2. Sexual Dysfunction Health 27 Fall 2007 Patrick Barresi Health 27 Fall 2007 Patrick Barresi

3. source Castleman, M. Great Sex. Rodale. 2005 Simon, H. Harvard Guide. Free Press. 2002 Castleman, M. Great Sex. Rodale. 2005 Simon, H. Harvard Guide. Free Press. 2002

4. Sexual Dysfunction - Types Erectile Dysfunction Lack of Desire Premature Ejaculation Delayed Ejaculation Others –Retrograde Ejaculation –Priapism –Peyronies Disease Erectile Dysfunction Lack of Desire Premature Ejaculation Delayed Ejaculation Others –Retrograde Ejaculation –Priapism –Peyronies Disease

5. Sexual Dysfunction - Myths

6. A real man should want sex all the time. Men should always initiate and orchestrate sexual activity Real men never fail Performance is everything, feelings nothing Sex should always culminate with intercourse and ejaculation A real man should want sex all the time. Men should always initiate and orchestrate sexual activity Real men never fail Performance is everything, feelings nothing Sex should always culminate with intercourse and ejaculation Sex should be spontaneous and natural, with lots of action but little planning and talk Sex should always be satisfying for both partners Intimacy requires sex, and sex requieres a rigid erection Nobody believes these things anymore, which is the biggest myth of all! Sex should be spontaneous and natural, with lots of action but little planning and talk Sex should always be satisfying for both partners Intimacy requires sex, and sex requieres a rigid erection Nobody believes these things anymore, which is the biggest myth of all!

7. I. Erectile Dysfunction

8. Impotence or Dysfunction? Traditionally termed impotence, ie, lack of power. 1992 - NIH panel suggests erectile dysfunction as alternative 1998 - Viagra hits the market; Bob Dole is spokesman Pfizers marketing of Viagra popularizes ED as the term now commonly used. Traditionally termed impotence, ie, lack of power. 1992 - NIH panel suggests erectile dysfunction as alternative 1998 - Viagra hits the market; Bob Dole is spokesman Pfizers marketing of Viagra popularizes ED as the term now commonly used.

9. Definition Persistent (at least 3 months) inability to achieve or maintain an erection sufficient for satisfactory sexual performance. –American Urological Association (AUA) Persistent (at least 3 months) inability to achieve or maintain an erection sufficient for satisfactory sexual performance. –American Urological Association (AUA)

10. ED Myths

11. Myth: Erection is something a man achieves. Truth: Most men dont know how to achieve erections. They just happen. Penises dont become erect through work but through deep sensual relaxation. Truth: Most men dont know how to achieve erections. They just happen. Penises dont become erect through work but through deep sensual relaxation.

13. Myth: Sex is a performance. Truth: AUA definition satisfactory sexual performance. Spectatoring -- observing and crticizing yourself during sex Instead think of it as a form of adult play. Truth: AUA definition satisfactory sexual performance. Spectatoring -- observing and crticizing yourself during sex Instead think of it as a form of adult play.

14. Myth: Men are sex machines, always ready, always hard. Truth: Younger men can get erections pretty easily (typically) But After age 30 a set of conditions need to met for erection What are some conditions? Truth: Younger men can get erections pretty easily (typically) But After age 30 a set of conditions need to met for erection What are some conditions?

15. Myth: During each sexual encounter, you only get on shot at an erection Truth: Most mens erections come and go during sex Anxiety deflates erection Women expect erections to stay firm so may blame themselves. Communicate! (not necessarily right then!) Truth: Most mens erections come and go during sex Anxiety deflates erection Women expect erections to stay firm so may blame themselves. Communicate! (not necessarily right then!)

16. Myth: Ill never get it up again Truth: Dont over-generalize to a history of ED. Dont generate a self-fulfilling prophecy. What are reasons why things might not work once in a while? Truth: Dont over-generalize to a history of ED. Dont generate a self-fulfilling prophecy. What are reasons why things might not work once in a while?

17. Myth: If I cant get erect, they wont be satisfied sexually Truth Review the sexual anatomy of partners! Truth Review the sexual anatomy of partners!

18. Myth: If they say it doesnt matter, theyre lying! Truth Most women say they wish men wouldnt get so obsessed with the issue Erections matter to women because they matter to men Truth Most women say they wish men wouldnt get so obsessed with the issue Erections matter to women because they matter to men

19. Myth: Most men will develop ED with age.

20. ED Trends by Age Castleman: Severe ED incidence: 18 - 29 3% 30 - 395% 40 - 497% 50 - 5912% 60 - 6916% 70+25% Castleman: Severe ED incidence: 18 - 29 3% 30 - 395% 40 - 497% 50 - 5912% 60 - 6916% 70+25% Simon: ED in General: 40s2% 6525% 7555% 8565% 40 to 70 35% All men 52% Simon: ED in General: 40s2% 6525% 7555% 8565% 40 to 70 35% All men 52%

21. Causes: Performance anxiety -- give pleasure Relationship problems and life stresses Getting older Acute illness Heart Dz including HBP and High Cholestero Performance anxiety -- give pleasure Relationship problems and life stresses Getting older Acute illness Heart Dz including HBP and High Cholestero

22. More causes: Smoking Obesity Diabetes Neurological disorders Hormonal imbalances Depression Alcohol Drugs Smoking Obesity Diabetes Neurological disorders Hormonal imbalances Depression Alcohol Drugs