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Even with largely physical problems, such as vaginal dryness or erectile difficulties, certain nondrug steps may be worth trying. Furthermore, not everyone who experiences changes in sexual desire and function as they age is bothered by those changes, and shouldn't be made to feel either abnormal or in need of a cure. This report will help you talk intelligently with your doctor about when sex-enhancing drugs may be appropriate and when other steps-including leaving well enough alone-are enough.

Despite the increasing use of testosterone to stoke waning sexual desire, our consultants say that it's rarely worthwhile, for several reasons. There is little or no correlation between libido, sexual performance, and the normal age-related decline in testosterone. There's little evidence of the therapy's long-term efficacy and safety.

And many other factors—from stress and lack of sleep to changed feelings about a partner—can contribute to decreased sex drive. When low testosterone levels are well below normal, sexuality and performance may be affected.

But those declines often stem from correctable health problems, notably pituitary or testicular disorders. Even when those causes have been ruled out, taking testosterone is still a gamble. In men, while it can boost libido in those who have clearly low levels, side effects include breast enlargement and decreased sperm production. And it may speed the growth of prostate cancer and increase the risk of blood clots. In women, some research suggests that restoring testosterone to a high normal level can increase sexual desire, at least temporarily.

But it can also cause hair growth and acne, and may raise the risk of breast cancer. And other possible risks are largely unknown because of lack of long-term studies. Moreover, the only testosterone product (EstraTest) approved for women in this country uses a combination that can reduce HDL (good) cholesterol.

And while some doctors and pharmacists now compound special testosterone formulations for women, or use creams or gels intended for men, the safety and efficacy of such products or such use is even less well understood.

The reservations about testosterone apply doubly to DHEA, which is still allowed to be sold as a dietary supplement.

That's because there's even less evidence of its safety and benefits and because it may increase both estrogen and testosterone levels. Further, dietary supplements are largely unregulated, so you don't know if what's on the label is in the bottle. And your use of this potentially potent hormone is unlikely to be monitored by a physician.

What to do : Our consultants advise avoiding DHEA entirely, and taking testosterone only after evaluation by an endocrinologist, a specialist in hormone therapy. (See "Testosterone Treatment in Men and Women," below).

Other measures—treating underlying disorders, adjusting drug dosages, reducing stress, or addressing problems in your relationship with your partner, with a therapist's help if necessary—should generally be tried first.

The therapist could be a traditional one, a marriage counselor, or a sex therapist who focuses on negative sexual attitudes or beliefs.

And remember that a lack of sexual desire is only a problem if you think it is.

A recent study published in the November 2008 issue of Obstetrics & Gynecology found, for example, that while 43 percent of women report sexual problems, most commonly reduced libido, only about 12 percent were actually bothered by it.

Testosterone treatment in men and women Despite its increasing use, testosterone should be prescribed only in very limited circumstances, described below. Men Women Comments Consider testosterone replacement therapy if…

You

AND You understand that long-term risks, especially for men with moderately low levels, are largely unknown.

You have 200 mg generic viagra bothersome decline in libido starting after ovary removal or possibly after menopause. AND Other causes of low testosterone or reduced libido have been ruled out or addressed. AND You understand that long-term risks are unknown.

· Measuring testosterone may not help determine women's need for therapy since tests aren’t accurate for women and normal levels have not been determined. · Women should avoid testosterone if they've had breast or uterine cancer or liver or heart disease.

· Men should avoid it if they've had breast or prostate cancer or have high prostate or breast-cancer risk, major prostate enlargement, or elevated red-blood-cell count.

Treatment options include… Injections (Delatestryl, Depo-Testosterone, Testro-La), patches (Androderm, Striant, Testoderm), or gels (AndroGel, Testim). · For women, some doctors use low doses of men's creams or gels or create special formulas, though their safety is unknown. While anxiety sometimes causes erectile dysfunction, that disorder usually stems from physical problems, often the same ones that cause heart disease.

Sildenafil ( Viagra ), tadalafil ( Cialis ), and vardenafil ( Levitra ) can help improve men's potency by dilating blood vessels in the penis, to allow for the increased blood flow necessary for an erection.

However, such drugs should be used cautiously, since they can cause potentially serious side effects. Those risks may include an increased chance of heart attack or stroke among men already at risk of such events-including those with coronary disease-as well as fertility problems and worsened sleep apnea. In some men, the drugs may also cause temporary vision or hearing problems.

And they can interact with many medications, most notably nitrates (used to relieve angina) and certain herbs, including St. What to do: Addressing coronary risk factors—reducing blood pressure, cholesterol levels, and weight, stopping smoking, exercising more, and rigorously treating diabetes—may help correct erectile dysfunction. Pelvic-muscle exercises called Kegels—where you tightly tense the muscles that interrupt the flow of urine or passage of gas—may be worth trying as well.

If reducing risk factors and performing Kegels don't help, men could consider erection-boosting medication. Tadalafil, which lasts for about 36 hours compared with 4 hours for the other two drugs, may be a good choice for men who value spontaneity, though side effects may also be prolonged.

Men considering any impotence drug should first have a doctor assess their risk of heart disease and review all of their medications for possible interactions.

Reduced vaginal lubrication and clitoral sensitivity may sometimes stem from the same cardiovascular problems that can cause erectile dysfunction. But more often those problems stem from declining estrogen levels after menopause.

Sildenafil ( Viagra ) and related drugs may improve sexual function in some women, including those who experience side effects from antidepressant drugs such as fluoxetine ( Prozac and generic), paroxetine ( Paxil and generic), and sertraline ( Zoloft and generic), according to preliminary research.

Supplemental estrogen can also help relieve that problem as well as vaginal dryness.

But both treatments pose risks, so should be used cautiously. What to do: In theory, reducing coronary risk factors may improve sexual function in women as it does in men.

Extended foreplay and nonpetroleum lubricants like K-Y Jelly and Replens can usually provide sufficient moisture.

Staying sexually active may also help keep the vagina moist and responsive. Those steps, combined if necessary with treatment of a partner's sexual problems or of issues that impair libido, may improve a woman's ability to achieve orgasm as well. Women who want to try estrogen for dryness or possibly insensitivity can use creams (Estrace, Premarin) or vaginal inserts (Estring), which allow you to use smaller doses that are less likely to

increase

For example, they could try a lower dose or switch to generic bupropion, since some research suggests it's less likely to interfere with your sex life than are other antidepressants.

There are currently no drugs approved for treating premature ejaculation, the most common form of sexual dysfunction in men. But some doctors do prescribe antidepressants such as fluoxetine ( Prozac and generic), paroxetine ( Paxil and generic), and sertraline ( Zoloft and generic) for premature ejaculation, since one of their common side effects is to inhibit orgasm. Unfortunately, they probably have to be taken daily, not just before sex, and can cause a number of side effects.

Some other doctors prescribe topical anesthetics, such as lidocaine, but the evidence for such use is sparse.

What to do: You may be able to ease the anxiety and overexcitement that often underlie premature ejaculation by having sex more often, prolonging foreplay, and trying not to worry during or after sex, regardless of the outcome. Or talk with a sex therapist about other approaches that may train men to gain physical control over ejaculation.

Before resorting to medication or hormones to treat sexual problems, you and your doctor should first consider whether the problem stems from an underlying disorder or a medication you take.

In some cases your doctor could ease or eliminate the problem by changing the prescription or treating the disorder. Note that some side effects listed here may be only theoretical, particularly in women, or based on limited evidence, and that the list may not be complete.

If you experience a sexual side effect soon after starting any new medication, ask your doctor if the drug could be contributing to the problem. Note that many of the brand-name drugs listed below are also available as generics. It’s the truth: You reach a certain age where having sex isn’t as easy or satisfying as it used to be. Many factors can contribute to erectile dysfunction (ED) — anything from smoking to cardiovascular disease to general stress — and you shouldn’t be shy about discussing any erectile problems with your doctor. If there’s an underlying health condition causing your troubles, treating the cause may get you back to top form in no time.

Of

course

But before you pop a pill, try these natural tips for sexual health.

Smoking causes arteries to become stiff, which can have the opposite effect on your erection. Decreased blood flow to your sexual organs can make it difficult to achieve an erection. It can’t be stressed enough — a healthy diet and lifestyle has numerous benefits, including in the bedroom.

ED is linked to cardiovascular disease and diabetes, so eating a Mediterranean-style diet rich in fresh fruits and vegetables, healthy fats, and whole grains can reduce your chance of developing heart problems and, in turn, can alleviate your ED. Studies have shown that engaging in aerobic exercise at mid-life may treat erectile dysfunction. While researchers continue to investigate, I can tell you that regular aerobic exercise in combination with a healthy diet will reduce your chance of developing heart disease and type 2 diabetes — which is good for your sexual health.

While there isn’t a lot of scientific evidence that supports using herbs to increase sexual urges, most of these supplements won’t hurt you.

Try classic libido-enhancing herbs like maca, tribulus, rhodiola, ginseng, omega-3s, DHEA, and L-arginine. But be sure to consult your doctor first if you take blood thinners or other medications for heart health.

Choose a setting that promotes intimacy and communication with your partner, which can reduce performance anxiety.

We live in a society that expects high performance in every aspect of life — including sex. If you’re having erectile dysfunction issues, practice stress-reducing techniques every day so you can relax and enjoy intimacy without worrying about your performance. Sometimes low libido or sexual dysfunction can occur due to low testosterone levels. But that doesn’t necessarily mean you need a testosterone supplement. Your body usually can produce adequate testosterone, but it needs downtime to convert precursor hormones into testosterone. If you’re burning the candle at both ends, your body will convert those precursors into cortisol instead.

So rest, relax, and allow your body to build up its testosterone stores. I mentioned taking herbs and supplements to treat erectile dysfunction, so I want to add a note of caution about using so-called “natural male enhancement” pills.

The Food and Drug Administration (FDA) recalls dozens (if not hundreds) of these products each year for containing the active ingredient in medications used to treat ED.

When you buy those products from the internet, or even from a retail store, you have no real way of knowing what you’re ingesting. The active ingredient in drugs like Viagra, Cialis, and Levitra can negatively interact with other medications, so it’s essential that you take them with medical supervision.

The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app.

If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider. Share All sharing options for: Hims’ on-demand Viagra doesn’t guarantee good sex. “[Forty] percent of men by age 40 struggle from not being able to get and maintain an erection,” exclaims the website for Hims, a recently launched telemedicine startup that sells generic versions of popular baldness and erectile dysfunction treatments. Hims has a solution: with the help of sildenafil (also known as generic Viagra), you can have “an erection when you want one, not just when your penis says it’s allowed.” “Nobody wants to go to the doctor,” says Hims founder and CEO Andrew Dudum as we talk on the phone.

With a “sensitive and uncomfortable topic” like erectile dysfunction, seeking help can feel especially intimidating. The Hims model allows users to upload photos and chat with a physician remotely. Instead of having a face-to-face conversation with your physician (or a sex therapist), you can submit your info online and sign up for a monthly subscription of erectile dysfunction medications.

You don’t even have to worry about whether or not your insurance

company

Cialis and Levitra are not currently available as generics.) Yet in their attempt to help men sidestep awkward conversations about erectile embarrassment, Hims is aggressively promoting the idea that a healthy sex life is one where erections occur on demand and last as long as you want. That’s a message some sexual health professionals find disturbing. Hims might help you maintain your erection, but it won’t help you understand your body, your sexuality, or give you a more expansive understanding of pleasure.

Destigmatizing men’s erectile woes is a noble mission, but the company’s claim that it’s “weird” to leave a frustratingly flaccid member unmedicated does far more harm than good.

Although many of us assume that instantly hard, long lasting erections are not just desirable, but a sign of healthy, “normal” sexuality, the reality is much more complicated. Chris Donaghue, author of Sex Outside the Lines: Authentic Sexuality in a Sexually Dysfunctional Culture , tells me that much of what we label “dysfunctional” about erectile performance is just a natural part of getting older.

“When you’re in your forties, you should expect erectile frustration about 40 percent of the time,” says Donaghue, noting that the figure increases about 10 percent with each passing decade.

That’s normal.” Even when erectile dysfunction is an accurate diagnosis, medication is rarely warranted as a first-line treatment, particularly among the young men Hims is targeting, explains Donaghue. Younger men’s erectile issues often have mental and emotional causes, says TT Baum, a San Francisco-based sex educator who does hands-on work with clients who struggle with sexual issues.

For those men, Hims’ promise of embarrassment-free treatment could seem particularly appealing: If you’re overwhelmed by the idea of talking about your anxiety-induced erectile dysfunction, a pill you order online can feel like an easy out. But that doesn’t address the underlying anxiety — and in some cases, pills may make it worse, making users feel their sexual fulfillment requires medication. A post on the Hims blog does note that erectile dysfunction can have psychological causes that aren’t readily resolved by popping a pill, but you have to search to find this information. Its impact is somewhat lessened by the coupon code for Hims that appears at the top of the page. Also, sildenafil is a prescription medication — one that has side effects. Painful, hours-long erections occasionally

land

But headaches, loss of vision, indigestion, and diarrhea are also fairly common; rarer side effects include facial swelling, renal problems, laryngitis, and, perversely, an inability to experience orgasm. Those are just the physical side effects; mental ones can occur, too. Using sildenafil regularly can cause a kind of disconnection, where the erection isn’t tied to the “emotional/psychological arousal state,” but is instead fueled by chemical assistance, Donaghue says. That disconnection can drive an even bigger wedge between men and their emotions, and making users who crave an easy, automatic erection further dependent on medication.

Men who see good sex as being synonymous with the presence of an erection — any erection, no matter how emotionally disconnected from it they may be — are especially prone to developing a dependency on erectile dysfunction drugs, says Baum.

These medications can promote an attitude of “If I don’t have to do the work, why should I?” Baum says.

While getting chewable viagra soft tabs younger men hooked on sildenafil might make for a profitable business model, it’s not a great way to promote healthy attitudes toward sex, Baum notes. “It’s not about if you’re hard or not, it’s about ‘How does this feel?’” Instead of seeing a disappointing erection as a problem,

Donaghue

Going long periods of time without an erection is unhealthy for erectile tissue and may damage it.

We believe that having erections keeps erectile tissue healthy. It works best if it’s given about 5 to 15 minutes before you want an erection. Your advanced practice provider (APP) will review the instructions below with you.

Generally, the training for the injections takes 2 office visits.

Please be aware that each visit may take up to 1 hour, so you should plan your schedule on the day of your appointment.

Use this resource to help you the first few times you inject on your own. Do not take the following medications within 18 hours of injecting (before or after): Sildenafil (Viagra®) - 20 mg to 100 mg Vardenafil (Levitra®) - 10 mg to 20 mg Avanafil (Stendra®) - 50 mg to 200 mg. If you take tadalafil (Cialis ® ) 10 mg or 20 mg, do not inject within 72 hours (3 days) of taking the medication. If you are using tadalafil (Cialis) 5 mg daily, ask your APP how you should use this medication along with your injections.

The 3 most commonly used medications for injection therapy are Trimix, Bimix, and Papaverine. Most men begin injection therapy with Trimix, which is a mixture of 3 ingredients: alprostadil, phentolamine, and papaverine.

These ingredients work by relaxing the smooth muscle and opening the blood vessels in your penis, causing an erection. Your APP will decide whether Trimix or a different medication is best for you.

The alprostadil in Trimix can weaken over time, so Trimix should be stored in the refrigerator and away from light.

This can keep the medication good for a few additional months.

If you’re using Bimix or papaverine, you don’t need to keep the medication in your refrigerator because these medications don’t contain alprostadil.

Don’t use the medication if: It has particles or is cloudy.

After your second training visit, your medication will be delivered directly to your home from the compounding pharmacy (specialized pharmacy). Call the compounding pharmacy to make arrangements for billing and shipping. Gather your supplies: 1 medication vial 1 syringe (one-time use only) 2 alcohol wipes Sharps container. You can use an empty detergent or bleach bottle with a cap, or a metal coffee can with a plastic top.

If you’re using the medication for the first time, take the cap off.

Open an alcohol wipe and wipe the rubber stopper on the top of the vial.

You must always wipe the rubber stopper with alcohol before you insert the needle.

Be very careful not to let anything touch the needle. If anything touches the needle, you must throw the entire syringe away in the sharps container and use a new one. First, holding the syringe upright so the needle faces the sky, pull the plunger of the syringe back past the dose you were told to inject. Next, push the plunger back up until the top of the plunger (the thin black line closest to the needle) is at the dose you were told to inject. Turn the syringe downward so the needle is facing the floor. Hold the syringe in your hand like you hold a pen or dart.

Hold the syringe close to the needle with your thumb, index (first) and middle (second) fingers.