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The Truth About Impotence

male sexual problems

Below is the text of the May 12, 2001 live event RealAudio question and answer session with Dr. Irwin Goldstein, additional questions and answers sent in following the live event, and the entire set of questions and answers in list form.

KEN BADER: Hello, I'm Ken Bader, coming to you live from NOVA at WGBH in Boston. In the studio with us tonight is Urologist, Dr. Irwin Goldstein, a leading expert on one of the most talked about subjects in America today, impotence. Ever since the Food and Drug Administration approved the oral medication Viagra, the spotlight has been turned on a condition that is estimated to affect up to 30 million American men. But Viagra is not the only treatment for impotence. What other options are available? For the next hour, Dr. Goldstein of the Boston University Medical Center will respond to questions sent in by our Web listeners. Please be aware that this event will consist of general advice and is not intended to be a substitute for visiting your own physician should you require medical assistance. Dr. Goldstein, thank you for joining us.

DR. GOLDSTEIN: Ken, thank you. Glad to be here.

KEN BADER: And here's our first question. It comes from a 29-year-old woman from right here in Massachusetts and she asks, "Do women suffer from impotence and if so, how would you diagnose it?"

DR. GOLDSTEIN:Women do suffer from sexual health issues. Women probably have a very similar physical problem related to blood flow, and they diminish vaginal lubrication and increased time to vaginal arousal and diminished sensation and diminished orgasm. We're primarily treating women who are post-menopausal with a history of cigarette smoking and diabetes and high cholesterol, just like the men who suffer from circulation problems with their sexual dysfunctions. We intend to one day have ultrasound studies to record blood flow to the clitoris and vagina, which we are in development now. We will record things like pH of the vagina and other aspects of the physiology of the vagina. And right now, unless and until other drugs become available, our primary method of increasing the blood flow in these women who have dysfunction because of decreased blood flow will be the Viagra. And we've anecdotally utilized this in a series of women and actually have seen remarkable resu lts. Pfizer has an on-going study in Europe at four cities in which women are given either placebo or different doses of Viagra. And these studies will be considered to be done in the United States starting the end of this year.


 

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KEN BADER: OK, another question from another woman listener. She's 53 years old and she's from Washington, D.C. She writes: "I've heard a lot of men talking about getting Viagra so they can have better sex. If they don't already suffer from impotence will it really allow them to have better sex?"

DR. GOLDSTEIN: That's a very commonly asked question. Is Viagra useful in men with normal erectile function? And the answer is it probably is not useful. You can't really get a better erection than a normal erection. However, there's a caveat here. Some people claim to have normal sexual activity and are having sexual activity, but with say a 50 percent erection, which really only allows two or three minutes. So whereas they're having sexual activity they may not be having normal erections during the sexual activity. And it gets a little confusing to listeners. So you may go to a party, and John may say, hey, I'm having intercourse three times a week, but you'll speak to the wife who will say, well, the intercourse is really not that great compared to what it once was. In that population who's sexually active with less than perfect erections, Viagra is very successful.

KEN BADER: So the bottom line is, yes?

DR. GOLDSTEIN: Well, it's yes, but it depends what you define as normal. A man who is able to have an erection, rigid, sustained in the basement, goes to the second floor of the house, and then the attic of the house, and Viagra won't help him.

KEN BADER: We have a question from a 69-year-old gentleman in Florida. He says, "Can the sexual function be reinstated following a radical prostectomy. If so, how?" And he says, "Incontinence has placed a severe damper on foreplay and arousal."

DR. GOLDSTEIN: Prostate cancer is a very common problem in men, unfortunately. And like women with breast cancer, radical... or prostate cancer occurs in one in eight men. And one of the common treatment options for men with prostate cancer for a long term cure is a radical prostate. And unfortunately, the nerves and arteries that bring blood to the penis are often next to the prostate. And in removing the prostate during surgery, sometimes the plumbing and the nerves to the penis can be injured. We have had good success with Viagra, in radical prostate patients. But if the Viagra isn't successful, we've had very, very nice success with the pellet therapy, and the injection therapy, and we've even had wonderful success with implants. So if you have prostate cancer, get the treatment. If you're concerned that impotence is a consequence there are great therapies to reestablish sexual function after the prostate therapy.

KEN BADER: Here's a question from a 62-year-old gentleman from Florida. He writes, "Even with treatment to correct impotence, it can still be difficult to ejaculate or reach orgasm. Why is that? What would inhibit ejaculation and/or orgasm?" He says, "They are still possible but not frequent. It's kind of a hit or miss thing." He adds, "I never know when I'm going to be able to function normally, either with a vacuum pump or Viagra."

Last Updated: 08 April 2016
Reviewed by Harry Croft, MD

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