DR. HOOK- Keep it up: Health, exercise mean good sexual health

"Conjunction junction, Erectile dysfunction." 

I don't think my changing the lyrics of this School House Rock song would go over very well. I think Superhero Verb Man would take action against me.

   But, lately, erectile dysfunction (ED) medication ads have become the Male House Rock to bring awareness of male sexual dysfunction. Really, before these treatment alternatives became popular, men just wouldn't bring it up... to their doctors that they have problems.

   In 1994, the Masssachusetts Male Aging Study found that male sexual dysfunction starts at age 40 and gets worse each decade, really sliding downhill after 50. (Is that why old millionaire men always date 17.9-year-old girls? To get a  jump start?) 

In this study, in the 40-year-old men, 40 percent had some level of dysfunction (ED, decreased sex drive, less satisfaction with orgasm, less ejaculation). Another study showed in men older than 55, 47 percent had ED. That's a downer.

   Who are most at risk for male sexual dysfunction? Well, I don't want to beat it in again, but it's those who don't exercise, eat right, and keep their weight around ideal body weight.  Obese men and men with diabetes have many excuses for male sexual dysfunction. Studies have shown ED alone will improve in one-third of men who exercise and lose weight. The way I look at it is this: in the animal kingdom, who gets to mate with the females? The lion king or the lazy cowardly lion?

   Diabetic men are at risk for low testosterone, and that hormone is needed to help erections and make the man... well, horny. But also diabetic and obese men are at increased risk of high blood pressure, high cholesterol, and cardiovascular disease. All these factors can lead to damaged pipes going into and out of the penis, leading to ED.

   Adam Ant in the '80s sang, "Don't drink, don't smoke, what do you do?" Well, he included "subtle innuendos" about having sex. And those who smoke, do drugs, and drink too much alcohol are at risk for sexual dysfunction. 

   Stress, psychological factors, and emotional issues can definitely affect a man's sexual abilities. Psychiatric disorders need to be treated with psychotherapy and medications. But antidepressants– in particular the SSRI meds (e.g. Zoloft)– can cause sexual dysfunction.

   Cimetidine, an over-the-counter antacid, can lower hormonal levels to lead to sexual dysfunction. Spironolactone, a type of BP medication, can do the same. Thiazide diuretics, like HCTZ or chlorthalidone, for treatment of high blood pressure can deflate the penis. 

But for most men on BP medicine who have ED, the medicine is usually not the problem. The ED is from the years of uncontrolled hypertension that led to vascular damage to the penis. The penis needs higher blood pressure to fill up, but that doesn't occur as well with reduced normal blood pressure.

   Peyronie's disease isn't talked about a whole lot, although one famous politician's allegedly crooked member was discussed by a woman who sued him. Fibrous tissue develops so that the erect penis bends, kind of like an elbow. It can also be painful– for both the man and his partner.

   Neurological disorders like stroke, MS, and spinal cord or back injury can all cause sexual dysfunction. We hear the brain is the biggest sexual organ in the body, and that's true for most men (with the exception of John Holmes, Hugh Hefner, and Charlie Sheen).  Genital nerve damage can impair sexual function, and hard-core bicycle riders are more vulnerable to this.

   So if you're having male sexual dysfunction, talk to your doctor about it. It's nothing to be embarrassed about, and it shouldn't deflate your ego.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.