KEN BADER: A question from a 34-year-old resident of Indiana. He's a male. And he asks, "What role does frequent (once a day) masturbation play in a man's inability to achieve erection later on in life? He says, I masturbate frequently, and have begun noticing less rigid erections."

DR. GOLDSTEIN: That's a great question, but to the best of my knowledge there is no relationship between the frequency of masturbation and the onset of an erection problem. You could almost argue that frequent erections are good for erections. The sort of the opposite of "if you don't use it, you'll lose it" sort of syndrome. If you are experiencing erection problems and they're consistent and they're lasting six months, it is a reason to see a physician. There may be some other issue such as we just discussed earlier. Some trauma to the crotch region. Another obvious possibility is just simply slow down on the masturbation frequency and see if your erections restore themselves. But in a young man, having an erection problem is worth seeing a physician about, because it's not a good time to have an erection problem, when you're young.

KEN BADER: Dr. Goldstein, here's another question from the Midwest. A 64-year-old man writes, "I had an implant 2 1/2 years ago. I find that when really stimulated, erectile tissue goes beyond the erection established by the implant. This has been a total surprise. Is it possible that Viagra would additionally enhance the erection? I'm certain that you know that the implant erection leaves the head of the penis somewhat flaccid. Might Viagra help that also?"

DR. GOLDSTEIN: This is an absolutely great question and it just speaks to the valuable role Viagra is having in the treatment of all types of sexual conditions. I had the exact same patient walk in my office yesterday and I put him on Viagra, and today he called, and he's had far better erections with his implant on Viagra than without the Viagra and his implant alone. So it looks like Viagra can stimulate residual tissue that still exists within the penis of a man with an implant. Just to sort of expand the answer, we are now using Viagra in conjunction with men who inject themselves, and we're using Viagra in conjunction with men who use the pellets. And we're using Viagra in men who are undergoing psychologic therapy. And in fact, I do a procedure called a bypass operation for younger men who have blocked arteries and I'm starting to use Viagra as a sleeping pill in these patients. Why would I use it as a sleeping pill? Because it actually enhances the erections when you sleep. And we're finding that men enjoy that. And we find that in by-pass patients, giving Viagra in that way as a sleeping pill enhances their night erections, gives them better ego, better satisfaction and have a better result with the implant, with the by-pass operation.

KEN BADER: A 60-year-old man here in Massachusetts writes, if a 50 milligram Viagra pill has no effect, is it safe to try two pills, that would be 100 milligrams, without first checking with my doctor or urologist?

DR. GOLDSTEIN: Well, in general when you change the dosage of medications, you should consult your physician. If you're taking a 50 milligram tablet and not experiencing any of the side effects and also not getting the erection, it's not unreasonable to increase the dose because that would be what the doctor would tell you to do. But of course, again, with all medications it is wise to check with your physician.

KEN BADER: A 28-year-old male listener from New Jersey writes, "Dr. Goldstein, what is the length in time of a normal erection? Also what is the length of a normal erect penis?"

DR. GOLDSTEIN: Those are two good questions. Well, the duration of a normal erection should be related to the stimulation. If you have a partner that you find stimulating and you wish to have intercourse with that partner, and you wish to have intercourse for 30 minutes or 45 minutes, or an hour, and both are engaging in this relationship, you should be able to maintain the erection for that long. The average penile erect length is about 5 1/2 inches long in the United States of America. Now there are some fascinating things relating to penile length, and that's called penile anthropometry, which is the study of body part length. What's interesting about erect penile length is there are racial differences, there are differences in that you can predict erect penile length. The body part that predicts erect penile length is arm length, interestingly enough. And that if one smokes or has hypertension or cigarette smoking or diabetes or high cholesterol, you actually, compar ed to people who don't, you actually have a shorter penis. So those are some of the interesting observations, about erect penile length that we're now understanding.

KEN BADER: A 49-year-old male from South Carolina writes, "One question I have not seen answered about Viagra, does an individual maintain an erection after orgasm?"

DR. GOLDSTEIN: OK, the answer to this question is really based on, do you have sexual stimulation after orgasm. Many men, of course, go right to sleep after orgasm, so they're not going to have sexual stimulation, so they will lose their erection. If one is in a situation where sexual stimulation is maintained after orgasm and ejaculation, then it is quite possible to either reerect or to maintain the erection. Remember, the role of Viagra is to prevent the breakdown of a second chemical inside the penis that persists the muscle relaxation and increases the blood flow. So all of that works as long as there is on-going sexual stimulation.

KEN BADER: An interesting question from a 49-year-old woman in Massachusetts. She says, "My husband is 62, and he has a problem with his heart's electrical signals causing him to skip a beat, usually when he gets more active. At some point his cardiologist says he will need a pacemaker. Currently, he has impotence in terms of being able to sustain an erection for more than a few minutes. What effect or risks would a pacemaker have on the various treatment for impotence?"

DR. GOLDSTEIN: That is a wonderful question and the answer is that unless a patient has angina, which means chest pain and relates that chest pain to blocked arteries and is treated by nitrates, and the most common example is nitroglycerin, there is no contraindication. So having a pacemaker would not be a contraindication if it was not associated with angina and treatment by nitrates or the example being nitroglycerine. If nitrates are used it is contraindicated. It should not be that you are taking Viagra.