How your man can retain his VIRILITY

Surprising advice from one of the world’s top experts on male libido

MALE virility is a complex business, with implications not just for men’s love lives, but t heir health, too, as a new book reveals.

The author, Dr Ronald Virag, is a French cardiovascular surgeon and leading authority on male sexual health and erectile dysfunction (he pioneered the use of injections to treat the problem). Here Dr Virag reveals some surprising facts about men’s sexual function — and what to do when it goes wrong...

YES, YOU CAN HOLD BACK THE RAVAGES OF TIME

JUST as men develop grey hair and creaky joints as they hit middle age, from the age of 40, their blood vessels start to age, affecting their virility. The blood vessels become furred with fatty deposits, impeding blood flow to the penis. This lack of blood also means that some of the tissue around the vessels becomes deprived of oxygen — another trigger for erectile dysfunction. Before the age of 40, less than 10 per cent of men have concerns about their erections — after that, more than 50 per cent complain of problems, and it is a worry for the vast majority of the over-70s.

Another problem is that from the 40s onwards, testosterone levels drop because the testicles aren’t able to produce as much of it.

Animal studies have shown that lower levels of testosterone affect penile tissue. There are testosterone receptors, which bind to the hormone to make it effective, inside the penis so they won’t be activated if there isn’t enough of the hormone, making it difficult for the penis to become rigid. This phase has been dubbed the ‘andropause’ as the time it starts matches the time of the female menopause (although while the menopause affects a woman’s fertility, this is not as dramatic in men). However, regular sexual activity can help to maintain erections — and may also even extend life expectancy.

Studies show that men over 50 have a longer life expectancy if they have at least two orgasms a month, compared with those who have none, while heart attack patients survive longer if they have frequent sexual activity.

Scientists are unsure of the reasons behind this, but say that the rush of f eel- good compounds may boost health by lowering blood pressure and boosting heart health. As we will see, one of the key lessons about male virility is that an active sex life creates a virtuous cycle — it makes erectile dsyfunction less likely, protects a man’s prostate and even stops the penis shrinking with age. So, use it or lose it!

VIRILITY REVEALS HOW HEALTHY YOU ARE

STRUGGLING to achieve and maintain an erection can indicate more than a localised problem — it can be a sign of other underlying health conditions. Depression undermines sexual desire, while antidepressants can often hinder sexual function because they reduce desire in the brain. (Although some medications, such as tricyclic drugs often used as treatment for mental health problems, can spontaneously cause erections, possibly because they spark metabolic changes.)

Erectile dysfunction can also be an early sign of multiple sclerosis — which damages nerves. Around 5 to 10 per cent of male MS patients are affected in this way.

Erection problems can also be the first sign of diabetes, because a high blood sugar level prevents the automatic production of nitric oxide, a compound that helps widen blood vessels. Erection difficulties can also suggest furred-up arteries (risk factors include high cholesterol, smoking, alcohol, diabetes, high blood pressure and obesity) — even a small blockage in the penile arteries will lead to a poor-quality erection because the vessels are so narrow.

Studies suggest that in a group of men with penile artery disease, 50 to 75 per cent of them will also have the early stages of blocked arteries around the heart.

So as well as being a symptom of heart disease, erectile dysfunction can be a vital early warning sign of it.

Therefore, the risk factors need to be addressed. A supplement called arginine may also help — it works mainly by increasing the production of nitric oxide.

WHY SLEEP IS SO IMPORTANT

WHILE we sleep the body undertakes maintenance and r e pair t o al l our cells and t i ssues, i ncluding t he genitalia.

Throughout the night men experience a number of erections, which are thought to be crucial to the health of penile tissue.

These occur in the REM (rapid eye movement) phases of sleep, also known as dreaming sleep, at the end of the 90-minute adult sleep cycle.

We have four or five of these cycles in a healthy night’s sleep, and often wake up during the REM phase, which is why men experience morning erections. Erections occur when blood flows into chambers in the penis — most of the time, the sympathetic nervous system releases low levels of adrenaline, which reduces the flow of blood by contracting muscles in the penis.

However, during REM sleep, a different branch of the nervous system takes over, taking the br a kes off, and widening the blood vessels.

The increased blood flow means a greater supply of oxygen and nutrients — without this regular flow, the tissue can become deficient in oxygen, and studies suggest that this can even lead to damage in the layer of tissue, affecting the ability of the penis to become rigid.

Indeed, scientists have found that men whose automatic nocturnal erections reduce or disappear have more difficulty sustaining erections when awake.

These kinds of problems can be triggered by a disrupted sleep cycle (caused by taking sleeping pills or working night shifts). Men who no longer experience automatic morning erections may want to see their GP, especially if it’s accompanied by a difficulty maintaining or gaining an erection when aroused.

FOR OLDER MEN, IT’S A WAITING GAME

A MAN’S libido can take hours or even days to peak again after ejac refr

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culation, in a period called the ractory phase. his starts with the instant and multaneous arrival of two types of emical messengers — adrenaline d endorphins. he adrenaline causes the arteries in

penis to constrict, limiting blood w, and the muscles in the penis contract. Meanwhile the endorphins e body’s natural feel - good micals) cause a feeling of calm and phoria. Eventually these chemicals clear, and the body starts to produce nitric oxide, which relaxes the vessels and allows blood to flow into the genitals again, once aroused.

This refractory phase lasts longer as a man ages, possibly because it takes longer for the body to clear the feelgood chemicals and s t art t he production of nitric oxide.

The refractory phase can vary from one minute for a 16-year- old to one month for a 90-year- old man, but is usually several hours. If it becomes longer over a short time it can be due to depression or a drop in testosterone levels.

Studies have found that men with low testosterone often say it is difficult to achieve another erection — this improves when they are treated to boost their testosterone levels.

WHY NERVES CAN RUIN THE MOMENT

WHEN a man is anxious about his sexual performance, it triggers a vicious cycle.

The fear of failure means that instead of relaxing, he becomes stressed, which triggers the production of adrenaline, blocking an erection.

The more failures a man has, the more he then tries to avoid sex altogether — and his fear increases and his desire plummets.

This lack of desire leads to a drop in l evels of a hormone — known as luteinising hormone — which is crucial for sexual appetite.

This is produced each time you have sex, but if you don’t have sex, the brain lowers its production because there is no need for it any more.

This process can take months or years, but will eventually lead to fewer spontaneous erections, which only exacerbates a man’s anxiety. Additionally, not having sex means the penis is not oxygenised as much, so men have poorer erections — which also contributes to their worries.

All ages can suffer from fear of failure — pressure and shyness can be factors — but as men get older they worry about impotence.

Medications, such as beta-blockers, may help, as these block the action of adrenaline.

SEX IS GOOD FOR YOUR PROSTATE

ONE in ten men develops prostate cancer at some stage in their lives, potentially needing some or part of this gland removed, which can affect their sexual health.

Looking after the prostate is therefore very important. The prostate produces two-thirds of the seminal liquid which, with sperm cells, forms semen. But the gland itself often ages badly because it has few blood vessels in it, meaning that the tissue receives little oxygen and nutrients. In many men it enlarges naturally, though it isn’t clear why this happens.

As a result the gland, which surrounds the urethra like a doughnut, presses on it, disrupting urine flow and ejaculation. Some of this enlarged gland can be surgically removed, but this can damage some of the valves in the urethra, causing semen to travel into the bladder rather than out of the body, in a process known as retrograde ejaculation.

The gland is also surrounded by two bundles of nerves that are vital for maintaining an erection. If the gland turns cancerous, and needs to be surgically removed, these nerves can become damaged, affecting sexual function.

To keep the prostate healthy, men should not smoke, they should have regular sexual activity, and maintain a healthy weight.

There is also some evidence that drinking cranberry juice and avoiding fatty red meat can help.

MISERY OF BEING TOO AROUSED

PROLONGED arousal may seem like a happy event, but it is a nightmare for those affected by priapism, which occurs when blood cannot drain away due to a blockage in the arteries of the penis.

It’s not known exactly why this happens, but it often occurs without any sexual activity — it can occur as a result of leukaemia (a blood cancer that causes the blood cells to change shape) or from a direct knock to the area.

Most commonly i t’ s caused by sickle-cell anaemia — a disease mainly affecting African men where the red blood cells are sickle-shaped, instead of round, making them more likely to become trapped inside the penis so it remains rigid.

The condition causes pain and if not treated quickly, can lead to long-term damage affecting potency.

It is treated with injections of a drug that helps to drain the blood out of the area.

THAT AGE-OLD CONCERN...

THE vast majority of men have no reason to be anxious about their size, because medically, a true ‘micropenis’ is defined as less than 5cm (2in), which is very rare.

The average length of an erect penis is 15cm (6in) — ranging from 11.5cm (4.5in) to 19cm (7.5in). An average flaccid penis is 9.5cm (3.7in).

In a healthy man, the size of their organ can decrease slightly with the ageing process, due to changes in blood flow due through blocked arteries, while the collagen that helps keeps tissue firm becomes less efficient with age.

But regular activity can minimise loss in size.

ADAPTED by CARA LEE from Erection: The User’s Guide by Dr Ronald Virag, published by Clement Editions and available as an ebook for €9.99 from iTunes