New Frontiers in Men’s Sexual Health Recent Titles in Sex, Love, and Psychology Judy Kuriansky, Series Editor Relationship Sabotage: Unconscious Factors that Destroy Couples, Marriages, and Family William J. Matta The Praeger Handbook of Transsexuality: Changing Gender to Match Mindset Rachel Ann Heath America’s War on Sex Marty Klein Teenagers, HIV, and AIDS: Insights from Youths Living with the Virus Maureen E. Lyon and Lawrence J. D’Angelo, editors Rock ’n’ Roll Wisdom: What Psychologically Astute Lyrics Teach about Life and Love Barry A. Farber Sixty, Sexy, and Successful: A Guide for Aging Male Baby Boomers Robert Schwalbe, PhD Managing Menopause Beautifully: Physically, Emotionally, and Sexually Dona Caine-Francis NEW FRONTIERS IN MEN’S SEXUAL HEALTH Understanding Erectile Dysfunction and the Revolutionary New Treatments K. Anthony Hanash, M.D. Sex, Love, and Psychology Judy Kuriansky, Series Editor Library of Congress Cataloging-in-Publication Data Hanash, Kamal Anthony. New frontiers in men’s sexual health : understanding erectile dysfunction and the revolutionary new treatments / K. Anthony Hanash. p. cm. — (Sex, love, and psychology, ISSN 1554–222X) Includes bibliographical references and index. ISBN 978–0–313–36263–7 (alk. paper) 1. Impotence. I. Title. II. Series. [DNLM: 1. Erectile Dysfunction. WJ 709 H233n 2008] RC889.H253 2008 616.6'92—dc22 2008026226 British Library Cataloguing in Publication Data is available. Copyright © 2008 by K. Anthony Hanash, M.D. All rights reserved. No portion of this book may be reproduced, by any process or technique, without the express written consent of the publisher. Library of Congress Catalog Card Number: 2008026226 ISBN: 978–0–313–36263–7 ISSN: 1554–222X First published in 2008 Praeger Publishers, 88 Post Road West, Westport, CT 06881 An imprint of Greenwood Publishing Group, Inc. www.praeger.com Printed in the United States of America The paper used in this book complies with the Permanent Paper Standard issued by the National Information Standards Organization (Z39.48–1984). 10 9 8 7 6 5 4 3 2 1 My wife, France, and children, Tony, Patrick, Alain, and Carla, whose patience and encouragement made this book possible. This page intentionally left blank CONTENTS Foreword ix Judy Kuriansky Preface xi 1. Sexual Evolution and Revolution 1 2. Sex Education 14 3. Male Anatomy 25 4. Rise and Fall: The Erectile Process 32 5. A Tragedy of the Bedroom: Sexual Dysfunction 41 6. Effects of Sexual Dysfunction on Men and Their Partners 49 7. Physical Causes of Erectile Dysfunction 59 8. Psychological Causes of Erectile Dysfunction 78 9. Diagnosis of Male Sexual Dysfunction 87 10. Conservative Treatment of Erectile Dysfunction: Critical Considerations 106 11. Conservative Treatment of Erectile Dysfunction: Oral and Topical Medications 117 viii CONTENTS 12. Conservative Treatment of Erectile Dysfunction: Vacuum Devices, Intraurethral Inserts, and Intracorporeal Injections 137 13. Surgical Treatment of Erectile Dysfunction: Penile Prostheses and Vascular Surgery 156 14. Treatment of Psychogenic Erectile Dysfunction 179 15. Ejaculatory Disorders 185 16. Low Sexual Desire in Men 202 Glossary 217 Bibliography 225 Index 237 FOREWORD When I was hosting my radio call-in advice show every night for years, all topics were welcome. But as soon as one man called up about a problem with his sexual functioning, the phone lines were flooded with similar calls from worried males, with the result that I could spend the entire rest of the night talking about men’s sexuality. The most common calls were from guys who were fearful that they were too small—when in fact their penis size was within normal range—and from guys worried about not lasting long enough, or hav- ing a hard time getting hard. The age of men talking openly about their sexual problems has exploded. The good news is that—finally—men are not hiding in shame, thinking they don’t measure up to a macho male societal image. But the open talk led to a shock—that so many men were suffering. Fortunately, over the years, more help has become available for every man’s complaint. In this book, New Frontiers in Men’s Sexual Health: Understanding Erectile Dysfunction and the Revolutionary New Treatments, Dr. K. Anthony Hanash brings us up to date with all the complaints men have, and even better, with all the latest hope for solutions. A urologist, Hanash has professional cre- dentials and 35 years of experience. In this book he backs up everything he addresses with the most solid, scientific, and up-to-date scientific research. In these pages, we find out about all that can go wrong for men, their partners, and also how to fix it. Even I, who have been in the field of sexuality for as long, was rapt while reading these pages. Like a murder mystery, there were parts I couldn’t put x FOREWORD down, unraveling the medical and psychological mysteries of a man’s sexual functioning and what can be done to solve the predominant complaints of size, desire, or performance. What Dr. Hanash gives us in these pages is a thorough review of the literature and scientific knowledge about male sexual functioning, in clear-enough language so we can truly understand the answers to pressing questions like “Is there a bone in the penis?” Or “Does anything really work to make the penis longer?” All this is then put into context of the man in his relationship, as partners are affected by any problem the man suffers. Most compelling is the promise of the book’s title—New Frontiers in Sexual Health: Understanding Erectile Dysfunction and the Revolutionary New Treatments—that we would discover in these pages revolutionary new treat- ments for male sexual problems. And indeed we do. Any health professional, and any man or woman, will be compelled by the exploration of the new frontiers presented here. Hanash keeps the reader amazed as he explores “Is sexual desire in the genes?” and as he describes experimental treatments and new products under study to treat male sexual problems. Some are intended for other purposes, like calcitonin, nitroglycerine, and minoxidil (for hair growth). Others are names of compounds the average person hardly recog- nizes now—like a PT-141 inhaler, or “recombinant erythropoietin” (a protein which stimulates the production of red blood cells)—but that may appear on the nightly news tomorrow as the next new hope, In this book, Dr. Hanash has taken his extensive and intensive knowl- edge and made it understandable. In that, he has reached the goal he set for himself—to take a complex subject and make it simple enough for everyone to comprehend. Dr. Judy Kuriasky Series Editor PREFACE It is better to light a candle than to curse the dark. Chinese proverb The word impotence is derived from the Latin impotentia, or “lack of power.” It has hounded men since the beginning of time. Impotence has triggered wars, lost kingdoms, tarnished reputations, and collapsed dynasties. Because of its pejorative connotations, the term was recast more positively a few years ago as erectile dysfunction (ED), which better defines the condition and has since been accepted internationally. Approximately 152 million men worldwide—a figure projected to increase to over 320 million by the year 2025—needlessly suffer from the inability to achieve or maintain an erection sufficiently rigid for successful penetration and subsequent orgasm and ejaculation. It has been estimated that ED, to dif- ferent degrees of severity, may affect more than 50% of the world’s men over the age of 40 and may be particularly bothersome to a third of them. Statistics show that approximately 12.5% of the male population in the United States, or about 20–30 million men—including up to about 52% of men 40 to 70 years old—currently suffer from sexual dysfunction. Statistics further reveal that almost all men will, at one time or another, experience tem- porary episodes of inability to perform sexually. Although the great majority of adults of all ages view sexual activity as a key issue for optimal quality of life, sexual dysfunction is underreported, misdiagnosed, and poorly treated in the xii PREFACE United States and all over the world—despite being a major cause of marital discord and, probably, divorce. The sexually dysfunctional man finds his life shattered by his problem. He loses confidence and self-esteem. He is anxious, stressed, depressed, and may feel inadequate. His sense of manhood, his virility, and his self-image are bruised. Tension develops between the man and his partner and may emerge in his professional performance as well. Disharmony appears in his relationships with family and friends. He may deny the problem or shift the blame to his partner. Often, ED leads to total avoidance of any sexual ac- tivity or relationship, resulting in complete abstinence for fear of failure and embarrassment. With the revolutionary discovery of the phosphodiesterase type 5 inhib- itors, such as Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil), and the use of these oral medications by millions of men with excellent results and only a few minor side effects, a new era has dawned for the successful and safe management of ED. This recent advance has markedly increased people’s awareness of sexual disorders, and it has helped a large number of men and women to discuss the issue socially and in the mass media without any shame or embarrassment. It has also encouraged millions of men in all parts of the world to seek the new drug therapies, resulting in a very high satisfaction rate and marked improvement in the psychological and emotional disturbances associated with ED. Ironically, treatment success has also caused some marital problems, due to the sudden resurrection of potency in men who, after ignoring sex for a long time, have recovered their sexual prowess.