happen,” Brown says.

Things That Can Deflate Your Erection

Depression

The brain is an often-overlooked erogenous zone. Sexual excitement starts in your head and works its way down. Depression can dampen your desire and can lead to erectile dysfunction. Ironically, many of the drugs used to treat depression can also suppress your sex drive and make it harder to get an erection, and they can cause a delay in your orgasm.

Alcohol

Medications

The contents of your medicine cabinet could affect your performance in the bedroom. A long list of common drugs can cause ED, including certain blood pressure drugs, pain medications, and antidepressants. Street drugs like amphetamines, cocaine, and marijuana can cause sexual problems in men, too.

Stress

It's not easy to get in the mood when you're overwhelmed by responsibilities at work and home. Stress can take its toll on many different parts of your body, including your penis. Deal with stress by making lifestyle changes that promote well-being and relaxation, such as exercising regularly, getting enough sleep, and seeking professional help when appropriate.

Anger

Anger can make the blood rush to your face, but not to the one place you need it when you want to have sex. It's not easy to feel romantic when you're raging, whether your anger is directed at your partner or not. Unexpressed anger or improperly expressed anger can contribute to performance problems in the bedroom.

Anxiety

Worrying that you won't be able to perform in bed can make it harder for you to do just that. Anxiety from other parts of your life can also spill over into the bedroom. All that worry can make you fear and avoid intimacy, which can spiral into a vicious cycle that puts a big strain on your sex life -- and relationship.

Middle-Aged Spread

Carrying extra pounds can impact your sexual performance, and not just by lowering your self-esteem. Obese men have lower levels of the male hormone testosterone, which is important for sexual desire and producing an erection. Being overweight is also linked to high blood pressure and hardening of the arteries, which can reduce blood flow to the penis.

Self-Image

When you don't like what you see in the mirror, it's easy to assume your partner isn't going to like the view, either. A negative self-image can make you worry not only about how you look, but also how well you're going to perform in bed. That performance anxiety can make you too anxious to even attempt sex.

Low Libido

Low libido isn't the same as erectile dysfunction, but a lot of the same factors that stifle an erection can also dampen your interest in sex. Low self-esteem, stress, anxiety, and certain medications can all reduce your sex drive. When all those worries are tied up with making love, your interest in sex can take a nosedive.

Your Health

Many different health conditions can affect the nerves, muscles, or blood flow that is needed to have an erection. Diabetes, high blood pressure, hardening of the arteries, spinal cord injuries, and multiple sclerosis can contribute to ED. Surgery to treat prostate or bladder problems can also affect the nerves and blood vessels that control an erection.

Low T: E

Can You reverse your poor condition?

WebMD Feature

By Eric Metcalf, MPH

Reviewed By Brunilda Nazario, MD

If you're looking for ways to boost your testosterone level, start by looking at your daily habits. "I never prescribe testosterone alone without talking to men about their lifestyle," says Martin Miner, MD, co-director of the Men's Health Center at the Miriam Hospital in Providence, R.I.

Some changes that are good for your overall health could also provide benefits in helping to maintain a healthy level of this important male hormone.

1. Get Enough Sleep.

George Yu, MD, a urology professor at the George Washington University Medical Center in Washington, D.C., says that, for many men with low testosterone, poor sleep is the most important factor. A lack of sleep affects a variety of hormones and chemicals in your body. This, in turn, can have a harmful impact on your testosterone.

Make sleep a priority, aiming for 7 to 8 hours per night, even if it means rearranging your schedule or dropping your habit of late-night TV. Prize your sleep, just like you'd prize a healthy diet and active lifestyle. It's that important. 

If you're having problems getting good sleep on a regular basis, talk to your doctor.

2. Keep a Healthy Weight.

Men who are overweight or obese often have low testosterone levels, says Alvin M. Matsumoto, MD, of the University of Washington School of Medicine in Seattle.

For those men, losing the extra weight can help bring testosterone back up, he says. Likewise, for men who are underweight, getting your weight up to a healthy level can also have a positive effect on the hormone.

3. Stay Active.

Testosterone adapts to your body's needs, Yu says. If you spend most of your time lying on the couch, your brain gets the message that you don't need as much to bolster your muscles and bones.

But, he says, when you're physically active, your brain sends out the signal for more of the hormone.

If you're getting little exercise now, Miner suggests starting by:

• Walking briskly at least 10 to 20 minutes a day.
• Building strength with several sessions of weights or elastic bands each week. Work with a trainer to learn proper form so you don't injure yourself.

Don't go overboard. Extreme amounts of endurance exercise -- working out at the level of elite athletes -- can lower your testosterone.

4. Take Control of Your Stress.

If you're under constant stress, your body will churn out a steady stream of the stress hormone cortisol. When it does, it will be less able to create testosterone. So, controlling your stress is important for keeping up your testosterone, Miner says.

Miner's advice to the over-stressed men he sees in his office is to:

• Cut back on long work hours. If you're logging lots of overtime, try to whittle your workday down to 10 hours or less.
• Spend 2 hours a day on activities you like that aren't work- or exercise-related, such as reading or playing music.

SEX PAST THE 40’s

SEX PAST THE 40’s

Among the common misconceptions around sex- especially in India- is that it is a pointless exercise after 40. That it is pointless is wrong, but it sure is a great way to exercise. For a lot of people, after 40 is when they have the time and the freedom of not looking after the kids, elders and job stresses. You are mostly settled and have a little more time for your spouse. So if anything, it's the best time to spice things up and go for it. While the fervour and the excitement will not be on the level it was in your 20's, the intimacy, love and sensuality should make up for it. Knowledge and understanding play a big part in maintaining a healthy sex life past the forties.

 

Here are a few ways you can keep the magic alive:

 

Keep the excitement levels up in more ways than one. Dopamine plays a vital role in sexual inspiration. With age and stability, the predictability of the relationship may get a little stale. Try to keep the dopamine flowing by indulging in something adventurous like vacations, gliding, rafting or even amusement park rides.

Common sense dictates that libido will decrease by the time you reach your forties.  Perimenopause (the stage before menopause) can begin as early as 35. If you are concerned about your hormone levels, have your doctor test for both estrogen and testosterone levels. Symptoms like sleep disturbances, vaginal dryness and even hot flashes occur in women past the forties. Men may suffer from very low libido and erectile dysfunction. So it is not the worst idea to keep your medicine cabinet stocked with right medications. Viagra, vitamin E, a water or silicone based cream for dryness and estrogen tablets are among the most commonly used medications.

Exercising is great not only to keep the fitness levels up but also for sex. Yoga and meditation keep the body and mind relaxed and stress free while working on firming up loose muscles. As we have said in our previous issue, kegel exercises are a boon for the sex life past the forties. They help in keeping your pelvic floor strong and they can also help to prevent bladder control issues. Best of all, regular Kegels can help you enjoy longer, stronger orgasms.

Sex aids are often looked down upon and are very hard to find in India but they help in a big way to keep the spark alive past the 40's and can be easily ordered online. Using warming lubrication or a clitoral stimulator can speed up your sexual response and make sex more comfortable and exciting. Plus, just the added excitement of using them will enhance your sex life for the future.

Put the relationship before kids. Parents do find this hard to do and dote over their kids to a point where the relationship takes a back seat. A lot of couples devote all of their emotional energy, time and resources to their children and end up having nothing left for their spouse. If you are among the majority, change this. This does not mean you shouldn't love your kids any less — it just means that you need date nights, vacations without the kids, and more time spent with your spouse alone.

Be open. At this point in your married life, you should be comfortable to ask your spouse what they like in bed and explain to them what works for you. Communication is of vital importance, not only in the bedroom but also for everything in a relationship. Don't sit back and expect your partner to make the first move. It’s your sex life, and there is nothing wrong with being proactive and communicative about it.

You need to have sex at least once a week. It will help keep the love and intimacy at a much higher level. Plan out a night every week- keeping each other’s schedules in mind- for just the two of you. And make sure you do not cancel it unless it's really important. Your laundry and cleaning the closet can wait for another day but your relationship should not have too.

 

So there you go. Some extremely simple yet highly effective ways to keep the proverbial spark alive. Age should never come in the way of your sexual relationship. After all, it is just a number. Sex doesn't come with an expiry date. Just keep at it and it will always be as fresh as ever.