By Austin Davis
Such claims aren't just medically irresponsible–they also gloss over how ED pills actually work, the role they can play in personalized therapy plans, and the shame that comes with experiencing erectile issues in the first place.
Sildenafil, commonly known by the brand name Viagra, and its contemporaries mostly work in the same way: they increase blood flow to the penis by blocking specific hormones for hours or days at a time, allowing for easier erections during sexual stimulation. These pharmaceuticals have salvaged thousands of relationships, making them the go-to ED treatment preferred by both patients and physicians for the past 25 years.
But there's a downside: ED medications are only effective in, at most, 71 percent of users. Not included in that figure are those suffering from contraindicating factors like heart disease, who can't take ED medications without the risk of exacerbating their existing conditions. Meanwhile, studies now suggest that lifestyle changes–such as increasing physical activity and reducing stress–can even positively affect erectile performance to the same degree that medication can.
When those suffering from ED have false expectations about the efficacy of these medications, it intensifies the shame that goes hand in hand with erectile dysfunction. On average, it takes two to three years for a man suffering from ED to visit a doctor. If prescriptions don't work–or side effects crop up, as is the case in as many as 25 percent of users–it can discourage a patient from visiting a doctor again. Studies now suggest that all of these reasons contribute to the fact that 50 percent of men prescribed ED medications will ultimately stop taking them.
Pills aren't a silver bullet, but that doesn't mean they can’t be included in a holistic approach to treating ED–one that addresses underlying causes of the condition as well. Pills can provide short-term support for men suffering from ED, increase blood flow to support the body's natural regenerative process, and serve as one of many tools physicians can utilize to treat patients. But we need to put their use into context.
The ancient Greek poet Antiphanes once wrote of old age that "You shall not make love, not even for a thousand drachmas, such is the impotence that awaits you."
Such verses of Greek choruses haunt men of all ages to this day, but science tells us that ED isn't an inevitability of old age, nor is it a particularly rare ailment. Though estimates differ, recent studies suggest that 1 in 10 men will experience some form of ED on a long-term basis.
Erectile dysfunction as a function of the natural aging process is indeed common–as men age, their vascular tissue strength and testosterone levels decrease, subsequently increasing the risk of ED. The Cleveland Clinic estimates that 40 percent of men at age 40, 50 percent of men at 50, and 70 percent of men at age 70 experience some form of ED as a result.
Even so, a variety of factors that crop up at any age can contribute to ED–everything from alcohol use to obesity, and psychological factors such as depression and anxiety. A 2013 study in the Journal of Sexual Medicine concluded that one in four patients seeking help for ED for the first time was younger than 40.
ED is common and nothing to be ashamed of, but that doesn’t mean symptoms should be ignored if they become persistent. Studies currently draw a link between ED and cardiovascular health–malfunctioning of the inner lining of the blood vessels and smooth muscles in the penis is a reliable warning sign of cardiovascular disease.
So reliable, in fact, that medical experts have developed a simple motto when seeing new patients: a man with erectile dysfunction and no clear symptoms of cardiovascular disease should be treated as a cardiac patient until proven otherwise.
But there's an upside to this causal link: studies show that holistic lifestyle changes used to reduce the risk of cardiovascular disease, heart attack and stroke can lead to significant improvement in sexual function, and that taking steps to alleviate erectile dysfunction can lead to better overall cardiovascular health. That's something men at any age should take to heart.
Men reportedly think about sex twice as often as women, but that doesn't mean they're always raring to go. Many factors affect libido, and much of what we assume to influence sex drive isn't as clear cut as one might think.
Take aging. It's true that testosterone naturally decreases as we get older, but according to the Kinsey Institute's 2010 National Survey of Sexual Health and Behavior, 63 percent of partnered men aged 70 and up report having sex at least a few times a month.
In fact, age has little effect on sexual desire when other more influential factors like sexual function and health, predisposition towards sex, and relationship closeness are taken into account.
Science also provides a picture of how often the average adult does the deed: 54 times a year, or about once a week, according to a 2017 study published in Archives of Sexual Behavior. As for duration of copulation, there's a study for that, too. When participants were asked to time themselves between penetration and ejaculation, one study from 2005 found that the average length of intercourse was just 5.4 minutes.
But that's not to say these are set benchmarks. Writing in Social Psychological and Personality Science, a team of researchers concluded that having sex more than once a week doesn't necessarily increase feelings of well-being. And there was a huge amount of variation in the study about duration of intercourse–from 33 seconds to 44 minutes, or an 80-fold difference.
The truth is that there's no "normal" amount of time or frequency any person should be having sex, couples counselor Raffi Bilek tells Health.
"Couples often make the mistake of shooting for some number in order to feel okay about their sex life," he said. "The truth is that whatever is comfortable for you and your partner is your normal. You don't need to be having sex any more or less than you'd like."
Is bigger necessarily better? Many men seem to think so. According to a study published in the journal Psychology of Men and Masculinity, 45 percent of men are dissatisfied with the size of their member and want it to be larger–even though only 2 percent of people have erect penises larger than 8 inches. Most stack up anywhere between 4.5 and 6.5 inches, according to the Journal of Sexual Medicine.
Testimonials also reveal that averagely endowed men have nothing to be ashamed of, despite what they might glean from porn or pop-culture. Men with "problematically large" penises say they face many challenges–from finding large enough condoms, to social stigmas that can affect relationships, and navigating how to have sex without causing discomfort to themselves or their partner
A recent study from the Universities of California and New Mexico backs up those sentiments: Women actually prefer an average-sized penis (6.4 inches) for one-time encounters as opposed to a whopping appendage.
Ultimately, the bulk of your penis plays an outsized role in sexual mythology, sex advice columnist Dan Savage concludes. Those struggling with penis size could follow the guidance of transgender folks or female-identifying individuals, he adds: any combination of rubbing, sex toys and/or intimate play can be just as–if not more–satisfying as penetrative and oral sex. It's all a matter of discussing preferences with your partner.
A new online movement has gained popularity among straight, male-identifying individuals: #Nofap. The erstwhile Reddit thread preaching the health benefits of abstaining from masturbation and intercourse is now a self-described forum to support individuals struggling with porn addiction and sexual compulsions.
These issues are real, and many people may find that a break from coitus or self-satisfaction is a worthwhile step to help reset unhealthy behaviors. But #Nofap takes things a bit further in its claim that prolonged abstinence results in increased levels of testosterone. Because the naturally occurring hormone is indeed linked to improved mood and motivation, muscle growth and physical prowess, #Nofap's claims have been problematically coopted by right-wing groups and misogynists like the Proud Boys.
Scientists, however, say that the link between increased testosterone and abstinence is spurious at best–more reliable are the numerous studies documenting the benefits of sexual activity, biochemist Daniel Kelly writes in The Conversation. Whether it's the release of endorphins after an orgasm, a better grasp on sexual desires and pleasures, or physical rehabilitation following prostate surgery, science dependably points to masturbation as a net-positive behavior.
Moreover, negative perceptions of masturbation can cause psychological stress, guilt and anxiety that can actually decrease testosterone levels–the exact opposite of what #Nofap claims to help men achieve.
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