Monthly Archives: June 2020

What Women Need to Know About Men’s Health – Talking About Men’s Health™

What Women Need to Know About Men’s Health – Talking About Men’s Health™

Dear Doctor: As a wife, daughter, sister, and mother of two boys, I’m surrounded by men. What do I need to know about men’s health?

A: I’ve always maintained that men’s health is a women’s issue, since when men are healthier, their partners become healthier too (along with their children and communities). Here are the basics:

Male-Specific Health Problems

  • Testicular Cancer. This is the most common cancer in men ages 15 to 35. Although it can’t be prevented, thanks to improved treatments and diagnostics, it has a very high cure rate if caught early.
  • Low T. Testosterone is the most important male hormone, yet millions of men suffer from testosterone deficiency, which, left untreated for too long, is linked with long-term health problems such as loss of muscle mass, low sex drive, erectile dysfunction, inability to concentrate, and even osteoporosis.
  • Prostate Problems. This walnut-sized gland produces semen and naturally enlarges as men age. Potential problems include prostatitis and BPH (benign prostatic hyperplasia) which can cause swelling and painful or difficult urination.
  • Prostate Cancer. Prostate cancer is a concern for men 50 and older, or high-risk men 40 and older (including African-Americans, men with a family history of prostate cancer, and men exposed to Agent Orange), all of whom should be screened yearly. Caught early, this disease is often treatable.
  • Erectile Dysfunction. ED is the inability of a man to get or maintain an erection sufficient for his sexual needs or the needs of his partner. Although ED becomes more common with age, men of any age can suffer from it–and most briefly do at some point in their life. Erectile problems are usually caused by an underlying health problem, such as diabetes, clogged arteries, or high blood pressure. Unfortunately, most men won’t discuss ED with either their partners or sexologist in Delhi. As a result, men feel embarrassed, and women feel that their men no longer find them attractive. So if you want to make love and he says he has a headache, pay attention: it might be something far more serious.

Recognizing Other Health Problems

Male-only conditions aren’t the only ones men suffer from. They die at higher rates than women from stroke, heart disease, kidney disease, diabetes, and cancer. When a warning light flashes on the car dashboard, most men take the car to the shop. But when warning lights flash on their body, they ignore them. Here are a few flashing lights you should look out for:

  • Changes in Bowel or Bladder Habits. This can be an indication of prostate or bladder problems. And blood in the urine is a common indicator of kidney problems. Does he get up repeatedly at night to go to the bathroom? Chances are he won’t notice, but you will.
  • Symptoms. Persistent backaches, changes in the color of urine or stool, obvious changes in warts or moles, unusual lumps, recurrent chest pains or headaches, bleeding that won’t stop, nagging cough, unexplained weight loss, and extreme fatigue can all be symptoms of serious health problems.
  • Depression. Although women may be more likely to attempt suicide, men are four times more likely to succeed. Because men are reluctant to ask for help and may try to hide their depression, you may recognize the symptoms sooner than he does. These can include being angry or anxious, having trouble sleeping, social isolation, complaining of feeling empty or helpless, engaging in risky or reckless behavior, or losing interest in hobbies or other pleasurable activities (including sex).
  • Osteoporosis. Although usually considered a women’s disease, osteoporosis affects men too, and is generally under-diagnosed in men. This disease, which causes the bones to become fragile and more likely to break, can lead to permanent disability or death.
  • Breast Cancer. Men have breast tissue too, and 400 men die of breast cancer each year. Men often confuse their symptoms with a sports or work injury, and because they’re less likely to recognize or report symptoms, they’re usually diagnosed only after the disease has spread.

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How to diagnose and treat syphilis

How to diagnose and treat syphilis

Do you have painless sores, blisters or ulcers on your penis, vagina, and anus, or inside your mouth or on the lips? You could have syphilis, a sexually transmitted infection is caused by a type of bacteria. The infection usually starts as a sore in or on the genitals, anus or mouth. It then leads to a painful skin rash and can lead to damaged organs, if not treated. With the right treatment, though, you can get this infection sorted.

Syphilis happens in primary, secondary, latent, and tertiary stages:

Primary syphilis

During this stage, you develop a sore that’s usually painless. This often happens within three weeks of getting the bacteria. At this point, you are very contagious.

For men, the painless sore often appears in the genital area, but not always on the penis.

For women, the sore develops on the outer genitals or on the inner part of the vagina. You may not notice the sore if it grows inside the vagina or at the opening to the uterus (cervix).

Secondary syphilis

The secondary stage involves a skin rash and sore throat, which means that the bacteria from the sore has spread to the bloodstream. The rash usually doesn’t itch and can be found on the palms and soles. Some people don’t notice the rash.

Other symptoms include:

  • Swollen lymph nodes (small glands all around your body that are part of your immune system)
  • Fatigue
  • Fever
  • Headaches
  • Aching joints
  • Weight loss
  • Hair loss

Latent syphilis

The third stage of syphilis is usually referred to as the hidden stage. While the primary and secondary symptoms of syphilis show no noticeable symptoms, at this stage, the bacteria remain in the body. This third stage could last for years before developing into the fourth stage, called tertiary syphilis.

Tertiary syphilis

This is the last stage of the infection. While this stage is rare, it has the most severe complications. It can affect different organs, like the brain, heart, spinal cord, liver, bones and joints, which could result in death.

This last stage is life-threatening and can develop years after the initial infection. Some other complications of tertiary syphilis include:

  • Neurosyphilis, an infection of the brain or spinal cord
  • Mental illness
  • Memory loss
  • Blindness
  • Deafness
  • Destruction of soft tissue and bone
  • Neurological disorders, like stroke or meningitis
  • Heart disease


Risk factors

  • Having sex with multiple partners.
  • Having unprotected sex.
  • Being infected with HIV; the virus that causes AIDS.

Treatment

Syphilis can be cleared with antibiotics. Blood tests can determine whether you’ve been infected with syphilis or not. If left untreated, it could increase the risk of HIV and infertility. If you’re sexually active, it’s best to get tested by sexologist in Delhi every six months and between new partners for all types of STIs.

Prevention

  • Always use a condom when you have sex; this helps minimise your risk for syphilis.
  • If you’re having sex with multiple partners, it’s important to use condoms and have regular STI tests.
  • Discuss your sexual health with your partner and know each other’s sexual health status.

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Orgasm Disorders: Anhedonia

Orgasm Disorders: Anhedonia

Problems with orgasms, while not as common as other sexual disorders, are some of the most frustrating sexual health issues around. To be clear, we are talking about orgasms, no ejaculations. An orgasm is the euphoric feeling that occurs primarily in the brain and is a sudden release of a cocktail of hormones and chemicals. Because orgasms are a combination of the neurological phenomenon, brain chemistry, emotional state, and arousal, the problems are very complicated to diagnose and treat.

The most two common problems that we see are ejaculatory anhedonia and sexual anhedonia. Anhedonia is based on the Greek root for pleasure; this is the source of the word, “hedonism”. Anhedonia means lack of pleasure. Sexual anhedonia is where sexual stimulation and arousal simply do not feel pleasurable. Ejaculatory anhedonia is where there is no euphoric orgasm accompanying ejaculation.

These disorders are very frustrating for the patient and often lead to significant mental and emotional distress. The typical scenario is that a man is functioning perfectly normally and through some set of circumstances or events, he loses his sense of sexual pleasure. It can be sudden onset or a gradual decline.

Diagnosis is complicated because we must rely solely on the individual’s reports and responses. There is no test to determine orgasm function or pleasure received from stimulation. Many men have been to various doctors seeking help. Virtually every patient has been told there is nothing wrong with him and it’s all in his head. However, this is a very real problem and it can devastate a man’s sex life.

Part of our diagnostic process is to do a complete medical and physical checkup. There are several hormone issues that can contribute to this problem. Low testosterone can be involved. Too much prolactin can be a culprit. Medications can cause problems. SSRIs (antidepressants) are notorious for causing sexual anhedonia. Even blood pressure medication can contribute to this. Neuropathy can be involved and some diabetic patients report sensory problems.

The mental health professional will look at various factors as well. Depression or anxiety can trigger anhedonia. Relationship problems can complicate things. Trauma of any kind can be a culprit. And like most things sexual, once the train-wreck-in-the-brain gets involved, things spiral downhill very quickly. Diagnosing this issue requires ruling out probable causes, and that takes time and perseverance.

Treatment largely depends on the cause – if it can be determined. There are medications that can enhance dopamine levels in the brain which is a primary component of an orgasm. Creating optimal testosterone levels is often part of the treatment. Treating depression and anxiety medically requires using drugs that tend to have fewer sexual side effects. Sex therapy is often a good idea. Psychotherapy is usually recommended because this is a complicated problem to deal with and can be very frustrating.

Alternative therapies can include acupuncture as well as hypnotherapy. Some men have found relief by changing their diets and discovering their body was reacting badly to something they were eating. Some men try chiropractic treatments. Alcohol tends to exacerbate anhedonia. I have had patients use reiki healing for this. Basically, there is no treatment that is off the table when it comes to treating this elusive condition. We will support the patient in his search, and we will leave no stone unturned.

Because this is a less common condition, the sense of isolation and loneliness is very common among these men. Many times, the men tell me they feel “broken” and like “damaged goods.” This is where sex education and therapy can help patients cope with this condition while we are exploring treatments. While uncommon, this condition is more prevalent than people realize.

If you suffer from anhedonia of any kind, begin your journey of healing with a qualified sexologist in Delhi, contact us for consultation.

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Dealing with Unsolicited Fertility Advice from Others – Talking About Men’s Health™

Dealing with Unsolicited Fertility Advice from Others – Talking About Men’s Health™

They’re probably just trying to help, but getting an earful of advice from others about your infertility issue can be incredibly uncomfortable. And belittling. And distressing. Like you haven’t already been endlessly researching options and talking with providers. Untargeted infertility advice is often way off target…and it just keeps coming. But, although no one has been through exactly what you have, they may still be able to support you.

Eight Ways Out

How should you react to statements that seem to rub salt in your emotional wounds?

  • Realize that you may never be able to respond to the statement, “You can always adopt.” This may just not be part of your vocabulary.
  • When you hear that “What happens will happen,” remember that the source of the advice is not God or Darwin and that hope floats all boats.
  • When confronted with “Look on the bright side,” understand that it’s OK to pass on bright things for now.
  • Let the statement, “At least it’s not cancer” remind you that not everyone can validate the experiences of others. Forgive them.
  • And remember to hug the friend that says, “I wish there was something I could say to make things better.”
  • Know your limits when others talk about their pregnancies or their children in your presence. And kindly excuse yourself from the conversation if those limits are reached.
  • Find ways to connect and communicate with others on topics that you used to enjoy talking about.
  • Try to think of advice from friends as a prickly form of support which could make it all a bit more palatable and tolerable.

I’m convinced that infertility affects lives just as much as cancer does. But not everybody knows that. It can take a herculean effort to simply survive, and even more to thrive. So, do what you have to do to get through this, because just surviving will make you an infinitely stronger human being. In the words of Sarah Lewis, “We thrive not when we’ve done it all, but when we still have more to do.”

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Ejaculation vs. Orgasm…what’s the difference?

Ejaculation vs. Orgasm…what’s the difference?

When it comes to talking about sex, our culture struggles with understanding terminology and definitions. Using words and meaning is necessary for clear communication. If we are not able to communicate clearly, we are not able to explain accurately what is going on with our bodies. If we are not using the words correctly the doctor can often end up focusing on the wrong problem. There are two words that I find people often use incorrectly: ejaculation and orgasm.

Ejaculation and orgasm are not the same things at all. They are two vastly different bodily functions that happen to occur usually around the same time. Both ejaculation and orgasm can have function problems. If we are not clear in describing the issue, the doctor is going to be unable to help us. The general public is not alone in this confusion. I am often amazed when I’m talking to urologists that even they confuse these two events.

Ejaculation is the pulsing contraction of pelvic/penile muscles to expel semen. Ejaculations can include one or many muscular contractions that can last anywhere from a couple seconds to 30 seconds or more. It is normal for the semen to dribble out and it is also normal for the semen to shoot several feet! Everyone is different.  For some men, no semen will come out. That does not mean that there was no ejaculation – it is simply called a “dry ejaculation.” The ejaculation process is controlled by a lower spinal cord nodule that acts as a miniature brain controlling sexual response.

An Orgasm is the euphoric feeling that occurs with the climax. Very often, an orgasm can contribute to muscle spasms, vocal sounds, and other body movements. But these movements do not aid in the expulsion of semen. An orgasm is caused by a sudden release of brain chemicals. These euphoric sensations can be described as a big, small, genital-focused, whole body, and can even seem to emanate from various areas of the body. Orgasms can last anywhere from a few seconds to 15-20 seconds for some men – the average for most men is 5-10 seconds.

Most men think they experience these two events simultaneously. The truth is they do occur near each other but for some men, they feel an orgasm right before the ejaculate and other men begin to ejaculate and then feel the orgasm. Both of these are perfectly normal. The pulsating contractions of ejaculation are pleasurable, but they are not really part of the orgasm any more than the pleasurable stimulation on the penis is part of the orgasm.

Interestingly enough, some men learn to separate ejaculation from an orgasm. Some men can learn to have multiple orgasms and never ejaculate until they choose to do so. This takes a lot of practice, but it can be done. Some men learn to have whole-body orgasms from anal/prostate stimulation. These orgasms do not have an accompanying ejaculation – in fact, these orgasms have nothing to do with the penis at all! There are anecdotal stories of men who have experienced spinal cord injuries who cannot feel their penis but can give themselves an orgasm from stimulating other parts of their body such as armpits or neck. Some men can give themselves orgasm from nipple stimulation. Some men can ejaculate/orgasm without touching their penis at all!

Both orgasms and ejaculation can have problems. If that happens to you, please be sure to be aware of what exactly is going wrong. Are you having trouble with ejaculation (such as timing, pain, or semen) or are you having problems with orgasm (loss of euphoria, diminished sensation, loss of orgasm)? Make sure to consult with a sexologist in Delhi.

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What Guys Need to Know About Masturbation

What Guys Need to Know About Masturbation

Masturbation is natural and healthy. Over 94% of men masturbate.

It feels good. It can reduce stress and tension by releasing endorphins, oxytocin, and dopamine, and it can even help you sleep.

It helps young men to explore their bodies, and learn what they like and don’t like.

But most men know very little about masturbation, so we’re going to cut through the myths and misinformation, and answer some practical questions.

Does Masturbation Cause Erectile Dysfunction?

This is a common belief, but extensive studies have shown that masturbation has no effect on a man’s ability to achieve and maintain an erection. The International Society for Sexual Medicine says, “The notion that masturbation causes erectile dysfunction (ED) is a myth.”

However, some studies show that there could be a potential link between watching too much porn and erectile dysfunction.

Are There Health Benefits from Masturbation?

In addition to reducing stress, masturbation may actually have a measurable effect on reducing your risk of prostate cancer. Studies have found that men who ejaculate at least 5 times per week have a significantly lower risk than men who ejaculate less frequently (2 or fewer times per week), although researchers don’t understand why.

Researchers at the University of Sydney claim that masturbation improves immune functioning by increasing cortisol levels, which can regulate immune functioning in small doses. It also reduces depression by increasing the amount of endorphins in the bloodstream. They add that engaging in self-pleasure can also ‘lower the risk of type-2 diabetes (though this association may also be explained by greater overall health), reduce insomnia through hormonal and tension release, and increase pelvic floor strength through the contractions that happen during orgasm.

Masturbation also promotes blood flow, an important factor in the health of the penis. This is especially important for men who don’t have nighttime or morning erections, which are believed to be the body’s mechanism for ensuring an adequate blood and oxygen supply to the penis.

Are There Risks from Masturbation?

If you masturbate frequently, the penis can become irritated. To prevent this, use a good quality sex lube, or a lotion without scents or additives.

If you masturbate too vigorously, or if you bend or twist the shaft, it’s possible to fracture your penis, by rupturing the corpus cavernosa – the sponge-like chambers in the penis that are responsible for erections. Signs of this include:

  • Extreme pain
  • A noticeable ‘popping’ sound
  • Loss of erection
  • Swelling or bruising of the penis

A fractured penis requires immediate medical attention. Without treatment, a fracture may result in permanent damage.


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COVID Affects Everything—Even Your Sex Life – Talking About Men’s Health™

COVID Affects Everything—Even Your Sex Life – Talking About Men’s Health™

Dear Healthy Men: I had a nasty case of COVID-19 several months ago. It’s taken a while, but I’m fully recovered—except for one thing: I’ve been having trouble getting and keeping an erection. I know that most men have erection troubles at some point, but I never have before and I’m wondering whether there could be any connection between COVID and sexual difficulties.

A: What a great question. In a word, the answer is Yes. A recent study published in the Journal of Endocrinological Investigation explored that exact question. Professor Emmanuele A. Jannini, M.D., of the University of Rome Tor Vergata and his colleagues found a definite connection between erectile dysfunction (ED) and COVID-19. How does it work? According to Jannini, there are several likely culprits:

  • Overall health issues. Like it or not, ED is a good indicator of our overall health and is often a symptom of an underlying health problem. And since COVID-19 can aggravate (or cause) many health concerns, it’s no wonder that there’s a connection to ED.
  • Psychological issues. In addition to the damage COVID-19 can do to one’s physical health, there are also numerous mental health issues, including depression and anxiety, both of which can cause ED. Men’s Health Network (MHN, menshealthnetwork.org) and the Patient-Centered Outcomes Research Institute (PCORI, pcori.org) recently organized a conference entitled “Behavioral Health Aspects of Depression and Anxiety in the American Male,” which discussed this topic in detail. MHN and PCORI have also put together a series of webinars on the effects of COVID-19 on the mental health of men and boys. You can read more about the conference and the webinar series at either website.
  • Cardio issues. Many people with COVID have developed cardiovascular problems, including dangerous levels of inflammation in the heart and circulatory system. And any problems with blood circulation may result in ED.

To dig deeper into the connection between COVID and ED, I spoke with Dr. Judson Brandeis (brandeismd.com), who’s a urologist and an expert in men’s sexual medicine. He’s concerned that “the COVID-19 pandemic will result in widespread erectile dysfunction.” How? Brandeis explains the big picture this way: “Erectile function is highly dependent on pressurized blood flow, which starts at the heart, pulses through the large arteries, and then flows through the small blood vessels. Conditions like diabetes, high cholesterol, and smoking cause damage to the inner lining of the blood vessels, which causes ED. So does COVID-19.” That’s fairly to understand. But there’s also a more complicated—yet fascinating—explanation.

“The coronavirus hijacks our own cells to create new copies of itself, which then get released throughout our body,” Brandeis says. “However, since our body has never seen this virus before, it hasn’t developed the antibodies that would allow it to mount a targeted defense. As a result, it tries to stamp out the invader by launching a massive, non-specific immune response. The body’s massive response ends up damaging itself—particularly the endothelium, which is the delicate layer of cells that lines our blood vessels.” The bottom line: blood vessels are narrowed and blood flow is restricted, which increases erectile dysfunction.

Ask your doctor about ways to protect your endothelium. Several clinical trials are currently exploring the use of nitric oxide (a chemical produced naturally in our body that acts as a vasodilator, relaxing the lining of blood vessels and increasing blood flow). According to Brandeis, the results so far are optimistic. Also, get vaccinated as soon as possible. That will help your body produce the right antibodies and may reduce blood-vessel damage. In the meantime, keep wearing a mask and avoid groups of people.

Image by Arek Socha from Pixabay 

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Why Do Some Men Continue to Look and Feel Young?

Why Do Some Men Continue to Look and Feel Young?

The short answer is that there’s a strong correlation between testosterone levels and overall sexual health. Testosterone is  a key hormone that contributes to looking and feeling younger.  More specifically, testosterone plays one of the most important roles in a man’s overall vitality and sexual pleasure. Men’s testosterone levels often peak during adolescence and early adulthood, but over time, they gradually decline. In fact, it has been projected that men 30 years of age and older will experience a 1.6 % decrease in total testosterone levels each year. Low testosterone, or Low T, is a medical condition that occurs when the body is not producing enough testosterone,  causing a variety of symptoms such as, erectile dysfunction, decreased libido, infertility, decreased muscle mass, fat gain, mood changes, unexplained emotions, and fatigue. Depending on who you talk to, “normal” testosterone levels can vary significantly. That’s why it’s so important to  have your levels checked by a provider who specializes in testosterone replacement therapy.

As men age, it is common to see changes in body composition, resulting in loss of muscle and a gain in fat mass, especially visceral and central fat. Evidence-based practice suggests that  when testosterone treatment is given to men ages 24 to 85 years of age, they saw an increase in lean body mass with a total reduction in both central and visceral obesity.  A decrease in visceral fat is important as we now know it is a predisposing factor that leads to metabolic syndrome, diabetes, and cardiovascular disease.

Evidence-based practice has also proven that men with low T who have started testosterone replacement therapy experienced a decrease in fat, decreased total cholesterol levels, increased bone mineral density, improved erectile dysfunction, improvement in cognition, improved mood, and better glycemic control in men with diabetes. Any combination of these factors can ultimately lead to more energy and an increase in activity, resulting in a more youthful appearance and feeling young again!

If you feel like you may have low testosterone, contact us for a consultation.

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You CAN Get Pregnant During Your Period

You CAN Get Pregnant During Your Period

A lot of us grow up hearing all sorts of myths about sex, and since many of us don’t get comprehensive sex education, some of these untruths never get corrected. Today, I’m here to change that! Well, I am not going be able to teach you everything you need to know about sex, but I will be busting some myths about period sex.

The misconception exists that you can’t get pregnant if you have intercourse on your period, but this isn’t true. It IS possible to get pregnant during this time of the month. So, if you’re not on birth control and not trying to get pregnant, always make sure to use a condom for intercourse during your period.

However, just because you can get pregnant it doesn’t mean you should avoid sex or intercourse altogether. Some people aren’t into the idea of having sex on your period, and that’s fine! But also know that there’s nothing wrong with having sex during your period–it can actually be really great. Some people find that they have increased libido during their periods, and that orgasms can reduce menstrual cramps. So, if you’re interested, have at it! Just put down a towel first (and maybe make sure your partner doesn’t faint at the sight of blood).

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When It Comes to Your Health, Your Penis May Be the Canary in the Coal Mine – Talking About Men’s Health™

When It Comes to Your Health, Your Penis May Be the Canary in the Coal Mine

Dear Healthy Men: Like a lot of men my age (I’m 44), I have occasional problems in bed. I think it’s happening because I’m stressed about finances and life in general. I’ve been taking medication that helps, but my wife is concerned that it might be a symptom of something more serious and is urging me to get checked out. Could she be right?

A: Your wife sounds like a smart lady—and she’s definitely right. While there’s no question that erectile dysfunction (ED) can be caused by depression or anxiety, there’s also no question that it can be caused by existing or impending physical problems. These include cardiovascular issues (including high blood pressure and high cholesterol), diabetes, hormone imbalances (including too-high levels of prolactin and/or too-low levels of testosterone), urinary tract problems, spinal cord injury, and some neurological issues.

What most of these conditions have in common is that they effect blood flow throughout the body. And since the arteries in the penis are smaller in diameter than those in the heart, it doesn’t take much to reduce or block blood flow there, which in turn may lead to ED. That’s why it’s more common for men with known coronary artery disease to complain about ED than it is for men with ED to complain about heart problems—but that doesn’t mean that those heart problems don’t exist. In fact, “having ED can predict that a man will probably have heart disease symptoms within five years,” according to the Cleveland Clinic (my.clevelandclinic.org). They add that, overall, “having ED is as much a risk factor for heart disease as a history of smoking or a family history of coronary artery disease.”

Okay, so now you understand the connection between ED and other health issues. But putting aside sex for the moment, do you have erections during the night or first thing in the morning? Most adult males have three to five erections every night, each lasting roughly five to twenty minutes. Judson Brandeis (brandeismd.com), the urologist and men’s sexual medicine expert I quoted here a few weeks ago, says that these nighttime erections (technically referred to as “nocturnal penile tumescence” or NPT; less-technically referred to as “morning glory” or “morning wood”) are the body’s way of providing oxygenated blood to the penis and keeping scar tissue from forming.

NPT can be very helpful in diagnosing or ruling out underlying physical problems. For example, if you have frequent, strong NPTs but suffer from ED when you try to have sex, your medical provider may be able to rule out conditions or diseases that affect blood flow, and may want to investigate psychological causes instead. On the other hand, a decrease in—or total lack of—NPT is a strong indicator that the problem isn’t “just in your head,” and is, instead, physical.

So follow your wife’s advice and schedule a physical exam. Tell the sexologist about your ED (yes, it may make you uncomfortable, but do it anyway) and ask to be screened for high blood pressure, cholesterol, and diabetes. Also be sure to talk about lifestyle issues: both cigarette smoking and alcohol consumption are strongly associated with ED.

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