Now You See It, Now You Don’t

Recently I have had some difficulty achieving/maintaining an erection. When I’m in a sexual situation it will just disappear suddenly and I can’t get it back again. This is really affecting my confidence and I’m worried that it might start affecting my relationship with my partner. What’s going on?

Having erectile difficulty is something many men suffer from at some point in their lives – so don’t feel like you’re alone in this. It’s perfectly normal for this to worry you but you shouldn’t let it knock your confidence. Erectile dysfunction is a problem that can be dealt with.

First of all, it’s important to figure out whether your problem is physical or psychological. You say you’re in your thirties, but you haven’t gone into detail about your health. How is your weight? Are you physically active? What’s your lifestyle like? All sorts of different factors can affect your sexual function; from underlying medical conditions like diabetes, to personal factors like stress.

I would advise that you first speak to your partner about this. A supportive partner can make the world of difference. Make sure that your sexual problems aren’t caused by problems you might not be addressing in your relationship.

If the problem persists, speak to your doctor. They should be able to address any underlying physical issues and help you on your way to healthy, happy sex life.

The Great Disappearing Act…

I’m a healthy 60-year-old man and I have no problem getting an erection or ejaculating, but over the past few years the amount of semen coming out has become less and less. I’m concerned that this means there’s something seriously wrong with me. Should I be worried?

It sounds like this is perfectly natural. As men age the amount of sperm they produce decreases. A twenty-year-old would be expected to produce about 4.0ml of ejaculate. By the time you reach your sixties this amount will have about halved.

If you are ejaculating and no semen is coming out then this may be a cause for concern. This is known as a dry orgasm and is not normal.

Without a physical examination there’s no way of making sure there’s nothing wrong with your ejaculation. If you start feeling any pain, noticing blood in your semen or you begin experiencing dry orgasms, visit a doctor immediately.

Is Lighting Up Letting You Down?

I am in my early thirties and I have just quit smoking. I’ve not had any trouble with getting or maintaining an erection – but I’m worried that because of my smoking I will in the future. Is this true? How can I prevent it?

First of all, congratulations on quitting smoking. It’s not an easy feat for anyone and you should be commended for taking this positive step to preserve your health for the future. Smoking does do lasting damage to your body, but every day smoke-free helps your body recover and improves your long-term health prospects.

Smoking can affect your erections because the act of smoking damages your heart and your blood vessels (which are absolutely essential to getting and maintaining an erection) it can contribute to erectile dysfunction.

You’ve never experienced erectile dysfunction and you’ve taken the positive step to quit smoking – so the problem will not suddenly develop as a result of past misdemeanors! If you want to give yourself the best chance of avoiding erectile problem just make sure you maintain a healthy diet, a healthy weight and a healthy lifestyle – oh, and stay quit!

Don’t Strangle The Snake!

I am in my twenties and would call myself a fairly fashionable man. I’ve been wearing skinny jeans for a few years now – nothing too tight, but I read recently that skinny jeans can affect your fertility – is this true?

Ah, the great conundrum! Must we suffer for fashion?

The bad news is, some studies suggest that wearing tight jeans and underwear could affect your fertility. The good news is that this probably won’t affect you.

Wearing tight jeans affects your circulation especially around the groin and knees. If your testes have been kept too close to the body, affecting their circulation it could affect your fertility.

But you say your jeans have not been too tight, which suggests they’ve never been tight enough to cause discomfort – so you should be safe. But do be careful about wearing tight clothing around the groin.

The Ball’s In Your Court

Hi, I’m getting older and my father contracted testicular cancer in his sixties, so I’m concerned about getting the condition myself. How do I do a testicular self exam?

I’m sorry to hear about your father and unfortunately this does mean you’re more at risk of developing the condition. But don’t let that panic you! It’s not inevitable.

Knowing how to do a testicular self exam is essential for every man. As with all cancers, the earlier you spot testicular cancer the easier it is to treat – so well done on being proactive.

The best way to do a self examination is to move your penis out of the way (make sure your hands are suitably warm first, of course) and hold your testicle in between the thumbs and finger of both hands. Gently, roll your testicle between your fingers checking for any hard lumps, bumps or changes in size, feel or consistency.

If you do find something of concern, don’t be afraid, contact your doctor immediately.

To T Or Not To T

I was listening to a podcast recently which talked about the use of testosterone replacement therapy to stay in shape and “cheat death”. The speaker was a 48-year old MMA personality who is in great shape! I am 38 and a big fitness fan but as I grow older, I find it increasingly harder to put on and maintain muscle through the gym. Should I consider TRT to stay in shape?

I’m not sure what this person meant by “cheating death”, but it is true that TRT can counter some of the aging effects men experience, such as decreased muscle mass and weight gain. Sportsmen have been using testosterone as a performance enhancing drug for a while (including Lance Armstrong), and it is now banned by the World Anti-Doping Agency as it’s considered to create an unfair playing field for athletes to compete upon. Testosterone increases the size of muscle cells, and also encourages these muscle cells to multiply – it also plays a key role in controlling your weight.

So yes, testosterone can be used to enhance your fitness – but don’t rush to your doctor just yet. Using Testosterone Replacement Therapy if you are not suffering from low testosterone levels can have side effects. Most importantly, testosterone overdosage causes feminisation due to excessive oestrogen production: not only do you grow permanent “moobs” (male breasts), you also reverse any benefits you might enjoy from testosterone. You may want to consider whether something aesthetic like muscle size is worth running these risks for. My advice would be to go to the doctor and have your testosterone levels checked, to find out whether TRT is really something that you need, and to have a proper discussion about the risks and benefits.

High Blood Sugar, Low Sexual Function?

I was recently diagnosed with Type 2 diabetes and my doctor informed me I had been suffering late onset diabetes for almost four years. I am worried about the effect of those years on my body as I have already developed complications such as background retinopathy. I have read that uncontrolled diabetes can cause erectile problems – I don’t have a girlfriend at the moment, but should I be worried about this?

Getting diagnosed with a condition like diabetes can be can be scary, and it’s natural to feel concerned about the effect on your sex life. But don’t worry – with a few key lifestyle changes, diabetes and its effects on your body can be controlled. If diabetes is not properly managed, it can cause damage to nerves and blood vessels, which can reduce blood flow, and you’re right in thinking that this can affect your ability to get and maintain a satisfactory erection. There are also psychological factors to consider as performance related anxiety will have a negative effect on the hydraulics.

I’m wondering about your age, which is a significant factor in erectile dysfunction (ED) – the older you are, the more likely this is to affect you. Have you noticed any symptoms of erectile dysfunction during masturbation? Do you suffer from loss of sensation, or feel a reduction in your levels of desire?

Whether or not you’ve noticed symptoms, I would advise you to speak with your doctor for your peace of mind – it may seem an embarrassing concern, but your doctor will understand the importance of sexual health for your wellbeing. When managing a long term condition such as diabetes, it’s particularly important to get into the habit o f consulting your doctor with any concerns you may have.

No Hard Feelings

I’m very attracted to my wife, but I don’t seem to want sex that often, and when I do I rarely ejaculate. She is starting to blame herself and doesn’t believe me when I say it’s me, not her. I’m about 2 stone overweight but my blood pressure tests within a normal range…what should I do?

Low libido is very common, and affects most men at some point in their life, so don’t despair, you’re not alone. There are many reasons why your sex drive might temporarily decrease – stress, fatigue, depression, marital conflict – but it is also true that obesity can increase your risk of erectile problems by between 30-60%.

There are reasons for this which go beyond your apparently normal blood pressure – obesity increases your risk of low testosterone and also causes Type 2 diabetes, so it’d be a good idea to go to the doctor and get your testosterone and blood sugar levels checked, just in case. It could also be that it’s a general lack of fitness that is causing your failure to ejaculate – if you can finish alone, but not with your wife, it might be time to start working a bit of light cardio into your routine. Talk to your doctor and see how you can tackle your problems – the good news is that ED caused by obesity is usually reversible.

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