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Every Man”s Worst Sexual Fear THE DAY after his 36th birthday, Sam Hutton, an attorney was cleaning up the kitchen with his wife, Karen. Their children were already in bed. Sam suddenly picked Karen up end carried her to their bedroom. They started making love, but to his Surprise, Sam could not maintain an erection. Sam knew he wasn”t never felt better. His last medical checkup yielded a completely clean bill of health. He rode his bike 50 miles a week in the hills. He didn”t smoke eat rarer drank. The next morning, Hutton told himself the previous night”s episode wouldn”t happen again. But it did with increasing frequency. As the months passed, he began questioning his manhood. Karen feared he no Longer found her at tractive. At last, with his marriage in jeopardy, Hutton went to his family doctor. “Sam, I can”t find anything wrong,” the doctor reported. “it”s likely you”re just stressed out. I”m referring you to a psychologist.” Though Hutton didn”t think he had psychological problems, he was trilling to try anything But after at tending sex therapy with his wife for several weeks, his basic problem had not gone away. Then a friend told him about a clinic run by Dr. Irwin Goldstein, a professor of urology at Boston University School of Medicine. Not long after, Hutton went to see him. He nervously gripped the arms of his chair as Goldstein reviewed his case. “You said your impotence was becoming more consistent. You also said that your erections were taking a long time to develop.” The doctor looked up thoughtfully. Have you ever had an accident while riding your bike?” “Well, I did wipe out about two years ago,” Hutton Said uncertainly. “I hit myth haul Ha the crowbar.” Golden nodded Snow, “I”m sure we can help.” ALTOUGH RARELY DISCUSSED, impotence is something a majority of men experience, at least temporarily. According to an American study of nearly 1300 men ages 40 to 70, 52 percent said they have had some form of the condition. Yet despite its prevalence, men often suffer it in anguished silence. “Men can accept that they might have problems with their heart or stomach or lungs, but they think the penis is somehow exempt from difficulty,” says Goldstein one of the Uses foremost impotence experts. “Well, a penis is an organ like any other, and things can go wrong with it just as they do with any other body part.” Today more and more experts are zeroing in on the physical causes of impotence. A generation ago doctors would refer patients who came to them with impotence to psychologists, but now psychologists are referring them to physicians. “With any problem of erection there is a psychological component,” says Dr. John Whipple. “But we now know that many times the problem of impotence has an organic component as well. In order to obtain an erection, you need an intact nervous and vascular system.” An erection occurs when vessels open and the muscles around them relax allowing blood to flow into the penis. As the penis expands, the veins are squeezed off, preventing the blood from leaving. Experts say perhaps as many as 80 percent of impotence cases that doctors see are the result of a physical problem. And the most common causes of these problems are blood-flow abnormalities and vascular disease. Hypertension, or high blood pressure, is linked to the development of blockages in arteries, which may decrease blood flow to the penis. Other diseases may also be a source of the problem. Diabetes, kidney disease and multiple sclerosis can damage nerves and blood vessels. Another common offender is medication. A man”s erectile Unction is under the control of the autonomic nervous system. Many medications seem to block the receptors of that system, thereby causing dysfunction. Hypertension drugs have been found to have a particularly strong relationship to impotence Many men have hypertension. The medication can prevent them from dying of stroke, but it can play havoc with their sex lives. If you”re taking a drug that you suspect may be causing impotence ask your doctor if you can switch medications. Chances are, you can. In a small percentage of cases, primarily affecting younger men, accidents can cause impotence. Any trauma to the body between the legs can injure the part of the penis inside the body cavity by crushing it against the pelvic bone. Direct injury to the blood-vessel lining creates a narrowing the blood path, preventing the penis from filling properly. Blood vessels may narrow 60 grade that the trauma is forgotten long before it brings trouble. Falling from a bike or taking a knee in the groin while playing sports are just a few ways the hidden part of the penis can be hurt. “No athletics equipment protects against such injuries,” Goldstein says “A jock-strap or cup won”t do it.” But physicians can detect the problem. Ultrasound and other testing can measure the diameter of and blood flow in the erection arteries In Hutton”s case Goldstein found a serious arterial blockage caused by the bike accident. TED ARCHER, 41, had difficulty getting and maintaining an erection. His family doctor found nothing wrong But Dr. Lonnie Epstein, a specialist, detected a mild impairment of the blood flow to his penis. “Of every 100 men in Ted”s age group who come to me with an erection problem, I find blood-flow impairment due to early hardening of the arteries in at least 20,” says Ep8tein. Epstein discussed with Archer treatment options for his impotence. Archer decided on injection therapy. Drugs employed include papaverine, phentolamine and prostaglandin E-1. Archer learned to use a very fine needle to give him8elf a nearly painless injection in the tide of his penis. The combination of drugs he uses produces in about ten Minutes an erection that lasts more lean half an hour. This therapy felt Fly natural to both11 d and his ~ e,” says Epstein. “Whatever awkwardness he might have felt at first was overcome by the boost to his confidence.” Despite its frequent success, many men say “thanks but no thanks” to the idea of using a needle. An alternative is the use of a vacuum Devon Patients get a plastic cylinder, a hand or battery-operated pump, and one or more elastic tension rings. The cylinder is placed over the penis, and the device creates a vacuum that draws blood flow into the penis. A tension ring is then pushed off the cylinder and onto the penis, where the ring remains during intercourse. Another alternative is the penile implant. In an operation that became available in the 1970s, semirigid material is inserted directly in the penis Since the material stays permanently in place, the penis is always semierect—firm enough for intercourse but flexible enough to be unnoticeable. In a newer operation an inflatable device is implanted in the penis along with a tiny pump in the scrotum and a small fluid reservoir in the abdomen To cause an erection, the pump is squeezed, pushing fluid into the penis. Normally a valve in the pump releases the erection. FOR A SELECT FEW—like attorney Sam Hutton—a bypass operation is a possibility. ”lithe only treatment option that interested Sam Hutton was a complete cure,” said his physician, In tin Goldstein. “I performed bypass surgery, and within a month Sam”s sex life was back to normal.” As in heart-bypass surgery, a new vessel was fashioned to shunt the blood around the blocked arteries. This procedure is still considered experimental, however, and is used for only a few eligible candidates. Fortunately only a minority of impotence problems require any kind of surgery. And given what we now know, there are things a man can do that may help prevent the condition: Eat a low-fat if you need to, exercise regularly, control your cholesterol and triglyceride levels, and you”ll stop the progressive decrease of blood flow in the penile arteries.” Stop smoking. According to a study, current smokers are 50 percent more likely to report themselves as important than former smokers or those who never smoked. That”s because smoking contributes to hardening of the arteries. “Quitting is one of the most Important things you can do to avoid the early onset of impotence,” say Bruman. Skip the happy hour. Alcohol, a depressant, inhibits your reflexes and your ability to become aroused. The spirit may be willing, but the flesh will be weak. With prevention and treatment, there is no reason a man cannot have a fulfilling sex life as long as he lives. “The field of impotence research is bright with hope for those who are afflicted,” says Dr.Goldstein. That”s good news for husbands and wives alike.
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