Other Articles of Interest

The Many Faces of Little Beach

by DoctorG on September 21, 2011

The Little Beach controversy has grown. A tiny secluded beach on Maui’s South Coast, between posh Wailea and undeveloped Makena has become the “eye” of a cultural storm about the custom of “clothing optional” dress for its visitors. Little Beach has been known for a decade or more as a place where those who choose can remove their clothes . It is a lovely beach, separated by a small hill from a pristine stretch of sand known as Big Beach, frequented by locals and tourists alike. To access Little Beach, one has to climb a small cliff separating Little Beach from Big Beach and at the top of the hill the view is spectacular of both beaches and the majesty that is Maui.

Some claim that nudity is an affront to traditional Hawaiian values. Some claim that nudity is a God-given right. If the good Lord had wanted us clothed , he would have created us wearing clothes! Some come to Little Beach to see nude or semi-nude people. Some say they come to Maui BECAUSE Little Beach is here. On Sundays, the tribal gathering includes music-making, drumming, dancing, chanting and being! Little Beach changes as does all of Maui and the Hawaiian Islands with the weather.

There are many “faces” to Little Beach, depending on your viewpoint. You can see it from the ocean, from the hilltop, from the beach itself, through the bushes and trees that mark its perimeter. There are also the people who inhabit Little Beach. They can better be known by their faces than by their bodies. In these photos you can see “the many faces of Little Beach” You are invited to enjoy them, to examine them, to appreciate them. Welcome to Little Beach. Come in person when you can. You are all welcome.

Aloha, Ed Jor-el Elkin

 

The Many Faces of Little Beach

Photographs
by Ed Jor-El Elkin, Ph.D.

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Viagra® and Your Relationship

by DoctorG on September 21, 2011

by David S. Hersh, EdD, FAACS

Previously taboo men’s medical issues such as erectile dysfunction and prostate cancer are now regularly in the headlines. Men are beginning to pay attention to the physical problems that can cause loss of life-or loss of sexual function.

Viagra® has come to Canada! Like everything else, it has positives and negatives. When it debuted in the U.S., it provoked comment by the media and became the source of numerous jokes. Barbara Walters mentioned that some men want to take the pill every night, and their wives are not necessarily thrilled with the added sexual attention. Others have suggested it is the start of a new sexual revolution similar to the introduction of the birth control pill.

Viagra® has been demonstrated to be effective for both physical and psychological causes of erectile failure. Nevertheless, the longer the sexual dysfunction has been going on, the less likely it is that you and your partner will return to your previous level of functioning. Over time, both of you have accommodated to the lack of erection. Unfortunately, many couples, especially where communication about sex is lacking, drift toward the complete termination of sexual relations.

So, now you can enhance your erection with a pill, but it will not increase either your sexual desire (libido) or the receptivity of your partner. In fact, if someone surreptitiously slipped the drug into your drink, you would probably notice nothing at all without sexual stimulation. If sexual activity is not initiated, there will be no physical response of erection. There will be no psychic sense of having taken a drug, no feeling of getting “high.” There will be no mood alteration.

How will this new ability to get an erection affect other factors in your relationship? I expect it will have great impact. Some men do not initiate sex because they fear they will fail to get a really firm erection. If Viagra® gives confidence and better erections to men who occasionally get nervous or have occasional erectile problems, it may mean a more satisfying sex life overall.

My concern is not with the ability of a drug to help you overcome erectile dysfunction. Anything that works! My concern is that it may be perceived as a cure-all. But what real impacts will it have, and will it actually have far reaching effects beyond helping you attain erection? Will it decrease the divorce rate? (Do women really leave their husbands because they no longer have the sexual energy of a twenty-year-old?) My experience demonstrates that the number one reason why couples break up is definitely not a man’s lack of ability to achieve an erection. Both men and women need to understand that the normal aging process results in changes to our sexual functioning, which can lead to anxiety and erection problems.

This drug could have an adverse effect on relationships in general, by reinforcing the cultural focus that many men have on performance and “goal-oriented sex.” The situation is bad enough now. Good sex does NOT equal a good relationship.

Will the use of this drug delay a man or woman from leaving a bad relationship, or allow a good relationship to continue? Will it deceive a partner into believing that he/she is really loved and wanted? I tend to believe that Viagra® will not profoundly change the manner in which men and women relate to each other.

My point is simply that sex and relationships are complicated, and simple solutions are usually wishful thinking. Viagra® will not eliminate the other problems in the relationship, but may only bring them to the fore. This may occur after a period of happiness, satisfaction and experimenting with the new erection capability.

A couple of words about what Viagra® does not do:   it does not make men good listeners-that drug, unfortunately, is still a very long way off. It does not make men desire their partners more, make them better lovers, increase their passion or do most things that people would like it to do. There’s obviously a great danger of your having unrealistic expectations in all directions.

With the availability of Viagra®, you are more likely to bring your sexual questions directly to your primary care physician. Hopefully, your concern about erections will translate into paying more attention to your overall health. It will give you the opportunity to have your physical symptoms evaluated to rule out many conditions that need to be addressed prior to prescribing Viagra® for you. Your doctor will find that Viagra® is easy to prescribe, effective in most cases, and almost free of side effects. This is a wonderful advancement! Please proceed with caution and examine where it fits into your relationship.

 

Some Frequently Asked Questions

 

What is Viagra® and how does it work?

The effect on erection of Viagra® (sildenafil citrate) was discovered accidently. It was initially tested for heart disease, but failed. When researchers asked for it back, many of the test patients refused to return it. The researchers soon realised the unexpected side effect of improving erection.

Viagra® works by prolonging smooth muscle relaxation (and hence erection) and improves blood flow to the erection chambers within the penis, and to the pelvic area in general. At the end of one study, 88% of patients reported that Viagra® improved their erections, however, many of these patients did not have an erection sufficient for penetration on a number of occasions.

What should I worry about?

In general, you should know there is a degree of risk to the heart with any physical activity. A thorough medical history and physical examination by a physician can rule out other diseases that can be present and contributing to your erection problems, and to be sure that you can handle the physical exertion of sex.

Viagra® should not be combined with other medications for treatment of erection problems; safety studies have not been done yet.

Viagra® should not be taken with medications called nitrates. Some specific examples of organic nitrates include nitroglycerin, Nitro-Bid®, Nitro-Dur®, nitropaste, or basically anything with “nitro” in it, or iso-butyl nitrate or “poppers” which are sold over-the-counter as video head cleaner or room deodorizer. You should check with your pharmacist if you are at all uncertain. To take Viagra® together with a nitrate may lead to a severe drop in blood pressure and other problems, possibly even death.

Cimetidine (Tagamet®), erythromycin, ketoconazole (Nizoral®), and itraconazole all interact with the drug. Please inform all physicians you are seeing that you are taking Viagra®.

Side effects from the medication include headache in approximately 16%, flushing in 10%, and abnormal vision in 3% of patients. The abnormal vision is usually mild and short-lived, predominately involving blue-tinged or blurry vision. These side effects typically occur at higher doses; however, only a few patients who experience them need to stop the medication.

How much to take and when to take it.

For most patients, the recommended dose is 50mg. taken approximately one hour before sexual activity. The dose can be increased to but not exceed 100mg. Regardless of the strength of medication, patients should not use more than the advised dose in a 24-hour period.

Important stuff you should know.

Viagra® is not an aphrodisiac. It will not increase your sexual desire. It is not a sexual device or stimulant.

Viagra® improves the erectile function of your penis, but still requires appropriate sexual stimulation to help bring about a useful erection for intercourse. Taking a Viagra® tablet with little additional sexual stimulation is unlikely to lead to a good erection. All the good, old inputs are necessary and might include your partner, your mood, the setting, music, aroma, and other erotic stimuli. Each of these may enhance the quality of the erection and the overall experience.

Please do yourself a favour-don’t just pop one pill, get a poor erection, and feel the medication and you have failed. You need to give the medication four or five tries to have a good idea whether it will help you or not. Anticipation, the anxiety of the situation, and expectations for your performance can make the first attempts less than perfect.

Can a woman use Viagra®?

The drug has not been approved for use by women, but some doctors are still prescribing it. Studies are underway but have not yet been completed. Anecdotally, some women who have tried Viagra® report a sensation of warmth and openness, probably resulting from increased blood flow to the pelvic area, which has given them a pleasurable response to genital stimulation and intercourse.

Call your physician if you have any questions or problems.

Copyright © 1999 David S. Hersh, EdD, FAACS
2nd edition, July, 1999.

Dr. Hersh’s web site is http://Doctor-Sex.org

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by Jim English and Ward Dean, M.D.

On March 27, 1998, the FDA approved the drug Viagra (sildenafil citrate) as a treatment for male impotence. Aside from the recent gyrations in the stock market, little else has generated as much excitement as the response to the availability of this new drug designed to deal with the common but embarrassing male problem of erectile dysfunction.

Is That A Bottle In Your Pocket.?

Viagra was originally investigated as a potential anti-angina medication, based on its ability to release nitric oxide and increase blood flow to the heart. Although Viagra failed as a heart medication, researchers in London became excited when many of the men in the clinical trials reported the frequent occurrence of unaccustomed erections and improved sexual performance. Following this serendipitous finding (and five years of clinical trials), Viagra was finally granted approval as a treatment for men suffering from difficulty in achieving erections due to conditions such as diabetes, vascular disease, spinal cord injury, and radical prostatectomy.

Viagra is a drug that lives up to all the hype, lifting the hopes and self-esteem of up to 80 percent of men suffering from non-organic impotence. Others with mild to moderate organic impotence also respond to Viagra. Additionally, Viagra also seems to enhance sexual performance and enjoyment and reduce the “latent period” between erections even in men who have no dysfunction.

In the two months following its release, over one million prescriptions were issued, making it one of the most successful drugs ever introduced. As expected, the success of Viagra also raised Pfizer’s profits and drove stock prices through the roof. .

Or Are You Just Happy to See Me?

Viagra is also quickly gaining a reputation with women. This makes sense when one considers that the clitoris, structurally similar to the penis, becomes engorged with blood during sexual arousal. Viagra may provide similar benefits, enhancing the sexual sensation and orgasmic enjoyment of women. In response to this growing demand (and very lucrative market) Pfizer is now conducting clinical trials of Viagra as a pill for sexual enhancement in women.

Rising to the Challenge

Vascular smooth muscle (VSM) cells surround arteries and arterioles, contracting and relaxing the arteries to regulate blood pressure. The given state of smooth muscle cells, and their effect on blood pressure, understandably have a profound effect on the male sexual organ. Let’s examine how this process works.

Normally, in the presence of sexual stimulation, blood flow is directed into “pockets” known as the corpus cavernosum, contained within the shaft of the penis. The resulting inflow of blood leads to the enlargement and stiffening of the penis.

This engorgement is triggered by nitric oxide (NO), a short-lived neurotransmitter. Nitric oxide, synthesized from the oxidation of the amino acid arginine, activates an enzyme that manufactures cyclic guanosine monophosphate (cGMP), a biochemical signaling enzyme. Under normal circumstances, cGMP, directs the smooth muscle cells to relax, leading to the dilation of penile arteries.

However, immediately following release of NO and production of cGMP; another enzyme, cGMP phosphodiesterase type 5 (PDE-5), is activated.

PDE-5′s main activity is to destroy cGMP almost as fast as it is formed. The result of this breakdown of cGMP by PDE-5 is a rapid decrease in smooth muscle relaxation and a loss of blood flow to the penis. Subsequently, the penis returns to its flaccid state.

How Viagra Works

Unfortunately, as we age, cellular concentrations of cGMP decrease. Viagra works to achieve and maintain erections by (1) enhancing the effects of nitric oxide, and (2) maintaining higher levels of cGMP, the two key players in penile erection. The way Viagra does this is to selectively inhibit the cGMP-destroying actions of PDE-5. By blocking the actions of this enzyme system, cGMP is no longer broken down. This leads to elevated cGMP levels in the corpus cavernosum. This in turn prevents relaxation of the smooth muscle in the corpus cavernosum, increases blood flow to the genitals, and leads to stronger erections and intensified sensation.

Viagra: Side Effects

The most common side effects of Viagra include headaches, facial flushing, and indigestion. The FDA also noted that three percent of men taking the little blue pill reported temporary changes in their vision, including light sensitivity and a bluish tinge in their vision.

In early May, the American Academy of Ophthalmology, meeting in San Francisco, urged that the problem be taken more seriously. “FDA clinical trials show that taking the medication, especially at higher doses, can cause some retinal dysfunction, and affect the way we see for a number of hours,” association spokesman Dr. Michael F. Marmor said in a statement.

Marmor, a professor of ophthalmology at Stanford University, said a clinical study showed that electrical measures of retinal function dropped by 30 to 50 percent and lasted for at least five hours after taking a large dose of Viagra.

He suggested that people with retinal eye conditions such as macular degeneration or retinitis pigmentosa use the drug with caution, staying with the lowest dose possible.

The recommended dose level for most patients is 50 milligrams, according to the FDA.

Viagra and Nitrates

In addition to eye problems, both the FDA and Pfizer have warned against taking Viagra with any nitrate-based cardiac medications (i.e., sublingual nitroglycerin tablets, nitroglycerin patches, etc.). Pfizer warned that heart patients should not be treated with nitroglycerin if the patient has used Viagra in the previous 24 hours. Pfizer says there have been cases where patients who received both drugs have died after developing irreversible hypotension (a severe drop in blood pressure).

This is due to the drug’s action of enhancing the smooth muscle relaxing effects of nitric oxide. Thus, a combination of Viagra and a vasodilating drug like nitroglycerin might result in a significant and potentially dangerous drop in blood pressure

Natural, Safe and Affordable Alternatives to Viagra

Perhaps the biggest drawback to using Viagra (aside from side effects) is the high cost, which can range upwards of $10 per pill (or more)! As noted earlier, Viagra works to increase both the levels and activity of nitric oxide, leading to increased cGMP, increased blood flow to the genitals, and more intense sensations. Fortunately, there is a less expensive way to naturally increase the amount of nitric oxide released during sexual stimulation. The key is supplemental L-arginine, the direct precursor of nitric oxide.

L-Arginine

In the 1990′s, scientists discovered that L-arginine, a non-essential amino acid commonly found in the diet, is an oxidative precursor of nitric oxide (NO). As mentioned previously, nitric oxide is required for achieving and maintaining penile erection. Under conditions in which nitric oxide is produced for a specific physiologic purpose, the concentration of L-arginine (from which it is formed) can be a limiting factor.

Researchers at New York University School of Medicine gave L-arginine to a group of impotent men, and found that six out of 15 men receiving the amino acid claimed an improved ability to achieve erections, while none of the 15 men in the placebo group reported any benefit.

Choline and Vitamin B-5

Sexual arousal occurs not just in the genitals but in the whole body and, especially, in the brain. For men, it actually begins when the brain sends impulses down the spinal cord and out to the nerves that serve the penis. These impulses trigger the production of nitric oxide (NO), which causes penile arteries to dilate and the spongy core of the penis to relax and become engorged with blood. The neurotransmitter that carries the sexual message is acetylcholine (ACh). ACh also seems to control sexual behavior through its activity in the brain. For women, ACh is also a very important part of sexual function.

Numerous studies confirm a key role for cholinergic nerve transmission in sexual responses. Simply speaking, with too little ACh, sexual activity goes down. Increase ACh levels, and sexual activity goes up. ACh is involved in the build-up toward orgasm and the urethral and vaginal contractions that occur during orgasm as well as the subjective perception of orgasm intensity and duration.

In addition to its direct role in the sexual response, ACh is also the primary chemical the body uses to transmit signals from nerves to skeletal muscles, the muscles that move the body. You need this chemical for muscular control and proper muscle tone. There is reason to believe that enhancing cholinergic neuromuscular transmission will enhance your energy and stamina by raising your ACh levels and that this can provide indirect sexual benefits by allowing you to perform longer and with more energy.

While drugs can enhance the body’s cholinergic activity, these drugs not only have unpleasant or even dangerous side effects, but are available only by prescription. One way to safely and effectively enhance ACh levels is to take supplements of choline, along with vitamin B-5, so that the body will manufacture more ACh.

Vitamin B-5, also known as pantothenic acid or calcium pantothenate, actually seems to enhance endurance by two routes. The first is its already-mentioned role in creating ACh from choline. Second, is its role in the energy-producing Krebs Cycle, which is vital for all living cells. An early indication that vitamin B-5 might increase physical endurance came from a study in which rats were placed into a tank filled with cool (64°F) water and forced to swim until they became exhausted. Prior to their swim, the rats’ diets had included either high, adequate, or deficient levels of vitamin B-5. The high dose rats lasted more than four times as long as those whose diet had been B-5 deficient. In another experiment, pieces of frog muscle were stimulated electrically to make them twitch. The stimulation continued until the muscle became exhausted. Muscle tissue that was bathed in vitamin B-5 had double the work output as the control muscle. [Ralli, 1953].

What are the sexual effects of choline and vitamin B-5?

As these results suggest, the primary sexual effect of treatment with choline and vitamin B-5 or B-5 alone is reported to be increased endurance. “I can generally have sex for about twice as long as I can without it,” said a man in his 30s, who takes vitamin B-5 by itself.

One woman, who uses choline plus vitamin B-5, says they help her feel more relaxed during sex. “There’s no muscle tightness,” she said. “It makes your body feel smoother, especially if you tend to tense up while having an orgasm.”

Dosage and timing

Experienced users recommend taking choline plus vitamin B-5 or B-5 by itself about 20 to 30 minutes before sex in order to get the full effect right from the start. But, notes one user, “Don’t worry if you start too soon, it’ll kick in as you’re going.” He adds that, “Not everybody will notice it, but if you set a clock, you’ll notice that you have the energy to go longer. Pretty much everyone I’ve told about B-5 has had that effect.”

Combinations that many people have found effective include three times as much choline as B-5 (for example, 500 – 1,000 mg of B-5 in combination with 1,500 – 3,000 mg of choline). It is probably wise to begin with lower doses in this same ratio, and gradually increase the dose as tolerated.

Tyrosine and Phenylalanine

Several lines of evidence link activity of the neurotransmitter dopamine in the brain with sexual behavior. Generally, it appears that higher levels of dopamine are associated with more sexual interest and vice versa. Increased brain dopamine activity caused by taking the drug L-dopa is believed to be the cause of a “hypersexuality” syndrome in people who take the drug for Parkinson’s disease. L-dopa is a chemical precursor of dopamine (which in turn is a precursor of norepinephrine). In other words, the body uses L-dopa to make dopamine. L-dopa is available only by prescription, but you can also increase your brain dopamine levels by taking the nonprescription amino acids that the body uses to make L-dopa: tyrosine and phenylalanine. People who have lost interest in sex because they are depressed may benefit from taking doses of 100 to 500 milligrams of L-phenylalanine or L-tyrosine for two weeks. Supplements of vitamin B-6, vitamin C, folic acid and copper in addition to the tyrosine or phenylalanine, should help maximize the conversion of L-dopa to dopamine.

Reprint courtesy of Vitamin Research Products (http://www.vrp.com/)

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The Easy Erection: Penile Panacea? (1998)

by DoctorG on September 21, 2011

by Gary Schubach, Ed.D., A.C.S. and Shama, C.H.T., C.D.C.

As a partnered pair of sex educators we, of course, felt it was our duty to explore the Viagra experience before we gave our opinions to our clients and the public (the things we do for science). Although we had some initial concerns after what we had read and heard, just like everyone else, we were curious.

Just in case you have somehow missed the media blitz, the recent approval of Viagra by the FDA has created a firestorm of interest from the media and the public. Viagra is the first of a new generation of drugs that aid with male erectile problems by targeting a key enzyme that controls blood flow to the penis.

As anticipated, the initial demand for Viagra has been tremendous, with projected first year sales of $4 billion. Every day there are numerous stories about Viagra on television and in the other media. Such public figures as Bob and Elizabeth Dole sheepishly extol its use. Jokes about Viagra and its use appear everywhere and it has become fodder for TV talk shows and has even been worked into the plots of series programs such as “NYPD Blue.”

Aside from the joy of another opportunity to ply our sensual skills together in the interest of public service, we also wanted to know, first hand, how the medical community was responding to patient demand. As the Viagra publicity broke, we were most concerned about the way it was being marketed by the drug company and the potential emotional/relationship effects of treating only the physical symptoms of erectile issues, while perhaps ignoring the emotional components.

Until fairly recently, the generally held wisdom was that erectile difficulties were anxiety-based in approximately 95% of cases with only 5% resulting primarily from physiological reasons, such as diabetes, where proper blood flow to the penis was impaired. Anxiety caused by such things as male performance fears, relationship problems and/or the stresses caused by modern living can also cause an inhibiting of blood flow to the penis. Traditional treatment has usually been by talk therapy and/or sensate focus exercises where the patient and his partner were taught how to touch and be touched in non-coital ways of sexual expression that did not require erection. The benefit of this approach was to not only broaden the couple’s sexual repertoire, but also to reduce anxieties so that erections could appear naturally.

Pfizer, the drug company which is the holder of the Viagra patent, and others now say that due to such new developments as antidepressants, increased rates of prostate cancer, and other medical conditions, as many as 80% of male erectile problems are now primarily physiologically based,not psychologically based. While the Viagra trials involved men with identifiable physiological conditions, Pfizer and others are telling us that as many as 30 million men in the U.S. may suffer from ED (Erectile Dysfunction) and be candidates for Viagra. Needless to say, the drug companies would like a broad and profitable distribution of these drugs.

In fact, the broadening of the definition of Erectile Dysfunction pathologizes age-old male sexual anxieties about obtaining and maintaining erections. There is probably hardly a man alive who has not experienced some difficulty or concern about erections at some time in his life. These new drugs treat emotional discomfort as well as “disease.”

The practical problem for physicians, as patients are demanding Viagra, is to determine the appropriateness of this as a treatment for the patient’s condition. If we simply raise men’s levels of performance, without raising the couple’s consciousness around sexuality, we may indeed see some interesting side effects such as “Viagra divorce.”

To compound the problem, surveys have found that 36% of physicians are reluctant to discuss sexual health issues with their patients. Of these, almost one in three report that it is either “extremely difficult” or “very difficult” to discuss sexual function with their patients. This is not surprising considering that they have received only an average of 12 hours of classroom study in medical school on the subject of human sexuality, other than for reproductive biology. Many doctors have received no training at all and the trend in medical schools is definitely towards less theoretical learning and more towards problem-based learning. It is natural that in problem-based learning the inclination will be to treat the failure to be able to achieve and maintain erection with medication or surgery. However, here again this “problem-solving” approach often fails the patient, since by merely treating the symptom rather than the emotional cause of the problem, it may likely resurface in the same way or creates new problems.

As to our personal adventure with Viagra, and in fairness to this audience, we must disclose that due to our education and training, in our sexual relationship, we have already studied and gleefully mastered sexual and sensual techniques to prolong and extend our lovemaking. So, we were certainly curious as to how Viagra would impact us, if at all.

Gary’s view: Gary admits that he had a great deal of difficulty writing about Viagra before actually experiencing it. “I approached my personal physician, who knows I am a sexologist, about writing a prescription so that I could give it a first hand try. He properly required that I have my annual physical before he would prescribe Viagra. After I passed the physical with flying colors, he wrote a prescription for six 50-mg. Viagra tablets. Unfortunately, my health insurance would not cover the cost of the prescription, so my cost for six 50-mg. pills was $57.49. Interestingly enough, the pharmacist told me that the charge would have been the same if I had been prescribed six 100-mg. tablets. Needless to say, this made me somewhat suspicious about Pfizer’s pricing policies and profit margins.”

“Without telling Shama in advance, so as to see whether she would detect any difference in my erection, I swallowed my Viagra tablet on Saturday morning before she woke up. We had recently experienced a challenging two-week separation, and had only reunited the night before with fevered passion. So when I awoke, I was still pretty emotionally and sexually charged.”

“It was a very interesting experience. I was pleased to find that the effect of the drug felt very natural. There was no sensation of localized pressure or any unnatural inflammation that I had felt previously when I experimented with Muse urethral suppositories. Over the course of the day, we made love several times, taking breaks to eat and deal with life. I found I was able to attain, maintain and lose erections Ð and then begin the cycle over again, and regain an erection, quite easily and naturally. Not having to be concerned about losing an erection took a lot of pressure off of me. It allowed me to do a number of things during intercourse, such as simply remaining motionless inside Shama for several minutes, that I could not have done without Viagra. This substantially increased our pleasure and sense of intimacy and created the opportunity for us to explore additional things that I could do with my stiff penis to give Shama pleasure.”

Shama’s view: ”I noticed upon waking that Gary’s erection was unusually hard. I just thought it had to do with the excitement of our reunion. With the training we have had to prolong lovemaking, some of the exercises we use to forestall ejaculation will temporarily soften the erection slightly as the sexual energy is re-directed from the genitals to the rest of the body. However, this time, each time we made love it stayed really hard during intercourse Ð and it was markedly noticeable.”

“We are not usually particularly intercourse-focused in our lovemaking. We really enjoy exploring all the other realms of pleasuring one another. However, that day I must admit that we engaged in intercourse to a far greater degree than usual. Even though my intellect knows that the woman is not responsible for her partner’s erection or arousal, my emotions sometimes still operate according to a program that feels somewhatresponsible. In retrospect, I think that because his erection was so strong, I felt it actually took some of the pressure off of me to help maintain a certain level of arousal between us, so that intercourse was a more readily available option. The combination of our thrill at reconnecting after our separation, the emotional depth and openness that we were ready to explore to expand our relationship, combined with what I viewed as his impressive arousal state made that day beautifully memorable and juicy for us.”

The next day, Sunday, we were giving a party. We were very tired from our reunion celebrations and stressed from the demands of preparation and hosting. We were still not feeling as grounded in our connection together as we would have liked and a little anxious. It had been a difficult day so, at bedtime on Sunday, as another experiment, Gary took another 50-mg. Viagra tablet.

“Interestingly enough, even though my penis was stimulated and my desire was there, my erectile response was minimal. T his confirmed my suspicion that, while many men may find immediate success when first trying Viagra, they may have somewhat less success in attaining and maintaining an erection if they are tired or there are relationship or other difficulties present when they attempt to connect sexually with their partners.”

Since the initial problem may be psychologically based, it is possible that there may be significant psychological and emotional side effects in treating the symptom and not addressing relationship issues. In most cases, this is the patient’s and his partner’s anxiety and discomfort around sexuality. This is most often caused by a lack of knowledge in this area and/or discomfort with even discussing non-medical treatment options or alternative behaviors.

Couples may find that after initial success in using Viagra, the effect may very well “wear off.” This temporary cure, which can create erection-on-demand, but not necessarily the knowledge of “how to use it” may actually compound emotional and psychological problems that already exist in the patient and in his relationship(s). Sex is not just about a stiff penis, but is also about communication and mutual validation. Erectile or any other difficulties in sex between men and women are not just the problem of the partner with the physical difficulty.

Please know that the point of this article is not to condemn science for building a better mousetrap. There are millions of men with true physical conditions that may prevent an erection. However, our concern is that most doctors have neither the knowledge about Human Sexuality nor the resources to determine the most appropriate treatment. We would recommend that continuing education classes be required in human sexuality, so that physicians can gain the necessary expertise and skills to more fully serve the needs of their patients.

Our belief is that doctors need to be trained to take a look at the bigger picture in the way they evaluate symptomology. In this case, we would argue that impotence is about more than a lack of an erection. Impotence literally is a sense of powerlessness. We have often found that feeling of powerlessness comes from apprehension from a deep-seated knowing that most men haven’t been properly educated or trained in sexual expression so that their lovemaking can truly show love and caring for their partners and themselves. Many of our clients have admitted that they are apprehensive because, at core, they don’t feel competent and, in many cases, they’re not. Knowledge is power. The knowledge of how to have our sexuality be satisfying to ourselves and our partners can make us more potent than any pill or drug.

Another concern that came out of our experience was whether men might become even more intercourse-focused (than they already are) and less interested in so-called foreplay or other non-intercourse activities. It seems to us that the traditional approach towards erectile difficulties, of taking the focus off attaining an erection and putting it on the myriad of pleasurable activities available, is still a good idea. We feel that many of these other types of activities naturally contribute to increased intimacy and heart connection between partners, which we believe is essential to healthy relationships.

What Viagra can provide is a reduction of anxiety about whether an erection can be attained and can create a situation for men where intercourse actually is another option in lovemaking (where it may not have been readily available previously). However, we want to stress here, that for healthy relationships, the act of intercourse is best used when it feels most appropriate, but please, not as the goal of lovemaking. We still believe that the goal of lovemaking should be the conveyance between the partners of their love, caring and nurturing of each other. In this regard, we see the potential of Viagra as a valuable “tool.

Another area where Viagra can make a valuable contribution is in the reduction of “condom anxiety” on the part of men. Many men are reluctant to use condoms because of fears of loss of sensitivity and/or failure to attain or maintain an erection. The increased sensitivity caused by Viagra could go a long way towards encouraging a greater use of condoms and thus, safer sex practices during intercourse.

Also, trials have begun to assess the value of Viagra in increasing the blood flow and perhaps, vaginal and clitoral sensitivity in women. A couple of weeks after Gary’s experiment, Shama elected to try Viagra (also in the interest of science). “When Gary and I made love this time, I noticed a marked increase in sensitivity in my genitals which did heighten my pleasure. He also commented that I felt “wetter and juicier” than usual. I believe that for me, as well, I was able to “stay with it” for a more extended period of time.”

“Would I do it again? Although I did notice some improvement in my functioning, the degree to which I experienced improvement was not enough to inspire me to overcome my natural distrust of synthetic chemicals. However, if I was experiencing more dysfunction in my nether regions, I might. My “bottom line” on the use of Viagra is one of caution as regards our enthusiastic acceptance and use, since the long term effects and results are really not in yet.”

Determining whether Viagra may have value to women may create an opportunity for long needed research into female sexuality and how to improve women’s pleasure during sex. In the past, there has been a lot more research done on male sexual function but these new drugs, including Viagra, may change all that. Public interest in this medication may give women greater permission to talk about their sex lives, how they are experiencing sex and how that might be improved. Also, with “baby boomers” approaching menopause, there is a greater need than ever to study the physiological changes that these changes bring to women’s sex lives.

Medications like Viagra can make a contribution towards a happier sex life, but it is still most important that men and women know how to more fully use their bodies as instruments of pleasure. The real task is to give people permission to talk about their sexuality and to educate everyone, particularly those in the helping professions, as to the true potential of our sexuality and sensuality as an expression of our love and caring. We all need to understand that people need to work at having a good sex life in order to make it work for them.

While Viagra is not the long sought-after aphrodisiac that will create desire and turn sexual problems into bliss, it does have a potential for good. It is creating the opportunity and permission for dialogue on a once-taboo subject. It has already caused many of us to stop and look deeper at all the aspects of our sexuality, how to improve the quality of our sexual experience, and what role we want sex to play in our relationships.

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