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Join us at noon CT (1 p.m. ET/10 a.m. PT) on Tuesday, May 3, to chat about older men's sexual health with Tribune reporter Judy Graham and panelists, Dr. Laurence Levine and Dr. Andy McCullough.

What happens to mens' hormones, their sex drive, their desire for intimacy and their ability to perform sexually as they get older? What treatments are available, with what pros and cons? What happens when chronic illnesses such as heart disease, arthritis or prostate cancer crop up?

Dr. Laurence Levine is a professor of urology and director of the male sexual function and fertility program at Rush University Medical Center in Chicago. He is a past president of the Sexual Medicine Society of North America.



Dr. Andy McCullough is the director of men's health and a professor of surgery in the urology division at Albany Medical College. He has conducted nearly a hundred clinical trials on sexual issues affecting men and is a sought-after expert on sexual dysfunction after prostate cancer surgery.

Can't make the chat? E-mail questions in advance to jegraham@tribune.com.

Health chat: Older men's sexual health

(05/03/2011)

  

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11:47

Judy Graham:  Good afternoon everyone. We're delighted to have you join us for our chat on older men's sexual health. This is a great forum to ask sensitive questions of two leading national experts. Join us at NOON for what we're sure will be a fascinating discussion. And please -- send your questions. Don't worry about your identity being disclosed; it won't be unless you sign your name. Tuesday May 3, 2011 11:47 Judy Graham

12:00

Judy Graham:  Here we go everyone. Let's start with a question for Dr. McCullough. What physical changes related to aging affect men's ability to have sex? Tuesday May 3, 2011 12:00 Judy Graham

12:00

Andrew McCullough:  As men age several changes occur. Let’s face it, we weren¿t programmed evolutionarily to be having sex after forty. 100,000 years ago at age forty, we were at the back of the cave with no teeth, no food and no women. Sex was for the young 19 year olds. We have come a long way from them and are demanding a lot more out of life. As we age: 1. The stresses of life increase giving us less free time to have sex. 2. Our partners may not be as interested in having sex as they approach menopause 3. Are testes produce less testosterone because: a. The cells that produce the testosterone decrease in number b. The brain doesn¿t send as much message down to the testes to produce as much testosterone. 4. Our penis are not as reactive to sexual stimuli and take more stimulation to react and are not as efficient at staying erect 5. Our penis (the barometer of the health of the vascular system) suffer the ravages of years of abuse from overeating, smoking, lack of exercise. 6. Our penis are affected by the other illnesses that we suffer such as hypertension, high cholesterol, diabetes and the consequences of the treatment of prostate cancer Tuesday May 3, 2011 12:00 Andrew McCullough

12:00

Judy Graham:  Here's one for you, Dr. Levine. Erectile dysfunction is a fairly common for older men. What causes it? Tuesday May 3, 2011 12:00 Judy Graham

12:01

Laurence Levine MD:  Erectile dysfunction is a complex problem, but most commonly it is a vascular problem. Several conditions accelerate the normal aging of blood vessels, such as: diabetes, high blood pressure, elevated cholesterol and smoking. In addition, obesity, metabolic syndrome and some drugs also contribute to erectile dysfunction. It should also be remembered that because it is such an emotionally charged process, there is almost always a psychogenic component due to the distress caused by having erectile dysfunction. In light of that, it is also noted that men who are depressed frequently have erectile dysfunction. It is not clear whether depression is responsible for ED, or the ED is responsible for depression. It tends to be thought to be a bidirectional problem. Tuesday May 3, 2011 12:01 Laurence Levine MD

12:01

Judy Graham:  Do we know how common erectile dysfunction is? Tuesday May 3, 2011 12:01 Judy Graham

12:01

Laurence Levine MD:  ED is quite common. In fact, the first large scale trial, known as the Massachusetts Male Aging Study, demonstrated that 52% of men over the age of 40-70 had some degree of erectile dysfunction. The likelihood of having ED was also higher with increasing age, and as men aged they were more likely to have more advanced erectile dysfunction. This study was repeated with similar findings in virtually every industrialized country. Tuesday May 3, 2011 12:01 Laurence Levine MD

12:02

Judy Graham:  I'm sure men wonder -- why do I have erectile dysfunction? What's the cause? How do they find out? Tuesday May 3, 2011 12:02 Judy Graham

12:03

Laurence Levine MD:  This is a question that is best answered by discussion with your primary care physician or a urologist who is interested in treating erectile dysfunction. As noted before, the most common causes are vascular due to accelerated aging of blood vessels caused by very common conditions including: diabetes, high blood pressure, elevated cholesterol, and a current or remote history of smoking. Just aging alone causes changes in blood vessels making it so that inadequate blood flow will not allow proper filling of the penis. It is also possible that low testosterone levels are contributing to your ED. Tuesday May 3, 2011 12:03 Laurence Levine MD

12:03

Andrew McCullough:  Recently I have been seeing a lot of men in their 20's and 30's with ED! We are not all born as Michael Jordan's in the sexual arena. There is a spectrum of normality. Tuesday May 3, 2011 12:03 Andrew McCullough

12:04

Judy Graham:  What do you think is going on? Tuesday May 3, 2011 12:04 Judy Graham

12:05

Andrew McCullough:  There is a lot of anxiety in young men and there are also congenital blood vessel abnormalities as well as biochemical abnormailites that we havent completely worked out. Tuesday May 3, 2011 12:05 Andrew McCullough

12:06

[Comment From Jonell MichellJonell Michell: ]  WHERE CAN UPRIMA BE PURCHASED> Tuesday May 3, 2011 12:06 Jonell Michell

12:06

Judy Graham:  I think Dr. Levine is going to take a shot at this question. Please let us know what's on your minds. Tuesday May 3, 2011 12:06 Judy Graham

12:07

Laurence Levine MD:  Uprima is a drug that works on the central nervous system. It adjusts levels of a variety of sexual neuro-hormones, ie chemicals that induce erection. The drug was not approved for use in the U.S. due to side effects, but it apparently is available in Europe and possibly Canada. The primary side effects are nausea and vomiting. Tuesday May 3, 2011 12:07 Laurence Levine MD

12:07

[Comment From NormanNorman: ]  Do men go through menopause? Tuesday May 3, 2011 12:07 Norman

12:07

Andrew McCullough:  Testosterone naturally declines with age and illness in men (and women). The decline is gradual so that a man doesn¿t wake saying “Gee my testosterone is low." He may suddenly realize that he hasn't had sex in weeks or months and doesn't realize it or miss it. He may be taking naps in the day having "run out of gas." He may notice that his mood is darker and he lacks the zest” that he had. These are all common complaints in men who have low testosterone. The first thing that a physician needs to do is listen and suspect. Testosterone deficiency is determined by a blood test. I always like to get two levels to make sure that a low level was not a lab error. Tuesday May 3, 2011 12:07 Andrew McCullough

12:08

Judy Graham:  Can you give us a little more information about testosterone treatment, Dr. McCullough? Tuesday May 3, 2011 12:08 Judy Graham

12:08

Andrew McCullough:  Testosterone deficiency can be corrected with daily gels or patches, weekly injections or implantable pellets every 4 months. Levels should be monitored to make sure that the desired levels are being reached. After adequate levels are achieved then its pretty routine follow up. Tuesday May 3, 2011 12:08 Andrew McCullough

12:09

Judy Graham:  Here's a resource on testosterone treatment from the Mayo Clinic: http://www.mayoclinic.com/health/testosterone-therapy/MC00030 Tuesday May 3, 2011 12:09 Judy Graham

12:09

Laurence Levine MD:  Testosterone is the primary male hormone which is made by the testicles. As men age, they lose anywhere from 1-3% of their testosterone production every year. Low testosterone is associated with easy fatigability, loss of energy, diminished libido, reduced muscle strength, mood irritability, and even long-term low testosterone has been associated with loss of muscle mass, bone mineral density, and possibly predisposing to early dementia. Testosterone replacement is indicated when the testosterone level is low and the man has any of the above symptoms. It can be administered in a variety of ways. Tuesday May 3, 2011 12:09 Laurence Levine MD

12:09

Laurence Levine MD:  A variety of treatments are available, including oral medication, which is not recommended currently because of potential risks to the liver. There are pills available outside of the U.S. which may in time become available here. Injections of testosterone are available. But, the most common treatment today is the use of topical testosterone gels, of which there are now 4 different types. Lastly, there is implantation of pellets of testosterone, which can last anywhere from 3-6 months. Tuesday May 3, 2011 12:09 Laurence Levine MD

12:10

Judy Graham:  We know that many participants are watching what's going on. We want to hear from you. Dr. Levine, are there side effects of testosterone therapy? Tuesday May 3, 2011 12:10 Judy Graham

12:10

Laurence Levine MD:  The side effects of treatment actually are less than the side effects of not being treated, but it is very important to monitor the testosterone levels and undergo regular evaluation to ensure that side effects do not occur. This is done by routine blood tests of one's blood count, and serum PSA levels, which is a blood test measuring prostate activity. At this time, there is no evidence that testosterone replacement increases the risk of developing prostate cancer as compared to men who do not take testosterone. Tuesday May 3, 2011 12:10 Laurence Levine MD

12:10

[Comment From NormanNorman: ]  If you had low testosterone, how would you treat it? Tuesday May 3, 2011 12:10 Norman

12:11

Andrew McCullough:  I would use the pellets. Since I have the Y chromosome, compliance with daily treatments is not my "forte." Tuesday May 3, 2011 12:11 Andrew McCullough

12:12

[Comment From NormanNorman: ]  How do I get the pellets? Tuesday May 3, 2011 12:12 Norman

12:13

Andrew McCullough:  Most urologists have access to the pellets. It takes 5 minutes to put in Tuesday May 3, 2011 12:13 Andrew McCullough

12:13

Laurence Levine MD:  The treatment for low testosterone would depend somewhat on age. For younger men who are concerned about preserving their fertility, then clomifene citrate can be used. On the other hand, if fertility is not an issue, then I would use topical gels or, as Dr. McCullough has suggested, the testerone pellets, which are administered by the doctor in the office. Tuesday May 3, 2011 12:13 Laurence Levine MD

12:14

[Comment From katekate: ]  how can a woman help her husband when erectile dysfunction is a regular occurrence (p.s. the pills are ineffective) Tuesday May 3, 2011 12:14 kate

12:15

Andrew McCullough:  40 % of men who fail Viagra drugs are not taking them properly. 1. They should always be taken on an empty stomach 2. You need to be sexually stimulated (it doesn't happen by itself) 3. Repeated attempts increase the likelihood of success (in a study that I did,success was maximized after 6 attempts) If after that it still doesn't work, I worry about underlying medical condition. The penis is a very sensitive barometer of the health of the vascular system. If a man truly fails the Viagra drugs, I worry that that may be a harbinger of blockage in the "more important" coronary arteries. There are very effective treatments if the pills dont work but the failure of the Viagra drugs must be taken seriuosly Tuesday May 3, 2011 12:15 Andrew McCullough

12:15

[Comment From MarieMarie: ]  Is there increased ED when combining blood pressure and cholesterol medication? Tuesday May 3, 2011 12:15 Marie

12:15

Laurence Levine MD:  Absolutely, but it is not so much the drugs as the underlying medical condition, which injures the tiny blood vessels within the penis, reducing the flow of blood needed to create the erection. Tuesday May 3, 2011 12:15 Laurence Levine MD

12:16

[Comment From WLWL: ]  Please comment on the causes and treatment of Peyronie's disease. Tuesday May 3, 2011 12:16 WL

12:16

Laurence Levine MD:  Peyronie's disease is currently understood to be a "wound healing disorder," which involves only the penis. This occurs in men who are genetically predisposed to a scar following injury to the penis. This may occur in the flaccid or erect state. The ultimate result is that the scar is an inelastic segment within the shaft of the penis, which does not go away. The effect of a Peyronie's scar is much like placing a piece of tape on a balloon before blowing it up. Once it is blown up, the tape will restrict expansion in that area, resulting in a curved balloon. Similarly, scarring within the tissues of the penis will result in this deformity. It is not a cancer nor will it degenerate into a cancer, but it can have dramatic psychological as well as functional effects. It is estimated that up to 9% of men can develop Peyronie's disease. Unfortunately there is no cure at this time, but there are both medical and surgical treatments which have been employed that can result in improvement of function, reduction and/or correction of curvature. Tuesday May 3, 2011 12:16 Laurence Levine MD

12:17

Laurence Levine MD:  The non-surgical treatments include oral therapies (pills), none of which have been shown in properly done clinical trials to have any clear benefit over placebo, but the currently used agents include an old generic drug known as pentoxifylline, as well as the over-the-counter amino acid L-arginine. Interestingly, all three of the PDE5 inhibitors, including Viagra, Levitra, and Cialis, have also been shown to have an anti-scarring effect. Taken alone, oral therapy has not yet shown any evidence of significant benefit for correction of the scarring process. The second arm of therapy includes intralesional injection of drugs which can alter the effects of the scar. These agents are injected into the scar in the doctor's office. These include verapamil, interferon, and currently undergoing clinical trials, an enzyme known as collagenase. The third arm, which may be the most effective at this time, is applying external traction forces to the penis with a device known as a penile extender. When this device is applied to the flaccid penis, the stretching forces applied over several hours per day can result in reduction of curvature, recovery of length loss, and possibly reducing the necessity for surgical correction. It is a process which requires significant dedication by the patient, as it has been suggested that it must be worn at least 3 hours per day (not during sleep) for 4-6 months. Tuesday May 3, 2011 12:17 Laurence Levine MD

12:18

[Comment From NormanNorman: ]  Is there something like Viagra for women? Tuesday May 3, 2011 12:18 Norman

12:18

Andrew McCullough:  Viagra works for Women but it needs to be for the right reason. In women on SSRI's Viagra has been shown to reverse the sexual side effects of the SSRI's (prozac, paxil, etc.) there is currently a drug that is under investigation for decreased sexual desire in women. Tuesday May 3, 2011 12:18 Andrew McCullough

12:19

Judy Graham:  We had a fascinating web chat on older women's sexual health last month. Here's how you can access it: http://www.chicagotribune.com/health/ct-health-chat-women-sex-health,0,7492189.htmlstory Tuesday May 3, 2011 12:19 Judy Graham

12:19

[Comment From MarieMarie: ]  Can/do vascular surgeons treat/repair blood vessels in the penis like they can in other parts of the body? Tuesday May 3, 2011 12:19 Marie

12:20

Laurence Levine MD:  The problem with the penile arteries is that they are very small and usually the injury is throughout the penis. As a result, bypass surgery has not been successful. For men who have a small area of vascular obstruction, a new stent is under investigation, which may open the artery much like the stents that are placed in the coronary arteries of the heart. There are only a few centers in the U.S. offering this option. Tuesday May 3, 2011 12:20 Laurence Levine MD

12:21

Judy Graham:  Let's shift gears for a moment. What do we know about how often men have sex once they reach 65 or 70, Dr. McCullough? What's usual? Tuesday May 3, 2011 12:21 Judy Graham

12:21

Andrew McCullough:  73% of American aged 57-64 reported being sexually active 53% of Americans aged 65-74 reported being sexually active 26% of American 75-85 reported being sexually active 52% of men over 40 experience erectile dysfunction with a 10% increase every decade What ever the age, a 2007 study of 2453 elderly in Taiwan showed that increased sexual activity was associated with increased life span after adjusting for confounding factors. There is no "usual number of times" but couples who tend to be sexually active in younger years tend to be more sexual later in life. Tuesday May 3, 2011 12:21 Andrew McCullough

12:21

Judy Graham:  What about desire in older men? Does it change significantly? Tuesday May 3, 2011 12:21 Judy Graham

12:23

Andrew McCullough:  Decreased desire may be a reflection of a low testosterone. I have also been seeing a lot of older men (80's+) with decreaed orgasms due to low testosterone. Tuesday May 3, 2011 12:23 Andrew McCullough

12:23

Laurence Levine MD:  It does appear that desire does diminish with age, which may be a natural process. To ensure that there is not a medical cause, the blood testosterone level should be checked. If it is low, then testosterone replacement may help improve sexual desire, also called libido. Tuesday May 3, 2011 12:23 Laurence Levine MD

12:24

Judy Graham:  What if testosterone levels are normal for older men but there are still issues with desire? What can an older man or a couple do? Tuesday May 3, 2011 12:24 Judy Graham

12:25

Andrew McCullough:  Sometimes its not in the little brain but in the big brain. There is value to a good sex therapist or counsellor in those cases. Tuesday May 3, 2011 12:25 Andrew McCullough

12:25

Judy Graham:  Please, send in your questions. Our experts are happy to answer them! Tuesday May 3, 2011 12:25 Judy Graham

12:25

Laurence Levine MD:  If the man is out of shape, then regular exercise can help. Weight loss, stopping smoking, a good night's rest may all improve sexual function. But if there is a couples-related issue, then sex therapy may be beneficial. Tuesday May 3, 2011 12:25 Laurence Levine MD

12:26

[Comment From NormanNorman: ]  What is an "normal" level of testosterone? I am 60 years old. Tuesday May 3, 2011 12:26 Norman

12:27

Andrew McCullough:  I dont make much of "age specific" norms. If it's low and you have symptoms I would replace your testosterone. Should we "condemn" older men to low testosterone because they are "old." Tuesday May 3, 2011 12:27 Andrew McCullough

12:27

Laurence Levine MD:  This is actually a complex question. The normal lab values would suggest that the testosterone level should be above 300. But some men need a higher level to realize the benefit of testosterone. Tuesday May 3, 2011 12:27 Laurence Levine MD

12:28

[Comment From rickrick: ]  what if i have a high bp and heart related issues what can i do? Tuesday May 3, 2011 12:28 rick

12:29

Andrew McCullough:  Viagra was originally designed for the heart. If anything Viagra is probably good for the heart and the circulatory system. The problem is that if a "couch potato" hasn't been physically active and he takes a Viagra for sex, he may be stresses out his heart, just as if he were to suddenly run up a flight of stairs. Its not the pill that is causing the problem, it's the activity that it is allowing. It would be like blaming a snow fall as a cause of heart attacks when we all know its not the snow but the shoveling that causes the heart attack. Tuesday May 3, 2011 12:29 Andrew McCullough

12:30

Laurence Levine MD:  He should make sure his high blood pressure and other related heart issues are under control, and then a trial of medication like Viagra or other more advanced treatments are reasonable so long as your heart can tolerate the low level of exercise associated with sex. Tuesday May 3, 2011 12:30 Laurence Levine MD

12:30

[Comment From GuestGuest: ]  I seem to wake up with an erection every night, usually followed by a trip to the bathroom. Does this mean anything?? I have a pretty healthy sex life, and continued desire for it... Tuesday May 3, 2011 12:30 Guest

12:30

Andrew McCullough:  Nocturnal erections are healthy for the penis. "Keep them coming" Tuesday May 3, 2011 12:30 Andrew McCullough

12:31

Judy Graham:  This is related to a question above at 12:28. Should men with heart disease be worried about sex? Tuesday May 3, 2011 12:31 Judy Graham

12:32

Andrew McCullough:  Is sex a bad idea for someone with heart disease? Sex is always a good idea. As long as one can withstand the "exercise" of sex there is no reason to avoid sex. My threshold for sex is being able to walk up a flight of stairs. On the other hand what ever the exercise, if it causes chest pain or angina it should be avoided. Common sense should prevail her. The same is true for someone who suffers a stroke. Tuesday May 3, 2011 12:32 Andrew McCullough

12:33

Judy Graham:  We've talked about erectile dysfunction. Dr. Levine, what other sexual problems can occur in older men? Tuesday May 3, 2011 12:33 Judy Graham

12:33

Laurence Levine MD:  There are several different types of changes that occur as men age besides experiencing diminished rigidity of the penis at the time of sexual arousal. These include: 1) Diminished orgasm intensity 2) Reduced power of the ejaculation process 3) Delayed or inability to experience orgasm These problems appear to be natural events, which occur with the aging process, and unfortunately there is no known effective treatment to address any of these problems unless the patient's testosterone level is below normal. Low testosterone can have an effect upon libido, or sexual drive, and erectile function, but may also have some effects on the intensity of the sexual experience including orgasm and ejaculation. Therefore it is reasonable to assess all men who present with any of these complaints with a blood test for testosterone. If the testosterone level is low, then replacement therapy may help with those problems. It may take up to 3 months to see a response. Tuesday May 3, 2011 12:33 Laurence Levine MD

12:34

[Comment From stevesteve: ]  i'm only 40 and had a very mild heart attack in Dec. since then I have been on Plavix and not able to maintain an erection as well as previously. i exercise regularly and am in other wise good health. any thoughts? Tuesday May 3, 2011 12:34 steve

12:35

Andrew McCullough:  Steve, The penis is telling us what we already know from your history, your arteries need help. Keep exercising, eat better, stop smoking and take Viagra like pills. Tuesday May 3, 2011 12:35 Andrew McCullough

12:35

Judy Graham:  While we're waiting for Dr. Levine to answer, here's another useful resource from the ever-valuable Mayo Clinic web site. This one is a primer on sexual health and aging. http://www.mayoclinic.com/health/sexual-health/HA00035 Tuesday May 3, 2011 12:35 Judy Graham

12:36

Laurence Levine MD:  If you have a risk factor for cardiac disease, including smoking, obesity, high blood pressure, diabetes, or elevated cholesterol, these issues need to be controlled. Once your doctor clears you to have sexual activity, then you can use medications like Viagra, Levitra, and Cialis, which have no direct adverse effects on the heart. Tuesday May 3, 2011 12:36 Laurence Levine MD

12:36

[Comment From GuestGuest: ]  How is masturbation viewed by the panel for older men? Tuesday May 3, 2011 12:36 Guest

12:36

Andrew McCullough:  Masturbation is good at any age as long as it doesn't become an obsession. Tuesday May 3, 2011 12:36 Andrew McCullough

12:37

Judy Graham:  I know many men are concerned about sex after prostate cancer. Do treatments for prostate cancer inevitably interfere with sexual function? Tuesday May 3, 2011 12:37 Judy Graham

12:39

Laurence Levine MD:  All treatments for prostate cancer including surgery, radiation, or drug therapy, can negatively affect erectile function. But all the usual treatments can be effective, including all oral medications, penile injections, vacuum devices, and even insertion of a penile implant. Tuesday May 3, 2011 12:39 Laurence Levine MD

12:39

Andrew McCullough:  Prostate cancer surgery always results in a loss of ejaculation and decreased erectile function but it does not affect the ability to have an orgasm. If you do experience erectile dysfunction it can be treated very easily. All prostate cancer treatments usually decrease sexual function.There is not a man who suffers erectile dysfunction who can't be helped. after prostate cancer treatments. Tuesday May 3, 2011 12:39 Andrew McCullough

12:39

[Comment From GuestGuest: ]  How often would you consider "obsessive" masturbation a problem? 2-3 X per week? Tuesday May 3, 2011 12:39 Guest

12:39

Laurence Levine MD:  2-3 times per day. Tuesday May 3, 2011 12:39 Laurence Levine MD

12:40

Andrew McCullough:  Guest, When it interferes with your sexual intimacy with your partner. I have had men that masturbate so much that they don't have sex with their partner. Tuesday May 3, 2011 12:40 Andrew McCullough

12:40

Judy Graham:  Dr. Levine, you mentioned penile implants. Can you tell us more about this option? Tuesday May 3, 2011 12:40 Judy Graham

12:41

Laurence Levine MD:  A penile implant is a plastic device which is surgically placed within the tissues of the penis so as to mimic the erect penis, which is normally filled with blood, but in this circumstance the cylinder fits into the space and is typically filled with a saline solution. A penile prosthesis is indicated for men who either fail all of the previously noted non-surgical treatments, or find that their side effects are intolerable, or want the most reliable and simple method to resume sexual activity. The prosthesis is placed in the operating room typically in less than one hour with an overall high patient satisfaction rate. In fact, studies which have compared patient satisfaction with the prosthesis to injection therapy or oral therapy find that penile prosthesis recipients have the highest satisfaction. This is probably because the motivated man who undergoes prosthesis placement is able to resume sexual activity in the most natural way without having to rely upon a pill, shot, vacuum or pellet. In this circumstance, when the man wants to engage in intercourse, he would inflate the prosthesis which takes typically 10-15 seconds and allows a rigid erection. There are two potential problems with the penile prosthesis. One is mechanical failure of the device. The current prostheses have a lower than ever mechanical failure rate, which has been estimated to be in the 10-15% range over a 10-year period. If the device were to fail mechanically and the patient would still like to be sexual active, then it would require removing the broken prosthesis surgically and replacing it with a new one. These are usually outpatient procedures. The second major concern with a penile prosthesis is infection. Should the device get infected it would need to be removed. It could potentially be immediately replaced. Infection rates with the current new designs for prostheses have reduced this rate to the 1-2% range. These devices are designed to last for life and in fact they are warranted for life, so if a mechanical failure were to occur, at least the cost for a new device would not be borne by the patient or insurance company. Tuesday May 3, 2011 12:41 Laurence Levine MD

12:41

[Comment From GuestGuest: ]  How about performance after prostrate cancer removal? Tuesday May 3, 2011 12:41 Guest

12:43

Judy Graham:  Thank you for all the great questions coming in. The doctors are working on an answer.... Tuesday May 3, 2011 12:43 Judy Graham

12:43

Andrew McCullough:  Guest, I believe that men should resume sexual intercourse as soon as possible after surgery. I have my patients start the PAINLESS penile injections as early as 6 weeks from surgery. I believe in EARLY sexual rehabilitation. The pills will not work for at least 6 months!!! Why wait? Tuesday May 3, 2011 12:43 Andrew McCullough

12:44

[Comment From KevinKevin: ]  how effective is foresta for low testerone? how long until a benefit should be observed? Tuesday May 3, 2011 12:44 Kevin

12:44

Laurence Levine MD:  Fortesta is a brand new topical gel which is applied daily to the inner thighs, typically after a morning shower. Published experience with this treatment is very limited, but adequate testosterone levels have been reported. Tuesday May 3, 2011 12:44 Laurence Levine MD

12:44

Andrew McCullough:  i think anything rubbed on the inner thighs might be good, Larry. Tuesday May 3, 2011 12:44 Andrew McCullough

12:47

Judy Graham:  When erecetile dysfunctions drugs don't work or side effects are intolerable, what other options are available? Tuesday May 3, 2011 12:47 Judy Graham

12:48

Laurence Levine MD:  When oral therapy fails or there are side effects which are intolerable, then other treatments are available, including: 1) Vacuum constriction devices. This is one of the oldest treatments for ED, spanning back to the beginning of the 1900s. This device is the least invasive and least expensive, but the least natural of all of the approaches. With a vacuum device, a tube is placed over the penis and a vacuum is created to pull blood into the penis. To keep the blood there, a specially designed rubber band is placed around the base of the penis, at which point the tube may be removed and intercourse may begin. These devices are usually effective, but many patients do not like the cumbersome process, as well as the unnatural feeling and looking erection. 2) Injection therapy into the penis has been used since the mid 1980s. This process uses drugs which are injected directly into the side of the penis with a tiny, virtually painless needle just before intercourse is performed. These drugs cause blood vessels to dilate, thereby bypassing the brain, and give a stronger impulse to get the increased blood flow to create an erection. There are certain limitations with injections in terms of frequency of use, and there are side effects including scarring or an erection which lasts too long. Proper training in injection technique is critical, as well as determining the proper dose before home use. This is usually conducted in the urologist's office. 3) There are also urethral pellets that can be placed into the urethra known as MUSE. This pellet is inserted directly into the end of the penis, massaged there, and in 40% of men a satisfactory erection will occur. Unfortunately, 30-40% of men will have pain, which may compromise its use. 4) The last option in men may in fact be the best option, and that is the insertion of a penile prosthesis, or penile implant, which will be discussed in another segment. Tuesday May 3, 2011 12:48 Laurence Levine MD

12:48

[Comment From WLWL: ]  Several years ago, a combination of vitamin E and selenium was touted as beneficial to prostate health. What's the latest on this? Tuesday May 3, 2011 12:48 WL

12:49

Andrew McCullough:  Excessive Vitamin E can be harmful and of no benefit. A selenium prostate cancer study was recently stopped because of adverse effects. Tuesday May 3, 2011 12:49 Andrew McCullough

12:50

Judy Graham:  We haven't talked about smoking as a risk factor for sexual dysfunction. What about this, Dr. Levine? Tuesday May 3, 2011 12:50 Judy Graham

12:50

Laurence Levine MD:  Smoking, in fact, is the number 1 most common single cause of erectile dysfunction. This is because tobacco causes an acute constriction of blood vessels, thereby preventing good blood flow into the penis, but over time causes progressive hardening of the blood vessels themselves so they cannot dilate in response to a sexual signal. As a result, there is inadequate blood flow, and with continued smoking, the vascular problem worsens. Tuesday May 3, 2011 12:50 Laurence Levine MD

12:50

[Comment From GuestGuest: ]  can i get a reverse vasectomy? Tuesday May 3, 2011 12:50 Guest

12:51

Andrew McCullough:  Yes vasectomies can be reversed. It is routinely performed by infertility specialists. We also can harvest sperm from the testis to be used with IVF and ICSI. The testes never stop producing sperm! Tuesday May 3, 2011 12:51 Andrew McCullough

12:52

Laurence Levine MD:  Yes, vasectomy reversal is a regularly performed operation, best performed by a urologist with experience using the operative microscope. Success rates depend to some degree on how long after the vasectomy the reversal is performed. The longer, the lower the success rates. It is an outpatient procedure. Tuesday May 3, 2011 12:52 Laurence Levine MD

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Judy Graham:  If you had three pieces of advice to give older men regarding their sexual health, what would they be? Tuesday May 3, 2011 12:52 Judy Graham

12:53

Laurence Levine MD:  Don't smoke. If you do, lose weight if you are overweight. Exercise regularly. Tuesday May 3, 2011 12:53 Laurence Levine MD

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Andrew McCullough:  1. Sexual health is a primal form of communication but don't forget conversation outside of the bedroom. 2. Don't forget to wash the dishes, take out the trash, walk the dog and bring the roses. She is always right! 3. Live healthy, your penis will thank you. Tuesday May 3, 2011 12:54 Andrew McCullough

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[Comment From MarieMarie: ]  what are the best natural remedies/supplements for treating ED? eg cayenne is great for circulation Tuesday May 3, 2011 12:55 Marie

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Laurence Levine MD:  There are no known herbal remedies that have been shown to be effective for treating a vascular cause to ED. Herbs may provide some psychological benefit, which, if it works, is fine with me. The only supplement that I recommend is L-arginine, which can be purchased at health food stores or general pharmacies now. Tuesday May 3, 2011 12:55 Laurence Levine MD

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[Comment From GuestGuest: ]  Is there a higher incidence of prostrate cancer with men who have had vasectemies? Tuesday May 3, 2011 12:56 Guest

12:56

Andrew McCullough:  Several studies failed to link vasectomies with prostate cancer. Remember association does not imply causality!!! Tuesday May 3, 2011 12:56 Andrew McCullough

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Judy Graham:  I've learned a lot from this chat and will look forward to rereading it and assimilating all the great information here. Thank you so much, doctors, for your time and your good advice. Participants, you can find me now on twitter at @judith_graham. I look forward to seeing you there. Tune in next Tuesday at Noon central for our next Tribune web chat with Julie Deardorff about how plastic affects developing children. Tuesday May 3, 2011 12:57 Judy Graham

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Laurence Levine MD:  It's been a pleasure to be online with you, Judy and Andy. Tuesday May 3, 2011 12:58 Laurence Levine MD

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Andrew McCullough:  Dear Audience, It has been a honor and a pleasure to converse with you. Andy McCullough Tuesday May 3, 2011 12:58 Andrew McCullough

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