Dudley S. Danoff, MD, FACS
When the new year rolls around, men often turn their attention to improving their health. Here are five healthy sex habits men should be pursuing in 2020.
- A healthy sex life requires a healthy prostate. If you are forty or over, discuss your medical and family history with your doctor to determine whether getting your prostate checked annually is advisable. Your prostate health is checked with a screening called a PSA (prostate-specific antigen) blood test, a digital rectal exam (a manual examination of the prostate gland), and a prostate ultrasound. Approximately one in nine men will be diagnosed with prostate cancer during their lifetime. It is the second-most-common cancer diagnosed and the second-most-common cause of cancer death in American males. The importance of screening and early diagnosis cannot be emphasized enough. Early diagnosis and treatment are key for a long, happy, healthy sex life.
- Have sex as frequently as you physically and emotionally are able. The number of orgasms, erections, and ejaculations you can have are limitless. Your seminal vesicles will not dry up if you ejaculate too much. Your penis will not become flaccid if you have sex a thousand times. You may get fatigued from having a lot of sex, just as you would from any physical activity, but if you use your penis frequently and vigorously, it will invigorate the rest of your body and keep your spirit young and vibrant. Penis underuse is a much bigger problem than overuse.
Nature designed your penis to take much more of a thrashing than other appendages. Damaging the penis is difficult, if not impossible, because the penis has no bones to fracture or ligaments, joints, or muscles to strain or tear. Surrounding the central channel in the penis is a fibrous tunica, tissue so tough that I have to apply extreme pressure to remove parts of it during surgery. If you have heard of men complaining of penis injury, chances are it had to do with the most vulnerable part of the penis—the skin, which can suffer abrasions, cuts, and bruises. These occur most often from accidents like getting your penis stuck in a zipper. The most frequent sex-related injury is skin irritation caused by excessive friction. This keeps more men from having sex than any other injury and is why one of my colleagues believes that “lubricants have saved more marriages than Dear Abby.” My advice is to increase your sexual encounters to your physical and emotional limits. - Think about testosterone replacement therapy (TRT). If your libido is sagging, your girth increasing, and your muscle mass diminishing, get tested for serum testosterone. This is done with a simple blood test, preferably in the morning when the circulating serum testosterone is highest. If your serum testosterone is below the normal range, you may be a candidate for TRT. This should only be done under the care of a qualified physician because elevating testosterone above normal levels can be disastrous for cardiovascular health. An abnormally elevated serum testosterone level results in a thickening of the red blood cells, often leading to blood clots, stroke, and heart attacks. When considering TRT, you should also be properly screened for prostate cancer because, although testosterone alone does not cause prostate cancer, it can act like a fertilizer for existing prostate cancer.
- If you are past your childbearing years or not interested in having children, consider vasectomy to improve your sexual health. Vasectomy is a safe, effective method of birth control for men who no longer wish to have children. This can free up your sexual inhibitions. The fear of an unwanted pregnancy is off the table. The procedure involves interrupting the continuity of the vas deferens, the tube that carries sperm from the testicles, where sperm is made, to the seminal vesicles, where the sperm is stored until ejaculation. The procedure is performed in less than ten minutes, usually in a doctor’s office under local anesthesia, through a tiny nick in the scrotal skin (using the “no scalpel technique”). The postoperative discomfort is minimal and rarely requires analgesics.
Vasectomy causes no reduction in sensation, no lowering of desire, no loss of testosterone, no loss of the ability to get or keep an erection, and no less satisfaction when having an orgasm. The only difference after a vasectomy is that you release no sperm, and sperm comprises a miniscule proportion of the seminal fluid, so the volume of semen ejaculated remains essentially the same. Vasectomy allows most men to no longer be inhibited by concerns about pregnancy. Longtime partners often feel more spontaneous. They do not have to interrupt lovemaking to deal with diaphragms or condoms, and may often feel heightened sensation during intercourse because there is no latex between the penis and the vagina.
Some vasectomy patients change their minds about having children and request a reversal, called a vasovasostomy, which involves reconnecting the vas deferens. This is a more difficult procedure than the original vasectomy but nevertheless has a high rate of success, and most patients are able to conceive children after this procedure.
- If you are having any problems with ED, for whatever reason, don’t forget the magic pills, such as Cialis and Viagra. Although these are not drugs of desire, they will certainly help you with performance. They are potent vasodilators, which means they increase blood flow to the penis and create a firm, long-lasting erection. The most common causes of ED are performance anxiety in younger men and atherosclerosis, which narrows the blood vessels, in older men. No matter the reason, vasoactive pills are almost universally helpful, and taking them is not a sign of weakness. All of these pills are safe and only contraindicated in men who have coronary artery disease and are taking medicines like nitroglycerine. You can safely take drugs for ED over a long period of time with no serious side effects. So, if your erections are sagging, feel free to pop a pill, knowing that it is safe, effective, and often life changing.
Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of The Ultimate Guide to Male Sexual Health.