Cialis

For men--and the women who love them--sexual-performance problems are so embarrassing that most would prefer to keep them under the covers. But at some point, most sexually active men will have trouble getting an erection or keeping it. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), between 15 million and 30 million American men suffer from erectile dysfunction, a sexual-performance problem that almost always has a physiological basis. No one knows how many men experience "performance anxiety," defined as premature ejaculation or other sexual difficulties due to both emotional and physical issues. But now that drugs to treat problems with erection are available (see "The Little Blue Pill: Facts You Need to Know"), men--brothers included--are asking their doctors for prescriptions. They're also buying and trading them over the Internet, in hopes of boosting their sexual performance. What's going on?

WHEN HEALTH PROBLEMS INTERFERE WITH SEX

Men of all ages sometimes experience difficulty getting or maintaining an erection or may ejaculate too quickly. But doctors classify sexual-performance problems into a few different categories. Erectile dysfunction (ED), formerly called impotence, develops and worsens over months or years and is chronic. While it is more common among older men, ED is not a natural consequence of aging. In fact, it can strike brothers in their late twenties. About 70 percent of the time, ED is caused by serious ailments such as heart disease and diabetes, which impede blood circulation to the penis, making it more difficult for it to get and stay hard. Sometimes ED is a man's first warning that he has a serious health issue.

Studies show that ED can often be corrected by stopping smoking, shedding pounds, eating fewer fatty foods, and exercising. Gerald Hoke, M.D., chief of urology at New York's Harlem Hospital Center, warns, "You have to give up smoking or eventually give up sex." The same with excess weight. "If a guy comes in with belly obesity, if he doesn't have erectile-dysfunction problems now, he's going to later," he says. If left untreated, ED symptoms worsen and can eventually stop his penis from getting hard at all.

TOO QUICK ON THE DRAW

More common than ED is premature ejaculation, in which a man can't control the amount of time between getting hard and ejaculating, says Los Angeles sex therapist Gail E. Wyatt, Ph.D. A man may come while whispering sweet nothings or during foreplay, leaving his partner surprised that the sex is over just as it was starting, she says. It's common among men of all ages, and the causes vary. For example, men often worry about satisfying their partners, and this anxiety can trigger the condition. "If he's having problems maintaining an erection but they're intermittent, it's usually anxiety-related," Hoke says.

GETTING TO THE HEART OF THE MATTER

Consistent problems can cause a man's self-esteem to plummet. But they're also problematic for women, making some sisters worry that their man is cheating or has lost interest. The bottom line, says Wyatt, is that you and he have to find out what's going on. If your partner repeatedly experiences problems that don't improve with rest and avoiding drinking or drugs, he probably needs a full medical exam to test for physical causes. "You need to rule those out before asking, 'What do we need to do to work together?' "Wyatt says.

What to Do If He Has a Problem

If your man is experiencing problems with his erection, how you handle the situation can help--or contribute to his difficulties. Los Angeles sex therapist Gall Wyatt, Ph.D., coauthor of No More Clueless Sex: Ten Secrets to a Sex Life That Works (Wiley), provides these do's and don't's:

DO SKIP THE APPETIZERS. Wining and dining followed by sex may look romantic in the movies, but don't try it at home. particularly if your man has a problem. Heavy meals, fatty food and alcohol make sex more difficult for him. "Don't set yourself up for a problem," Wyatt suggests. Eat and drink later.

DON'T LET HIM PUSH YOU AWAY. Many men who struggle with erectile difficulties will do anything to avoid the shame of not being able to satisfy their partner--such as picking fights or going to bed early or very late. If this happens, have a nonsexual conversation about getting some help together and try to take the focus off sex by cuddling instead.

DO TRY A LITTLE TENDERNESS. "Sometimes women can be insensitive about penis size, erectile dysfunction and premature ejaculation, and that can contribute to the problem," says Wyatt. "Find out how he's feeling, and either say something nice and honest, or don't say anything at all."

DO BE A GOOD LISTENER. "Men have had trauma, failure and successes and you need to hear about it," Wyatt says. "All those ingredients go into your partner's performance."

DO BE HANDS ON. Ask "What can I do to help you become more aroused?" And be prepared to suggest sexual activities you're willing to engage in. --H.B.

The Little Blue Pill: Facts You Need to Know

It's almost impossible to turn on a TV without seeing commercials for viagra, Levitra or Cialis. But are the drugs really the wonder pills their ads make them out to be? We asked the experts.

What do these drugs do?

According to the American Urological Association, all three medicines improve blood flow to the penis, helping about 80 percent of erectile-dysfunction sufferers have sex. The drugs will make his erection harder and may allow him to have multiple erections. But contrary to urban legends, they won't make him last all night.

Do they work for young men?

Myths touting sensational sexual performance make ED meds valuable on the street, where younger brothers, who may or may not need them, buy from older men with prescriptions. Theoretically, men who don't have ED won't benefit from the drugs, but there is an important caveat: the placebo effect. Even when men don't need the meds, says James Bennett, M.D., an Atlanta urologist, they may believe that taking the drugs will help them perform better. And since so much of sexual performance is psychological, that belief can be powerful.

How soon before you see results?

Viagra and Levitra, which can be taken once daily, require up to 60 minutes to work and help men have erections for four to six hours. Cialis takes up to two hours to kick in and keeps him erect for up to 36 hours. The drugs must be prescribed by a doctor. --H.B.

Hilary Beard is a freelance writer living in Philadelphia.

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