Ask Dr. Danoff
Welcome to Ask Dr. Danoff. Getting answers to your male sexual health questions is easy. Simply send your question to AskDrDanoff@theultimateguidetomenshealth.com.
Q: How can one know that one’s sperm is healthy for reproduction?
A: The best way, of course, is to try to impregnate one’s partner. A urologist can certainly do a semen analysis, which will determine the sperm count, motility, morphology (shape), and any visible abnormalities. However, only the ability to impregnate determines the health of the sperm. Even so, adequate sperm count, good motility, and good and normal shape are important. Using a microscope, the urologist looks for sperm that resemble tadpoles (one head, one tail, good shape, and forward motion). Beyond that, there is no way to tell if a single sperm is intrinsically healthy.
Q: What effect does removal of the prostate gland have on sexual ability?
A: The most common reason for removing the entire prostate gland is to treat aggressive prostate cancer. The operation is done with a Da Vinci robot. The skill of the surgeon preserves the nerves of potency and the nerves of continence so that after surgery, the patient should have normal erections and sensation and be entirely continent. Because the prostate gland supplies seminal fluid (the fluid that is ejaculated with orgasm and carries the sperm), loss of the prostate gland means that although the sensation of orgasm is unchanged, little if any fluid comes out.
Q: What is the cause of premature ejaculation?
A: The true cause of premature ejaculation is unknown, but it is one of the most common forms of sexual dysfunction in men today. It is estimated that premature ejaculation affects more than 30 percent of the male population. Incidents of this dysfunction are consistent across all age groups, although they are more common in younger patients.
The normal male sexual response follows a cycle with the following four phases: excitement (desire), plateau (arousal), ejaculation, and orgasm followed by a refractory period during which a man cannot ejaculate. The sexual response cycle in men with premature ejaculation usually characterized by a steep excitement phase followed by a short plateau phase that leads to premature ejaculation. Anxiety also appears to play an important role in premature ejaculation because it lowers the ejaculatory threshold.
Q: Why is it so difficult to develop a male birth control?
A: Spermatogenesis (production of sperm by the testicles) is a very complex process. Blocking male fertility without reducing circulating serum testosterone has not been done, and I see no meaningful research on the horizon that will solve this age-old problem. Circulating serum testosterone is what drives the libido, and without manipulating testosterone levels, blocking spermatogenesis is not possible at this point.
Q: How do Viagra and similar medications work to ensure a hard erection?
A: Viagra, Cialis, Levitra, and drugs in the same class, known as “PDE5 inhibitors,” are performance enhancers—that is, they’re not drugs of desire but rather drugs of capacity. They are essentially “vasodilators” and work by increasing blood flow to the penis. Except in rare cases, such as patients with coronary artery disease who take nitroglycerin for chest pain, these drugs are entirely safe.
Q: Should gay and transgender men have special concerns when it comes to their sexual health?
A: The prevalence of anal intercourse is higher with gay and transgender men than in the general population. Practicing safe sex (using a condom) is most important. Other than that, there is no other difference. You can read more about sexual health issues facing all men in an article posted at The Gayly.
Q: Is it better to be circumcised or uncircumcised?
A: I generally have no preference. If uncircumcised, one must be able to easily retract the foreskin for hygienic purposes; if the foreskin is unretractable, then circumcision is mandatory. There is recent evidence from Africa that the incidence of HIV/AIDS in circumcised males is significantly lower than in uncircumcised men. If an adult male is uncircumcised and the foreskin is not problematic, I do not recommend circumcision for medical reasons.
Q: What is the best testosterone supplement for a 45-year-old male? I have hypothyroidism and want to get my body back to feeling stronger.
A: Hypothyroidism has nothing to do with a low serum testosterone. If your morning blood level of testosterone is low, that is called hypogonadism, and it can be treated with supplemental testosterone, delivered most conveniently by a daily application of a topical gel (AndroGel 1.62%). Monthly injections of Depo-Testosterone can also be given, but they are less effective. There are no oral testosterone preparations available or approved by the FDA because oral testosterone has extreme toxicity to the liver.
Q: Dr. Danoff, what kinds of penises do women prefer?
A: This is probably the single most significant penis question on the minds of all the men with whom I have talked over the years. In my many years of urologic practice, I have had thousands of conversations with women about the most intimate details of their sex lives. They have told me things they have related to no other person, including their most esoteric sexual practices and wildest fantasies. For the most part, women do not ever seriously express to me a strong preference for one kind of penis over another.
Although some women have told me that they do have a definite preference as to size or shape, the overwhelming majority of women I have interviewed have confessed that length, width, appearance, and complexion are all factors that do not seem to matter in a long-term relationship, even to the women who describe in detail the specific kinds of chests, legs, and behinds that excite them in their mates.
Penis size is not as significant as most men believe it to be because the penis is not the only body part that can be used to stimulate and satisfy a partner. Whether or not penis size is an issue for you as a man or an issue within a sexual relationship, as a superpotent man, you must learn to use your hands, lips, tongue, or any other device that can aid in stimulating your partner.
Q: Dr. Danoff, I’ve seen the late-night commercials and ads in men’s magazines and online but have wondered, is there really a way to make my penis any larger?
A: The answer is unequivocally no! Many men come to me with questions about a variety of “enlarging” procedures known collectively as phalloplasty. Surgeons have and are using a number of techniques, including skin grafts (known as dermal matrix grafts), in an attempt to increase the girth of the penis. These procedures, as well as a lengthening technique that increases penis length by severing the suspensory ligaments, are falsely represented as legitimate ways to increase the size of the penis. I cannot emphasize to my patients enough that phalloplasty and lengthening procedures are both inventions of hucksters, charlatans, and fakes. Not only are they ineffective, they are also highly risky. The idea that men need to have huge penises is a cultural myth perpetuated more by men than by women. There is hardly a man alive who does not dream of a bigger penis. Be assured there is no medically or surgically effective way of doing this safely at the present time. To believe otherwise is to subject your penis to gross disfigurement.
Q: Someone once told me that if I have sex a lot, I can damage my penis. Is that true?
A: The chances of injuring your penis are miniscule, no matter how vigorously you exercise it. Nature has designed your penis to be tough, resilient, and durable. It can take much more of a thrashing than most other appendages. Try twisting your ear or bending a finger the way you can bend your penis. It can even stand getting whacked around more than most organs, although I suggest that you take my word on that and not experiment on your own.
If you still have doubts, you should look to your own experience for validation: how many men have you known who have injured their penises compared to those who have damaged their hands, arms, feet, or legs? If you can recall any man complaining of a penis injury, chances are it had to do with the skin. The skin is the most vulnerable part of the penis. It can suffer abrasions, cuts, and bruises, but these occur more often from accidents. Getting your penis stuck in a zipper is the most common cause of injury, rather than ordinary sexual activity. The most frequent sex-related injury is skin irritation caused by excessive friction. This kind of irritation keeps more men from having sex than any other injury and is why one of my colleagues believes that “lubricants have saved more marriages than Dear Abby.” It is also possible to bruise the glans (the head of the penis) by thrusting against a woman’s pubic bone or other hard body part. Again, traumatic injuries are more often caused by something other than ordinary sex.
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