Antidepressants Blog

Psychosexual medicine has evolved a discipline of looking at difficulties by concentrating attention on the doctor/patient relationship and also on what happens during the genital examination. A man may have his closest feelings defended by the fear that he is not normal – perhaps not as aggressive as the average man. This may form a barrier to the useful development of the relationship with the doctor. Some of the barriers here have been described by Tunnadine (1983).

It requires careful listening to hear where the vulnerability lies, particularly with men, as the opportunities to examine feelings via the exposure of the genitalia are less frequently available than they are with women. When such an examination is possible it can be excitingly enlightening.

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Often a woman has managed to be seen on her own during many visits to her GP and the gynaecology outpatient clinic without the inclusion of her partner. He may well have attended the clinics but somehow, because he was not invited into the consultations, he remained in the waiting room, on the fringe of this ‘women’s world’. How does this happen? Patients’ understanding of infertility problems revolve around the premise that it is almost entirely a female deficiency. Just in the same way that society has equipped itself for the fertile, so all assumptions and efforts at treatment have been tailored to the female side of the problem. Therefore it is so often the woman who appears first in the surgery with the statement, ‘We’ve been trying for a baby for so many months now, and I just don’t seem to be able to get pregnant.’ Because it is the woman who is there in front of the doctor it is usually she who is the focus of all the initial tests, without any discussion between the couple and the doctor. Such discussion with the couple, to exclude any psycho-sexual problems, is as important as the gamut of blood tests that are carried out. It can also act as a baseline for the recognition of developing difficulties during sometimes lengthy treatment.

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Miss B. was a pretty blonde woman who requested abortion. She came to the clinic accompanied by her boyfriend. Immediately, she stated that she did not want an abortion but that he did. Her anger was obvious and it seemed he had been brought to the clinic to suffer. She had come off the Pill some months earlier ‘to give her body a rest’, they had not used contraception and they were both apparently aware of the possible consequences. He went on to say that the relationship had been going through difficulties and he did not feel she was mature enough to look after a baby. She felt she could do so perfectly well if he supported her. They both realized that they were using this pregnancy to sort out their relationship once and for all. They wanted more time to talk and made another appointment. Miss B. returned alone, looking more composed. Her boyfriend had agreed to her keeping the baby but had placed so many conditions that she felt her life would be intolerable. She wanted an abortion and hoped that one day she would be able to have a baby with someone who was right for her.

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This is not a perfect nor a 100% successful method, perhaps easier to cope with because of, not despite, these apparent drawbacks. The risk factor, the possibility of pregnancy, is vital to some women if they are to really enjoy intercourse.

Mrs C. definitely knew that she and her husband did not want any more children. However, she could not contemplate sterilization, for herself or her husband. She cheerfully started taking the Pill, but three months later she was back, looking unhappy. No real problems, except . . . well, she quite liked sex, but . . . she could not come any more. Could it be the Pill? Different contraceptive pills were tried, to no avail. It was decided to try the coil, despite the doctor’s worries about the risk of pregnancy. She returned happier, the periods were ‘miserable’, but sex was good again. The doctor initially thought that this depression of libido was caused by the Pill but Mrs C. confided that she had realized that at the point of orgasm she silently called to her husband, ‘Give me a baby . . .’ She used this fantasy to release herself sexually, and the very unreliability of the coil was its best point.

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SIX GUIDELINES FOR FUTURE SEXUAL SUCCESS

There’s no reason why most men can’t enjoy potency well into old age. Your chances of enjoying intercourse in your later years are determined largely by your genetic heritage, your daily habits and your emotional well-being. While there’s nothing you can do about your gene pool, you do have a lot of control over your lifestyle. You can live in a way that puts the odds for maintaining potency in your favor, or you can set yourself up for problems. The choice is yours.

If you want to prolong your potency, try to follow these essential guidelines:

• Eat a low-cholesterol, low-fat, high-fiber diet.

• Maintain your proper weight.

• Keep your blood pressure normal.

• Exercise regularly—at least three times a week,

• Don’t smoke, chew or sniff tobacco.

• If you drink alcohol, drink moderately.

Let’s take a closer look at these suggestions.

The Potent Lifestyle

The link between lifestyle habits and loss of potency is supported by the work of some French physicians who studied 440 men with erection problems. The doctors found that men with erection problems are likely to have one or more of the following: diabetes, high cholesterol levels, high fat levels and high blood pressure. Many also smoke. In fact, the doctors found that every man they studied who had two or more of these major risk factors also had low blood pressure in his penis, which indicates poor blood flow, one cause of erection problems.

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Sometimes the shots give an added bonus. After three or four injections in the doctor’s office, some men find that their erections actually return to normal and they don’t need the shots anymore. Others still need the shots, but not on such a regular basis. Right now, researchers don’t understand why some men are fortunate enough to be affected this way. One study found that men with blood-flow and psychologically caused problems were the most likely to get erections on their own after a few shots, while those with nerve damage were most likely to need a shot each time they had sex.

Sidney, 62 years old, is a good example of a patient for whom the shots worked well. He had been married for almost 30 years, and first noticed problems with his erections 5 years before he visited a clinic. He was distraught that he was now completely unable to get any erection. Sidney had read a lot about the new advances in treatment for erection problems, and he announced his decision before he even sat down: He wanted a penile implant.

It wasn’t clear just what was causing Sidney’s problem, and the doctor decided that a penile shot could give important diagnostic information. Sidney responded to his first injection with a very poor erection, and he was clearly disappointed. Other tests showed that Sidney had a lower-than-normal flow of blood to his penis, a condition probably caused by important arteries being partially blocked. Sidney’s hormone levels were fine, and he didn’t suffer from any chronic diseases which could cause such a potency problem.

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Men’s Health-Erectile DysfunctionKnowledge alone isn’t enough. The attitude of your doctor is critical to your sexual success. Some people, doctors included, can talk about anything—except sex and death. But a doctor who’s embarrassed discussing sexuality won’t do you much good, no matter how much he knows about the subject. Your doctor should be at ease when talking about potency.

And the reverse is true. A doctor who’s easygoing, intent, respectful, talkative and kind but doesn’t know much about what does and doesn’t make a man potent won’t be of much use to you. Because the erection process is complicated, and currently the subject of much exciting research, ifs essential that you find an expert who treats potency problems frequently and keeps up with the latest findings. Many physicians have received little or no formal training in this area, and the information they do have may be out-of-date. For example, when a patient told one young physician about the usefulness of penile shots, the doctor initially thought it was a joke. But there are physicians, psychologists, sex therapists and other professionals who are well trained and equipped to help you.

We recommend that you start with a urologist who specializes in treating impotence. Or, if you meet all the criteria for psychologically caused impotence we gave in chapter 6, you may want to start with a trained, qualified sextherapist. But even if you suspect your problem may be psychologically caused, we recommend that you have an urologist do a thorough physical evaluation. Many of the physical causes of erection difficulties are subtle and easy to miss.

The only way to find a good urologist who specializes in potency is to ask around. Here are some places to start:

• Ask your family doctor for a referral.

• Call the urology department of the nearest university medical school and ask them for advice.

• Contact your local medical society for a list of doctors who treat potency problems.

• Contact support groups such as Impotents Anonymous.

Once you find a doctor who might be good, if s time to ask some serious questions. Don’t be afraid to quiz your doctor. Remember, you deserve the best. If a doctor “doesn’t have the time to be bothered” with your questions, you should consider looking for someone else.

Here are some questions to ask:

• What training have you received specifically related to erection problems?

• How-do you keep current on the subject? For example, do you attend continuing education courses on impotence, do research into the problem or routinely review medical journals for the latest findings?

• How much of your practice is devoted to treating problems like mine?

• Do you regularly consult other experts?

You should be able to tell from the answers how experienced the doctor is in treating erection problems.

Another important tip is to steer clear of anyone who’s a proponent of just one particular treatment for all potency problems. Unless he’s already seen a complete physical workup of you and thoroughly understands how the problem is affecting you, the doctor should not assume on your first visit that he knows the solution to your problem.

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It may seem far fetched that a couple could go for years without discussing so vital a matter as a major change in finances. But many couples react in just this way when it comes to vital sexual matters. Erection problems may be particularly difficult to talk about, because in our culture, many men equate erectile ability with being a man. Even a man who is basically secure may find himself questioning his professional and personal competence when he faces an erection problem. He may suffer reduced confidence, lack of self-esteem and depression.

The importance of erections to many men’s self-image is clear when we look at the comments of some men who used to have erection problems, but are now potent. For some, the significance of erectile ability goes far beyond sex.

One elderly man says that even though intercourse, because of ill health, is no longer a priority with him and his wife, he feels that restoration of potency was important. “It relieved some stress on my mind,” he explains. “The idea of being able to perform helps me a lot.”

Another man attributes his newly returned ability to get erections to a dramatic change in his whole attitude: “Now I feel that I can continue to function as a man. I fly an airplane and travel. I feel very special. I now move about in my social circles with confidence and pride. I am able to cope with life without embarrassment or doubts, and I enjoy every day as it occurs.”

Breaking the Ice

You and your partner can talk about erection problems, even if the subject has been completely off limits up until now. In fact, you must talk. Here are some tips to make your first discussion a little easier:

• Pick a time when you are both relaxed.

• Make sure you have plenty of privacy.

• Start by telling your partner how much you value your relationship.

You may want to bring up the questions below. The goal is to use this time to listen to your partner. Don’t try to change the way she feels, just try to understand. Questions to consider:

• Does the potency problem change the way you feel about me?

• What can I do to help the situation—and you?

• How has my behavior changed since the problem started?

• How does this change make you feel?

• What should we do about the problem?

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During the drug intervention trials, I interviewed a number of men and women, not only to gauge the physical effectiveness of the medication, but to get an idea of the psychological impact on them both.

The most immediate effect was on the men’s renewed perception of themselves as fully functioning sexual beings. Story after story bore this out. One often-voiced comment was that the ED medication allowed men to bring their own personal style to their sexual encounters. With their confidence restored, they could relax and, sure that their erections wouldn’t fail them, shift part of their focus to the pleasure of their partners.

One forty-one-year-old man who had injured himself in the gym and was unable to have sex for ten months told rne, “I feel liberated. That’s the only word for it. And because I was ‘damaged’ while exercising, I haven’t been back to work out. I used to be so proud of how I looked; but once I was hurt I didn’t care anymore. Now I feel whole again and I’m no longer fearful of the machines. I’m taking care of myself once more and I’m just so relieved that my lover didn’t lose interest in me. Because of that, and the fact that I can perform again, I feel that he and 1 have something even better.”

This man’s story had a happy ending because of a supportive

partner. Sadly, that is not always the case. For many men whose erections have been lost, especially for a long period of time, suddenly being able to achieve intercourse may not be the solution to a disintegrating relationship. “It’s not just a matter of having an erection and saying, ‘Let’s go for it, honey,’” says Robert Broad, a New York psychologist who treats many patients with sexual dysfunction issues. “First and foremost, the patient must honestly assess the general health of his sexual relationship and determine whether he and his partner are in sync and ready to work together toward the same common goals.

“Oftentimes, when the male is restored, new pressures are exerted on the relationship. Making the assumption that both partners are interested in intercourse is often a false one,” says Dr. Broad. “Many men are surprised to find that their partners are not happy to resume intercourse on a regular basis. What I often hear from female patients whose husbands have been successfully treated for ED is, ‘Why do I have to have sex all of the time now? I was happy the way it was.’

“There are also some women who have never viewed themselves as sexual—and prefer to stay that way. Many women are readily able to accept a partner’s ED because it is more in keeping with their own sexual appetite. Some are not sympathetic to their husband’s frustration at the loss of his ability—and they are not at all excited at its restoration.

“I find that the best interpersonal relationships are built upon constant communication between partners,” Dr. Broad states. “Sex is not just about being good in bed or having a hard erection; rather it has to do with two people caring, caressing, and accommodating changes in the area of physical abilities. It also has to do with accepting, rejoicing in, and celebrating the all-important gender differences, recognizing, too, the uniquely different sensibilities that men and women bring to lovemaking.”

People who have suffered with ED often lose sight of this, solely and unfairly equating ED with a loss of manhood. When this viewpoint is stuck in place, it is the erection—not the relationship—that becomes more important than anything else. In some cases it can irrevocably lead to an inability to trust any sexual partner, with the idea of sustaining a relationship a distant dream.

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AllergiesHistamine is a chemical that is released by the white blood cells (basophils), the blood platelets and the mast cells in that area of the body that a foreign substance is residing. Histamine’s job is to dilate the blood vessels so that extra lymphocytes can arrive quickly on the scene, and speed up the metabolic rate of all the cells in the area, that they may have the energy to protect themselves from and, in the case of lymphocytes, defeat the foreign body (virus, bacteria, fungus, etc.). In this way histamine acts as a normal part of the immune reaction and is vital if we are to survive invasion by infectious agents. Normal amounts of histamine dilate the blood vessels only as much as is needed to supply the required number of lymphocytes to do the job. The arrival of the extra lymphocytes, the dilation of the blood vessels and the increased metabolic rate of the cells in the area, produces only a mild inflammation which, for the main part, goes unnoticed.

If too much histamine is released there is an excessive inflammatory reaction that leads to tissue damage. In these circumstances the immune mechanisms are protecting us at the cost of tissue damage and excessive inflammation (swelling, redness, pain).

Allergic reactions take place in those people whose immune systems habitually over-react to certain antigens. Any antigen that causes such an over-reaction of the immune system is known as an allergen. However individual and different allergic people may be, they all have one thing in common: an immune system that over-reacts to antigens/allergens, such as foods, grasses, pollens, moulds, dust mites, dust, that are normally not life threatening.

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