Transcript Often the first thing a man touches morning and night (ritual)

Enhancing Romancing
(Sexuality for the present)
Danny L. Keiller, MD, FACS, MBA,
CPI
Penis facts !
 Often the first thing a man touches
morning and night (ritual)
Sexual pleasure depends on getting
and staying hard (society says so)
No unwanted hard-ons after age 30
A hood ornament (vs. female’s little
triangle)
History of new sexual “facts” !
• 60’s: clitoris discovered
– Useful on the race track to intercourse for
men (foreplay)
– Amazingly huge variation in nerve supply,
and sensitivity pattern (science)
• 80’s: Surgeon-General fired for
masturbation remark but oral sex
enters first grade vocabulary
• 2000’s: Increase in tolerance but
“sexual abuse” and “sexual
harassment” common
Changes in aging men..
• Decreasing hormones
• Hardening arteries
• Erectile or orgasmic dysfunction
• Decrease in ejaculation volume
• Need for medications
• Decreasing hearing
• Need for cancer therapy
ED as a result of CaP therapy
• Hypogonadism
• Nerve damage
–Postop
–Delayed
• Psychogenic
• Chemotherapy
QOL measurement
• Rosen, RC. U of Chicago: EF changes associated with
increased mood, QOL, partner satisfaction, family life.
(August 2004)
• IIEF = International Index of Erectile Function
• BDI = Beck Depression Index
• Likert scale = satisfaction with sex life
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SEAR = Self-esteem and Relationship
ISL= Index of Sexual Life
ED-EQoL = Erectile dysfunction-effect on QOL
PAIRS = Psychological and Interpersonal Relationship Scales
SLQQ = sexual life quality questionnaire
EDITS = ED Inventory of Treatment Satisfaction
MSQ = Mood and Sexuality Questionnaire
PIED = Psychological Impact of ED
SIS/SES = Sexual Inhibition Sexual Excitation Scale
PDE5 Inhibitors: Sildenafil
• Meet Important Patient Needs
• Most patients prefer oral therapy
• Action is physiology-based
• Consider partner needs and
satisfaction
• Long-term improvement in quality
of life
First-Line Treatment for ED: How PDE5
Inhibitors Work
Endothelial
Cells
Nitric
Oxide
Guanylate
Cyclase
Erection
NANC* Neurons
GTP
cGMP
GMP
PDE5
Smooth
Muscle
Relaxation
*Nonadrenergic, noncholinergic nerve.
Boolell. Br J Urol. 1996;78:257-261; Burnett. J Urol. 1997;157:320-324; Heaton. Neurosci
Biobehav Rev. 2000;24:561-569.
Optimizing PDE5 Inhibitor Therapy
Incorrect use  treatment failure
• Sexual stimulation needed
• Replace testosterone if level is low
• Risk factor treatment improves
outcomes
• Follow-up visits essential
• A number of trials may be required
(endothelial function improvement)
“Success” in intercourse.
• Orgasm = NO
• When it leaves you feeling less
grumpy, more solid,
invigorated, secure and
wholesome.
Romance
• Can evolve into sex
(not necessarily)
• Women who read romance novels
have sex twice as often as other
women
• Not associated with money
• Simple and thoughtful doings
contribute greatly
Simple and thoughtful doings:
• Kissing
• Kindness
• Fun
• Special gestures
• Trustworthiness
• Help maintain the abode (Windex
a better aphrodisiac than
oysters)
Female genital oral or
finger massage
• Labia
• Clitoris
• Thighs
• Urethra
• Slow
• Special places to be discovered
• “Ask”
G- spot
• Surrounds the female urethra
(for sure in some women..ask)
• Spongy area, in anterior vaginal
wall
• Homologue of prostate?
Additions
• Environment
• Pillows
• Sex toys
• Internet – Google, Erotic Writer’s
Assoc, Good Vibrations
• Not “opposite” sexes but “different”
• Ask, ask, ask, talk, talk, talk
• Intimacy: neither sex very good at it
(excluding dependency).
Lover types:
• Good lover
“Knows” what
partner wants
• Accomplished
lover
A wise student
Asks for copious
advice since they
“don’t know” what
partner wants
“Real” definition of foreplay
• Everything that has happened
between partners since their last
sex (and there is a lot more time
spent with pants on than off)
Bottom line for sex
• 90% of sex happens in your
mind and the rest is in your
head
• CONVERSATION is the clue
Patients Want to
Discuss Sexual Health . . .
85%
74%
Patients who
believe
physicians should
inquire about
sexual matters
Patients who felt
“undersatisfied”
by
physicians’
queries about
sexual matters
Metz. J Sex Marital Ther. 1990;16:79-88.
Failure of physicians
to inquire about sexual
functioning is a source
of dissatisfaction for
many male patients
N = 62
23%
Patients reporting
that physician
inquired about
sexual matters
. . . But Are Concerned
About Broaching the Subject
1999 Poll on Barriers Toward Seeking Help for ED: 500 men,
random-digit dialing
Very concerned
No medical treatment for
your problem
46%
Doctor would dismiss
concerns and say it was in
your head
51%
Doctor would be
uncomfortable talking about
the problem because it was
sexual
46%
0
*Numbers do not add up because of rounding.
Marwick. JAMA. 1999;281:2173-2174.
20
Somewhat concerned
30%
20%
23%
40
60
Percent
76%
71%
68%*
80
100