The Truth About Impotence - About Impotence

Written by Krista

Question (from a 32-year-old California woman):
Dr. Goldstein,
My partner and I have a wonderful sex life, however, we rarely engage in intercourse. When we try to have intercourse either he loses the erection while putting on a condom (I have tried many distractions during the process) or he will lose the erection during penetration. Once in a great while he will lose the erection while I give him oral sex. When he does maintain his erection thru penetration he often orgasms very quickly and says that it was too intense and he couldn't control it. Is this considered sexual dysfunction?? Or impotence?? Most often we engage in great oral sex instead...When I try to discuss it with him (in a non-threatening way, and when we're not having sex) he says "making a big deal about it only makes it worse." Could it be entirely psychological or combination of problems??

DR. GOLDSTEIN:
It is difficult to make diagnoses on patients based on the minimal information contained in the e-mail. Based on the above, it sounds that he has both erectile dysfunction (failure to maintain) and premature ejaculation. They may be independent or related sexual dysfunction phenomena. I would STRONGLY encourgage him to seek medical help - we can usually make such a great difference in these cases. Both conditions can be very easily managed.

Question (from a 60-year-old Florida man):
I was an active alcoholic between the ages of 15 and 51. I have not used any addictive drugs in the last nine years. During the last three years, I have used testosterone cream and 25 MG 2x/day DHEA supplements in an unsuccessful effort to overcome impotence. Furthermore, I am concerned about the possible cancer threat with their continued use. I have three questions:

1. In your opinion, is my concern about cancer valid?

2. Will Viagra be effective in someone who obviously has impaired adrenal function?

3. What are your recommendations for treating impotence due to alcoholism?

I really enjoyed your show on NOVA.

DR. GOLDSTEIN:
In your opinion, is my concern about cancer valid? Yes, yes and yes. Prostate cancer is very common - about one in eight men will develop prostate cancer and prostate cancer is a leading cause of death in men your age. Testosterone definitely helps prostate cancer cells grow. One should get a PSA (prostate specific antigen) blood test every three to six months if one is being treated by testosterone.

Will Viagra be effective in someone who obviously has impaired adrenal function? There are several rare disorders of the adrenal gland - but if you have one - this should be managed by an endocrine specialist. If impotence persists despite appropriate treatment of the adrenal condition, then Viagra may be added.

What are your recommendations for treating impotence due to alcoholism? Alcoholism may cause impotence by a number of mechanisms especially from psychologic and nerve-related damages to the penile erection process. Assuming appropriate counseling has been tried, medical treatment may involve the use of Viagra.

Question (from a 47-year-old Florida man):
I have read books which provide instruction on how to exercise the PC muscle in order to better ejaculation control, and in fact, achieve orgasm without ejaculation. The benefits touted are the ability to maintain an erection after orgasm, more frequent orgasms, better erections, etc.

1. Is there any benefit for a man to engage on a regular program of PC muscle training of 100 contractions a day?

2. Does the prevention of ejaculation during orgasm increase the ability to maintain an erection, and allow for more frequent orgasms?

3. I've noticed that by practicing extended contraction of the PC muscle, it will sometimes automatically go into spasm. Is there any benefit to this? Any negative effect on a man's anatomy?

DR. GOLDSTEIN:

1. Is there any benefit for a man to engage on a regular program of PC muscle training of 100 contractions a day? There is much anecdotal information on this topic, but not good scientific knowledge. In my opinion, there is only a minimal effect on ejaculation in an otherwise normal male.

2. Does the prevention of ejaculation during orgasm increase the ability to a maintain an erection, and allow for more frequent orgasms? The prevention of ejaculation during orgasm is extremely difficult to perform during normal intercourse. If one could prevent ejaculation, this would definitely enhance the intensity of a subsequent orgasm.

3. I've noticed that by practicing extended contraction of the PC muscle, it will sometimes automatically go into spasm. Is there any benefit to this? Any negative effect on a man's anatomy? There is probably no harm to inducing a spasm in this or any muscle.

Question (from a 50-year-old California man):
Dear Dr. Goldstein, My experience suggests that a male can experience the physical phenomenon of ejaculation without always experiencing the mental/physical phenomenon of orgasm. Thus, my question concerns the relationship of these, both neurologically and psychologically. I'd also be curious to know if non-human i.e. animals, experience orgasm, or if their brain structures somehow don't allow this.

DR. GOLDSTEIN:
Orgasm is a sensory phenomenon which occurs in the septum of the thalamus. After receiving appropriate sensory information from the penis and genitals, a disproportionate amount of neurotransmitter is released into surrounding thalamic tissue. This causes a depolarizing wave to affect a wider area in the thalamus. Pleasurable sensation is passed to appropriate cortical sensory areas of the brain (orgasm) - while the spreading wave causes activation of ejaculation pathways. It is possible to ejaculate with only a minimal orgasm.