A number of common medical problems can affect sexual functioning. Because sexual activity is often important to a person’s well-being, most older people may have a thought on male enhancement just like the younger fellows. physicians should include a thoughtful discussion of sexuality when treating the medical problem.
Heart Disease
People with angina or heart failure and those who have undergone coronary artery bypass surgery or have had a myocardial infarction may avoid sex because of an assumed risk to life, but studies indicate that cardiac death during or after sexual activity is rare. Under most circumstances, patients with heart disease have few reasons to abstain from sex and many reasons to continue (eg, an opportunity for mild exercise and release of physical and emotional tension).
After myocardial infarction, an 8- to 14-wk waiting period is generally recommended before resuming sexual intercourse. The period of abstinence depends more on the patient’s interest, general fitness, and conditioning. Depression and anxiety are common up to 1 yr after myocardial infarction, and avoiding sexual activity may exacerbate depression. Antidepressant drugs may further reduce sexual libido and capacity. A physician’s support and encouragement can greatly help patients overcome their fears.
When heart failure is managed effectively, the physical exercise and emotional release associated with sexual activity may contribute to a patient’s improvement. After an episode of pulmonary edema, a 2- to 3-wk recovery period is usually advised before resuming sex.
Physical symptoms, side effects of medical treatment, or fear of sudden death from physical exertion causes many patients to become sexually dysfunctional even before they become candidates for coronary artery bypass surgery. Patients who have had surgery should be reassured about the safety of sexual activity within reasonable limits to prevent straining the surgical repair. The sternum usually requires 3 mo to heal completely. Self-stimulation or mutual masturbation may be a less strenuous alternative to intercourse and usually can be started earlier in the recovery period.
Prolonged sexual problems can occur after surgery if the patient is not closely monitored. Exercise programs to improve cardiac function (eg, increasingly strenuous walking) can reassure patients who are afraid to resume sexual activity. Even though surgery may eliminate the need for medication, some patients become psychologically dependent on nitroglycerin before sexual activity because of previous chest pain upon exertion. Patients with arrhythmias may need the reassurance of successfully performing a treadmill test to overcome anxiety about engaging in sexual activity.
Hypertension
Men and women with mild to moderate hypertension need not restrict sexual activity. In men with untreated hypertension, the incidence of impotence is about 15%; the effects of hypertension on female sexuality are not as well studied. Selection of antihypertensive drugs should focus on those that do not impair sexual response (see EFFECTS OF DRUGS ON SEXUALITY, below).
Stroke
Sexual activity has not been shown to cause stroke or to increase neurologic deficit after stroke. Unless a stroke causes severe brain damage, sexual desire is usually unimpaired. However, sexual performance is more likely to be affected. Some men experience impotence; others do not. The unaffected side of the body should be emphasized in lovemaking. The partner of a woman who has suffered a stroke may become impotent if he fears injuring her, in which case reassurance may be needed. The use of headboards and bedboards can greatly assist positioning necessary for sexual activity.
Diabetes Mellitus
Sexual problems are common in men with diabetes. Impotence occurs two to five times more often in diabetic men than in the general population, even though sexual desire is unaffected. Good control of the diabetes may reestablish potency; however, if the diabetes is already well controlled, the impotence is likely to be irreversible. Concurrent endocrine problems (eg, a thyroid condition) may reduce potency.
Arthritis
The physical disabilities associated with osteoarthritis and rheumatoid arthritis may interfere with sexual desire or performance, but drugs commonly used to treat arthritis do not. A program of exercise, rest, and warm baths is especially useful in reducing arthritic discomfort and in facilitating sexual performance. Experimenting with new sexual positions that do not aggravate joint pain is often helpful; the side-by-side position may be preferred by both partners, especially when the patient has many tender areas and pain trigger points. Since osteoarthritis tends to be less severe in the morning and rheumatoid arthritis less severe in the afternoon and evening, sexual activity can be planned for times of the day when pain and stiffness are diminished. Some patients find that regular sexual activity relieves the pain of rheumatoid arthritis for 4 to 8 h; such relief may be due to hormone production, release of endorphins, or the physical activity involved.
Chronic Prostatitis
Chronic prostatitis is associated with unusually frequent sexual intercourse as well as with abstinence, excessive preliminary sexual arousal, or an incomplete orgasm. The pain of chronic or recurrent prostatitis may diminish sexual desire. Mild prostatitis may cause some perineal pain after ejaculation.
Therapy for chronic or recurrent prostatitis includes antibiotics, warm sitz baths, and periodic gentle prostatic massage. Kegel’s exercises, which involve contracting the pelvic floor muscles, may also help.
Cystitis and Urethritis
Some women experience recurrent episodes of cystitis and urethritis after intercourse. Although these problems are usually due to the introduction of bacteria into the urethra during thrusting, the cause may be unclear. A urologic or gynecologic evaluation is indicated to determine the cause, as is a discussion of therapeutic and preventive options.
Peyronie’s Disease
Intercourse is painful for about 50% of men with Peyronie’s disease. When the penis is angled too sharply, penetration may become impossible. However, tumescence is preserved in about 90% of cases, even though there may be some pain. Psychotherapy can help the patient adjust to the structural and functional changes in the penis. Medical or surgical intervention is not usually effective, but symptoms sometimes disappear spontaneously after several years.
Chronic Renal Disease
Men with chronic renal failure may have reduced levels of serum testosterone, although the reason is unknown, and they are often impotent. Such patients may be treatable when the problem is intensified by concomitant emotional reactions such as anxiety or depression; treatment of the associated, underlying anxiety or depression and couples counseling can be helpful. Kidney transplantation often restores sexual capacity in impotent dialysis patients.
Parkinson’s Disease
Parkinsonism is commonly associated with depression, which may lead to impotence in men and lack of sexual desire in both men and women. Advanced organic involvement may also result in impotence. Sex drive and performance improve in some men treated with levodopa, probably because of greater mobility and an increased sense of well-being. There is little evidence that levodopa acts as an aphrodisiac, and it should not be prescribed as such.
Chronic Emphysema and Bronchitis
Shortness of breath brought on by chronic emphysema and bronchitis hinders physical activity, including sex. Solutions include resting at intervals, finding the least taxing ways to have sexual contact, and using oxygen during sexual activity.
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