My boyfriend’s erectile issues are affecting my confidence

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March 14th, 2016

Q. Sometimes my boyfriend and I have great sex — but occasionally he struggles to get enough of an erection for penetrative sex.

I find it difficult because it affects my confidence, and of course his. What could the reason be?

A. The cause could be psychological, or it could be an indication of an underlying health problem. Either way, your boyfriend needs to see a doctor.

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Sexual health does not exist in a realm of its own. It is integral to, and an important marker of, everyone’s general health.

In men, erectile difficulties are associated with a host of serious conditions, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease and other neurologic and endocrine disorders.

Before you get too anxious, however, I should add that the bulk of research into erectile dysfunction (ED) has been carried out on men over 50 and these conditions also tend to be more common in older men, so there is uncertainty about what is cause and what is effect.

Because erectile function declines with age, when younger men go to a GP with erectile difficulties there is a tendency to presume that the problem is psychological.

However, younger men with ED should always be screened for underlying health problems — a recent study confirmed that in men under 40 ED may be the first clinical sign of the thickening and hardening of the walls of the arteries, which is a precursor to heart disease.

One of the most important clues about the nature of a man’s ED is whether or not he can achieve a rigid erection during manual masturbation.

If your boyfriend can sustain a firm erection during solo sex but he fails when you try to have sex with each other, his problem may relate to stress, anxiety or depression.

If, however, he can’t sustain a firm erection during masturbation and he doesn’t experience nocturnal penile tumescence, the problem is more likely to be related to a health condition.

Psychological ED can often be traced to difficult life events, such as job loss, bereavement, or relationship problems, but it can also be triggered by stressful sexual events.

All men, no matter what their age, experience the occasional uncooperative erection. Hangovers, for example, make it more difficult to get an erection and because hangovers also increase anxiety, they can set up a nasty feedback loop where a failed erection causes performance anxiety, which, in turn, inhibits erection.

Whatever the cause of your boyfriend’s problem, the one thing you need to know is that it is not a reflection of how attracted he is to you.

Try not to take it personally and do your best to encourage him to get a diagnosis as soon as possible. It is very difficult for young men to process the implications of ED, so your support will be hugely important.

Although this might seem like an insurmountable hurdle now, couples who have to deal with sexual difficulties often find that being forced to talk openly to each other about sex establishes much more open and honest lines of communication, and this improves their overall satisfaction within the relationship.

The good news is that there is an ever-increasing range of treatments available to treat ED, so with the right medical or psychological help, he should be able to resolve the problem.

In the meantime, focus on sustaining intimacy in any way you can.

Stepping It Up For Women’s HIV Prevention

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March 14th, 2016

By Shayna Buhler, Senior Program Officer, Interagency Coalition on AIDS and Development (ICAD)

When it comes to HIV, there’s a long way to go to Step it up For Gender Parity by 2030, but progress is being made on several fronts. Key to addressing HIV among women and the gender inequities that fuel the epidemic among them, is the search for new prevention options that make sense in women’s lives and give them the power to make decisions about their own sexual and reproductive health, including HIV prevention. Women continue to be at disproportionately high risk of HIV infection and AIDS is the leading cause of death worldwide for women of reproductive age.

Many women around the world are placed in situations where they are often unable to negotiate with their partners to be faithful or to use condoms. Stepping it up for gender parity requires that women have access to a range of HIV prevention options, including those that they can use without partner involvement if they choose. Recent advances in oral pre-exposure prophylaxis have contributed to an expanding set of options, and two weeks ago, the results of two vaginal microbicide trials were released, taking us one momentous step forward along this path.

Microbicides are biomedical products being developed to protect healthy people from becoming infected with HIV during sex. Both the Ring Study, led by the International Partnership for Microbicides (IPM), and ASPIRE, led by the US national Institutes of Health -funded Microbicide Trials Network (MTN) demonstrated that a monthly vaginal ring containing the anti-retroviral drug dapivarine worked to safely reduce the risk of HIV infection among the women who wore them. This was the first time that two studies have confirmed that a vaginal microbicide can safely offer protection against HIV. Participants from this and other trials, their communities, prevention advocates and researchers have been working and waiting for this moment for a long time.

The results of the two trials were positive but not overwhelmingly so. The trial showed that compared to the placebo, the monthly dapivarine ring reduced the risk of HIV infection by 31 percent and 27 percent respectively. Much more will be learned as the data continues to be analyzed but a couple of things seem clear. One, the ring works much better when it is used consistently. It works best when it is kept in for the full 30 days and then replaced with a new ring. This is not surprising. We have learned of the importance of consistent use with oral pre-exposure prophylaxis and from previous microbicide trials.

We know this to be true for condoms as well– if they aren’t used consistently and correctly, they just don’t work as well. We also know that the women in the trial removed a ring that to their knowledge may have contained either dapivarine or a placebo, and that dapivarine may or may not work to prevent HIV infection. They were being reminded of these uncertainties at every clinic visit. In Open Label Extension studies that will follow, in which participants from both placebo and dapivarine arms of the trial can participate and access the monthly dapivarine ring (without being blinded), we will be able to get a much clearer picture of how consistently women might use a product that they know contains a drug that has been proven to work.

The studies also indicate that the dapivarine ring showed higher efficacy among women over the age of 21 and showed little to no protection in women ages 18 to 21. More research and analysis will help us to understand whether this is due to different levels of consistency in usage, or due to some other factor such as biological difference.

Young women desperately need more prevention options–globally, they face excessively high rates of HV infection, and may have less power than older women to negotiate the terms of their sexual relationships. But women aged 22 to 26 also have extremely high rates of HIV infection and we cannot underestimate the value of expanding prevention options for this age group.

We have only to look at the example of birth control to be reminded that as women’s lives change, so too will their decisions around sexual and reproductive health. A woman can go through several different birth control options throughout the reproductive life cycle, depending on what she has access to, her lifestyle, the level of risk she is willing to take on, her changing preferences and her biology.

There is no product that will be right for all women, and this highlights the necessity of developing a range of accessible options and to working with young women to figure out what they can and will use as HIV prevention, and of ensuring that young women have access to all prevention options, even if they won’t all choose to use them.

In September 2015, world leaders adopted the 2030 Agenda for Sustainable Development, which includes a set of 17 goals interlinked to end poverty, fight inequality and injustice, and tackle climate change by 2030. Preventing new HIV infections among women through an expanded range of prevention options has the potential to have an incredible impact on the Sustainable Development Goals, from addressing food security, advancing gender equity, building healthier communities — all contributing to economic growth.

Increasing the number of women who are living without HIV, and who have control over their sexual and reproductive health and rights, can face fewer challenges in going to school or work, caring for their children, giving birth to HIV negative children, and facing fewer strains on resources, which is a critical step towards gender equality.

Developing and providing women with access to and knowledge about tools to make decisions about their sexual and reproductive health, possibly with and possibly without negotiation with their partners, is an incredible step towards gender equality. This International Women’s Day, the recent trial results are cause for celebration and call for the redoubling of advocacy efforts to ensure that safe and effective products make it to the hands of the women who need them and that research and development continue to increase the number of options available to all women to prevent HIV infection.


Shayna Buhler
 is a Senior Program Officer with the Interagency Coalition on AIDS and Development (ICAD). ICAD provides leadership in the response of Canadian international development organizations and Canadian HIV organizations in reducing the impact of the global HIV and AIDS epidemic.

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This blog is part of an International Women’s Day series produced by theInteragency Coalition on AIDS and Development (ICAD) in recognition of International Women’s Day 2016 (March 8). The series runs during the week of March 7, 2016 and will feature a selection of blogs written by our member and partner organizations who will share their broad range. Each provides their perspective and their insight on what must be done to achieve UN Women’s campaign of “Planet 50-50 by 2030: Step It Up for Gender Equality” as we embark on the race to meet our 2030 Goals for Sustainable Development.

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

Can Testosterone Treatment Turn Back the Clock? Testosterone supplementation may improve sexual function in older men

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March 8th, 2016

It’s no secret that the privilege of aging comes with inevitable declines in health. As men age, they also see a decline in testosterone levels. New research tries to determine whether testosterone treatments can give men back some of their lost vitality.

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A team of researchers from the University of Pennsylvania School of Medicine conducted seven Testosterone Trials (TTrials), which were designed to see if testosterone therapy could relieve the symptoms of withdrawal from the hormone.

To conduct the study, the team enrolled 790 men, ages 65 and older, at 12 sites across America. All of the participants had lower testosterone levels than young healthy men, low sexual function, difficulty walking or low vitality.

The men were randomly selected to receive either a testosterone gel or placebo gel, which was applied daily for a year. The trial was double blind, meaning neither the researchers nor participants knew who was taking which gel. Researchers measured testosterone levels periodically for a year and monitored prostate and cardiovascular problems.

The research team found that among the men with low sexual function, testosterone treatment modestly improved sexual activity, sexual desire and erectile function compared to the placebo. Among men in all three trials, walking speed and distance also improved with the testosterone treatment.

Though testosterone treatment didn’t significantly affect fatigue symptoms, men in all three groups who received the testosterone reported slight improvements in mood, energy and depressive symptoms.

The study was led by Dr. Peter J. Snyder from the University of Pennsylvania School of Medicine.

“The results of the TTrials show for the first time that testosterone treatment of older men who have unequivocally low testosterone levels does have some benefit,” Dr. Snyder said in the press release. “However, decisions about testosterone treatment for these men will also depend on the results of the other four trials.”

According to the study, researchers found few adverse effects from testosterone treatment. The authors emphasized that larger and longer studies are needed to assess the risk of testosterone treatment in older men.

Researchers said that older men seeking testosterone treatment should consult with a physician.

The results for the first three elements—sexual function, walking and vitality—were reported February 18 in theNew England Journal of Medicine. Results for other outcomes, including cardiovascular, bone density, cognition, and anemia, will be reported in future papers.

The study was funded in part by The National Institute on Aging-The National Institute of Health.

The authors disclosed several potential conflicts of interest, including that Dr. Snyder reported receiving consulting fees from Watson Laboratories. Co-author Dr. Bhasin received fees to serve on advisory boards from Eli Lily and Sanofi, consulting fees from AbbVie and grant support from Regeneron Pharmaceuticals, Eli Lily, AbbVie and Novartis.

Apps for Managing ED

By
March 8th, 2016

Health-related apps have exploded on the internet, for both operating systems. It was only a matter of time before those that help to diagnose, manage, or treat ED came into being. There are several on the market today for those who have found that their performance on many different occasions was less than stellar. Some of these apps can give some discreet insight into what might be going on. Apple has an app called “Fire Up Your Sex Drive.” It does seem to make exorbitant claims for itself. The apps purveyor’s claim that not only does it address ED, but kicks one’s libido into high gear. After just 20 days, your sexuality should be advanced by over 80%, developer’s claim. They also say that using this app is the equivalent of taking Viagra. It works by sending out high-frequency alpha waves which will supposedly synchronize to the user’s own brain waves. After slapping down $2.99, a user has to listen to the app for six minutes, once a day. This is thought to stimulate the endocrine system into producing more testosterone, ramping up the sex drive and helping to reverse ED. Trouble is, most men with ED have it because of a physical problem, such as clogged penile arteries. In this case, alpha waves would do little to reverse it. Unfortunately, there is no evidence that this in fact cures the condition.

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Another out of Bangalore, India is called, “Dr. Vasan’s CurED” app. Here, the user answers a series of questions to see if they in fact do have ED. If so, it also determines how severe it is. The app utilizes two professional metrics, the International Index of Erectile Function and Sexual Health Inventory for Men. If the patient receives a poor result, it can even help him contact a doctor. Lastly, there is the Erectile Dysfunction Self-Test. Available on the Google Play store, this app gives a four part, professional screening. Created by an Austrian couple where he is a psychotherapist and she a couple’s and sex therapist, the app gives a fairly accurate assessment and tips to improve the situation. Some of these apps may be helpful. But nothing can replace the experience of seeing a physician or urologist in the flesh and receiving a proper examination. These experts can help determine what is causing ED and how best to cure it. Contact a doctor or urologist near you should you be experiencing ED.

‘Female Viagra’ gets mixed reviews

By
March 3rd, 2016

By Elizabeth Cohen, CNN Senior Medical Correspondent

A new review of the “little pink pill” for women with low sexual desire says the drug doesn’t work very well — but some doctors and patients who’ve been using the treatment disagree. The drug, Addyi, or flibanserin, has been on the market since October.

“The data presented in this review suggests that the meaningful change caused by flibanserin is minimal,” according to the team of Dutch researchers.

The researchers looked at eight studies on Addyi that together included nearly 6,000 women. They said for women using the drug, the number of additional “satisfying sexual events” averaged out to about 0.5 per month.

The agency asked Sprout Pharmaceuticals, which makes Addyi, to do more studies on the interaction between Addyi and alcohol.

An editorial accompanying the article, published in JAMA Internal Medicine, questioned the FDA’s approval of the drug. “The FDA approved a marginally effective drug for a non-life-threatening condition in the face of substantial — and unnecessary — uncertainty about its dangers,” wrote Dr. Steven Woloshin and Dr. Lisa Schwartz at the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice.

The researchers said the drug had significant known side effects, such as dizziness, sleepiness, and nausea.

The FDA approved Addyi last August with a “black box warning” to highlight the risks of severe low blood pressure and fainting when patients drink alcohol, take certain drugs, or have liver problems.

 Some doctors and patients who’ve been using Addyi say the drug has been helpful. There are no other FDA-approved treatments for women suffering from low sexual desire.

Dr. Lauren Streicher, medical director of the Center for Sexual Medicine at Northwestern Memorial Hospital in Chicago, said the results cited in the Dutch study are averages, and while Addyi doesn’t work for everyone, many of her patients have benefited from it.

She says she’s written Addyi prescriptions for about 10 women, and three or four have emailed her back to say it’s worked. “They say, ‘Oh my God, this has changed my life. Things are wonderful,’” Streicher said.

Jodi Cole, a 33-year-old stay-at-home mother from Porter, Oklahoma, said before she started taking Addyi, she didn’t want to have sex with her husband, Matt. “I love my husband and I believe God created emotional and sexual intimacy as key components of marriage. So we had sex, usually a couple of times a week. And while I was willing, part of me dreaded it. Every time,” Cole wrote in an email to CNN.

Cole said she started taking Addyi in November, and within six weeks felt a difference. “I was amazed,” she wrote. “I actually enjoyed being intimate and for the first time in a long time felt that connection with Matt.”

She said for her it wasn’t about increasing the quantity of sex she was having, but rather the quality. “What (Addyi) does is give just enough support so I can think about that part of our relationship with anticipation of pleasure rather than anxiety,” she wrote. She understands Addyi can have side effects, but said women should be able to choose to take it just as men choose to take Viagra despite its side effects.

“I should be able to choose whether the side effects are worth the benefit,” she wrote.

The controversy over Addyi

 

Seldom has one pill raised such controversy among medical professionals.

Doctors who treat women with low libidos tore apart the JAMA study. Streicher, an associate professor of clinical obstetrics and gynecology at the Northwestern University Feinberg School of Medicine, said the study drew “erroneous conclusions.”

The International Society for the Study of Women’s Sexual Health went even further, calling the study “a great disservice to the millions of pre-menopausal women suffering from (hypoactive sexual desire disorder).”

The doctors had several problems with the study’s methodology, including that three of the eight studies the Dutch researchers analyzed were not published. When studies are published, they go through a peer review process to assess whether the study methodology is sound.

One of those studies used a dosage of the drug that was half as high as what the FDA approved.

Dr. Loes Jasper, one of the authors of the Dutch analysis, said she and her colleagues removed the results from that study and still found that Addyi’s affects were minimal.

She said she and her colleagues included the results of the unpublished studies because sometimes negative studies of a drug don’t get published.

“We included all published and unpublished studies to capture a complete overview of the benefits and risks of flibanserin, without bias,” Jaspers wrote in an email to CNN.

According to the FDA, which looked at three clinical trials of Addyi that included about 2,400 women, about 10% more patients treated with Addyi reported meaningful improvements in satisfying sexual events, sexual desire, or reduced distress compared to women taking a placebo.

In their editorial, Woloshine and Schwartz said Sprout and others put pressure on FDA to approve the drug.

“While it is unclear how strongly politics influenced the decision, it is clear that the science was weak,” they wrote. “We all need a drug approval process that delivers good decisions based on adequate evidence.”