Category: Erectile Dysfunction

Popping the little blue pill. The cost/benefit analysis to taking Viagra and Cialis.

I think it may be so very hard for guys to date and love modern women. It’s a generality I know but modern romance puts pressure on men. Women expect a tremendous amount of confidence, skill and performance from the men we sleep with. Otherwise we may be tempted to throw you under the bus and replace you with a more virile model. We expect men to make the first (and second, third and fourth) moves, know their way around our bodies and perform regularly, for a considerable time, and with enthusiasm. Get hard, stay hard, don’t come too fast, and make sure we achieve multiple orgasms. If you can do all of this while romancing us with wine and flowers so much the better.
It’s from this premise that I am seeing lots of new kinds of sexual dysfunctions. One of the issues with porn addiction is the relief that men feel while focused exclusively on new sexual images without having to meet their partner’s needs. Men can enjoy their orgasms without the work of making us come. Pornographic images offer newness with zero pressure. Masturbation means guys aren’t getting criticized for lying on our hair, forgetting the lube or being a one-minute guy. It’s not the only reason men use porn compulsively, but it’s one of them. I have a number of men who are afraid to start dating because they suffer from premature ejaculation, performance anxiety of not getting hard with a new partner, or concern about a small penis size. I have a number of men as clients who would rather go without sex or be single their whole lives than face the trauma of being perceived as sexually inadequate. And men who are recently divorced and out on the singles market over 45 have age, blood pressure and the physiological effects of erectile dysfunction to contend with. There is a lot of pressure on guys and it’s a scary world out there.
So is it any wonder that men turn to the foursome of sexual enhancing drugs (Cialis, Viagra, Staxyn and Levitra) when faced with the absolute requirement to perform? Viagra and Cialis can both increase erections AND slow down ejaculation. Why wouldn’t any man want to be on it? As one client told me about Cialis; “its fun to walk around with a three day erection. It’s like High School all over again. Erections are longer, harder and bigger. You brush against a woman and get an immediate hard on”. Erections like that don’t happen beyond the early 20’s and even then they don’t happen if men are stressed. So you get some side effects like headaches and a flushed face but that’s an infinitesimally small price to pay in comparison to feeling like a stud. And women give you complete reinforcement. Some women give lip service to the idea that ED happens, but we are really disappointed if you can’t get it up. And men know this. Women will also blame themselves if a man can’t get hard. It must be that we aren’t attractive enough if you can’t get an erection for us. We believe it’s our fault even if your male partner is 50 pounds overweight, smokes a pack a day and is on a cocktail of cholesterol meds and anti-depressants.
So if using “Bob Doyle’s little helper” has men leaping tall buildings what’s the problem? Is there such a thing as psychological addiction to sexual performance enhancers? I think there are a few reasons why men are concerned about taking “steroids for their penis” in the form of these pharmaceuticals. The first is the stigma. Going to your doctor is embarrassing. It’s why these drugs are the most common thing bought through internet pharmacies. In Thailand they sell them at gas stations. Secondly, women can be dismissive of men taking erection meds. Again, we must not be attractive enough if you can’t get it up for us. Then there is the cost. On average, a single pill can cost anywhere from $4 to $12. And then there is the built up tolerance where men may need a higher dosage to get the same results. Finally, there is the challenge of sneaking the meds, and the fear of spontaneous sex with the terror of not being able to perform if your partner jumps you by surprise. The anxiety that follows not having pills on hand, or the worry that you have a secret in your pocket, wallet or glove box that could be discovered is real for many men.
For the average man, taking erection meds is not much more detrimental to your liver and overall health than taking a Tylenol. And if you can deal with the almost universal headaches and slightly weird feeling, or bluish tinge to your sight that some men describe as a side effect then the cost/benefit analysis comes down firmly on the side of the little blue (and yellow) pills. And men are not addicted to the pill (there is no chemical addiction), men become addicted to the feeling of women telling them that they are a sex God. Who wouldn’t want to feel like that? It feels good to feel hard. You are more readily horny and therefore sex becomes even more top of mind when you are hard. And as I mentioned, erection-enhancing drugs slow down the ejaculation for most men. No wonder they sell billions of dollars worth. Cialis is a confidence pill. Cialis let’s you get hard at the drop of a hat over a three-day period. With Viagra, it lets you get hard fast. And I mean break your hand on it its so hard fast. What’s that worth to the average guy? I tell people that if I was a guy over 40 I would have a plenary of erection-enhancing drugs in my medicine cabinet depending on the kind of sex I was expecting. Most men don’t necessarily need it all the time, (especially with a long term partner), but if there is someone else in the house, fatigue, or work related stress can cause a slowdown in men’s sexual reactions. It’s the equivalent to women using lube. If every time a woman went to have sex, she was too dry to achieve it successfully then how readily would she reach for the bottle of lube even if it had slight side effects like a low grade irritation? I think most of the time.
As women we are so worried about our bodies and grooming, and in truth most men prefer natural looking girls in a range of sizes. Yes we can be crazy and paranoid about our stretchmarks. Yes we can be high maintenance. Men can also be clueless about our need for intimacy. Men understand that women need some warm fuzzies as well as pounding intercourse. However we often change the rules about how we want it mid-thrust. Pleasing some women sexually can be like patting your head and rubbing your tummy. So guys will use any advantage they can get.
As one client said, “having a raging erection is like his convertible. Women love it, and they look at him differently when he’s driving it” He said he’ll never go back to driving a compact.

Why men don’t last. Why it happens, why its a problem and how to fix it.

I am constantly reading medical journals and sex articles in search of something new. For instance, women who have a longer distance between their clit and their vaginas are far less likely to climax during sex than women who’s vagina and clitoris are closer together. It turns out that there may be both a genetic and anatomical connection with men who suffer from Premature Ejaculation. Did you know that there is a gene for premature ejaculation? Think about it. 100,000 years ago some ancestor of yours came across a fertile woman. Before her father could find his club they had banged her and impregnated her quickly. The gene to get off quickly was passed along down the line you you. The moral of this story is that you can blame your Dad for your PE. Smile.

PE also happens with increased heart rate and faster breathing. We both know that our heart rate goes up by thrusting and as our excitement builds. Duh, Sue excitement causes us to hurry up as the little head takes over. Tantric or slow building sex works well to balance PE. Some of the creams work well. The new Promescent spray seems to have some success. For guys that seem to have no control I do a five step approach from the least intrusive to the most intrusive clinical things to help them last longer in the sack.

First I think keegal exercises help most men. Read my blog on tightening up that muscle by clenching and releasing the muscle you sit on. Then I implement the five stages of practical PE treatment all the while doing emotional counseling, teaching new sexual techniques and offering up the science of orgasms.

If you want to try-this-at-home and don’t want to try a counseling appointment here are my action items in order.

1. Try a cock ring around the top of the testicles, and a little desensitizing spray. Keeping your testicles down and your penis slightly desensitized delays climax.
2. I then use a different high octane spray and have them practice different ways of masturbation. ie. Masturbating with a rubber glove, leather glove, using cooling and warming gets, masturbation sleeves etc.
3. I have those one minute guys try about 10 mg of Cialis. I also add a testosterone boosting/estrogen blocker (supplement) to the mix. It turns out that Cialis and Viagra increase your erections, let you hard again quickly, and it slows down ejaculation.
4. I do sexual hypnosis. No kidding dealing with your subconscious mind works well for most men.
5. Finally, for men who still continue to struggle I send them back to their doctors for a short trial of antidepressants. I have loads of men on SSRI medications that have slowed ejaculation down to the point where they have the opposite problem.

That’s the general overview. The truth is that these steps really help but there is no one size fits all when it comes to sex therapy. Everyone is unique and I have to play with the options.
Get some help if you are having difficulties. Because it affects your partner. Have a read at the study that was published last week about delayed ejaculation and partner’s frustration. If its still not better drop me a line and we can set up a skype or in person appointment. I’m covered by all the health insurance plans so your employee benefits can cover the cost of an improved sex life.

New research suggests that when a man is too focused on delaying premature ejaculation, women are more sexually frustrated than when a man has an early orgasm.

Experts report that premature ejaculation causes increased psychological strain and stress on women as well as men.

In a new study, sex researcher Dr. Andrea Burri, a clinical psychologist at the University of Zurich, polled 1,500 women from Mexico, Italy, and South Korea and discovered that 40 percent report ejaculation control is very important for satisfactory intercourse.

Investigators found that it is not the short duration of lovemaking that is primarily regarded as the main source of sexual frustration by the majority of women, but the fact that the man is focused too strongly on delaying ejaculation.

As a result, he ignores the sexual needs of the woman and is unable to satisfy her individual desires.

For the majority of the women polled, satisfying sexuality does not only consist of sexual intercourse, but also includes kissing, caressing, and other forms of sexual stimulation, which are considered equally important.

If the man is primarily preoccupied with his problem — premature ejaculation and thus his performance — these needs are ignored.

“In the long run, the woman becomes distressed and frustrated. Much like the man, she avoids sexual contact for fear of rejection and the resulting trauma for her own sexuality,” said Burri.

The woman thus suffers a loss in quality of life and ultimately calls the relationship into question.

It is mainly women who do not perceive intercourse as the central aspect of sexuality, but prioritize sexual creativity that suffer from the man’s one-sided attention.

“Interestingly, lengthy coitus is primarily important for women who do not have any trouble climaxing,” says Burri.

For women who rarely reach orgasm — if at all — how long coitus lasts is not central. Instead, the sexual act serves to establish and experience intimacy and commitment.

Although premature ejaculation is also regarded as exasperating by women, the short duration is deemed less problematic than the partner’s inattentiveness towards their other sexual needs.

The survey reveals that an essentially harmonious relationship often ends in a split due to the woman’s psychological strain and bottled-up frustration.

The majority of the women indicated having been considerably more satisfied in previous relationships with partners who did not suffer from a sexual problem.

This was primarily linked to the fact that too much importance is attached to the problem of premature ejaculation in the current relationship.

Moreover, a quarter of the respondents had already experience a breakup in the past because of this sexual problem.

“After all, the consequences are often more far-reaching than simple sexual dissatisfaction as, in extreme cases, it poses a threat to the desire to have children if the man already ejaculates prior to actual intercourse,” Burri said.

Delayed or non-existent ejaculation. What should you do if you simply can’t come?

Orgasms are great. You know it, and I know it. Often called the peak human physiological sensation, the urge to “have a genital sneeze” or “rub one out” is one of life’s great pleasures.

Unlike with women where orgasm is separate from the physical response of ejaculation, (and we can engage in orgasms over and over again) male ejaculation can often mean the end of sexual activity for the moment. Then your partner rolls over contentedly and falls asleep. Or gets up looking for pizza. Ejaculation, no matter how pleasant it may feel, is simply an unconscious reflex that is generated by the prolonged stimulation of blood flowing against nerves in and around the pelvis. I know it is a very clinical explanation for something that can feel so amazing. I spend a lot of my time talking to men about their orgasms. Some men have sorted out the sensation of orgasm as different from ejaculation. Meaning they can stay at the sensation of peak pleasure without the fluid, and continue prolonging the pleasure until they finally decide to “shoot some seed”. Ejaculation and orgasm happen almost instantaneously together but they are separate responses that make up what we call sexual climax. Doug Arama in his book The Multiply Orgasmic Man has a great understanding on how men can learn to separate out the difference of orgasm and ejaculation. I consider it a must-read for anyone wanting to improve their game sexually.

Given that premature ejaculation is so common, I’ve focused disproportionately on ways to solve those the too quick phenomenon over the years in my blog. With PE, there seems to be some solutions in sight given the success of some of the anti-depressants like Wellbutrin or other medications such as Percocet or Tramadol. I also like the new PE cream Promescent as a possible solution for quick ejaculation. But what do you do when the opposite is true? What happens when you just can’t seem to come? Or when you can only come through masturbation? It turns out that there more men are finding almost impossible in reaching orgasm.

Clinically the research suggests that 10% of men have difficulty ejaculating when they want to. I think it may be even higher than that given the increased number of men on anti-depressants and other medication that prevents ejaculation. It can mean anything from not being able to ejaculate during intercourse, to taking forever to come from any and all sexual pleasure. Or for some men, they even having trouble climaxing through masturbation. So if you are on anti-depressants, anti-anxiety meds, high blood pressure pills, or even Propecia for hair loss you might be experiencing a big problem filling the condom. These medications can lead to a delay in ejaculation in men who previously didn’t have any difficulty ejaculating. Traditionally sex therapists have had little training in the area of slow ejaculation. It was considered a good thing if you had a guy who could last all night without coming. Tell that to men who can’t come no matter how hard they try, or take an act of God with all the planets in alignment to get them to erupt. I see retarded ejaculation in men who are often what I call late bloomers who spent their adolescence and often their twenties with only their right hand as a partner. They have trained themselves to only come with their own hand.

So how do you treat delayed, or retarded ejaculation?

The longest established treatment for DE assumes that a man can work on his existing level of arousal, building on it by using techniques to increase his sexual arousal and desire. In essence,therapy can find ways to stimulate the man – with sexual fantasies and in the physical world – that work for him. DE can be a result of stress, fear of impregnating a partner (even with contraception), or a psychological desire for control. Counseling can help with the psychological challenges if there are any.

Pragmatically, other options include orgasm cream (sometimes called clitoral gel- I like the Pink brand) which opens up the blood vessels. You can turn down the heat in the bedroom (cooler temperatures make it easier to ejaculate), move the testicles up towards the body, or try some gentle vibration on the head of the penis or behind the scrotum on the perineum. Practicing with an artificial vagina, using cooling gels and hand stimulation until almost at the point of no return and positioning the penis close to the vaginal opening while there is direct stimulation on the glands may also help.

Increased arousal techniques might also work. These are exercises designed to sexually arouse him by touching his partner, both sexually as well as non-sexually; exercises to help him relinquish his need for control and techniques to desensitize him from whatever has become his accustomed method of gaining arousal.

Finally, if none of these things work there is a electrical current that can be gently applied near the prostate that helps men reach completion. It’s the technique used to get men with spinal cord injuries to produce semen samples.

I have a number of clients who are trying to get their wives pregnant and can’t. If you can ejaculate by hand, use a syringe (or the infamous turkey baster) to move the fluid up the vagina closer to the cervix. Nature should be able to do the rest.

So if you are struggling to feel sexually satisfied by having a full orgasm and ejaculation don’t give up. These are the tip of the iceberg of suggestions to help men more easily ejaculation. Send me an email at sue@sexwithsue.com and let’s talk about your satisfaction.

It’s not all in your head. Men, low libido, ED and Premature Ejaculation.

I often feel very badly for my male clients. While 80% of my low libido clients are women, more and more men are looking for solutions for their waning desires. I spend my days speaking to guys about the angst they feel about what amounts to massive pressure to perform sexually. Think about it. They have to get hard, stay hard, last long enough (but not too long), and to understand what their partners what without being told. All this while dealing with high cholesterol, blood pressure and stressful work situations. It is a myth that all men are horn dogs that want constant intimacy. Of the individuals I see for low libido, 20% of them are male. And they come into my office with frustrated partners who feel pushed away, unattractive and never know when intimacy is going to happen. I’m also finding more and more young men with symptoms that the Canadian Urological Association associates with low testosterone. Which include erectile problems as well as low libido and what I call “The Archie Bunker Syndrome. And the issues of erectile dysfunction from diabetes, anti-depressants has many men keeping a store of those little blue or gold pills in their medicine cabinet (Viagra or Cialis). There are some newer and very effective solutions for erectile dysfunction. If stress is responsible for 80% of all illnesses (it must be true, its printed on all the Lululemon bags) then impotence is certainly impacted by lifestyle, anxiety and worry that they have all the necessary moves in the bedroom. And then there are those one minute guys.There are some newer and very effective solutions for erectile dysfunction. If stress is responsible for 80% of all illnesses (it must be true, its printed on all the Lululemon bags) then impotence is certainly impacted by lifestyle, anxiety and worry. And then there are those one minute guys. Beyond the start/stop method (and nothing says PE like grabbing the base of your penis and freezing during intercourse), daily keegal exercises and lot of prayer, traditional sex therapy hasn’t offered much in the way of solutions.

Fortunately, there is more help in that department. The desensitizing creams have improved beyond the Stud 100 to the new Promescent spray that is far more effective. Many of my clients are on certain types of medications. Viagra, Cialis and the new Staxyn does slow down the process, but so does either percocet or tramadol.
I had one client review that said for PE, “percocet was fantastic. Best non-drunk sex I ever had.” But there are downsides to adding medications to your life. I work with physicians to help balance what’s going on with the psychology and techniques related to being quick off the mark beyond meds for the rest of your life. The only thing I do know that doesn’t work is to ignore the problem and hope it goes away on its own. For some problems that works. For libido, erectile dysfunction and premature ejaculation, I guarantee that it won’t. Send me a note, I can make it all go away and the next person who’ll be singing “Oh what a beautiful morning” skipping down the street will be you.

Why balancing your hormones (Men- testosterone, Women-Oxytocin) eases the chaos with your partner.

hormones1Despite it being June and with summer holidays looming collectively, we should be in a great mood. That is if it would ever stop raining and we can get finally to the cottage and start our all over tans. Traditionally sunshine and time off (especially we Canadians) makes us feel better. It just seems to me that despite all we do to be happier, we feel overwhelmed. Call it a general grumpiness and a underlying disconnect between couples. Life is stressful. And busy. And if we listened to all the advice about self care we would probably pull out what is left of our hair. At least I know I would. A quick glance through the Supermarket and unread beach magazines offers up an extensive list of must do’s to make us happy, healthy and beautiful. It turns out that we must have connected date nights, exercise an hour a day, eat organically, take the right supplements, get over 8 hours of sleep, engage in meditation, along with community involvement, have fresh air and intimate time. Sound familiar? If I listened to all the propaganda about having a great life, I doubt I or anyone would get any work done. So how do you know what advice to follow and how do you fit it in a schedule bulging at the seams as it is?

If you figure it out let me know. Smile. Seriously, the longer I’ve been a shrink the more I am convinced that we are ruled by a million years of evolution and all the proteins coursing through our body. Hormones tell us how to behave, regulate our happiness to a much greater degree than they ever explained to us budding therapists back in those dusty lecture halls. It turns out that achieving hormonal health is the key to happiness. Recent scientific discoveries have proven that the difference between the sexes and how they relate to one another and can be explained by our hormones. Biologically men and women have similarities. Hormonally, we are poles apart. Men have 35 times the testosterone that women have. The higher the testosterone levels, the lower the stress. At middle age men turn into what I call “The Archie Bunker Syndrome”. The ways to increase hormone levels include watching Sports Centre (going to the man cave), fixing things around the house, (feeling competent and powerful), sex, exercise, and generally feeling protective of their mate and families.

For women, it’s all about the hormone Oxytocin. This is the cuddle hormone that your brain starts pumping out when we are first sexual with our partners. It lowers our stress levels and makes us feel connected. We build the most Oxytocin when we give and receive nurturing support. But who has time for nurturing support when we are stressed and busy!!! By nurturing I mean everything from baking healthy muffins for your kids, to ranting to your friends about your co-workers. Sleep, massages, and chocolate also help.
I’ve listed below the best 5 foods that lower your cortisol levels, balance your blood sugar and give off that sharing and giving love feelings.
1. Ginger, lemon and cinnamon tea with honey. It’s got 4 of the ingredients that soothe your inflamed cells, and is something I dink by the potful daily.
2. Coconut Oil. It has become the cooking oil of choice. It stimulates the body to burn more fat, and well as deals with the inflammation of hormonal imbalances. 🙂
3. Acai berries. I use 1/2 teaspoon of dried berries in my daily smoothie. Acai berries are known to raise your metabolism without caffeine and lower your stress.
4. Maca Powder. It’s derived from a root from Peru and has been long been associated with sexual functioning. Maca can help stop hot flashes and increase libido.

The new word and new product in Premature Ejaculation. There is hope.

pe4

I’ve been sampling a new Premature Ejaculation treatment to some of my patients. Although I haven’t had what I would consider a full scientific sample yet, the early news seems promising. I’m cautiously optimistic as at least 25% of men suffer from being “a little quick off the mark”.

The new treatment is called Promescent. It’s a a Lidocaine-based topical spray, that has been created by a urologist, Promescent is a topically applied spray that not only helps relationships impacted by “early release,” but also those looking to prolong an intimate encounter. PE affects more men than erectile dysfunction, making Promescent a new treatment that is en route to becoming a household name.

Here is some of the propaganda about this new miracle cream. As I said, the jury is still out but it looks promising.

Promescent is designed to absorb below the surface of the skin where nerve endings are located, ultimately prolonging intercourse and bridging the arousal gap to bring couples closer together.
The patented Promescent, is absorbed below the skin, sexual pleasure is not sacrificed – there has never been a report of any side-effects, and unlike other numbing creams, numbness does not transfer to partners.
Promescent is available over-the-counter, at www.promescent.com, through select doctors’ offices, and in pharmacies across the country. (No prescriptions needed) Right now, the only treatment for PE is a prescription for anti-depressants, regardless if they are depressed or not.

Bill Clinton has emergency heart surgery for blocked arteries. The issues that block the big pipe will be blocking little Bill

www.sexwithsue.com , http://abcnews.go.com/Health/HeartDiseaseNews/president-bill-clinton-hospitalized-routine-stent-surgery-heart-chest-pain/story?id=9811364

Bill   I was reading about Bill Clinton's chest pains and emergency surgery today. More clogged arteries, and high cholesterol levels. Too much of that southern deep fried food. As a sex therapist I see so many patients who are struggling with erection problems as it relates to those blocked, small blood vessels in the penis.

The top issues related to erectile dysfunction are (in order based on my patients) are:

1. Diabetes, 2. blocked arteries (cholesterol), 3.anti-depressants side effects, 4.high blood pressure medication, 5.smoking and drinking, 6.prostate problems

I see men as young as low 30's with these problems. Good medical care, stating to try and de-clog those pipes, and a Viagra prescription may get Bill back in the romance business. However, there are a number of new herbal products that I would be recommending to Bill if he was my patient. Despite the offer, they never hired me to treat his sex addiction, but i have a plan to get him back in the saddle.

He needs to be on a combination of vitamin E, low dose aspirin, yohimbine, CLA, thrust and Maga (herbal viagra), along with a small amount of Cialis before intercourse. The Yohimbine and Thrust will increase the nitric oxide levels in his blood stream, and the combination of Vitamin E and aspirin will help clean out the gunk. Clinton may not read this, but would do well to consult a sex therapist to keep the legendary Clinton romance skills in play. 

Pass the bong…and the Viagra

Smoking2 I, like many of my peers, had a bit of a misspent youth.  A few of the wrong guys, a couple of crazy pranks, and lots of experimentation with illicit substances.  So now that I’m all grown up and a responsible sex therapist (ha), I’m seeing a bunch of guys for whom that lifestyle of partying is catching up with them.

I’ve recently seen a few 40 year old men with erectile dysfunction that I think is caused by what I call the Bob Marley Syndrome.  Too much ganja, and exposure to a number of women.  All of these guys had at least one STI (sexually transmitted infections,  the politically correct term for the clap), and they have smoked a lot of the dried week in their lives. 

I know that Impotence2two of the big reasons for  impotence is smoking and drinking excessively, especially of controlled substances. (included in that list is diabetes, anti-depressants, high blood pressure and it’s treatment, crazy chlorestoral levels).  I haven’t found a study in any of the new literature, and a few patients doesn’t prove cause and effect, but anything that clogs the smallest blood vessels (unfiltered tabbacco, and hemp), and a build up of phages and white blood vessels from an infection (like they are discovering is the reason for heart attacks), may be a scary story for some guys who think they can smoke ’em and love ’em with immunity.  A great excuse for Just Saying No.

Here’s a new pill to make Mr. Happy stand at attention

Vitamins The truth as I know it about supplements. There as, yet are no pills to make you bigger. period. Don’t believe it, it is a scam.  I’ve interviewed 3 experts – Kevin Trudeau, www.naturalcures.com, Mike Bode -Mr. Universe guy, (www.thefitshoppe.com) and Ray Sahelian MD.www.physicianformulas.com (his site tries to sell you stuff, just to warn you…)  There is still no magic pill to help premature ejaculation.  Have a listen to my interview with Mike Bode, and I’ll see if I can get the Kevin Trudeau one to play as well.

There is however, interesting stuff to enlarge your breasts (the pills causes your breasts to retain fluid), and a bunch of herbal viagra (Valura, and Vigor are the two best known ones), and a few others to cause you to bump up that failing libido.  The news from the Natural Health Expo that happened last week in Anaheim, California was that low carb is out, and cocao and chocolate and NONI juices are in.  Yeah for chocolLove ate lovers.  Now if you could combine chocolate with great sex herbs…hmmmm.

feeling the love, Sue

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