Viagra

Men Deserve to Feel Proud of Th eir Sexuality Remember a time when a buddy made a bragging sexual comment and you felt intimidated; you wondered if you were sexually “normal”; a TV program described male sexuality in a negative way; the time you felt confused about what to do sexually with a woman; whether your sexual fantasies were healthy; whether your expectations of lovemaking were realistic; when you thought, “Yes, I really like sex, but I feel diff erently than what other men feel.” If you’ve ever had moments or thoughts like these (and the great majority of men have), this book will help you develop a healthier, more confi dent, and satisfying sex life. What’s diff erent about this book?

We’ll tell you the honest truth—no hype, no magic, no “BS.” We will share with you the best available scientifi c, psychological, medical, and relationship information. Th e truth about sex is that every man deserves to feel proud, confi dent, and healthy about his masculinity and sexuality. Th e truth is that sex is an essential part of who we are as men. To begin, we ask you to take our 21-item true–false quiz to assess your understanding of male sexuality. Don’t worry about performance anxiety; you can score this yourself to see how knowledgeable you are, and you don’t have to tell anyone your score.

Low self-esteem – this can be due to prior episodes of ED (thus a feeling of inadequacy) or can be the result of other issues unrelated to sexual performance Unresolved sexual identity issues Childhood abuse or sexual trauma Stress due to any number of causes

Sexual Myths and Misinformation

An additional psychological cause of erection problems in many young men and some older men is due to anxiety caused by belief in erection myths. It’s surprising how much these myths can affect us even if we know consciously that they’re not true. Don’t get taken in by them. If you are concerned about your sexual life, don’t suffer in silence, talk honestly and openly to your partner and if necessary, seek professional advice together. Here are the most common sexual myths, and the truth about them: Myth 1: Size matters. Fact: This tops the list as THE most common concern for men. Most men wonder about their size in comparison to other men, often relying on locker room or adult film comparisons. Based on this flawed information, you might conclude that your penis doesn’t measure up, or isn’t good enough – either too small (or perhaps even too large, but that’s rarely the case), not shaped right, or just not normal. The fact is that penises and testicles come in a variety of shapes and sizes. It’s important to understand that when not erect, penises can appear to be quite different in size, but while erect, their sizes are much more similar. Since few men see each other’s erect penises except in adult films, they seldom have a realistic basis for comparison. Adult film producers often hire actors on the basis of unusual size, enhanced through camera angles, with lean abdominals to optimize exposed penis length, and with shaved genitals to give the appearance of larger size. No wonder men may feel inadequate.

Women are at risk as well, and susceptible to vaginal nerve damage. But you don’t necessarily have to give up riding to avoid cycling-related erectile problems. Consider these changes you can make: • Ride a recumbent bicycle. A German study found that riding a conventional bicycle caused a dramatic (though temporary) drop in oxygen supply to the penis, but that riding a recumbent bicycle did not. 42 © 2006 by ActionEbook.com. All Rights Reserved. Unauthorized duplication or distribution of any part of this publication without expressed, written consent is prohibited. • Wear padded biking shorts for extra protection. • Raise the handlebars so that you’re sitting relatively upright. This position will shift the pressure away from the perineum to the buttocks. • Change your bicycle seat (saddle). Narrow seats place the most pressure on the perineum. A wide, well-padded bicycle seat will better absorb the impact of the ride. A gel- filled seat is an excellent choice. Recent desig n changes also relieve the horn area, eliminating pressure on the perineum. This style is available in a wide variety of designs. Position the seat so that it puts minimal pressure on the perineum. Make sure the seat is not so high that your legs are fully extended at the bottom of your pedal stroke. Don’t tilt the seat up. • If you feel tingling or numbness in your penis, stop riding for a week or two and consult your physician as appropriate. These are warning signs that your bike ride could lead to erectile problems. Even if you don’t feel any warning symptoms, it’s a good idea to change your position and take breaks during long rides.

Drug abuse – amphetamines, barbituates, marijuana, cocaine, heroine, methadone, and other mind-altering drugs have been reported to cause erectile dysfunction. Fatigue – physical exhaustion can result in ED. High fat diet – known to lead to elevated cholesterol, obesity, high blood pressure, and vascular disease, all of which are ED risk factors. Marijuana use - Long-term marijuana use suppresses the production of hormones that help regulate the reproductive system. For men, this can cause decreased sperm counts. Very heavy users can experience erectile dysfunction. Smoking – Tobacco smoke is a mixture of gases and small particles of water, tar and nicotine. The tar consists of hundreds of toxic chemicals, many of which are known to cause cancer (e.g., nitrosamines, benzpyrene). Harmful gases in tobacco smoke include carbon monoxide, nitrogen oxides, hydrogen cyanide, ammonia, and other toxic irritants – formaldehyde and acrolein among them. A cigarette burns at high temperatures (over 1400°F or 800°C), cranking out many more noxious chemicals than are found in non-burning tobacco or ingested by use of smokeless tobacco (e.g., snuff contains no tar or gases). More than 4,000 chemical compounds have been identified in tobacco smoke. The health risks of smoking have long been known, but a direct link to ED was established by study findings released by the American Heart Association in March, 2006: • Men who smoked more than 20 cigarettes daily had a 60% higher risk of erectile dysfunction, compared to men who never smoked. • 15% of the past and present smokers had experienced erectile dysfunction. • Men who currently - and formerly—smoked were about 30% more likely to suffer from impotence. • Among men who had never smoked, 12% had erection problems.

In their 2000 study, Harrold et al. examined the use of Viagra in the first six months of its availability in a managed care setting in order to determine prescribing trends, characteristics of Viagra users, prescriber characteristics, and usage patterns in a cohort of Viagra users. They found that media attention clearly resulted in a greater awareness of erectile dysfunction as a treatable condition, and increased the demand for the drug. In fact, almost 60% of American patients who were prescribed Viagra had never sought medical attention for the problem, and as such had no documentation of prior treatment for erectile dysfunction. The study also found that 85% of firsttime prescriptions being filled for the drug occurred within the first twelve weeks of its availability (Harrold et al., 2000). Physicians have always been the direct link between pharmaceutical producers and patients, which is why the pharmaceutical industry spends billions of dollars on symposia and galas for physicians, offering incentives for prescriptions, and advertising and promoting their products to physicians. The role of physicians as “providers” however, is changing in the current medical marketplace, particularly due to direct-toconsumer advertising undermining their authority with regards to which drugs to prescribe (Conrad and Leiter, 2004). The Federal (USA) Drug Administration Modernization Act of 1997 made drug advertising both more feasible and more attractive to pharmaceutical manufacturers, a development which Pfizer used to their advantage when marketing Viagra in 1998 and onwards. The changes to the act, which now allowed television and radio advertisements to name both the disorder and the drug’s benefits without a lengthy summary of potential side effects and contraindications, are seen as the main reason for annual spending on direct-to-consumer advertising for prescription drugs tripling between 1996 and 2000 (Conrad and Leiter, 2004). Pharmaceutical companies claim that direct-to-consumer advertising has an educational function that creates betterinformed consumers, encouraging them to consult their physicians about underdiagnosed symptoms and treatment options, and enabling patients to make better choices with regards to their health care (Bonaccorso and Sturchio, 2002; Lyles, 2002). The American College of Physicians has stated its position that consumer advertising “does not constitute appropriate patient education” (Maguire, 1999). Regardless, 3.5% of Canadian patients, and 8.2% in the United States, report using advertising as an information source (Mintzes et al., 2003). Although these figures appear negligible, it must be considered that although some patients may not consciously employ such sources to provide information, they nonetheless internalize the messages they are exposed to daily by various media. A study by Mintzes et al. compared prescribing decisions in a US setting with legal direct-to-consumer advertising and a Canadian setting where such advertising of prescription drugs is illegal, but some cross-border exposure occurs (2003). The results suggest that more advertising leads to more requests for advertised medicines, and more prescriptions. If direct-to-consumer advertising opens a conversation between patients and physicians, that conversation is highly likely to end with a prescription, often despite physician ambivalence about treatment choice. Pfizer’s advertising of “ask your doctor” takes advantage of such dynamics between patients and physicians. Given that a potential patient inquires about Viagra to their physician, a prescription, and concurrent sale of the drug is more likely than not. According to Mintzes and colleagues, physicians fulfilled, on average, 75% of requests for direct-toconsumer advertised drugs (2003). Conrad and Leiter hypothesized that pharmaceutical manufacturers are circumventing physicians’ control over knowledge regarding available drugs (2004). The case of Viagra certainly supports this notion. Physicians are increasingly frustrated that the developments associated with increased direct-to-patient advertising are putting their patients in the “diagnostic driver’s seat” (Maguire, 1999). Some note that increasingly, patients are presenting them with lists of drugs which they would like to try, many of which are neither “time-tested” nor “cost effective” (Maguire, 1999). Other physicians state that patients believe that certain (advertised) drugs are going to be a panacea for their problems, and as a result pressure them for prescriptions, regardless if the physician feels otherwise.