Physician's Notebooks 8 - http://physiciansnotebook.blogspot.com - See Homepage2. The Sexual Response
(Update 25 Aug. 2021)
List of Chapter Content
The physical signs
The dependence of erection, Viagra
My erections: folate/vit. B12 effect
Advice for the aging man
Viagra et al.
Orgasms
Impotence
The physical signs of the sexual response are due to muscle relaxation in artery wall, allowing increased blood flow. At tips of body (penis, clitoris, nipples), this response engorges tissue and causes erection; in brain it enhances pleasure. In fair-skinned woman a skin flush signals sexual arousal. At first, erection is a spinal reflex from touch stimulus. Later it becomes the sexual response. The dependence of erection on artery elasticity explains why the response is best in youth and weakens in old age. (Also explains the effect of Viagra and like medications, and failing sexual response in diabetics and others with premature circulatory illness)
I interrupt for my experience. My erections were good until age 70s. This followed a blood test testosterone (TE) fall from a youthful 1000+ nanogram per deciLiter (ng/dL) to 400 at age 74 and then a low of 138 ng/dL at 75 in late 2008. I did not miss the strong erection because sexual relations were unimportant to me then. I could still masturbate and achieve orgasm and ejaculation with a semi-erect penis. But my blood test showed a borderline low folic acid (folate) and vitamin B12 (cobalamin) to which my attention was drawn because I developed a macro RBC anemia typical of folate/vitamin B12 deficiency. I started taking high-dose folic acid and vitamin B12 and not only did my anemia get better but my serum testosterone rose and my erections improved. Since then the serums Folate 480 ng/mL and vitamin B12 levels have risen at times of high dosage to 1300 pg/mL – >20X and 1.6X above normal.
Then, from late July 2018, I have been on 4-weekly 250mg Testosterone injection. The effect of these injections, has been subtle; perhaps an increase in sexual desire and a more happy mood and a greater energy and stamina. During this time, my red blood cell count, which had been anemic because of just previous accident and surgery, improved along with my stamina.
Aging has an affect on erection; also, folic acid and vitamin B12 deficiency – even borderline - should be checked and treated. My data suggest a good effect of the megadoses of folic acid and B12, which show no bad side effect and are low cost.
Then, from late July 2018, I have been on 4-weekly 250mg Testosterone injection. The effect of these injections, has been subtle; perhaps an increase in sexual desire and a more happy mood and a greater energy and stamina. During this time, my red blood cell count, which had been anemic because of just previous accident and surgery, improved along with my stamina.
Aging has an affect on erection; also, folic acid and vitamin B12 deficiency – even borderline - should be checked and treated. My data suggest a good effect of the megadoses of folic acid and B12, which show no bad side effect and are low cost.
Further advice for the aging man who plans to have sex with a younger person is that, in the day before the planned sexual relation, with weak erections, to take a daily hot bath and eat a red meat dinner several hours before the sex. Also if you know ahead, then not taking your day's beta blocker, anti-depressant and ACE-I medications will enhance. (No harm missing the pills for 1 day.) And keep in mind that erection is strongest between 4 AM and 8 AM assuming you regularly sleep nights. (We are writing here about a one-night stand. In the case of an old man getting married to a young woman, a different approach needs to be used, probably the targeted use of Viagra to the sexual intercourse.)
Viagra aka sildenafil citrate as tablets 25 mg, 50 mg or 100 mg. It enhances erection by relaxing the walls of the main artery and allowing more blood to flow into penis. But it dilates all arteries so it has the potential to drop blood pressure and cause fainting while erect. Relates to dose. If you plan to use it, from my experience, I advise it best to ask your doctor for the 25-mg pills. Also it is high cost so, at first, order only a small amount (5 pills). Viagra should either be allowed to dissolve under tongue (or chew if that takes too long or swallowed at least 4 hours or more after last meal because food in stomach delays and dilutes & reduces effectiveness). Its effect maximizes after 30 to 120 minutes and then drops but may last up to 10 hours. It enhances erection (makes it firmer, easier to get, longer to keep); it does not make an erection from a totally soft penis. So you need cooperative stimulation from your partner.
Viagra aka sildenafil citrate as tablets 25 mg, 50 mg or 100 mg. It enhances erection by relaxing the walls of the main artery and allowing more blood to flow into penis. But it dilates all arteries so it has the potential to drop blood pressure and cause fainting while erect. Relates to dose. If you plan to use it, from my experience, I advise it best to ask your doctor for the 25-mg pills. Also it is high cost so, at first, order only a small amount (5 pills). Viagra should either be allowed to dissolve under tongue (or chew if that takes too long or swallowed at least 4 hours or more after last meal because food in stomach delays and dilutes & reduces effectiveness). Its effect maximizes after 30 to 120 minutes and then drops but may last up to 10 hours. It enhances erection (makes it firmer, easier to get, longer to keep); it does not make an erection from a totally soft penis. So you need cooperative stimulation from your partner.
Before starting to rely on Viagra, test the 25 mg dose and if that is not good enough, go to 50 mg but do not go higher without medical advice because of risk of fainting and other artery side effects. After age 65 the usual dose should be halved. Do not use with coronary heart disease or if taking nitrates for chest pain. A more recent pill is Cialis aka Tadalafil (Weekend Viagra) which has a longer lasting 36-hour effect allowing it to be used as a single pill for a full weekend (as 2, 6, 10 and 20 mg pills). Another recent Viagra-like pill is Vardenafil, the most rapid-acting, reaching a peak of effectiveness on empty stomach starting 20 to 25 minutes after taking the standard dose.
Who should consider using Viagra? Best for otherwise healthy man whose erection weakness or loss is due to pure old age and who has a willing partner. Do not use it to help masturbation; you can masturbate very satisfactorily without a full erection. Do not use it for psychological impotence (inability of erection in men under 70 due to particular inhibitions) Diabetics may try it but usually the effect is less.
As a final afterthought on this subject and speaking as an 88-y/o man, I should like to advise other old men to rely on masturbation and your imagination for sexual enjoyment rather than struggle around and get into all sorts of trouble just to experience sex with a younger woman.
Orgasms; According to surveys in U.S.A. 99% of men and 91% women by age 45 have had them. In a male, an ejaculation signals the orgasm. (But, ejaculation can occur without orgasm)
In a female the variation of description and physical response is wide. The orgasm may be noted by the woman having one, and also to an examining observer by abrupt peaking of the breathing rate, blood pressure and heart rate. Just before the orgasm peak, most women (and some of the partners) notice involuntary rhythmic contractions of vaginal barrel muscles. (In my wife, I noted these contractions as a characteristic feeling of vaginal twitching on my erect penis, just as we completed our sex relation.) When a woman clearly has an orgasm she should feel a burst of pleasure spreading outward from her sexual area but it is important to be aware of variations both between individuals and in same person. The pleasure varies and at times orgasm is described as painful, and some women claim to have orgasm and not to achieve the sudden crescendo and cessation typical of male orgasm; rather, they build up to pleasure and descend from it.
Who should consider using Viagra? Best for otherwise healthy man whose erection weakness or loss is due to pure old age and who has a willing partner. Do not use it to help masturbation; you can masturbate very satisfactorily without a full erection. Do not use it for psychological impotence (inability of erection in men under 70 due to particular inhibitions) Diabetics may try it but usually the effect is less.
As a final afterthought on this subject and speaking as an 88-y/o man, I should like to advise other old men to rely on masturbation and your imagination for sexual enjoyment rather than struggle around and get into all sorts of trouble just to experience sex with a younger woman.
Orgasms; According to surveys in U.S.A. 99% of men and 91% women by age 45 have had them. In a male, an ejaculation signals the orgasm. (But, ejaculation can occur without orgasm)
In a female the variation of description and physical response is wide. The orgasm may be noted by the woman having one, and also to an examining observer by abrupt peaking of the breathing rate, blood pressure and heart rate. Just before the orgasm peak, most women (and some of the partners) notice involuntary rhythmic contractions of vaginal barrel muscles. (In my wife, I noted these contractions as a characteristic feeling of vaginal twitching on my erect penis, just as we completed our sex relation.) When a woman clearly has an orgasm she should feel a burst of pleasure spreading outward from her sexual area but it is important to be aware of variations both between individuals and in same person. The pleasure varies and at times orgasm is described as painful, and some women claim to have orgasm and not to achieve the sudden crescendo and cessation typical of male orgasm; rather, they build up to pleasure and descend from it.
What is seen when a man comes in an orgasm is the ejaculate, a mix of semen and sperm. Sperm are being continuously produced in testes. (A single ejaculation in healthy youth could have up to 1-billion sperm.) And newly made sperm are constantly pushed out from a testicle into the sperm and semen tube - called vas deferens - by pressure from younger sperm behind. Millions of sperm are pushed along the vas deferens by its rhythmic muscular pump contraction toward the storage sac at end of each vas, called the ampulla, where they are stored awaiting orgasm and ejaculation.
Sperm only make up a few percent of the ejaculate. The fluid or semen is mostly produced by seminal vesicles and prostate gland and stored in paired seminal vesicles. Billions of spermatozoa are held in both ampullas and 5-7 ml fluid is in seminal vesicles and makes semen. The seminal vesicles are triggered to contract with start of orgasm and each pair expels sperm and semen separately into a common ejaculatory duct and on into the urethra at base of penis; then, by involuntary muscle contractions the penis spurts it out in several jets.
Volume of ejaculate and concentration of sperm depend on frequency of and time since the last ejaculation, as well as on one's age. The interval between each orgasm that results in maximal sperm count is c.24 hours. Orgasm is both physically and psychologically primed. Physical priming is from rubbing and touching; psychological priming is from responding to the mental image one has been conditioned to treat as sexual stimulus.
Volume of ejaculate and concentration of sperm depend on frequency of and time since the last ejaculation, as well as on one's age. The interval between each orgasm that results in maximal sperm count is c.24 hours. Orgasm is both physically and psychologically primed. Physical priming is from rubbing and touching; psychological priming is from responding to the mental image one has been conditioned to treat as sexual stimulus.
Women have the equivalent of ejaculation, or “come”, from secretion of paired Bartholin glands at vaginal outlet, and notice increase of moist lubrication as part of arousal (wetting panties). Women have been known to fake orgasm, but a knowledgeable male should be able to confirm his female partner’s orgasm by attention to the distinctive feel on his erect penis of vaginal twitching at orgasm and also a burst or peak of her rapid heartbeat and breathing at the time of orgasm. In men and women, erection of penis or clitoris is sure sign of sexual arousal but only in men is it required for coitus. The most frequent male sexual disorder is inability to get or hold erection. Note, full erection is not necessary for orgasm or ejaculation.
Psychological impotence (inability to get full penis erection) is common and caused by one or another kind of negative learning with regular sex partner. It can almost always be remedied by temporary absence of lovemaking or by variety. (Not only does "absence makes the heart grow fonder", it causes the penis to get "erecter") “Is it true blondes have more fun?” was an effective slogan for a bleach hair product that played on the idea of a woman masquerading in a different persona to stimulate her partner’s flagging erections.
Some impotent men, mostly ill or old, have physical impotence due to poor blood circulation or peripheral nerve disease. A simple test for a wife to see whether her poorly performing husband is truly ill or just bored is to observe her husband while he is asleep for a penis erection. If it is seen, the impotence is psychological and can be cured promptly by the wife changing her usual appearance or approach. (For example, trying oral sex, if that has not been part of love play)
As men age, after 60, they develop a relative impotence that requires greater erotic stimulus to get and hold erection and more time to reach orgasm. The older man’s waning sexual response may explain his increased tendency for sexual perversion. Since he needs increasingly greater stimulus for erection and orgasm he requires an increasingly perverse sexual scenario to satisfy self. Unfortunately, the current relaxation of censorship of pornography has stimulated the worst impulses of the diseased imaginations of us older man to give, now, the virtual epidemic of sexual perversion. Sixty years ago, we never saw anything like today and I take that to be the result of the relaxation from the then good nongovernmental, self-censorship of sexually explicit material. In the old days good taste, replaced the vulgarity we see today.
One other observation I made on quality of orgasm relates to effect of medication. Opioids and the tricyclic anti-depression pill Tofranil (imipramine 25 mg pill; and, possibly, other TCA anti-depressives) increase the pleasure of my orgasm. (Note: imipramine is reported to negatively affect erections but that is probably higher dose than the single 25 mg pill I am reporting on) The good effect I note starts at 1 hour and may last up to 4 hrs after last dose.
END OF CHAPTER. To continue next now, click 8.3 Incest - A Re-evaluation
END OF CHAPTER. To continue next now, click 8.3 Incest - A Re-evaluation
No comments:
Post a Comment