Check Up: Other little-discussed male sexual problems

Darius A. Paduch, urologist, lead researcher on Cialis' effects on other problems.
Darius A. Paduch, urologist, lead researcher on Cialis' effects on other problems.
Posted: February 12, 2013

A new study finds that the erectile-dysfunction drug Cialis can help other little-discussed male sexual problems, too.

While it is fun to imagine how this news will affect those couples in the bathtubs, the study is a serious window into the complex arena of male sexual shortcomings. The quality of erections, says lead researcher Darius Paduch, is not the only sexual-performance measure that affects quality of life.

His study found that men with erectile or prostate difficulties who took Cialis also had improvements in their problems with ejaculating and achieving orgasm, even when their erectile dysfunction was minor.

Paduch, a urologist and male sexual medicine specialist, who directs Sexual Health and Medicine at Weill Cornell Medical College, thinks these other problems, which cause a lot of emotional pain for men and their partners, are underreported and underappreciated. Not surprisingly, he said, male sexual satisfaction went up markedly when men were able to ejaculate and have orgasms.

"We need to change our verbal description from erectile dysfunction to sexual dysfunction," Paduch said. In the meantime, acronyms are proliferating. There's the ubiquitous ED for erectile dysfunction, the rebranded impotence. It ranges from the total inability to achieve an erection to occasional difficulty getting or sustaining one. Yet another recent study tied ED, which is related to blood flow to the penis, to risk for cardiovascular problems.

Then there's EjD or ejaculatory dysfunction. It includes premature ejaculation, but Paduch said more older men have been plagued by slow or nonexistent ejaculation. This is what his recent study examined. OD is orgasmic dysfunction. While problems with these increase with erectile dysfunction - and age - they are less about blood vessels and more about arousal and coordination of nervous impulses, Paduch said. Men can have erections, but be unable to have orgasms. They can also have orgasms without ejaculating.

Joseph Harryhill, a University of Pennsylvania urologist who treats many men with sexual problems, said the onslaught of drug-company advertising may have made men more comfortable talking about erectile dysfunction, but they still find it embarrassing to discuss ejaculation and orgasm.

"It's the elephant in the room that nobody's talking about," he said. One reason doctors don't bring it up, he added, is the lack of an effective treatment.

He said his most frustrated patients have told him, "I don't have a problem with erections. The problem is I keep going and going, and I can't reach climax."

Primary-care doctors, who often prescribe ED drugs, Harryhill said, "are probably not aware of this situation at all."

In a previous study, Paduch found that, even among men who only occasionally had problems getting or sustaining erections, a surprising number often had difficulty "finishing." In men with mild erectile dysfunction, 22 percent were able to achieve orgasm less than half the time, and 17 percent had poor ejaculatory function.

Paduch's most recent study, which was published this month in the British Journal of Urology International, analyzed 17 double-blind, placebo-controlled clinical trials involving 3,581 men with erectile dysfunction. After 12 weeks of treatment with Cialis, 66 percent of men with severe ejaculatory and orgasmic dysfunction reported improvement, compared to about 36 percent in the placebo group.

Paduch's study was funded by Cialis-maker Eli Lilly & Co. He is a paid consultant for Lilly. The company said it did not plan to seek FDA approval to market the drug for sexual problems other than ED.

Paduch said he hoped his newest study would make it easier for couples to talk about these issues. Many women, he said, find ejaculation or orgasm problems threatening, fearing that their partners no longer find them attractive or are cheating on them. "It kind of changes the dynamic," he said.

If nothing else, some of them find sex exhausting. "These couples really work hard," he said.

Paduch says poor health is the culprit in many men with erectile dysfunction. The same things that are good for everything else in the body - exercise, a proper weight, a good diet - are good for sexual function. Testosterone may also be low.

While it is normal for a man in his 50s or 60s to take longer than he did when he was younger - aging affects sexual function just like everything else - Paduch thinks men who need more than 30 minutes to climax might want to talk to a doctor.

Harryhill says there's no magic number. Some men accept their limitations. A man who has to quit because he's too tired, and is upset about that, could feel freer now to ask his doctor some questions.


Contact Stacey Burling at 215-854-4944 or sburling@phillynews.com.

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