Ejaculatory Dysfunction-The New Sexual Dysfunction

Millions of men suffer from EjD or ejaculatory dysfunction.  The most common variety is premature ejaculation followed by retarded ejaculation or not being able to achieve an orgasm.  Another less common EjD is retrograde ejaculation or seminal fluid going back into the bladder instead of exiting the penis at the time of orgasm.  This article will discuss the three common EjD conditions and what can be done to resolve them.

It is estimated that one-third of American men suffer from premature ejaculation or ejaculation within seconds of vaginal penetration.  This is of great concern and embarrassment to those who experience this malady.

One folk remedy that is available to all men is self-stimulation or masturbation. Having repeated orgasms will bring on delayed ejaculation in nearly every man. The best premature ejaculation tip is to double the number of orgasms a man has per week. And if that doesn’t work, double it again.  Now isn’t that a great assignment?

Another method that requires cooperation with the partner or significant other is the “pull out technique.” This consists of having sex for a few minutes then pulling out and stopping for a few minutes to postpone orgasm.

Another method is to decrease the stimulation of the penis using desensitizing cream such as topical xylocaine.  Also, using one or more condoms can decrease the sensation and can prolong ejaculation.

When these non-pharmacologic techniques are ineffective there are medications that can help prolong the time from penetration to ejaculation. Selective serotonin reuptake inhibitors, or SSRIs — are known to cause delayed ejaculation.  Using an SSRI four to six hours before intercourse, men prone to premature ejaculation can last longer.

Delayed ejaculation (or retarded ejaculation) affects a much smaller number of men.  With this problem, men cannot reach orgasm at all, at least not with a partner.  It is most common associated with aging where more stimulatin is required for a man to reach an orgasm with advancing years because the nerve endings in the penis become less sensitive.  Delayed ejaculation may be caused by medicines – like antidepressants– are common culprits.

Retrograde ejaculation is the least common of the ejaculation problems. Retrograde ejaculation can be caused by diabetes, nerve damage, and various medications such as alpha-blockers like Flomax, which are used to treat enlargement of the prostate gland. Retrograde ejaculation is harmless and won’t interfere with the feeling of orgasm. (It can also make for an easy post-sex clean-up.) But since it does affect fertility, some men may need treatment if their partners are trying to get pregnant.

Bottom Line

EjD is a common medical condition that can be overcome.  Be open and communicate with doctor and share your concern with your partner.  Don’t suffer in silence and let the tension mount up and compounding the problem.  Most men with some advice and perhaps some medication form their doctor can over come this problem.  This translates to less worry and more sex.  Who could ask for anything more?

Dr. Neil Baum is a urologist in New Orleans, Louisiana and can be reached via his website, www.neilbaum.com or (504) 891-8454

How to Become a Better Patient

Communication between the patient and the doctor is crucial to your health and well-being.  The more information you can provide your doctor, the better he\she can help you lead a healthy lifestyle.

Write down what you want to discuss at the time of your office visit.  This may seem simplistic but so many times patients are unable to express themselves and not able to tell the doctor what are their problems. Start writing down the issues that you would like to discuss a few days before your appointment.  When the doctor enters the exam room, after the few seconds of perfunctory remarks, give the list of questions to your doctor or read it to the doctor.

Another suggestion for becoming a good patient is to always obtain copies of your medical records.  Keep a file of your test results, your current medications, your immunizations, your allergies, and a list of your medical conditions.  Every time you visit the doctor and have blood work or x-rays, you should request copies for your own records.

Arrange to have your tests performed several weeks prior to your scheduled office visit. Now when you meet with the doctor, he\she can analyze the data at the time of your visit and make the appropriate recommendations.  Failure to do so means you will meet with the doctor, then obtain your tests, and wait for weeks to hear from the doctor to review the results on the phone or using E-mail.

It is also helpful for older patients to bring a family member with them at the time of their office visit to help communicate various health issues with the doctor.   The family member can also write down the doctor’s recommendations.

If you really want to be a good patient, arrive 15 minutes before your appointment, complete your forms and questionnaires, and relax and enjoy the experience.

Finally, learn as much as you can about your illness or medical condition.  There are hundreds of websites that you can visit to find out about your medical problems.  Your physician can be a good resource for credible websites and educational material.

Bottom line:  It is not easy to be a good patient.  No one likes to go to the doctor but following a few of these suggestions will make you a better patient, will enhance your communication with your doctor, and will improve your health and well-being.

Dr. Neil Baum is a urologist at Touro Infirmary and can be reached at his website, www.neilbaum.com, or at his office, (504) 891-8454.

Attention Bicycle Riders-Your Seat May Be Affecting Your Sex Life

A middle age bike rider, who was perfectly potent, noted that his penis went numb at the end of a two-day, 200 mile charity ride.  The numbness continued for nearly six months and was accompanied by the inability to achieve an erection adequate for sexual intimacy or impotence.  After a work-up revealed arterial damage at the base of the shaft of the penis, his potency returned after treatments that increased the blood supply to his penis.

When you’re riding a bicycle, your weight is being focused on the perineum, the area between the rectum and the scrotum, and that’s where the arteries and nerves that feed the penis are located. Since the arteries are essentially unprotected, they’re prone to damage from constant  pressure from the bike seat.   When a man sits on a bicycle seat he’s putting his entire body weight on the artery that supplies the penis.

There are a number of things you can do to protect your potency:

• Penile numbness and excessive genital shrinkage are warning signs that there may be too much pressure on your perineum. The nerves in the perineum are being pinched, which means the artery that feeds the penis is also being compressed.

• Make the following changes in your riding style and/or your positioning on the bike: 1) Make sure your saddle is level, or point the nose a few degrees downward. 2) Check to see that your legs are not fully extended at the bottom of the pedal stroke. Your knees should be slightly bent to support more of your weight. 3) Stand up every 10 minutes or so to encourage blood flow.

• There are a multitude of anatomic racing saddles on the market, ranging from ones with a flexible nose to models with a hole in the middle. You may want to experiment with a wider, more heavily padded brand or a “double bun seat” that places the weight on the bones and off of the perineum.

• Heavier riders may be more at risk of arterial compression damage because of the greater weight that’s placed on the perineum. If you’re in this category, you should consider a wider saddle with extra padding.

• When riding a stationary bike, the tendency is to stay seated and grind against big gears for long periods. Get off of the seat as frequently as you would on your regular bike and be certain that it’s set up the same in regards to riding position.

•  Get off of the seat when riding over rough or irregular terrain. Use your legs as shock absorbers.

Most men are not aware of the relationship between their bike and their erections. My final advice for good health is that men shouldn’t necessarily ride farther but ride a lot smarter.

Dr. Neil Baum is a urologist in private practice in New Orleans and can be reached at 866 4825.

10 Healthcare Concerns for Men

10 Health Care Concerns for Men

Dr. Neil Baum

New Orleans, Louisiana

Most men have an attitude that “if it ain’t broke, don’t fix it.”  Now that may apply to the engines of your automobile but it doesn’t apply to the finely tuned engines that run your body. Most men have little need to visit a doctor between the ages of 18-45.  In order to sustain good health, men need to make an annual visit to their doctor beginning around age 45.

Cardiovascular Disease

High blood pressure, heart disease and stroke are the leading cause of death for most Americans.  In fact, coronary heart disease kills more people each year than all of the American soldieries who have died in all the wars this nation has fought this century. You can significantly reduce your risk of heart disease by participating in a sound fitness and exercise program and modifying your diet.

Prostrate Cancer

This is the most common cancer in men.  Nearly 250,000 new cases of prostate cancer are discovered each year and it annually takes the lives of more than 30,000 men, or half the capacity of the Superdome.  That’s the bad news.  The good news is that prostate cancer can be cured if it is detected early.  There are no symptoms for early prostate cancer.  The diagnosis made by rectal exam and a blood test called the PSA or prostate specific antigen test.  These two examinations are recommended annually for all men over the age of 50.  For men that have a blood relative (father, brother, or uncle) with a history of prostate cancer or in Afro-American men, they need the two exams after age 40.

Lungs, Colon and Rectal Cancer

Smoking is a risk factor that plays s a role in just about every major health problem that men face.  Smoking is well documented as the leading cause of lung cancer and may play a role in other cancers as well.  It also causes high blood pressure, impotence, and premature aging of the skin.

Colon and rectal cancer affects both men and women can be detected with screening test for blood in the stool.  All men over the age of 50 need an annual or semiannual sigmoidoscopy, which is looking into the end of the colon with lighted tube.

Impotence-Erectile Dysfunction

This is a condition that is feared by most men, yet is one that can be effectively treated in most cases.  Nearly 30 million American men suffer from impotence, or the inability to obtain and maintain an adequate erection.

Common causes of impotence include vascular disease, high blood pressure, heart disease, diabetes, never damage, and the side effects of medication. Drugs used to treat high blood pressure, ulcer medications, tranquilizers, pain pills and sleeping pills are some of the common rugs that can affect a man’s erection.

Viagra has been a boon to many men with impotence.  However in men where Viagra is ineffective, there are many other treatment options that can almost assure every man that has a problem with his erection can be helped.

Benign Enlargement of the Prostate Gland

After age 40, the prostate gland, for reasons not entirely known, begins to grows and compress the urethra making urination difficult.  This is a benign condition called BPH or benign prostatic hyperplasia.   Men have frequency of urination, dribbling after urination and the need two get up at night to urinate.  There are drugs that can actually shrink the prostate gland (finasteride) and drugs than can relax the muscles between the prostate gland and the bladder.

Infertility

There is nothing that produces more anxiety and tension in a marriage than if the couple wishes to have children and are unable to conceive.  The cause of infertility is shared between men and women.  So men have to take at least their share of responsibility to achieve a pregnancy.  In most men with infertility the diagnosis can be made with a history, a physical examination and a semen analysis.

Testis Cancer (Lance Armstrong Disease)

Cancer of the testicle is the most common cancer in men between the ages of 20-40.  In the past these cancers were fatal.  Now more than 95% of men with testis cancer can be completely cured with surgery, radiation or chemotherapy.  Just as s women are instructed to perform monthly breast self-exams, men should do the same thing.  Any lumps or bumps noted in the scrotum should be brought to the attention of doctor.  Most of these lumps are benign, but it requires a physician to make that determination.

Sexually Transmitted Diseases (STDs)

It was only a few years ago that the STDs that got the greatest attention were herpes and gonorrhea.  Now these two have taken a back set to AIDS and chlamydia.  Both AIDS and chlamydia can be prevented by using a condom.  Today, chlamydia is the number one sexually transmitted disease in the United States.  The symptoms are burning on urination or a discharge from the penis.  If left untreated it can cause sterility in men.  This STD can be successfully treated with antibiotics.

An AIDS test is recommend for all sexually active men and women on a semi-annual basis.

Stress

Stress is linked to the six leading causes of death, including coronary heart diseases, cancer, lung ailments, accidental injuries, liver disease and anxiety itself.  One of the best ways to reduce stress is not a pill or an hour a week on the psychiatrist couch, but by beginning a regular exercise program.  There are studies in the medical literature that have shown that a basic program of exercise 3 days a week for 20 minutes can produce significant improvement in a person’s psychological attitude, stamina, and endurance, and performance at work.

Family Planning

Today more men are taking a role in the limiting the size of their families by agreeing to have a vasectomy.  The procedure can be done now without an incision or a scalpel!   The operation can be performed in the doctor’s office under a local anesthetic and the man can return to nearly all activities the day after the procedure.

Dr. Neil Baum is a urologist in New Orleans and practices at Touro Infirmary.  You can obtain more information by calling his office, (504) 891-8454, or visiting his Web site, www.neilbaum.com