Sex in men's life seasons

Men have the chance to enjoy sex no matter the age. If one takes care of his health, sexual potency not only does not fade away in the course of time, but becomes even more prominent. Anyone can achieve that.

Youth

This is the time of wild passions and sexual records. A young man can "fire up straightaway" just at the thought of it. The elastic blood vessels stiffen the male organ, "recharging" is instant and a few consecutive intercources without loss of erection can be no exception. This helps even "fast runners" take the situation in hand.

Maturity

Men undertake new commitments throughout the years, which leaves thoughts of and time for sex away into the background. However, the importance of sexual performance remains, regardless of whether it is a matter of a lasting relationship or just an affair. To avoid unnecessary disappointment, one should be aware of some natural developments, which occur with age:

• An older man is like a violin – he needs more time for tuning to achieve excellent performance;
• His penis is not always as rigid as steel, however some women enjoy this velvety touch;
• "Automatic recharging" becomes more and more difficult, yet the skills for extending the act improve, and in most cases the task is completed as early as in the compulsory programme of the first intercourse;
• Even if the "forward" leaves the playground, a mature man has sufficient experience to carry on the game with his remaining ten players (fingers) to secure a victory.

Old age

For the majority of elderly men, sex is just a nice memory. Contemporary medicine, however, has found a solution even for this age group – there are medicines achieving an unbelievable effect. These are the agents from the group of phosphodiesterase inhibitors. Yet, such medication should be used only after consultation with a specialist, and should never be taken together with drugs containing nitrates.

How to preserve the sexual flame

How does erection occur?

Erection is the enlargement and hardening of the male sex organ, allowing penetration into the vagina. The process is a result of sexual stimulation (i.e. direct stimulation of the penis, watching of exciting scenes, or having exciting sexual thoughts, etc.). This provokes enlargement of the arterial vessels in the cavernous bodies and increases the blood influx. When the blood pressure in the cavernous bodies becomes equal with that in the other parts of the body, the blood carrying veins press against the external membranous cover, preventing the drainage of venous blood from the penis.

Stable and sound erection

An erection is good when it allows unhampered penetration of the penis into the vagina.

The erection stability reflects the emotional state of the man and is associated with complete indulgement in the erotic experience.

Sufficiently long lasting erection

The duration of the erection depends both on the physical and emotional state of the man. A long enough sexual act gives satisfaction to both partners. Sustained erection can be achieved with some medical help (e.g. taking the orange pill 15 minites prior to sexual intercourse), while the skill to postpone the end can be acquired by any man by following short tips from an expert sexologist.

Good physical shape

A sexual contact is not only a contact of the genitals; hence good physical shape is always a part of the sexual pleasure.

Physical activity, sport – Sexual longevity is a privilege of physically active men. Therefore, we should seize every opportunity for physical activities in the open. Physical exercises help to keep the cardiovascular system fit, the latter being vital for the quality of erection. Moreover, this is a good way of getting rid of the accumulated mental stress and physical tiredness and opening the mind and body for erotic thoughts and desires. When sport becomes the way of relaxation for the whole family, health benefits are reinforced by unforgettable experiences with the closest people – a natural stimulation of the sexual activity.

Diet – The majority of health disorders are due to irrational dietary habits. Various aphrodisiacs could help, yet it would be best to focus on moderate quantities of healthy food, such as fruits, vegetables, and fish. Overeating is the enemy of good sexual performance. Following excessive eating the blood flow to the digestive system increases, which causes drowsiness and difficulties with getting an erection. We would feel much better, if we eat slowly, choose tasteful dishes, and stop eating a while before feeling fully satisfied. Nuts, honey, and some seafood have been regarded for ages as food enhancing the sexual desire. However, experience shows that the company shared and the mood inspired are more important.

Smoking – The times when smoking was regarded as a symbol of manhood are long gone. The reason for this is the accumulated scientific evidence that vascular problems (including erectile dysfunction) occur twice as often and much earlier with smokers. Low doses of nicotine have a mild vasodilatating effect, which makes the smoker feel refreshed after the first cigarette. Higher concentrations, however, have the opposite effect. The instant effect of a higher number of cigarettes is constriction of the vessels and limited blood supply (including to the penis). It has been demonstrated that with chornic smokers, smoking more than one box of cigarettes per day, damages of the endothelial cells in the blood vessels occur much earlier, which dramatically increases the risk of erectile dysfunction, stroke or myocardial infarction.

Alcohol consumption – Alcohol makes people relax and boosts up their spirits, that is why it has been associated with sexual pleasures since ancient times. Excessive alcohol consumption, however, unhibits the sexual reactions and can lead to unpleasant surprises, such as unstable erection and impossible ejaculation. One or two glasses of wine are recommended, since it would expand the blood vessels and create good mood, without increasing the risk of failure.

Medication – Some medicines, such as antidepressants, some antihypertension drugs, etc. can suppress the sexual desire and make erection more difficult. You should consult your doctor about possible therapy replacement.

Testosterone – After reaching its maximum by 30 years of age, the level of testosterone – the manliest hormone – starts lowering by 1% per year. The state of low testosterone levels is known as hypogonadism (HG). HG is the main reason for erectile dysfunction (ED) in about 20% of the cases. Beside ED, hypogonadism is characterized with low libido, accumulation of fat in the abdominal area, muscle mass reduction, hair growth changes, decreased muscle tone, chronic tiredness and even depression. Testosterone deficiency is a condition which has to be medically treated, since besides being a cause for sterility, it is also associated with a higher risk of cardio-vascular diseases and diabetes, and higher mortality rates in men. We should not forget that the intensity of erotic experiences is one of the most powerful stimulants for increasing the levels of testosterone in men.

Overweight – Overweight represents a potential risk for both one's sexual abilities and for a number of other health aspects. To restore one's optimal body mass is a matter not only of diet and physical activity, but also a matter of choice of a different life style and other sources of pleasure.

Good technique

Regardless of the hardware available, the art of love making is magic, which happens thanks to our ability to create unique erotic atmosphere, intimacy and diversity.

Frequency of sexual contacts

Just like the regular physical activity keeps a sportsman in top form, regular sexual life is necessary to maintain an optimal sexual condition. Any formal abiding by some mechanical rhythm is void of meaning. Sexual contacts are not only the result of physical needs; they are mainly manifestation of the mutual desire to experience exciting moments together and spontaneous display of feelings. It is established that with couples over 60 years of age, maintaining of sexual activity is associted with 5 to 10 years longer life expectancy for both partners, to be enjoyed at that in a better health condition and higher quality of life.

Other diseases, causing erectile problems

The most frequent cause for the occurance of ED is the existence of an underlying disease:

• Hypertension – a frequent cause for disease-related loss of erection. As the diameter of the vessels in the penis is smaller compared to that of the coronary and brain vessels, the loss of erection in hypertensive subjects is an alarm signal. A timely consultation with a specialist can not only preserve the sexual potency, but also save the life of a man with a vascular risk.
• Diabetes – untreated diabetes can damage both vessels and nerves, related to the erection. That is why men suffering from this disease should be particularly strict in their adherence to the therapy to avoid the development of any diabetic complications. The rate of ED with men without adequate control of diabetes amounts to 50%.
• Neurological diseases (multiple sclerosis, spine injuries) – ED is observed with a number of neurological diseases, such as spinal trauma, peripheral neuropathy, damaged nerve endings of the small pelvis following operations of the rectum, bladder or prostate.
• Cardio-vascular diseases and high cholesterol level – Heart diseases are the most frequent problem, associated with ED. In fact, the presence of ED can be a warning for a cardio-vascular disease.

  The high cholesterol level increases the risk of ED occurrence by 80%.

  In 30 to 50 percent of the cases, the reason for ED are blood vessel disorders.

  Atherosclerosis is a risk factor for ED in 70 percent of the men over 60.

  The connection between ED and cardio-vascular diseases is real. This is one more reason to talk to your doctor if you think that you have ED symptoms. It could turn out that you suffer from another disease too.

• High blood pressure – In general, there is a relation between high blood pressure and ED. In fact, two out of every three men with high blood pressure also suffer from ED to some extent. High blood pressure hampers the work of the heart and strains the blood vessels. They become more narrow, which leads to decreased arterial blood supply to all body organs, including the penis.

  About 40% of the diagnosed ED cases are associated with high cholesterol levels and high blood pressure.

  The plaques coating the arteries (due to the high cholesterol levels), can be the cause for 70% of the ED cases with men at the age of 60 or over 60.

  ED can be the first symptom for other blood vessel disorders.

• Depression – With men suffering from depression, the cause for ED can be psychological, physiological, or a combination of both. With a lot of men, ED can aggravate the depression still further. This is due to the fact that erectile problems lead to lower self-esteem, lower self-confidence and problems with the partner. Furthermore, some medicines used for treatment of depressive conditions may lead to the development of ED as a side effect of the treatment.

  The likelihood for men with depression to have moderate ED symptoms is nearly 90%.

• Operation of the prostate – Sometimes, the occurrence of ED can follow as a consequence of an operation of the prostate. If your prostate was operated on, you may have noticed a change in the erectile function – the ability to achieve or maintain erection. This is not unusual. The majority of ED cases, due to an operation of the prostate, are curable. Therefore, you should ask your doctor about the most appropriate treatment for you.

How is ED diagnosed?

On the basis the complaints of the man and the story about the course of the disease.

A valuable assessment tool is the questionnaire – THE INTERNATIONAL INDEX OF ERECTILE FUNCTIONS (IIEF)

ED is often the first symptom of serious diseases, such as ischaemic heart disease, or arterial hypertonia and diabetes. An early diagnosis would help to detect any such diseases in their initial stage, and delay their development in time.

There are routine tests for diagnosing ED – analysis of the hormonal status, blood glucose levels, lipid profile, etc. These methods allow to identify the cause for ED, and refer the patient to a specialist.

Test with postal stamps

Its aim is to establish the quality of nocturnal erections. One needs seven strips of postal stamps. Each night, in the course of a week, he must put a stamp strip round the bottom of the penis and stick both ends together. In the morning, he must check whether the strip is torn at the perforated line. If such an erection happens at least once in the course of the week, this would confirm the idea of a rather psychogenic or temporary nature of the dysfunction. The absence of ripping does not confirm the presence of an organic dysfunction. This should focus the attention on a more detailed analysis of the erectile function.

How to differentiate between organic and psychogenic ED

Typical for the psychogenic ED is the achievement of sufficient rigidness of the penis at self-satisfaction, spontaneous erotic experiences, in the evening or in the morning at waking-up, and also at the beginning of the sexual contact, when it is still too early for the actual intercourse. Any possible separate successful contacts are also a sign for the absence of serious organic disorders.

Most frequent problems

Difficult erection

The most frequent cause for delayed erection or insufficient erectile quality is the existence of anxious self-observation and the fear of failure. The absence of sufficient erotic mood can also obstruct the achievement of erection, which, in its nature, is an emotional reaction. If, anyway, one has good erections in the evening or in the morning at waking-up, or at self-satisfaction, then it is definitely a matter of some ordinary «jamming».

In such cases, good results are achieved with the help of the pills from the PDE 5 group; the so called sexual stimulants. It is important to know that the higher the selectivity of the pill is, the safer and more reliable is its profile. In the event of permanent loss of any erection, and particularly at the existence of evidence for arterial hypertonia or diabetes, one should always seek medical assistance.

Quick loss of erection

One of the most frequent problems men have in bed is the short duration of the sexual intercourse. The reason is that being afraid of failure, men tend to lose their erection before ejaculation. This makes the contact too short, which is disappointing for both partners.

The results published in one of the most esteemed scientific magazines in this field, The Journal of Sexual Medicine, make sexologists see in that property of the drug a great opportunity to improve the quality of sexual performance with a lot of men. If the efforts to overcome such sexual difficulties by ourselves fail to lead to the required result, it would be best to refer to a specialist for competent sexological help. The quickest way to achieve permanent changes is when both partners are involved in getting back their normal sexual relationship.

Premature ejaculation

This is the most frequent problem with men, and in the majority of cases it is associated with the lack of ability to control the process of ejaculation. Over the last years medicines have become available, which can help any men suppress the centre of ejaculation and having the opportunity for more frequent contacts, build up an ability to control the process within a couple of months. This ability is sustained even after the gradual termination of the medication. The most reliable way to achieve the desired result is to consult a specialist.

Erectile dysfunction (ED)

According to the common definition, erectile dysfunction is the inability to achieve and retain erection, necessary for a sexual intercourse. In fact, ED includes both transitory "jamming", which can happen to any man, and conditions of permanent and definite loss of erection in men suffering from serious diseases. One of the most representative studies, the Massachusetts Male Aging Study, covering men between the age of 40 tо 70, indicates that ED affects about 52% of the men investigated. Among them, full loss of erection is observed with 5% of the men at the age of 40. According to data from another study, over 155 million men worldwide suffer from ED. Their number is expected double by 2025 and reach up to 322 million.

Types of ED – according to the cause for its occurrence

ED can be organic, psychogenic or most frequently a combination of both.

• 1. The psychogenic form of ED is most frequent with young men and is due to a high level of anxiousness and fear of poor peformance. It can occur at a first meeting with a new partner, in the event of a conflict between the partners, or at the presence of stressful and depressive experiences.
• 2. The organic ED can be provoked by a functional disorder of the blood vessels in the penis, hormonal, neurological or other diseases.
  • 2.1. The most prevailing form of organic ED is the vascular ED, where the influx of arterial blood to the penis is obstructed. This is due to damages of the penile arteries in cases of hypertension, inadequate control of diabetes, or other specific damages to the cavernous bodies.
  • 2.2.The most frequent hormonal cause for ED is testosterone deficiency (TD). This is a state characterised by decreased levels of the male hormone testosterone. Lower testosterone levels are observed in about 20% of the ED cases.
• 3. Combined – this form of ED is observed with an accompanying disease, causing erectile problems, which by itself leads to a psychological trauma of the patient due to fear of failure in bed.

The solution...

Sex pills

Over the last years have been developed efficient medicines, inhibiing directly a specific enzyme in the cavernous bodies of the penis, which ensures rigidness and sustainability of the erection. The most efficient and widely applicable medicines are those of the group of PDE5-inhibitors. In the presence of sexual stimulation, they guarantee good and stable erection. This is the most reliable method for a man to release himself from his worries about the quality of his sexual performance and to restore his usual successful contacts quickly. In case of more pronounced organic damages, the intake of such preparations is to be combined with treatment of the underlying disease, but only after a consultation with a specialist.

Men in Bulgaria can choose between several preparations

The first preparation, registered in our country, also known as the blue pill, has proven qualities in the world practice. Its effect lasts for 4-5 hours. It is available in doses of 25, 50 and 100 mg. The recommended initial dose is 50 mg.

The second is the orange pill, which according to research data guarantees an erection as early as 10 minutes after intake, and retains it for a sufficiently long time. In this way the sexual act is prolonged. This is the most selective molecule, with a good safety and reliability profile. If taken 15-20 minutes before a sexual intercourse, the orange pill helps the man to achieve stable and durable erection at sexual stimulation. Available in doses of 5, 10 and 20 mg. The recommended initial dose is 10 mg. It can be taken with food and moderate quantities of alcohol. The orange pill can be taken every day.

The third preparation is characterised by its long effect of up to 36 hours. Doses of 10 and 20 mg are available in Bulgaria. The recommended initial dose is 10 mg.

The choice of a pill should be made by a specialist, taking into consideration the personal preferences and specifics of each particular case.

Penile implants

These are small medical devices, filled with saline solution, which are implanted surgically in the penis to help erection. They supply the penis with fluid, when the man wants to achieve erection. They are unnoticeable.

The insertion of implants dates back to the early 70-ies. Ever since approximately 300,000 men have had their erectile problems treated by means of this method.

There are three types of implants.

• 3-piece implants (these are about 75% of all used implants);
• 2-piece implants (about 15% of all used implants);
• Semi-rigid (about 10% of all used implants).

As in all surgical procedures, there is a risk of infections here too. Although the implants are highly reliable, their use can cause certain problems.

Vacuum erection device

A plastic cylinder is placed around the penis to create vacuum through pumping out of the air. The vacuum draws blood out into the penis and makes it rigid. At the bottom of the penis is placed an elastic strip to retain the blood and keep the penis rigid.

The vacuum erection device consists of three parts:

• A plastic cylinder, in which the penis is placed
• A pump to take the air out of the cylinder and create vacuum. The pump can be manual or battery driven. The lower pressure in the cylinder increases the blood supply to the penis, leading to an erection.
• One or more plastic rings. They are placed at the bottom of the penis after vacuum erection is achieved. They help to sustain the erection by limiting the drainage of blood from the penis.

The vacuum device generates erection, which lasts up to 30 minutes and is sustained with the help of the elastic rings.

Injection therapy

A medicine is injected into the penis to expand its blood vessels. When they are expanded or dilated, the supply of blood is increased and erection is achieved.

The injection therapy has been applied since 80-ies, and was widely used before medicines for treatment of ED were discovered. Generally speaking, it is less effective than the orange pill and the urethral sticks.

The injection therapy uses a combination of medicines prescribed by a doctor, most often an urologist. They are injected straight into the penis. This leads to muscle relaxation and increased blood supply, thus to erection.

Medicines are injected directly into the penis by using a fine needle syringe (insulin type). Erection takes place within 10-15 minutes and lasts for 60 minutes. If it lasts longer, the man must contact his doctor who has prescribed the therapy or seek other medical assistance.

Urethral sticks

A soft suppository (stick) is inserted into the urethra, with medicine, which is absorbed by the penis. The increased blood supply produces an erection. The method is similar to the injection therapy, but it without a needle.

Usually, doctors give patients the opportunity to try a stick during the examination in the surgery to be able to determine the right dosage. Before the stick is inserted, one has to urinate. Passing urine makes the urethra moist and facilitates the absorbtion of the medicine.

The medicine, in the shape of a small ball, is inserted with the help of a small applicator into the urethra – the tiny hole at the top of the penis. Then the penis has to be massaged for about a minute to ensure the melting of the stick. Before inserting the stick, a band can be wrapped at the bottom of the penis, to keep the medicine in.

Usually, erection is achieved within 10-15 minutes following insertion of the stick. It lasts for about 30-60 minutes. Sticks can be used twice within 24 hours. However, they should not be used for a second time immediately after the first erection. Urethral sticks are prescription-only medical devices.

Herbs and food additives

They have been known since ancient times, and compared to medical agents are relatively less expensive and without pronounced side effects.

Their effect on sexual performance, however, is rather slower.

Testosterone replacement therapy (ТRT)

ED, being the result of hypogonadism, can be successfully managed by applying testosterone therapy, which compensates hormonal deficiency effectively and discreetly. The result of this therapy is a higher sexual desire and improved erectile function, fat tissue reduction, increased muscle power and bone density, considerable improvement of the psychological and emotional state. Two forms of TRT are available in our country: a long acting preparation, which maintains the levels of testosterone within normal physiological limits, applied by injection 4 times a year; and a testosterone gel, applied daily. Their prescribing is subject to clear indications and precise preliminary tests, carried out by a specialist.

Psycho-sexual therapy

In the event of more serious challenges in one's personal life or partnership, erectile dysfunction becomes a reason for seeking consistent support to overcome the existing conflicts. The psycho-sexual therapy does not exclude the use of the above mentioned medical agents; however it focuses the attention mostly on personal responsibility.