Meds Affecting Your Erection - Blood Pressure Medications

There are literally hundreds of different prescription medications that can interfere with your sex life. In this post, I am going to focus on medications prescribed to control blood pressure and how some of these may be having undesired effects in the area of erectile functioning. Please be advised that high blood pressure is a serious medical condition that requires proper treatment. Because of this, you should never stop taking your medication without consulting your doctor for advice or adjustments to your prescription. Information here is not tailored to any specific case and cannot be taken as individual medical advice.

Sexual arousal depends on a series of different mechanisms working in conjunction with each other in response to physical and/or psychological stimulation. Successful sexual arousal and performance relies on the participation of your brain, your nerves, your hormones, and your blood vessels. Since medications that are used to control high blood pressure have their effect primarily on blood vessels, they can easily cause sexual side effects. Here are some of the more common anti-hypertensive medications broken down by type:

1. Diuretics - These medications work to lower your blood pressure by causing the body to eliminate excess fluid. By doing so, the actual volume of blood is decreased, which leads to a decrease in your blood pressure. Studies suggest that there is a high prevalence of erectile dysfunction (ED) in men taking diuretics for blood pressure, especially in the first few years of treatment. What is interesting is that after several years, the amount of men reporting ED who weren't taking diuretics almost matched those men who were taking diuretics. This suggests that the diuretic itself is not directly causing the ED, but the lowered blood volume is uncovering another existing problem with the blood vessels needed for an erection. These medications also lower zinc levels, which leads to a decrease in testosterone production and negatively affects sexual desire and performance. An example of diuretics are the thiazides.

2. Beta Blockers - In order for an erection to occur, there has to be activation of beta-receptors in the tissues of the penis and arteries of the penis. Some beta blockers bind to many different type of beta-receptors and can often block those receptors(beta-2). That does not allow the blood vessels to relax enough to allow the penis fill up with blood for a proper erection. Propanolol, timolol, and nadolol are non-selective beta blockers and have the most potential for interfering with an erection. Beta blockers that are called 'cardio-selective' are those that only block the beta-1 receptors and do not tend to cause ED. Examples of cardio-selective beta blockers are metoprolol, acebutalol, esmolol, and atenolol. Some beta blockers also block certain alpha receptors as well, which can cause ED. Examples of these are carvedilol and labetalol. But there are some beta blockers that can actually help erectile function by increasing nitric oxide (NO) levels with their alpha-blocking properties, such as nebivolol. Interestingly, studies have shown that just having anxiety about having side effects is enough to produce the side effect. Studies also have demonstrated a placebo (sugar pill) worked just as well as Viagra to get rid of the ED associated with beta blockers.

3. ACE Inhibitors - These blood pressure medications do not tend to cause ED, and in some instances, can even improve erectile functioning. Examples of these medications include losartan, candesartan, and valsartan.

4. Calcium Channel Blockers - These medications do not seem to adversely affect erectile functioning. Men taking this type of anti-hypertensive medication had the same rate of ED as those men of similar age not taking them. Examples of calcium-channel blockers are amlodipine, nifedipine, diltiazem, and verapamil. Some people have reported a decreased libido on these medications, however.

As always, prevention is always preferred over treatment of a condition. Maintaining an appropriate weight, getting good sleep, learning how to respond rather than react to stress, practicing aerobic exercise at least 3-4 x/week, and lowering your salt and fatty food intake are all lifestyle choices that keep your body's functioning more in balance. If you can put these into practice early in life, you decrease your chances of having ED from any vascular disease, as well as decrease your chances of having to be on blood pressure medications later in life.

Improving Your Erection

There are multiple factors that affect your erection including physical, neurochemical, hormonal, psychological, and emotional. Because of this, a man needs to maximize all of these to ensure the best erection he can have. Oftentimes a man will seek help for his erections only after he has had difficulties for some time. But the best medicine is preventive medicine. This includes lifestyle choices and measures that you can adopt for overall health, and specifically for continued optimal erections.

So here are a few factors to consider when wanting to preserve or improve your erection:

1. Watch what you put into your body. Everything you eat, drink, or otherwise expose your body to, will affect your overall physical health and therefore, your erection. Diets that are high in fat, sugar, and artificial ingredients cause an increase in your body's inflammation response. Over time, this is damaging to blood vessels, especially those of your heart and your penis. Other culprits are nicotine (whether in cigarettes or in nicotine patches/gum) and excess in alcohol. Keep in mind that alcohol use of more than 1/2 - 1 drink per day has been shown to increase your triglycerides and LDL (bad) cholesterol which eventually contributes to arterial plaques and hardening of the arteries, resulting in decreased blood flow.

2. Get moving. Our bodies are designed to be active and in motion. By keeping active and engaging in regular aerobic exercise, you increase the blood flow to your muscles, and your penis along the way. One of the most interesting things about increasing your blood flow is that it becomes a signal to your blood vessels to grow and get wider. It benefits your brain, your heart, and your erection. The principle of "use it or lose it" is the best advise one can follow. In fact, if you don't engage in sexual activity at least once or twice a week, it would be beneficial to masturbate. This not only helps with prostate health, but encourages the blood vessels that contribute to your erection to maintain their patency and flow.

3. Don't be so uptight. When you have anxiety or stress, it creates a state in your body that directly opposes sexual arousal. This can interfere with getting or keeping an erection (or even reaching orgasm for some). Sometimes men are not aware of anxiety that they create for themselves, which may come in the form of doubts or negative thoughts. If you are having difficulties with your erection and have no physical cause for it, then it would be important to explore in what ways anxiety is affecting you. I believe that you owe this to yourself and the future of your sexual functioning.

4. Supplement your diet. Besides keeping a diet that works to create better health for you and your penis, there are certain vitamins and supplements that can improve your sexual performance and your erection. These days, our diets do not usually provide sufficient B vitamins and most people should be taking a B-100 Complex daily. In addition to this, Coenzyme Q10 100mg a day works as an antioxidant, may protect against high blood pressure, and may also be cardioprotective. But one of the most interesting supplements available is Epimedium (a.k.a. Horny Goat Weed). The active ingredient in this supplement works the same way as that of Viagra, Levitra, and Cialis - inhibiting PDE-5, thereby increasing the availability of NO. This directly causes dilation of arteries of the penis (and other locations) which causes erections. Look for preparations made from trusted sources that provide at least 400-500mg per dose and take twice daily. This works not just for those men who have started having difficulty with getting and keeping their erections, but also for men as they age to maintain the best blood flow they can.

Be aware that difficulties with an erection can be a signal to other existing medical problems such as heart or vascular disease, thyroid problems, diabetes, or other end-organ damage due to metabolic syndrome or drugs/alcohol. Please don't delay in seeking medical attention for any problems with your erection, paying attention to what may be contributing to it. But again, the best course of action is the preventative one.

Prostate Stimulation for Sexual Pleasure

The prostate is a gland in men that contributes to semen by producing up to a third of the fluid that mixes with the sperm produced in the testes. Together, this makes up the ejaculate that comes out at orgasm. Most men don't think about their prostate unless there is a problem with it, and would prefer if they never had to think about it. To talk about the prostate gland is to bring up images of cancer or surgery that people would prefer to ignore. But I'm here to get you to think about the prostate in a different way. The prostate can be a source of great pleasure for those willing to venture. Those men that enjoy prostate stimulation say that it greatly enhances their pleasure and intensifies their orgasms.

Many heterosexual men have a fear of having their prostate stimulated because they may interpret any pleasure they have from it as an indication that they might be homosexual, but this is not true. Fear of interpretation of the excitement with prostate stimulation is a misunderstanding of the one's anatomy. The nerves that allow for an erection pass along each side of the prostate gland. So when the prostate is stimulated, (even by a doctor) it may lead to an erection simply because the nerves are also stimulated along with the prostate. This just means that you are normal and have sensitive nerves, nothing else. But this can be used to your advantage.

Some do not want to proceed with any prostate stimulation or anal play because they are concerned with issues of cleanliness. This issue can be resolved with either a little prep work ahead of time, or with careful clean up afterwards. Simply using the bathroom ahead of time to empty the rectal vault will suffice for most. For those who want to engage in a large amount of anal play or sex, they may choose to prep with an enema. Others prefer to just wash with soap and water on the exterior and then wash themselves afterwards. The giver of the prostate stimulation can either use a glove, or a condom over a finger, or just wash the finger carefully afterwards with soap and water, paying careful attention to clean under and around the fingernails. Making sure that fingernails are trimmed and filed smooth is also a good idea.

Once you have decided to explore the sensations with prostate stimulation, you need to prepare yourself with plenty of lube and probably a little towel. One of the most important things to remember is that the anus does not produce any lubrication of its own and the tissues are fragile. Because of this, adding lubrication is very important to prevent tearing or irritation of those tissues. You can choose to use a water-based lube which is compatible with all materials and toys, but it does dry up faster than some other lubes. For anal play and prostate stimulation, you can also try silicone-based lubes. They are also compatible with latex and other condoms, and last longer than water-based lubes. Just remember that silicone-based lubrication cannot be used with silicone-based toys because the friction between them will cause the breakdown of the toy. Many people choose to use a condom over their silicone anal toy or prostate-stimulating toy in order to use the longer-lasting silicone lube.

You can experiment with different positions, some preferring to lay on their sides with one leg bent up. Others prefer to be on all fours. Others still prefer to lay flat on their backs. Whichever position you choose, a good thing to keep in mind is to go slow and let the receiver decide the pace of the activity. By going slow, the receiver feels things more intensely, it allows for relaxation, and there is less risk of hurting your partner. Fingers are the best way to start this exploration. Start by gently stimulating the exterior part of the anus with lube by stroking back and forth or pressing gently in a circular motion. Once the receiver is comfortable with this pressure, you can begin to gently introduce the tip of the finger either with constant pressure or with gentle in and out motion. As the receiver allows, you may continue to push the finger inwards until you reach the prostate.

If you point your finger forward towards the front of his body, you will find the prostate gland about 2-3 inches in, depending on the person's anatomy. You will feel a rounded surface about the size of a walnut. Once you find the prostate, you can press gently on it and stroke it from side to side or make circles around it. Because the prostate is a gland, it is softer than muscle tissue and needs to be treated gently. This means that it should not be poked, jabbed, or pushed with much force. There are many blood vessels in and around the prostate and it can get bruised if not handled properly.

It also is an added bonus that on orgasm, the PC muscles which also include the anal sphincter contract around your finger, creating extra sensation for the receiver. There are also a multitude of toys made especially for prostate stimulation. If you are going to choose one, you can use your experience with your finger's position and depth as your guide for comparison. When choosing a toy, remember that silicone, stainless steel, glass and hard plastic toys are non-porous, and do not allow bacteria to penetrate so they can be cleaned thoroughly. Some of these have loops that allow you to slip your fingers in for better handling of the toy. Regardless of what you choose, any toy used anally should have a flange/widened base to prevent it from accidentally sliding in all the way.

So if you and your partner find yourself in an adventurous mood, you can begin to explore how prostate stimulation can enhance his sexual pleasure. Don't be afraid to explore or start a dialogue with your partner. I welcome comments or questions.

How Anxiety Messes-Up Sex

In my practice, I have to say that upwards of 80% of the difficulties that people have with their sex lives and sexual functioning is rooted in anxiety. Most of the work I do is teaching people how to let go of their anxiety and just allow themselves to experience pleasure. From vaginismus, to premature ejaculation, to erectile dysfuntion in the absence of physical problems, to arousal difficulties in women - to name a few, all these are based in anxiety. The interesting thing about anxiety is that, although many people would admit that they have anxiety, many don't understand how it could interfere with their sexual arousal and performance. So I would like to take a couples of lines to speak about how anxiety interferes with sex.

Anxiety (or stress, nervousness, worry, or fear) is a natural part of life. Without a little anxiety, there would be little motivation to get things done or any sign to tell us that we are in danger. Anxiety is a way of alerting the body and mind that it should take some action. In order to understand just how anxiety works, it is important to explain the body's autonomic system. This is the part of the nervous system that is not under our voluntary control. It is divided into the sympathetic nervous system and the parasympathetic nervous system.

The parasympathetic nervous system is the one that is charged with our regenerative functions. It is the dominant system when we are digesting our food, sleeping, and maintaining our internal organs. It is opposed by the sympathetic nervous system, more commonly known as the "fight or flight response." When we are in danger and the sympathetic nervous system takes over, blood is diverted away from the internal organs and instead sent to the large voluntary muscles that allow us to take immediate physical action. It does this by constricting the blood vessels that supply our internal organs and raising our blood pressure. The heart beats faster to get the blood to the arms and legs, and the lungs breathe shallower and faster. These two parts of the autonomic nervous system directly oppose each other - the sympathetic system taking over quickly when danger (anxiety) is perceived. The difficulty is that our brain perceives our own anxious thoughts as signals of danger, and we respond physically with our sympathetic nervous system.

But what many people do not know is that sexual arousal is a function of the parasympathetic nervous system. It is important for the body and the mind to relax in order to have physical manifestations of sexual excitation. During arousal, blood flow to the pelvis and genitals increases when the blood vessels relax. This results in an erection for men and increased blood to the prostate, and in engorgement of the clitoris and other spongy tissue as well as lubrication in women.

With anxiety, these blood vessels constrict and sufficient blood cannot flow to the appropriate tissues. Different people are affected by anxiety at different levels. For some, a little is all it takes. It could be as simple and telling yourself "What if I don't get aroused?" Some wonder if their partner is attracted to them or if they will be pleased. Others try to will themselves to get aroused - which is counter to what the brain is trying to do.

The most important thing is to learn how to calm your own anxiety. Learning to soothe yourself and turn your negative thoughts into more positive and motivating thoughts is the way to achieve mastery over anxiety. Many people try to medicate their anxiety away or seek sexual enhancement agents to override their anxiety. This very often comes with side effects, or can result in a physical or psychological dependence. But learning how to decrease our anxiety takes effort, practice, and time. Unfortunately, our society seems to be moving more and more to instant gratification without taking responsibility or effort. But for those who would like to re-establish balance in their lives, be no longer ruled by anxiety, and not have to depend on medications for their sexual arousal and pleasure - I am there for you.

How do I masturbate? Let me count the ways....

Hers:

I cross my legs and squeeze my thigh muscles together which tickles my clit. I like the way it feels and I don't necessarily have to come.

I love to straddle the water jet in the pool, resting my arms over the top of the wall and just hold my body close to side until the water over my pussy in just the right spot gives me an orgasm.

When I lay down in my bed, I tuck the sheet under my hips and pull it through my legs until it's tight against my pussy. Then I tug it across my belly, up towards my chest. It puts pressure on my clitoris and makes me come.

A friend of mine told me about a shower massager. I bought a hand-held one and tried different settings until I found one I liked. I just let it spray across my clit and lips. Sometimes when I come, the water goes everywhere.

I can only come if a I use a vibrator. It takes a little while with the vibrator at a pretty high setting and in one spot, but it does the trick.

I use two fingers to rub up and down over my clit while I rub across my nipples with the other hand.

When I was little, I discovered that I could put my hips under the water stream and it tickled just right. So now, I lay myself flat in the tub, putting my legs up against the wall and let the water run over my pussy. I use my hand to pull the little hood up and it gets me right off.

I like to come best with something inside me, so I use a dildo to feel the excitement of having my pussy full while I rub my pussy with my hand.

I use a vibrator and slide it up and down my lips for awhile. Then, when I am really excited, I find the most sensitive area up at the top and focus on that spot. My orgasm spreads like a wave from that spot down my legs and up into my chest.


His:

I like to dig my fingers on the underside of my shaft, rubbing in a circle until I come.

Rubbing against the bed while I lay on my belly is my favorite way - literally, rubbing one off.

I use a sleeve filled up with lube - soft, wet, and with ridges, and I can squeeze as tight as I want.

The most intense feeling for me is just below the head, so I squeeze around with my index finger and thumb. The feeling of this tightness going up over my head and back down again lets me think of pushing in and out of my lover.

I use one hand on my shaft while the other hand cups and tugs my balls at the same time.

I started liking the feeling of having my ass stimulated when a girlfriend of mine starting touching me there. Now I have a small plug that I put in so that when I masturbate I can feel the squeezing of the muscles at the same time I feel the rush of coming.

In the shower with the hot water, I use shampoo to soap up and rub all over my hard-on all the way down to the base and my balls. When I come, I just keep washing myself off.

I used to press my erection up against the washing machine when it was on the spin cycle. My mom never figured out why I didn't mind doing laundry.

Fractured Penis

Yes, you can break your penis. It's called a penile fracture, but this is a misnomer because there is no bone to break. When a penis breaks, or ruptures, what happens is that the connective tissue (tunica albuginea) that surrounds the corpus cavernosum tears so that the blood can no longer be contained in the space that it occupies. The blood that was creating pressure inside the corpus cavernosum, and therefore an erection, then leaks out of that space to the surrounding tissues (more technically - a space). Here you can see an MRI of a fractured penis demonstrating the large hematoma caused by blood escaping into the surrounding space. Notice the small arrow indicating the tear in the tunica albuginea (seen as a thick black line). This results in what urologists call an "eggplant deformity" which is when the penis becomes swollen and takes on a purplish color because of the blood filling the space between the tissues. The penis is also usually bending to the opposite side of the tear. If the tear is large enough, it may actually extend to the urethra, causing inability to urinate and blood to come out of the tip.

So how exactly do you break your penis? Usually, a penile fracture happens when a woman is on top and the penis comes out of her vagina, but instead of going back into her vagina with the next movement, the head gets pushed against her pubic bone, the side of her labia, or the perineum, causing an acute 'bending.' If a man has a fairly full erection at the time, the tunica albuginea cannot take the incredible amount of pressure that builds up with the 'bend.' A tear is then created. There are cases where the penis does not completely come out of the vagina, but the angle of return is crooked, causing it to be forced to bend as just described. In all cases, an audible 'pop' or 'crack' is heard as the connective tissue tears and the erection is lost.

But there are some cases of penile fracture when a man is not having sexual intercourse, but instead just masturbating or even 'rearranging himself' and trying to move his erection to a different angle. If he is born with a slight flaw in a particular area of the connective tissue, that may be enough to get a tear at that spot, resulting in a fractured penis. It should be mentioned that there is a practice among some men to try to bend their penis in order to get rid of an erection. You should never try to bend your erection if it is fairly full because of the immense increase of pressure on these tissues and the risk of fracturing your penis. As you can imagine, it is an emergency and does require surgery to close up the tear in the tissues. With proper surgical attention, erectile and urinary function of the penis is restored.

After it heals, you can go back to banging away. Many times, men will feel very apprehensive about sexual activity after such an event. But as you continue to have positive (non-traumatic) sexual experiences, that anxiety continues to fade.