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As the saying goes, the best measure of a man’s character is the company he
keeps. But what about his health? According to Steven Lamm, MD, the best
measure of that is his erect penis.

“There’s an incredibly important link between a man’s health and sexual
performance,” Lamm, an assistant professor of medicine at New York
, tells WebMD.

Lamm’s recent book, The Hardness Factor, is a flashing neon sign
pointing to that link.

It is well known that heart disease, as well as diabetes, depression,
obesity, substance abuse, and many other health problems can quash erections.
Getting an erection isn’t crude mechanics, like inflating a balloon. It’s a
complex process in which blood vessels, muscles, hormones, the nervous system,
and the psyche all work together. If one part isn’t working well, it affects
the whole apparatus.

This isn’t another book touting Viagra, like Lamm’s The Virility
Solution, published in 1998, the same year Viagra hit the market. Lamm
says The Hardness Factor is not for men who are already dealing with
erectile dysfunction (ED). His aim is to convince young, healthy men to take
better care of themselves by speaking to their penises.

“If you want a 28-year-old man to stop smoking, let him read the
book,” Lamm says.

Heart Health and Sexual Health

Others in the field of sexual medicine agree that erectile function can be
closely related to overall health, heart health.

“When men who are otherwise healthy ask what they can do to prevent ED,
certainly the very things we recommend for cardiovascular fitness are exactly
the same things they should be doing,” Drogo Montague, MD, a urologist at
the Cleveland Clinic, tells WebMD.

To get erect, the penis must become engorged with blood. Atherosclerosis, a
condition in which fatty deposits build up inside arteries, may restrict blood
flow to the penis and cause erection . Diets high in fat and
cholesterol, high blood pressure, obesity, diabetes, and smoking are the main
causes of atherosclerosis.

“It’s very appealing to say that if you don’t have those unhealthy
factors in your lifestyle, then you’re less likely to develop erectile
dysfunction,” says Ira Sharlip, MD, a urologist at the University of
California, San Francisco.

“There are pretty strong suggestions that those things are true,” he
tells WebMD.

One persuasive piece of evidence appeared in the April 2004 issue of the
Journal of the American College of . Between 1972 and 1974,
in California surveyed 1,810 men about their risks for heart
disease. In 1998, researchers contacted 844 of them who were still alive and
asked them about their erectile function. The men who had risk factors for
heart disease in the ’70s were much more likely to have ED 25 years later.

If men with heart disease are more likely to develop ED, it stands to reason
that having ED could be a warning sign for heart disease, too.

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Has the “free love” generation lost its mojo?

If you talk to baby boomer gals, it seems the answer is yes. Indeed, as
millions of women enter perimenopause and then
transgress to menopause and beyond,
many say they check their sex drive at the door and most are not happy about
it.

“I don’t think a day goes by when at least one patient and usually
more complain that their sex drive is dropping off and want to know what they
can do about it,” says Laura Corio, MD, a gynecologist and clinical
instructor at Mt. Sinai Medical Center in New York City.

Clinically known as HSDD (hypoactive sexual desire disorder) Corio says she
doesn’t think more women are affected now than in the past, but she does
believe more are coming forward — prompted, at least in part, by the success
male potency drugs like Viagra.

“The man gets a for Viagra and he’s ready to rock and roll
while she’s thinking ‘Hey, where’s my pill?’ If she’s not ready to jump in the
old van and join him for a ride, there can be real problems,” says
Corio.

What’s Wrong

While male sex drive is easy to define — and relatively easy to restore –
that’s often not the case for women. Because the female sex drive is
multifactorial, the desire to make love is not only influenced by physical
issues, but emotional ones as well.

“Part of the desire to make love is clearly physical, but part is also
emotional depression can make a
difference, so can any emotional issue in a woman’s life; female sex drive is
very multidimensional,” says Glenn D. Braunstein, MD, an endocrinologist
and chair of the department of medicine at Cedars Sinai Medical Center in Los
Angeles.

While emotions are frequently behind a loss of sex drive in younger women,
doctors say it is frequently the agingprocess itself that’s at
when desire changes in women over age 45.

“The very fact that a woman is no longer ovulating regularly, or not
ovulating at all, takes her sex drive down a few notches,”
says Steven Goldstein, MD, professor of ob-gyn and NYU Medical Center in New
York City.

Nature’s Design for Sex

Indeed, as many women are aware, Mother Nature built in a natural increase
in the desire for sex beginning just prior to ovulation, and lasting several
days afterwards — not , the only time of the month conception is
possible.

Stop ovulating, says Goldstein, and you automatically lose that regularly
scheduled boost in your sex drive that has been present since puberty — and
you’re probably going to notice.

“There’s nothing wrong with you; it’s just the way nature works,”
says Goldstein.

Moreover, around menopause, when there
is also less estrogen circulating in your body, that too can bring your sex
drive down for the count.

“Estrogen is a mood elevator, it works in the brain to maintain interest
in sex, but it also works at the level of the genitals, helping to increase
sensation and just making sex more pleasurable,” says Corio.

Without it, she says, not only can desire take a dive, vaginal tissue begins
to dry and shrink. As a result, intercourse can become uncomfortable, or even
painful. Problems with desire, say experts, are easy to .

“Who wants to make love when making love hurts?” asks Goldstein.

Moreover, he says, avoiding sex because of pain only leads to more pain. The
old “use or lose it” theory really does apply.

“From a strictly physical standpoint, the less sex you have the more
painful it is when you try to have it,” he says.

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May 22, 2007 — Medications commonly used to treat erection problems in men
may also relieve the bothersome urinary symptoms associated with an enlarged
prostate gland, researchers say.

Studies on the topic were presented this week at the annual meeting of the
American Urological Association in Anaheim, Calif.

“Before, we looked at these two conditions as two different
diseases,” says Kevin McVary, MD, professor of urology at Northwestern
University Feinberg School of Medicine in Chicago, who moderated a press
briefing.

But in the past three or four years, he says, the thinking among urologists
has changed.

Sexual performance in men seems to decline as their prostate enlargement
becomes more severe, experts have begun to notice. Doctors also notice
that men with milder prostate problems often have less erectile dysfunction
(ED) than do those with moderate or severely enlarged prostates and urinary
symptoms.

“These two diseases — erectile dysfunction and the lower urinary tract
symptoms associated with benign prostatic hyperplasia — are probably
linked,” McVary says.

Conditions Increase With Age

Prostate problems and ED problems both tend to increase with age. About 31%
of men aged 50 to 59 have an enlarged prostate (also known as benign prostatic
hyperplasia or BPH); 44% of those 70 and older have an enlarged prostate,
according to the National Institutes of Health. As the gland enlarges, it
constricts the urine-carrying tube called the urethra, making it difficult to
empty the bladder.

Common symptoms of BPH include weak urine stream, leaking or dribbling,
feeling that the bladder hasn’t emptied completely after voiding, and more
frequent urination.

Medications are prescribed to relieve the symptoms. Some medications work by
relaxing the muscles at the neck of the bladder and prostate; others inhibit a
hormone that contributes to the growth of the gland.

Erectile dysfunction, defined as an inability to get or keep an erection, is
experienced by 20% to 46% of men aged 40 to 69, according to the NIH.
Medications to treat erection problems help increase blood flow to the penis
when a man is sexually stimulated.

Cialis Study

A once-a-day dose of Cialis helped men with erectile dysfunction and
moderate to severe urinary tract symptoms due to an enlarged prostate improve
sexual , says Marc Gittelman, MD, a urologist in Aventura, Fla., and
a study researcher.

Of the 281 men who enrolled in the study, “81% were sexually active, and
they were in their low 60s,” he says. All had moderate to severely enlarged
prostates and urinary problems; 68% of the sexually active men had a medical
history of erectile dysfunction. Gittelman’s team assigned about half to take
placebo and half to take Cialis.

At the end of 12 weeks, men who took Cialis — first 5 milligrams a day and
then up to 20 milligrams — had significantly higher scores on a standard index
of erectile function, he says.

He especially wanted to see if they were as likely to do well if their
urinary problems were severe as opposed to moderate. “They are equally
likely to respond to a dose of Cialis,” he says.

The study was funded by Lilly, which is the maker of Cialis.

In another study, 223 men aged 45 to 64 who had urinary symptoms due to an
enlarged prostate were assigned either to a group given 10 milligrams of
Levitra twice daily for eight weeks or a placebo for the same time period.

Compared with placebo, treatment with the ED drug significantly improved the
men’s quality-of- life scores and their reports of urinary obstruction and
irritation, says Boris Schlenker, MD, a urologist at
Ludwig-Maxmillians-Universitaet Hospital in Munich, Germany, who presented the
data. Erectile function improved in those who took the ED drug.

“Levitra is a promising new drug for men with lower urinary tract
symptoms, but we need long-term data on how it might affect the progression of
the disease,” he says.

The Viagra Study

In a third study, McVary assigned 369 men aged 45 and up who had both
erectile dysfunction and lower urinary tract symptoms to take either 50
milligrams of Viagra every night, 50 milligrams of Viagra an hour before
planned sexual activity, or to take a placebo. The dose increased to 100
milligrams after two weeks.

When he evaluated their erectile function and urinary symptoms, he found 73%
of the men with severe symptoms improved to having mild or moderate symptoms at
the end of the study.

“The changes in prostate symptom scores were dramatic,” he says.
“They compete with alpha blockers.” Alpha blockers are one type of drug
commonly prescribed to treat urinary symptoms associated with an enlarged
prostate. The more severe the urinary symptoms, the greater the
relief, he says.

The study was funded by Pfizer, which is the maker of Viagra.

“This really is cutting-edge,” says Gittelman.

The experts aren’t sure if the ED drugs will eventually supplement or
replace drugs used for urinary problems associated with an enlarged prostate,
or if new might be developed to deal with both conditions.

Some men on the ED drugs did report side effects, says Schlenker, with the
most common in his study being headache.

It’s not known exactly why the ED drugs also help the urinary symptoms,
McVary says. By increasing blood flow to the pelvic area, the ED drugs may help
relax the bladder enough to relieve the urinary problems.

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Nov. 16, 2005 — A drug called Revatio may help treat an aggressive condition called pulmonary arterial .

Patients with pulmonary hypertension have elevated blood pressure in the pulmonary (lung) blood vessels. The condition often arises from lung problems, but some cases are without a known cause. It can result in heart failure and early death.

Unfortunately, most of the medications that are used to treat this serious condition are not easy to take and are given by IV, injection, or inhalation — with real risks of unwanted side effects.

Revatio has the same active ingredient — sildenafil — as Viagra. Revatio and Viagra are made by Pfizer.

Pfizer funded the new study, which appears in The New England Journal of Medicine. Pfizer is a WebMD sponsor.

The researchers included Nazzarene Galie, MD, of the cardiology institute at Italy’s of Bologna.

Walking Test

The study lasted for 12 weeks. It included 278 patients with pulmonary hypertension. The patients lived in the U.S., Mexico, South America, Europe, Asia, Australia, South Africa, and Israel.

Three times daily, the patients took Revatio (20, 40, or 80 milligrams) or an empty drug (placebo) orally. That was in addition to any other standard pulmonary hypertension medications.

The big question was how far patients could walk in six minutes. That’s an important exercise test for patients with pulmonary hypertension. The farther patients can walk, the better.

Walking Farther

All of the patients taking Revatio walked farther at the end of the study:

• 20-milligram group: Walked about 148 extra feet (a 13% increase).
• 40-milligram group: Walked about 151 extra feet (a 13% increase).
• 80-milligram group: Walked about 164 extra feet (nearly a 15% increase).

Higher doses didn’t bring a notable increase in distance walked, the researchers report.

Patients were then allowed to take Revatio for up to a year; 230 did so. The researchers looked at the walking tests of 222 of those who were only taking Revatio as treatment. After a year, they walked about 167 extra feet, on average, compared with the beginning of the study.

How Patients Fared

Most of the patients included in the study had milder stages of pulmonary hypertension. Few cases worsened, regardless of treatment type, the study shows.

Patients taking Revatio weren’t any more or less likely to have their symptoms worsen during the trial.

The study wasn’t designed to see if Revatio helped patients live longer. Four died during the study. No deaths were judged to be linked to the , write the researchers.

Side effects seen with Revatio were mild or moderate and included headache, flushing, muscle pain, and diarrhea, report Galie and colleagues.

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