8 reasons for daily sex

Back in the 1940s, a renegade shrink named Wilhelm Reich recommended an orgasm every day to stay healthy. It was part of his reasons for sex he called the "sexual revolution." Unfortunately, folks were strung pretty tight back then, and they threw Reich’s ass in prison, where orgasms aren’t nearly as much fun.

But thinking this guy was onto something, we called some of the planet’s most renowned M.D.’s to find out if he was right. Guess what? He was. Unless you’re moving from girl to girl like Camryn Manheim moves through a sixpack of cling peaches in heavy syrup, a daily love session is just what the doctor ordered, for you and your partner in crime. Here are eight reasons to never get out of bed.

To get the body you want

When you cut your finger, does Ragú ooze out? Does the idea of exercising induce suicidal hollandaise binges? We can think of one way to have a blast and get in shape simultaneously. "Sex is a vigorous form of exercise," says Dr. Michael Cirigliano of the University of Pennsylvania. "The physiological changes in your body are consistent with a normal workout. Your heart and respiratory rates rise, and you burn calories." How many? Having sex three times a week for 20 minutes a pop for a year will burn some 7,500 calories (that’s the equivalent of a 4 1/2 pound wheel of brie). If you did it every day, you could shave off a pound of lard in two weeks. Of course, the more athletic the sex, the better the workout. See you in the emergency room.

Stay in the mood

Ever lie back after a good screw and think, Damn, the world’s a pit of misery. Why not end it all? Of course not. That’s because sex is an antidepressant. During the act your body’s producing pleasure-inducing fluids besides the ones that shoot out of your body. "You’re releasing endogenous opioids. They’re like drugs, but they’re manufactured internally," says Dr. Alice Ladas, a psychologist and one of the authors of The G Spot. In fact, studies show that merely touching someone can raise the level of serotonin in his brain, which is similar to what Prozac does.

Hurts so good

So she’s got a headache, huh? Arthritis? A fresh chain-saw wound? No excuse: Thanks to the endorphins released during sex, a rowdy belly dance can actually ease her suffering. "Pain threshold in women is elevated 60 to 80 percent during pleasurable stimulation," explains Dr. Beverly Whipple, a professor of neuroscience and president of the American Association of Sex Educators, Counselors and Therapists. In one recent study, Gina Ogden, author of Women Who Love Sex, experimented by attaching a clamp to a woman’s finger and squeezing, first while she was at rest and later while she was getting some. As her subject climaxed, Ogden pinched past the point at which the woman routinely howled, with no response at all. "In the midst of orgasm," Ogden noted, "she apparently feels no pain."

Controlling her hormones

Want to help ease those nasty PMS symptoms? Studies show that a woman’s overall reproductive system benefits from frequent penile insertions. "Sexual activity helps strengthen the pubococcygeus muscles (PC muscles), which in turn help keep the pelvic organs in shape and where they belong," explains Dr. Ladas. Regular love sessions can also postpone the onset of menopause, stimulate fertility, and regulate the menstrual cycle.

Keep it cumming

Fun fact: 52 percent of all men between the ages of 40 and 70 have trouble getting wood. But having more sex can better your chances. Frequent erections keep blood flowing through your capillaries, so the flesh in your bone stays nourished. And more important, an erection is an athletic reflex. "The more you train the coordination between nerve and muscle, the easier it is to perform," says Dr. Andre Guay, head of the sexual function center at the Lahey Clinic in Peabody, Massachusetts.

The gland of milk and honey

Yeah, the prostate’s a funny little gland. Not only is it a key component in your pleasure machine (and a male G spot, if you know how to find it), it tends to swell as we get older, causing agony for lots of guys. To keep it from bugging you, take saw palmetto (an over-the-counter herb supplement that relieves symptoms of prostate enlargement ), and keep ejaculating. "Most of the fluid you ejaculate comes from the prostate and the seminal vescles," says Dr. Guay. "When someone stops having orgasms, the fluids back up and the glands can become swollen." When prostatic congestion occurs, the gland squeezes your urinary tract; pain shoots through your guts and you have a hard time taking a leak. Talk about a spent fuel rod.

chemical attraction

Bet you didn’t know that testosterone is responsible for sex drive in women as well as men. Yup, a lady with no testosterone will be drier than an AA meeting. Plus, testosterone is a steroid that regulates the body’s metabolism, letting it use energy efficiently. And the more sex you have, the more testosterone you’re producing. "A consquence is that your body is able to stimulate tissue replacement and bone growth, which, among other things, helps prevent osteoporosis," says Dr. Susan Rako, author of The Hormone of Desire. "Higher levels of testosterone can also promote an overall feeling of well-being."

Been a long time coming...

Want to live longer? Try adding a little spice to your diet. In 1997 an inquisitive British doctor published a study that followed 918 men between the ages of 45 and 59 for 10 long years to determine how sexual activity affected their life spans. Here’s what he found: Men who had two or more orgasms every week were half as likely to croak as those who averaged fewer than one orgasm a month. And, hey, guys never lie about this kind of stuff, so we’re sure the data’s right on the money.

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Masturbation Myths

There exists almost universal agreement by medical doctors that masturbation is a normal, safe, and common practice.

However, masturbation continues to be associated with embarrassment, shame, and guilt, primarily due to societal perceptions of the act.

Because of this, several myths about masturbation have taken hold which need to be addressed.

Men who masturbate frequently will run out of semen

The truth? A man produces semen throughout his life. Masturbation will not deplete men of semen, because it is constantly replaced. But if one over-masturbated, if might depleted his bio-energy and accelerate the pace of aging. Many symptoms of over-masturbation, such as hair thinning, weak erection, premature ejaculation, and lower back pain can occur.

Masturbation leads to homosexual activity

The truth? Masturbation does not determine a person's sexual orientation. Just because you like to touch your own body, doesn't mean you want to touch someone else's!

People who masturbate can't be aroused any other way

The truth? Masturbation is healthy, and it won't make a person less responsive to stimulation by a partner. In fact, masturbation is a good way to learn about your body and sexual responsiveness. Men can use masturbation to learn how to prolong the time it takes to ejaculate. Women can learn what an orgasm feels like and how to produce it. And this can make sex with a partner more satisfying.

Only teenagers masturbate

The truth? Frequency of masturbation may be highest among people between 24-50. Masturbation also occurs within marriages. The idea that only sexually frustrated teens masturbate is a myth.

One can get STD or AIDS from masturbation

The truth? You cannot get AIDS or any other sexually transmitted disease from playing with yourself. These diseases are sexually spread, which means the germ that causes the disease (HIV in the case of AIDS) has to come from somewhere -- and that somewhere is an infected partner. If you have the disease, you have the disease whether you masturbate or not. If you don't have the disease, you cannot get it by playing with yourself.

Manual sex with a partner--that is where you touch the partner's organs with your hands, and vice versa--can theoretically provide an opportunity for the transmission of some kinds of sexually transmitted diseases, especially if semen or blood from one person comes in contact with broken skin of the other person. The risk involved in such activities is estimated to be extremely low, but it is NOT zero.

Group masturbation (circle jerks) where you play with yourself and the other parties play with themselves do not involve the risk of transmission of sexually transmitted diseases if you don't come in contact with blood or semen from anyone except yourself and you don't touch anyone else's sexual parts. Naturally, you can catch a cold if another person sneezes. If you want the risk of STDs to remain zero, you have to avoid sharing sex toys or towels that may have fresh fluids on them.

Over Masturbation

You might not want to hear this ...

It seems some scientist's had way too much time on their hands ... and some extra dollars to spend in their research budgets.

The effects of masturbation and over masturbation upon a mans body was recently looked at.

And what exactly did they find?

Frequent masturbation and ejaculation stimulate acetylcholine/parasympathetic nervous functions. Excessive stimulation can result in over production of sex hormones and neurotransmitters such as acetylcholine, dopamine and serotonin.

Abundant and unusually large amount of these hormones and neurotransmitters can cause the brain and adrenal glands to perform excessive dopamine-norepinephrine-epinephrine conversion and turn the brain and body functions to be extremely sympathetic. In other words, there is a big change of body chemistry when one excessively masturbates.

Note: Masturbation is a healthy sexual behavior. Like other behaviors, when over practiced or addicted it can lead to both psychological and physiological imbalances.

Side-effects of Masturbation

Other than an immediate need for a towel or tissue, the effects of masturbation upon the male body were:

• Fatigue. Feeling tired all the time
• Lower back pain
• Thinning hair / Hair Loss
• Soft / Weak Erections
• Premature Ejaculation
• Eye floaters or fuzzy vision
• Groin / Testicular Pain
• Pain or cramp in the pelvic cavity or/and tail bone

When to say when

How much is too much masturbation (and sex for that matter)? That depends but it's suggested men keep their ejaculation frequency down to 2-3 times a week. However, sexual activity can be experienced more often if men learn how to orgasm without ejaculation. Doing so can actually store bioenergy into your system and make your penis firmer, your erections last longer, and your ejaculate volume bigger.

Over masturbation participants experience problems with concentration and memory. This is a dangerous side effect of over masturbation and signals that the brain is being over drained of acetycholine. Over masturbation drains motor neurons and neuro-muscular endings of acetycholine, which is eventually replaced. Over masturbation can lead to absentmindedness, memory loss, lack of concentration, and eye floaters. To fight these symptoms, the chemical levels in your body needs to be balanced.

Notice a pattern yet?

The plethora of problems associated with over masturbation come from the fact that your body is drained of important nutrients and hormones from over masturbation.

Masturbation

Masturbation is a common act performed by men of all races and religions.

A commonality is found whenever middle-aged men confront me about premature ejaculation or erectile dysfunction; their private sexual practices are all the same.

The current medical/sexologist view is that masturbation is good and it is perfectly healthy. Masturbation is good and is healthy, but it does have its limits and like all good things, masturbation (and sex for that matter) can be come addictive.

While generally speaking, that may be a very true statement, it must be stated that over-masturbation kills sex and sexual performance ability.

Men who masturbate frequently seem to develop certain conditions. They are depressed, fatigued, lack concentration and suffer from male hair loss.

There are currently no serious studies to determine the effects of overmasturbation on the health of men, but it seems obvious a clinical correlation can be found.

Masturbation is the act of self-stimulation for sexual pleasure. People are programmed to be sexual creatures with sexual vitality, but what sets the human race apart from the lower rungs of the food chain is the factoring in of pleasure.

It has been noted that children at very young ages indulge in masturbation usually secondarily because of emotional trauma. It is the feeling of pleasure, self-induced, which the child and adolescent becomes dependent upon. However, this dependency can lead to health conditions later in life.

Masturbation frequently results in penis deformities. A common deformity is peyronies disease which is a bend in the penis. Usually in the vast majority of the cases, the bend curves opposite of the mans dominant hand side, leading one to think about the physics involved in the act of masturbation.

Some groups of individuals, generally from extreme religious backgrounds, believe that masturbation is a disgusting horrible act and subjects the partaker to damnation.

On the other end of the spectrum, lies the complete sexual permissiveness group which believes seminal discharge daily is your created right.

Like most things in life which affect your bodies function, processes and health, moderation is the key.

Sexual Vitality

vidently, there are many factors which seem to affect sexual vitality and performance.

Alcohol, nicotine, coffee, marijuana, and sugar are some of the pleasure drugs that may reduce sexual vitality, as can many pharmaceuticals, such as tranquilizers, antihypertensives, particularly beta-blockers, and hormones.

And don't think that age is a factor either. Young men are finding out very quickly ... their sexual vitality seems to take more and more of a back seat as their professional life begins to grow and develop.

Other factors that may influence sexuality include genetics, childhood upbringing, personal attitudes, and basic hormone levels. For example, men with higher testosterone levels and better adrenal function usually will have more sex drive.

Stress levels also can interfere directly with sexual vitality, sexual function and a man's sex drive. Often, underlying worries about money, job, and so on take our minds off sex. A recent study revealed that men who received raises or promotions at work increased their sexual frequency; the reverse happened to those who were demoted or whose pay was decreased.

Other Sexual Vitality Factors

Nutrition can also have a lot to do with sexual vitality, which clearly decreases with malnourishment. The focus of the diet is on antiaging and a healthy cardiovascular system. A wholesome diet low in fat and high in fiber and complex carbohydrates is a good place to begin. Any diet (and lifestyle) that maintains good circulation and normal weight and contains high-vitality fresh foods will lead to better sexual function.

A good protein intake is important, but excessive protein may interfere with sexuality. Likewise, adequate dietary fats and fatty acids are required for normal hormonal function. Cholesterol is a precursor of several sexual hormones, and if it is too low, this may lead to impaired sexual function and vitality.

Many of the foods traditionally believed to improve sexual function are from the ocean. Fish are thought to be good for brain and sexual function, especially the shellfish, such as oysters and clams. This may be because of their high levels of zinc. High-zinc foods have been thought to support male prostate function; pumpkin seeds, an old prostate helper, are high in zinc. Also from the ocean come the very-high-mineral seaweeds, which seem to support sexual function. Celery, especially celery root, is thought to be a mild aphrodisiac. Milk products such as cheeses and ice cream may have a sedative effect on sexual energy.

There are many specific supplements that influence sexual vitality, particularly vitamin E and zinc. Vitamin C, niacin, and the amino acid arginine also seem to support sexual function. Many glandular formulas are available, and some men and women may experience improvement with them. The idea that if we eat the organs or organ extracts from other animals to offer some essential help to our own corresponding organs is not a new concept and does make some sense, but there is no good research to substantiate the effectiveness of doing this.

Muslim Sex

A curious religious debate is raging in Egypt. The question is: should you keep your clothes on when having sex?

It began when Dr Rashad Khalil, an expert on Islamic law from al-Azhar university in Cairo warned that being completely naked during intercourse invalidates a marriage. His ruling was promptly dismissed by other scholars, including one who argued that "anything that can bring spouses closer to each other" should be permitted.

Another religious scholar suggested it was OK for married couples to see each other naked as long as they don't look at the genitals. To avoid problems in that area, he recommended having sex under a blanket.

Muslim Sex Views

It's not entirely clear whether Dr Khalil has considered the full implications of his edict. Doesn't the prospect of all those virile baton-wielding Egyptian riot policemen (for example) doing it in their boots and black uniforms sound just a little bit kinky? But we'll let that pass.

Unlike Christianity, which tends to be squeamish about sex, Islam has a long tradition of talking about it openly. Up to a point, this is much more healthy. While Catholic priests are enjoined to remain celibate, Muslim clerics are expected to marry and indulge heartily with their wives in the pleasures of the flesh. In many parts of the Muslim world, especially where folk are poor and uneducated, the local imam is the person many turn to for guidance on matters relating to sex and marriage.

Over the last few years, hundreds of Islamic "fatwa" websites have also sprung up on which clerics - often with uncertain qualifications - answer all manner of questions that have been sent to them by email, including questions about sex. Some of their answers about what "good Muslims" should or shouldn't do in bed are very explicit, so readers under 18 should stop here. While some of the advice is sensible, a lot of it is completely daft, so remaining readers over the age of 18 may wish to get a second opinion before putting it into practice.

Actually, it had never occurred to me that Muslims might be required to keep their clothes on during their most intimate moments until a few months ago when I was browsing through IslamOnline, the website supervised by the prominent (and controversial) Qatar-based cleric, Yusuf al-Qaradawi.

Delivering a fatwa on oral sex, 79-year-old Dr Qaradawi describes it as a disgusting western practice, resulting from westerners' habit of "stripping naked during sexual intercourse". But he continues: "Muslim jurists are of the opinion that it is lawful for the husband to perform cunnilingus on his wife, or a wife to perform the similar act for her husband (fellatio) and there is no wrong in doing so. But if sucking leads to releasing semen, then it is makruh (blameworthy), but there is no decisive evidence (to forbid it) ... especially if the wife agrees with it or achieves orgasm by practising it."

On this issue, Dr Qaradawi's views are more permissive than those of several other clerics on the internet. One states that oral sex is definitely forbidden, adding that "this hideous practice will draw the anger of Allah". Another, asked if oral sex is permitted, replies: "I don't know what is oral sex, please define it."

Muslim Masturbation Views

Masturbation is generally frowned upon by Islamic scholars, though they disagree about how sinful it is. The Inter-Islam website describes it as an indecent practice that has "crept into the youngsters of today". Masturbation has become prevalent, the website says, because of the modern tendency for young people to marry later (contrary to the advice of the Prophet). As a result, they feel a need "to fulfil their carnal desires but ... cannot do so in the normal way, ie sexual intercourse". Islamic Voice describes masturbation as an "abominable and wicked act" which is forbidden in Islam.

Other scholars argue that masturbation is basically forbidden but may be permitted if the person is unmarried or masturbates in order to avoid a more serious sin such as adultery, or if the masturbation is to release "sexual tension" rather than to fulfil "sexual desire".

In a fatwa for IslamOnline, Sheikh Mustafa al-Zarqa says: "I conclude that the general principles of sharia [Islamic law] go against this habit, because it is not the normal way of fulfilling sexual desire ... it is a deviation - and that is enough to condemn it, even though this act does not fall under the category of absolute prohibition."

Food and Sex Linked

Seafood and wine may not actually enhance the libido, but they're a tasty way to -- ahem -- "encourage" romance.

Health refers to a person's overall condition and implies a freedom from disease or at least a disease under control. Wellness is an amalgamation of physical and mental health promoted by proper nutrition, exercise and activities in general. When a patient asks their doctor about wellness, usually they start with nutrition. After all, food supplies all the necessary building blocks and fuel to run an organism.

Add sex to wellness, and the equation moves up a notch.

What is sexual wellness?

Wellness is as American as apple pie, but sex can be a prickly issue because it implies erotic activity.

The search for foods with aphrodisiac qualities started in the garden of Eden. Edible candidates through the ages included many foods, drinks, drugs and various love potions. More recently, fueled by the popularity of Viagra, the aphrodisiacs pendulum shifted from foods to drugs. It is time to look back and re-examine the links between foods and sexual health.

What are the myths?

A first-century B.C. Greek doctor recommended bulbs, snails and eggs to maximize semen production. A century later, Roman scholar and naturalist Pliny the Elder championed basil, pistachio nuts, turnips, lettuce seeds and river snails. Galen set the stage for centuries of aphrodisiac lore with his belief that effective semen delivery required foods with "windiness" qualities.

Near the beginning of the first millennium, life became more complicated. The ideal sexual stimulant was described as "nutritious, warm, and moist and that it generates windiness." This required the equivalent of ancient combination chemotherapy. Mixtures with multiple ingredients were popular.

The spice trade furthered this dependence on aphrodisiacs with multiple ingredients. Pepper and ginger led the list. "Spanish fly" became the street name for ground-up blister beetles. It supposedly causes sexual arousal by irritating the urinary tract.

In the dance halls of Louisiana towards the end of the 19th century, lusty young men would scatter dried chili on the floor in the hope of stirring the passions of their partners with the rising cloud of pepper dust. Today, chili is more of a cool-weather food with prodigious gas potential.

Columbus returned to Spain with all sorts of novel foods, including the sweet potato. The sweet potato took Europe by storm and became the Viagra of that period. By 1577, the English were calling it a "venereous root." In "The Merry Wives of Windsor," Falstaff fantasizes about being bombarded with sweet potatoes as he embraced a maiden.

In 1710, an English doctor advised boiling, baking or roasting sweet potatoes to "encrease Seed and provoke Lust, causing Fruitfulness in both sexes." As sweet potatoes became common, their attractiveness as an aphrodisiac vanished.

The Aztecs introduced subsequent Spanish invaders to chocolate, a New World food derived from cacao tree seeds. Chocolate contains several neurostimulants, including theobromine, caffeine and serotonin. Some folks describe a euphoria akin to effects from amphetamines and marijuana.

The Asian cultures are a graduate course in food and sexual stimulation. Chinese folklore recommendations for enhanced "sexual strength" include eel, raw egg, sake with turtle blood and garlic. Rhino horn and ginseng are Asian legends. Some garlic aficionados believe this "Italian rose" actually prevents sexually transmitted diseases. There is probably a grain of truth in this myth: It may be harder for heavy garlic eaters to find willing sexual partners.

Foods resembling male or female genitalia have always been favorites through the ages. Ancient favorites included carrots, orchid bulbs and our beloved oysters. As a food aligned with sex since the days of the Roman Empire, only the oyster still rates five stars.

Populations without oysters must make do. In the Bahamas, conch is the aphrodisiac food of choice. "You hear on the streets: `Hey mon, conch put lead in ya pencil.' People there eat it fried, diced in salads, ground in burgers and stewed all in search of better sexual health.

The bumper stickers say it all: "Eat fish, live longer; eat oysters, love longer."

Senior Sex

When the heart is willing but the flesh is weak, seniors search for solutions to a lack of senior sex.

They're using Viagra to get back their va-va-va-voom, turning to sex therapists for tips, donning their reading glasses for Sex and the Seasoned Woman or Better Than Expected: Straight Talk About Sex After Sixty.

And they're getting advice from clerks in adult retail shops about products that will better the bedroom experience.

Don't think your parents, or grandparents for that matter are concerned with sex in their senior years?

Think again my friends.

Senior Sex Statistics

Only about 5 percent of those 60 and older believe that sex should be left to the young, according to researchers for AARP, the nation's largest lobbying group for older people. About 85 percent of this age group has some sort of intimate experience once a week, including kissing or intercourse. The AARP poll of 1,682 people older than 45 had a margin of error of plus or minus 2.4 percentage points.

The final survey did reveal that sex, though not the most important part of life, is one important part of the majority of senior's lives.

Senior Sex Therapy

While the sexual revolution continues, the ability to perform has declined for many leaving seniors in the dust looking for answers.

Wanting to add a little something or restore what once was is what brings many clients to sex therapists who are seeing a steady increase in the number of older clients coming for advice over the past few years.

Of course, many of the couples need help in dealing with physical changes, such as menopause, andropause or problems maintaining erections. Viagra and similar medications have greatly improved sexual performance for many couples by addressing these issues.

Sexual dysfunction can increase with age, including complications of decreased amounts of circulating estrogen, cardiovascular disease and diabetes. Antidepressants can also alter libido.

But, when people ask about wanting to improve their sex lives, it isn't always based on physical problems. Often they don't have effective ways to communicate, something they developed early on in their marriage. If they had difficulties communicating 20 years ago, chances are they are still having problems today.

Everyone has to go through that and make decision and experiment to solve the mysteries of senior sex and sexuality, no matter how old.

Exploring your sexual side is a lifelong work in progress.

But don't overlook this basic fact ... senior sex is really about creating mutual erotic pleasure, not necessarily intercourse.

Is Testosterone synonymous with Sex Drive?

Testosterone is the primary male hormone or androgen. It is present as the male embryo develops, but its activity is not particularly pronounced until the onset of puberty.

At this stage, it is responsible for a young man's deeping voice, the growth of body hair, the development of his muscles and the maturation of his testicles.

Testosterone is also necessary for sexual activity.

In fact, its primary role in the adult male is to increase his sexual appetite. The amount of testosterone in the body therefore has an influence on the libido: the man with no or low testosterone has very little or even no interest in sex.

But you need to be careful.

This does not mean that testosterone is synonymous with sex drive. Interest in sex depends on a number of other factors:

• Education
• Age
• The man's personality
• His partner's personality
• The couple's particular situation.

In fact, all aspects of a man's life can affect his sexual desire.

Male Erection Types

The mechanics of erection are highly complex. However, it's important to remember that although an erection depends upon several factors, voluntary control is not one of them.

In short...not everything happens below the belt.

Becoming erect is the result of a perfectly balanced process involving the brain, blood vessels, nerves and hormones...in particular testosterone.

When a man is sexually excited, the brain triggers a series of reactions which cause the nerves in the penis to release neurotransmitters, which in turn causes a dilation of the penile blood vessels.

This dilation allows the penis to fill with blood.

As the cavernous and spongy bodies of the penis become engorged, the veins that normally drain the penis of blood are compressed so that most of the blood entering the penis can't drain out.

It's this engorgement and lack of venous blood drainage that brings about an erection.

After ejaculation, the accumulated blood flows out of the penis, which then regains its normal size in a flaccid state. It's also interesting to know that upon ejaculation, the nervous system closes the orifice between the urethra and the bladder, preventing semen from mixing with urine and vice versa.

Erection Types

Not counting the sexual activity erection, there are three kinds of erections:

• Reflex erections - common among children and babies. These are involuntary and take place without sexual stimulation. Among adults, they can be brought on by rubbing clothes or simply the vibration of a moving vehicle. Because this type of erection is controlled by a nerve center at the base of the spine and requires no input from the brain, men with spinal injuries that have not affected this area may get reflex erections.
• Psychogenic erections - occur when a man has sexual thoughts.
• Nocturnal erections- are not well understood. but it is known that healthy men of all ages have three or four each night with each erection lasting for 30 minutes.

Anatomy of the Male Genitalia

he male genital and reproductive organs are men's primary sex characteristics. The most important are the testicles, the epididymis, the prostate, the seminal vesicles, the duct sytem and of course...the penis (known affectionately as Herman the One-Eyed German by some.)

While the numbers show that male sexual dysfunction is widespread, fortunately our knowledge of the subject has evolved since the 1980's when it was originally believed that the majority of these problems were "all in the head."

For example...because there was no clear understanding of the mechanics of erection, it was generally believed that most erectile dysfunctions had a psychological cause.

Doctors of course, now know that in most cases physical health problems are responsible, and discoveries such as this have helped men come out of their shells and talk more openly about their sex lives.

Scientist continue to research the area of men's sexual health because the issue is becoming of increasing importance simply because the population is getting older, life expectancies are rising and most men (and women) expect to have sexual relations well into their golden years.

Regarding the elderly, their sexuality has always been a bit of a taboo subject in our society...until Viagra hit the shelves.

Pfizer, the makers of Viagra, undertook a massive study in 29 countries interviewing 26,000 people aged 40 to 80. Their study found that:

• 83& of men and 63% of women say sex is important in their lives.
• 40% of women say their partner's capacity does not diminish with age.
• 31% of the men polled disagree with that statement.
• 82% of men and 64% of women polled had sex within the polling year.
• 57% of men and 51% of women made love from one to six times a week over the last year.

Don't forget though...male sexual health statistics are like a woman in a bikini: what they show is nice, but what they don't reveal is essential.

Temporary Impotence

Did you fail to perform well in bed last night?

Did your erection fail mid-way?

Is the sudden failing erection giving you sleepless nights?

Stop chewing your fingernails over it and just admit it...Maybe you had your first bout of impotency.

Temporary impotence is a common occurrence, especially among young males and it can be caused due to several reasons, the most common of which is anxiety.

Other than that, stress, alcohol, tiredness or even having an unattractive partner can lead to temporary impotence. Most people associate it with a serious disease and are distraught at the thought. But temporary impotence can be cured much faster than long term impotence and on most occasions, it’s only a side effect of an underlying problem. Once that root problem is addressed, the temporary impotence disappears as soon as it arrived.

Primary Causes

You need to understand that an erection is the result of blood being pumped into the erectile tissues in the penis. It is when the penis is gorged with blood, that it looks full and erect. The blood being supplied is a two part action. When the penis is stimulated or the senses are aroused, a stimulus is sent to the nervous bundle which then pumps blood into the penis. When either one of these actions is interfered with then the penis fails to sustain an erection. So when you are suffering from a failing erection or aren’t able to get an erection at all, one of these two actions have failed. When you get too anxious, the sheer anxiety causes the nervous system to fail. The same results from depression, stress, overwork etc.

Temporary Impotence Cure

Do not even attempt self medication in such cases. Go and see a doctor. In most cases a couple of counseling sessions can cure the problem. In cases where medication might be necessary, the doctor will be the right person to identify the cause and prescribe medication accordingly. It may also be a side effect of an undiagnosed disease which may need immediate treatment. Diabetes is one of the common examples.

Keep Your Penis Healthy

So you've heard all about the most recent health kick advice...but did you know that keeping your penis healthy gets you far greater erection strength and stamina, as well as general sexual satisfaction.

Look at it this way...if you have a healthy penis you have a healthy sex life!

Older men know it sucks to age because as men grow older, their levels of testosterone, gradually decline starting roughly at about the age of 30 and continue to do so 10 percent every 10 years.

Yeah middle age!

What really sucks is that since testosterone is a hormone that helps maintain sex drive, sperm production, pubic and body hair, muscle, and bone, men don't know they are decreasing in testosterone until it almost too late.

The changes men experience are so slight and gradual over time that most men in middle age experience:

• Hair loss
• Bone loss
• Sweating and flushing
• Irritability
• Fatigue
• Loss of physical agility
• Increased fat
• Aches and pains
• Sleeping disorders
• Depression
• Decreased sexual drive and performance

With that in mind, getting and keeping a healthy penis should be priority one for all men. So stud, why not do your penis a favor and considering the following suggestions...

Penis Tips

You really should eat a healthy, well-balanced diet. Yes, I know those thickburgers are great and fill the void but to ensure normal erectile function, you need to keep the continuous flow of blood to the penis by taking care of the arteries that supply it...and those thickburgers simply don't help matters at all.

Men should consume a high fiber diet, low in saturated fats to prevent or reduce the build up of fatty deposits that narrow and clog penile arteries. Stay away from animal fats, sugar, fried or junk foods.

Dude, you should really quit smoking because smoking constricts blood vessels and leads to a build of plaque in the arteries that supply blood to the penis. Long term smoking (including pot) results in diminished erectile function, shrinkage of the penis, and impotence as far as current research has revealed.

Certain vitamins and minerals are good for maintaining general penile health, such as Vitamin A, Vitamin B complex, Vitamin C, Vitamin E, Chromium, Zinc, and L-arginine. While certain herbs such as Ginkgo biloba, Ginseng, Damania, Sarsaparilla, Wild yam, Saw palmetto, Dong quai, Gotu kola, Hydrangea root, and Pygeum, are known to be particularly helpful for weak erections or impotence. Be sure to consult with your doctor first.

You can also maintain healthy penis blood circulation by having regular erections and ejaculations.

Sound fun to me

Natural penis exercises not only ensure good circulation but can also aid in penis enlargement, both in length and girth.

Want to have a vigorous and healthy sex life in the future? Start by making the necessary changes today.

Positions For Mind-Blowing Orgasms

Is there such thing as “the best” lovemaking position?

Did you know the best positions for men and women are different? Also, did you know that by moving even one inch in any direction while in these positions, you can dramatically change the feeling and intensity of a position?

Take your time to find the best angles for the both of you, while using these positions.

The Best Position For Women To Climax

The reverse missionary is identical to the traditional missionary except that she is on top. This is probably the easiest position for a woman to climax because she can control the friction to her clitoris and/or G-spot.

Since you typically want the women to orgasm first, this would be one of your first positions and then move to a position where the guy has full control for his orgasm. You can vary your leg positions by both of you spreading your legs, or by alternating the one who has them spread and the one who has them together.

The Best Position For Men To Orgasm

Practically every animal species utilizes the rear-entry “doggy-style” position, so it is a natural one for humans to enjoy, as well. Although you won’t have face-to-face contact, there are many benefits. It is great for guys because it gives them full control.

This is one of the best positions for hitting her G-spot and allows you to fondle her breasts, stomach, clitoris, back, neck and other sensual spots. Even she can touch her clitoris in this position. She kneels before you (some women enjoy it more if their head is down on a pillow) and you enter her from behind. The main benefit for the guy is a view of her beautiful bottom and being able to see the action, while getting incredibly deep penetration (above-average guys need to be careful as deep thrusts might hit her cervix, which can be quite painful).

The Mistake Couples Make Using Lovemaking Positions

Of course, books show dozens, if not hundreds, of sexual positions, but the reality is that there are maybe only eight basic positions, with slight variations for each. So what happens when you've tried all eight positions to death? Let's face it––in the end, lovemaking is generally always the same.

That’s why you should explore ALL aspects of sexuality about each other. I don't mean anything freaky here. I just mean cultivate an adventurous spirit. Turn foreplay into a game. Add a prop or two. Try a new place. How about starting off with a plate of fruits? There are literally HUNDREDS of ways you can make your lovemaking more exciting, passionate and fulfilling long-term, rather than just trying new positions.

Naturally Increasing Libido

As men get older, we may notice a significant decrease in sexual appetite in ourselves or our significant other.

The loss of libido may signify loss of attraction, bad health, decreased testosterone and other hormonal issues, andropause or more serious problems such as erectile dysfunction.

For most men, a decreased desire for sex is a combination of poor habits, health issues and time-cramped lifestyles. The good news is that there are ways to help increase your libido naturally without drugs and without seeking medical attention. However, to naturally increase your waning libido, you'll need to commit to the necessary steps.

Improving Sexual Performance
The number one way to improve your sexual performance prowess is exercise. Unfortunately for you couch potatoes, it is true. Not only does regular exercise benefit your sex life, it helps you out in so many other ways as well. First of all, exercise gives you energy. Even if you are drop dead tired from the day's activities, you could spend a half hour to an hour at the gym and feel completely rejuvenated. One of the most incredible times to have sex is right after working out.....while you and your lover are washing off that sweat in the shower. Exercise also helps you to have a great night of sleep when you finally turn in for bed and being well rested is fundamental component for a healthy sex life.

Improving Your Sex Stamina
After exercise, diet is the next biggest factor in improving libido levels, if not it is the equal to exercise. As I have said before, testosterone production is necessary for sexual arousal as well as sexual stamina, but a bad diet can limit the production of this necessary hormone. For example, dehydration limits hormone production and therefore too much alcohol and caffeine can really do a number on your sex cravings.

Alcohol actually reduces the production of testosterone in men. Drunken sex might be fun while you are young but it just doesn't work as you get older.

Foods heavy in saturated fat can eventually clog arteries and lead to poor circulation which, as I stated above, plays a negative role in libido.

Let There Be Light
A surprising aid in libido increase is natural sunlight. Natural sunlight is detected by the body through the eye's retina. Natural light suppresses the production of melatonin in the body which is produced both in the retina and in the pineal gland of the brain. To make a long story short, melatonin produces hormones which suppress the natural appetite for sex in the body. You produce more melatonin in the winter months and less in the summer months when the natural sunlight is at a peak in volume.

This is why you seem a lot “hornier” in the summer than you do in the frigid winter. It could also explain why promiscuity and a heightened awareness of sexual activity is more prominent in the warmer and sunnier climates of the world.

Have you ever noticed that? Or perhaps its the great looking bikini's and thongs you see at the beach.

For couples that live in a colder and seasonal climate, you can still get boosts of natural sunlight with plenty of outdoor activities in the daytime such as skiing.

Prostatitis

Prostatitis
What is the prostate gland?
The prostate is a small organ located at the base of the bladder and wrapped around the urethra, the tube that empties the bladder through the penis. It sits in front of the rectum, and the back portion of the organ can be felt during rectal examination by a health care practitioner.

The prostate's purpose is to help with the male reproductive system. It makes up to 70% of the fluid that is ejaculated during intercourse, mixing its secretions with the sperm that are made in the testicles. The prostate also contracts at the time of ejaculation to prevent retrograde (or backward) flow of semen into the bladder.

Because of its location, the symptoms of any prostate problem tend to be associated with the bladder and can include urgency to urinate, frequency of urination, burning with urination (dysuria), poor urine flow, or inability to begin a urine stream.




What is prostatitis?
Prostatitis is the general term used to describe prostate inflammation (-itis). Because the term is so general, it does not adequately describe the range of abnormalities that can be associated with prostate inflammation. Therefore, four types of prostatitis are recognized.

What are the types and symptoms of prostatitis?

There are four types of prostatitis:

* acute bacterial prostatitis

* chronic bacterial prostatitis

* chronic prostatitis without infection

* asymptomatic inflammatory prostatitis


Acute bacterial prostatitis causes and symptoms
Acute bacterial prostatitis is an infection of the prostate that is often caused by some of the same bacteria that cause bladder infections. These include E. coli, Klebsiella, and Proteus. While it may be acquired as a sexually transmitted disease, the infection can also spread to the prostate through the blood stream, directly from an adjacent organ, or as a complication of prostate biopsy.

Patients with acute bacterial prostatitis present with signs of an infection and may have:

* fever,

* chills, and

* shakes.

Commonly there is urgency and frequency of urination and dysuria (painful or difficult urination).

Chronic bacterial prostatitis causes and symptoms
Chronic bacterial prostatitis is an uncommon illness in which there is an ongoing bacterial infection in the prostate. Chronic bacterial prostatitis generally causes no symptoms, however, on occasion; the low grade infection may flare and be associated with a bladder infection.

Chronic prostatitis without infection causes and symptoms
Chronic prostatitis without infection, also known as chronic pelvic pain syndrome, is a condition where there is recurrent pelvic, testicle, or rectal pain without evidence of bladder infection. There may be difficulties with painful urination or ejaculation, and erectile dysfunction. The cause of chronic prostatitis without infection is not clearly understood.


Asymptomatic inflammatory prostatitis causes and symptoms
Asymptomatic inflammatory prostatitis is exactly as its name describes. There are no symptoms. The cause of asymptomatic inflammatory prostatitis is not clearly understood.

How is prostatitis diagnosed?
The diagnosis of prostatitis relies on a careful history and physical examination by the health care practitioner.

The most important laboratory test is a urinalysis to help differentiate the types of prostatitis. The need for other blood tests or imaging studies like ultrasound, X-ray, and computerized tomography (CT) will depend upon the clinical situation and presentation.


Acute bacterial prostatitis diagnosis
After taking a history, the health care practitioner will likely have a directed physical examination concentrating on the scrotum, looking for inflammation of the testicle(s) or epididymis, and the flank and mid-back, where the kidney is located. If a rectal examination is performed, the prostate may be swollen and boggy, consistent with acute inflammation.

Laboratory testing may include urinalysis, looking for white blood cells and bacteria, signifying infection. The urine may also be cultured to identify the bacteria that are responsible for the infection, but results will take up to seven days to return. The results will help confirm that the antibiotic chosen is correct and may help choose an alternate antibiotic should the illness progress.


Chronic bacterial prostatitis diagnosis
The diagnosis is made by finding an abnormal urinalysis. Sometimes, a urinalysis is collected after prostate examination. This may allow some prostatic fluid to be expressed into the urine and cultured.

A blood test called PSA (prostate surface antigen) may be elevated in this type of prostatitis. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed.


Chronic prostatitis without infection diagnosis
To make the diagnosis of chronic prostatitis without infection, symptoms should be present for at least three months. The cause of chronic prostatitis without infection (chronic pelvic pain syndrome) is not known.

This is a frustrating condition for the patient and the health care practitioner since there is controversy as to the aggressiveness of testing, and exactly what tests should be done. Often, this is a diagnosis of exclusion, meaning that blood tests, urine tests, x-rays and ultrasounds tend to be normal, yet the patient continues to suffer.


Asymptomatic inflammatory prostatitis diagnosis
There are no symptoms with this type of prostatitis, however, when routine lab tests are performed, white blood cells (a sign of inflammation) are found in the urine, but there are no associated bacteria or infection.

What is the treatment for prostatitis?
Acute bacterial prostatitis treatment
Treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usually ciprofloxacin (Cipro) or tetracycline (Achromycin). Home care includes drinking plenty of fluids, medications for pain control, and rest.

If the patient is acutely ill or has a compromised immune system (for example, is taking chemotherapy or other immune suppression drugs or has HIV/AIDS), hospitalization for intravenous antibiotics and care may be required.

Chronic bacterial prostatitis treatment
Chronic bacterial prostatitis treatment is with long-term antibiotics, up to eight weeks, with ciprofloxacin (Cipro, Cipro XR), sulfa drugs [for example, sulfamethoxazole and trimethoprim, (Bactrim)], or erythromycin. Even with appropriate therapy, this type of prostatitis can recur. It is uncertain as to why, but it may be due to a poorly emptying bladder. A small amount of stagnant urine allows the potential for recurrent infection to occur. This situation can be caused by benign prostatic hypertrophy (BPH), bladder stones, or prostate stones.

Chronic prostatitis without infection treatment
Chronic prostatitis without infection treatment addresses chronic pain control and may include physical therapy and relaxation techniques as well as tricyclic antidepressant medications.

Other medication possibilities include alpha-adrenergic blockers. Tamsulosin (Flomax) and terazosin (Hytrin) are drugs that block the non-heart adrenaline receptors and are used in treating BPH and bladder outlet obstruction. Allowing better bladder emptying may help minimize symptoms.

Asymptomatic inflammatory prostatitis treatment

Treatment is not required for this type of prostatitis.

In patients undergoing infertility assessment, this inflammation may be treated with a course of either a nonsteroidal anti-inflammatory medication (ibuprofen, Motrin, Advil) or antibiotics.

What is the prognosis for prostatitis?

* Acute bacterial prostatitis is curable with a short course of antibiotics.

* Chronic bacterial prostatitis is often recurrent even with appropriate therapy. Fortunately, the disease tends to be asymptomatic.

* Chronic pelvic pain syndrome will be challenging for the patient and the health care practitioner. Symptoms tend to linger and be difficult to control.

* Asymptomatic inflammatory prostatitis is not clinically significant and does not require treatment.

Prostate Cancer

What is the prostate gland?

The prostate gland is an organ that is located at the base or outlet (neck) of the urinary bladder. (See the diagram.) The gland surrounds the first part of the urethra. The urethra is the passage through which urine drains from the bladder to exit from the penis. One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds. Another function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar. Semen is the fluid that transports the sperm. A man can manage quite well, however, without his prostate gland. (See the section on surgical treatment for prostate cancer.)

In a young man, the normal prostate gland is the size of a walnut. During normal aging, however, the gland usually grows larger. This enlargement with aging is called benign prostatic hypertrophy (BPH), but this condition is not associated with prostate cancer. Both BPH and prostate cancer, however, can cause similar problems in older men. For example, an enlarged prostate gland can squeeze or impinge on the outlet of the bladder or the urethra, leading to difficulty with urination. The resulting symptoms commonly include slowing of the urinary stream and urinating more frequently, particularly at night.


What is prostate cancer?
Prostate cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate gland. The tumor usually grows slowly and remains confined to the gland for many years. During this time, the tumor produces little or no symptoms or outward signs (abnormalities on physical examination). As the cancer advances, however, it can spread beyond the prostate into the surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread even farther) throughout other areas of the body, such as the bones, lungs, and liver. Symptoms and signs, therefore, are more often associated with advanced prostate cancer.


Why is prostate cancer important?
Prostate cancer is the most common malignancy in American men and the second leading cause of deaths from cancer, after lung cancer. Most experts in this field, therefore, recommend that beginning at age 40, all men should undergo yearly screening for prostate cancer.



What causes prostate cancer?
The cause of prostate cancer is unknown, but the cancer is thought not to be related to benign prostatic hypertrophy (BPH). The risk (predisposing) factors for prostate cancer include advancing age, genetics (heredity), hormonal influences, and such environmental factors as toxins, chemicals, and industrial products. The chances of developing prostate cancer increase with age. Thus, prostate cancer under age 40 is extremely rare, while it is common in men older than 80 years of age. As a matter of fact, some studies have suggested that among men over 80, between 50 and 80% of them may have prostate cancer!

Genetics (heredity), as just mentioned, plays a role in the risk of developing a prostate cancer. For example, black American men have a higher risk of getting prostate cancer than do Japanese or white American men. Environment, diet, and other unknown factors, however, can modify such genetic predispositions. For example, prostate cancer is uncommon in Japanese men living in their native Japan. However, when these men move to the United States, their incidence of prostate cancer rises significantly. Prostate cancer is also more common among family members of individuals with prostate cancer. Thus, a person whose father, grandfather, or even uncle has prostate cancer is at an increased risk for also developing prostate cancer. To date, however, no specific prostate cancer gene has been identified and verified. (Genes, which are situated on chromosomes within the nucleus of cells, are the chemical compounds that determine specific traits in individuals.)

Testosterone, the male hormone, directly stimulates the growth of both normal prostate tissue and prostate cancer cells. Not surprisingly, therefore, this hormone is thought to be involved in the development and growth of prostate cancer. The important implication of the role of this hormone is that decreasing the level of testosterone should be (and usually is) effective in inhibiting the growth of prostate cancer.

Environmental factors, such as cigarette smoking and diets that are high in saturated fat, seem to increase the risk of prostate cancer. Additional substances or toxins in the environment or from industrial sources might also promote the development of prostate cancer, but these have not yet been clearly identified.


What are the symptoms of prostate cancer?
In the early stages, prostate cancer often causes no symptoms for many years. As a matter of fact, these cancers frequently are first detected by an abnormality on a blood test (the PSA, discussed below) or as a hard nodule (lump) in the prostate gland. Usually, the doctor first feels the nodule during a routine digital (done with the finger) rectal examination. The prostate gland is located immediately in front of the rectum. As the cancer enlarges and presses on the urethra, the flow of urine diminishes and urination becomes more difficult. Patients may also experience burning with urination or blood in the urine. As the tumor continues to grow, it can completely block the flow of urine, resulting in a painfully obstructed and enlarged urinary bladder.

In the later stages, prostate cancer can spread locally into the surrounding tissue or the nearby lymph nodes, called the pelvic nodes. The cancer then can spread even farther (metastasize) to other areas of the body. The doctor on a rectal examination can sometimes detect local spread into the surrounding tissues. That is, the physician can feel a hard, fixed (not moveable) tumor extending from and beyond the gland. Prostate cancer usually metastasizes first to the lower spine or the pelvic bones (the bones connecting the lower spine to the hips), thereby causing back or pelvic pain. The cancer can then spread to the liver and lungs. Metastases (areas to which the cancer has spread) to the liver can cause pain in the abdomen and jaundice (yellow color of the skin) in rare instances. Metastases to the lungs can cause chest pain and coughing.


What are the screening tests for prostate cancer?
Screening tests are those that are done at regular intervals to detect a disease such as prostate cancer at an early stage. If the result of a screening test is normal, the disease is presumed not to be present. If a screening test is abnormal, the disease is then suspected to be present, and further tests usually are needed to confirm the suspicion (that is, to make the diagnosis definitively). Prostate cancer usually is suspected initially because of an abnormality of one or both of the two screening tests that are used to detect prostate cancer. These screening tests are a digital rectal examination and a blood test called the prostate specific antigen (PSA).

In the digital rectal examination, the doctor feels (palpates) the prostate gland with his gloved index finger in the rectum to detect abnormalities of the gland. Thus, a lump, irregularity, or hardness felt on the surface of the gland is a finding that is suspicious for prostate cancer. Accordingly, doctors usually recommend doing a digital rectal examination annually in men age 40 and over.

The PSA test is a simple, reproducible, and accurate blood test. It is used to detect a protein (the prostate specific antigen) that is released from the prostate gland into the blood. Most importantly, the level of the PSA is usually higher in people with prostate cancer than in people without the cancer. The PSA, therefore, is valuable as a screening test for prostate cancer. Accordingly, doctors usually recommend doing a PSA annually in men age 50 and over. Furthermore, for men who have high risks for prostate cancer as discussed above, most doctors recommend starting the PSA screening at an even younger age (for example, at age 40).

Results of the PSA test under 4 nanograms per milliliter of blood are generally considered normal. (See the next two sections on false-positive elevations of the PSA and on refinements in the PSA test.) Results between 4 and 10 are considered borderline. These borderline values are interpreted in the context of the patient's age, symptoms, signs, family history, and changes in the PSA levels over time. Results higher than 10 are considered abnormal, suggesting the possibility of prostate cancer. The higher the PSA value, the more likely the diagnosis of prostate cancer. Moreover, the level of PSA tends to increase when the cancer has progressed from organ-confined prostate cancer to local spread to distant (metastatic) spread. Very high values, such as 30 or 40 and over, are usually caused by prostate cancer.

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What are false-positive elevations in the PSA test?
False-positive elevations in the PSA are increases in the PSA that are caused by conditions other than prostate cancer. For example, benign prostatic hypertrophy (BPH) and infection or inflammation of the prostate (prostatitis) from whatever cause can elevate the PSA. Note also that even a rectal examination or an ejaculation within the prior 48 hours can sometimes elevate the PSA. False-positive elevations are usually in the 4 to10 range, but they can go as high as 25 or 30. At these higher levels, however, caution in the interpretation of the test is warranted because a prostate cancer may well be present. Non-prostatic diseases or infections, medications, foods, smoking, and alcohol do not cause false-positive elevations of the PSA.

The ability of the PSA test to detect prostate cancer (called the sensitivity of the test) is high. The reason for this is that most patients, although not all, with prostate cancer have a borderline or an abnormally elevated PSA. The ability of the test to exclude other diagnoses (called the specificity of the test), however, is lower because of the other conditions that can cause false-positive elevations of the PSA.


What refinements have been made in the PSA test?
Recently, several refinements have been made in the PSA blood test. The purpose of these refinements is to help doctors to better assess a borderline or an elevated PSA. The goal is to determine more accurately who has prostate cancer and who has a false-positive elevation of the PSA from another condition. In other words, the purpose of the improvements is to improve the sensitivity and the specificity of the test.

One refinement is called the PSA ratio. This ratio is determined by dividing the amount of PSA that circulates freely in the blood stream by the amount of PSA that is bound to proteins in the blood stream. Research has shown the PSA that circulates freely in the blood tends to be associated with benign prostatic hypertrophy (BPH) whereas the PSA that is bound to protein tends to be linked with prostate cancer. Thus, a high PSA ratio suggests a false-positive elevation of the PSA and weighs against the diagnosis of prostate cancer. In contrast, a high PSA with a low PSA ratio favors the diagnosis of prostate cancer.

Another recent modification of the PSA test is based on the observation that as men age, the amount of PSA in the blood can normally rise without the presence of a prostate cancer. Thus, doctors can use what is referred to as an age-specific PSA, especially to evaluate borderline values. In the age-specific PSA, the normal values are adjusted for the age of the patient. Accordingly, the age-specific normal ranges are 0 to 2.5 for men in their 40s, 0 to 3.5 in their 50s, 0 to 4.5 in their 60s, and 0 to 6.5 for men 70 and over. Therefore, as an example, a PSA of 4 would be considered borderline for men in their 30s and 40s, but could be normal for men in their 50s, 60s, and 70s.

Yet another improvement of the PSA test is called the PSA velocity or slope. The velocity is calculated as the rate at which the PSA changes with repeated testing over time. The more rapid the rise in the PSA, the more likely is the presence of a prostate cancer. The less rapid the rise in the PSA, the less likelihood there is that a prostate cancer is present.



How is prostate cancer diagnosed?
Prostate cancer is diagnosed from the results of a biopsy of the prostate gland. If the digital rectal exam of the prostate or the PSA blood test is abnormal, a prostate cancer is suspected. A biopsy of the prostate is usually then recommended. The biopsy is done from the rectum (trans-rectally) and is guided by ultrasound images of the area. A small piece of prostate tissue is withdrawn through a cutting needle. The TRUS-guided Tru-Cut biopsy is currently the standard method to diagnose prostate cancer. Classically a 6-core set is taken by sampling the base, apex and mid gland on each side of the gland. More cores may be sampled to increase the yield, especially in larger glands. A pathologist then examines the tissue under a microscope for signs of cancer in the cells of the tissue.

When prostate cancer is diagnosed on the biopsy tissue, the pathologist will then grade each of two pieces of the tissue from 1 to 5 on the Gleason scale. The scale is based on certain microscopic characteristics of the cancerous cells and reflects the aggressiveness of the tumor. The two scores are then added together. Sums of 2 to 4 are considered low, indicating a slowly growing tumor. Sums of 5 and 6 are intermediate, representing an intermediate degree of aggressiveness. Sums of 7 to 10 are considered high, signaling a rapidly growing tumor with the worst prognosis (outcome).

Gleason scores can be helpful in guiding treatment that is based, at least in part, on the aggressiveness of the tumor. The principal application of the Gleason score, however, is in predicting the risk for death from a prostate cancer. The tumor grade strongly affects the prognosis. Higher tumor grades are more frequently associated with lymph node and distant spread (metastases). Thus, recent studies have shown that men with Gleason scores of 2 to 4 face a minimal risk (4 to 7%) of death from prostate cancer over the ensuing 15 years, while men with scores of 8 to 10 face a high risk (60 to 87%) of death from prostate cancer over the 15 year period.


How is the staging of prostate cancer done?
The staging of a cancer refers to determining the extent of the disease. Once a prostate cancer is diagnosed on a biopsy, additional tests are done to assess whether the cancer has spread beyond the gland. For this assessment, biopsies of the surrounding organs, such as the rectum or urinary bladder, or of the nearby (pelvic) lymph nodes might be done. In addition, imaging tests are usually performed. For example, radionuclide bone scans can determine if there is a spread of the tumor to the bones. Additionally, CAT scans (coaxial tomography) and MRIs (magnetic resonance imaging) can determine if the cancer has spread to adjacent tissues or organs such as the bladder or rectum or to other parts of the body such as the liver or lungs. Newer scanning using a method called PET scan can sometimes help to detect hidden locations of cancer that has spread to various areas of the body.

In brief, doctors do the staging of prostate cancer based primarily on the results of the prostate biopsy, possibly other biopsies, and imaging tests. In staging a cancer, doctors assign various letters and numbers to the cancer, depending on which of the classifications for staging they use. The numbers and letters in the different classifications define the volume or amount of the tumor and the spread of the cancer. The stage of the prostate cancer, therefore, helps to predict the expected course of the disease and determine the choice of treatment.

Two main systems are used to stage prostate cancer. In the American urologic staging system, stage A describes a minimal cancer that can neither be palpated (felt) on physical examination nor seen by imaging techniques. Such a tumor is so small that it can be detected only by viewing it under a microscope. Stage B refers to a larger cancer that may be palpated, but that still is confined (localized) to the prostate gland. Stage C indicates local spread beyond the prostate into the surrounding tissues. Stage D1 signifies a spread to the nearby (pelvic) lymph nodes and D2 is for distant spread (metastasis), for example, to the bones, liver, or lungs.

The other main system for staging prostate cancer is called the tumor, nodes, and metastasis (TNM) classification. In this system, T1 and T2 are equivalent to stage A and B (respectively) in the American urologic system. T3 describes cancer that extends just beyond the capsule (coat) of the prostate, and T4 describes cancer that is fixed to the surrounding tissues. N1 is equivalent to Stage D1 and M1 is equivalent to D2.


What are the treatment options for prostate cancer?
Deciding on treatment can be daunting, partly because the options for treatment today are far better than they were ten years ago, but also because not enough reliable data are available on which to base the decisions. Accordingly, scientifically controlled, long term studies are still needed to compare the benefits and risks of the various treatments.

To decide on treatment for an individual patient, doctors categorize prostate cancers as organ-confined (localized to the gland), locally advanced (a large prostate tumor or one that has spread only locally), or metastatic (spread distantly or widely). The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy, hormonal therapy, cryotherapy, combinations of some of these treatments, and watchful waiting. A cure for metastatic prostate cancer is, unfortunately, unattainable at the present time. The treatments for metastatic prostate cancer, which include hormonal therapy and chemotherapy, therefore, are considered palliative. By definition, the aims of palliative treatments are, at best, to slow the growth of the tumor and relieve the symptoms of the patient.


What are the differences between hormonal treatment and chemotherapy?
Hormonal therapy is the mainstay of treatment for symptomatic advanced prostate cancer. Patients without symptoms, but with advanced disease, do not appear to have improved survival with treatment when compared with untreated patients. Therefore, treatment of patients with asymptomatic advanced disease is not essential. The treatments available for hormonal therapy are:

1. Orchiectomy is the surgical removal of the testicles.

2. Luteinizing hormone-releasing hormone agonists, otherwise known as Lupron and Zoladex, and antiandrogens, specifically a drug called Casodex, each produce symptomatic relief in about 80% of patients. Improvement is often dramatic.

3. Other agents that are helpful include the following: progrestins such as megastrol acetate given daily orally and other drugs that inhibit androgen production such as aminoglutethimide or ketoconazole. These agents are effective but are difficult to tolerate. Corticosteroids are often given simultaneously. As opposed to hormonal therapy, chemotherapy provides relief in only 20-25% of symptomatic patients with prostate cancer. Various regimens are being used. Estramustine, cisplatin, 5-FU, vinorelbine, and mitoxantrone are the most popular agents. However, recently Taxol has become the drug of choice used by oncologists in treating hormone-resistant prostate cancer.

When to use hormonal therapy and chemotherapy depends on the nature of the prostate cancer itself. If the prostate cancer is hormone-sensitive, then hormonal therapy is the therapy of choice. When the cancer becomes hormone resistant (for example, manipulation of the hormone levels has no effect on the prostate cancer), then the only potential therapy available to the patient is chemotherapy. Chemotherapy, then, is used generally when advanced prostate cancer is hormone-resistant. Unfortunately, chemotherapy coming after hormone therapy is nowhere near as effective as hormonal therapy because the cancer itself has often evolved to become more aggressive so that the prognosis is significantly worse. When patients' prostate cancer goes from being hormone-sensitive to hormone-resistant, the prognosis has taken a significant turn for the worse and the chemotherapy option at that particular time is usually the only treatment option available.

Other factors considered in choosing treatment include the age, general health, and preference of the individual and the Gleason score and stage of the cancer. The results of the PSA test sometimes also can help to decide on the treatment. For example, a borderline elevation of the PSA (4-10), if shown to be due to a prostate cancer, suggests that the cancer is confined to the gland. If other tests also point to an organ-confined tumor, surgery or possibly radiation can be considered to attempt a cure. In contrast, a very high PSA (for example, over 30 or 40) raises the possibility of metastases. If the metastases are then confirmed by other tests, the treatment options would be limited to hormonal therapy or chemotherapy.

PSA tests also should be done periodically after treatment to help assess the results of treatment. For example, an increasing PSA suggests growth or spread of the cancer, despite the treatment. In contrast, a decreasing PSA indicates improvement. As a matter of fact, a post-treatment PSA of zero may indicate complete control or cure of the cancer.

What about surgical treatment for prostate cancer?
The surgical treatment for prostate cancer is commonly referred to as a radical or total prostatectomy, which is the removal of the entire prostate gland. Since 1990, the radical prostatectomy has been the most common treatment for prostate cancer in the United States. This operation is done in about 36% of patients with organ-confined (localized) prostate cancer. The American Cancer Society estimates a 90% cure rate nationwide when the disease is confined to the prostate and the entire gland is removed. The potential complications of a radical prostatectomy include the risks of anesthesia, local bleeding, impotence (loss of sexual function) in 30%-70% of patients, and incontinence (loss of control of urination) in 3%-10% of patients.

Great strides have been made in lowering the frequency of the complications of radical prostatectomy. These advances have been accomplished largely through improved anesthesia and surgical techniques. The improved surgical techniques, in turn, stem from a better understanding of the key anatomy and physiology of sexual potency and urinary continence. Specifically, the recent introduction of nerve-sparing techniques for the prostatectomy has helped to reduce the frequency of impotence and incontinence.

If post-treatment impotence does occur, it can be treated by sildenafil (Viagra) tablets, injections of such medications as alprostadil (Caverject) into the penis, various devices to pump up or stiffen the penis, or a penile prosthesis (an artificial penis). Incontinence after treatment often improves with time, special exercises, and medications to improve the control of urination. Occasionally, however, incontinence requires implanting an artificial sphincter around the urethra. The artificial sphincter is made up of muscle or other material and is designed to control the flow of urine through the urethra.


What about radiation therapy for prostate cancer?
The goal of radiation therapy is to damage the cancer cells and stop their growth or kill them. This works because the rapidly dividing (reproducing) cancer cells are more vulnerable to destruction by the radiation than are the neighboring normal cells. Clinical trials have been conducted using radiation therapy for patients with organ-confined (localized) prostate cancer. These trials have shown that radiation therapy resulted in a rate of survival (being alive) at 10 years after treatment that is comparable to that for radical prostatectomy. Incontinence and impotence can occur as complications of radiation therapy, as with surgery, although perhaps less often than with surgery. More data are needed, however, on the risks and benefits of radiation therapy beyond 10 years, especially because late recurrences (reappearances) of the cancer can sometimes occur after radiation.

Choosing between radiation and surgery to treat organ-confined prostate cancer involves considerations of the patient's preference, age, and co-existing medical conditions (fitness for surgery), as well as of the extent of the cancer. Approximately 30% of patients with organ-confined prostate cancer are treated with radiation. Sometimes, oncologists combine radiation therapy with surgery or hormonal therapy in efforts to improve the long-term results of treatment in the early or later stages of prostate cancer.

Radiation therapy can be given either as external beam radiation over perhaps 6 or 7 weeks or as an implant of radioactive seeds (brachytherapy) directly into the prostate. In external beam radiation, high energy x-rays are aimed at the tumor and the area immediately surrounding it. In brachytherapy, radioactive seeds are inserted through needles into the prostate gland under the guidance of transrectally taken ultrasound pictures. Brachy, from the Greek language, means short. The term brachytherapy thus refers to placing the treatment (radiation therapy) directly into or a short distance away from the cancerous target tissue. The theoretical advantage of brachytherapy over external beam radiation is that delivering the radiation energy directly into the prostate tissue should minimize damage to the surrounding tissues and organs. The actual advantages or disadvantages of brachytherapy as compared to external beam radiation, however, are still being studied.


What about hormonal treatment for prostate cancer?
The male (androgenic) hormone is called testosterone. It stimulates the growth of cancerous prostatic cells and, therefore, is the primary fuel for the growth of prostate cancer. The idea of all of the hormonal treatments (medical and surgical), in short, is to decrease the stimulation by testosterone of the cancerous prostatic cells. Testosterone normally is produced by the testes in response to stimulation from a hormonal signal called LH-RH. The LH-RH stands for luteinizing hormone-releasing hormone and is also called gonadotropin-releasing hormone. This hormone comes from a control station in the brain and travels in the blood stream to the testes. Once there, the LH-RH stimulates the testes to produce and release testosterone.

Hormonal treatment, also referred to as androgenic deprivation (depriving the prostate of testosterone), can be accomplished surgically or medically. The surgical hormonal treatment is removal of the testes in an operation called an orchiectomy or a castration. This surgery thus removes the body's source of testosterone. The medical hormonal treatment involves taking one or two types of medication. One type is referred to as the LH-RH agonists. They work by competing with the body's own LH-RH. These drugs thereby inhibit (block) the release of LH-RH from the brain. The other type of drug is referred to as anti-androgenic, meaning that these drugs work against the male hormone. That is, they work by blocking the effect of testosterone itself on the prostate.

Today, most men electing hormonal treatment choose medication over surgery, probably because they view surgical castration as more devastating cosmetically or psychologically. Actually, however, the effectiveness and side effects of medical hormonal treatment as compared to surgical hormonal treatment are very much the same. Both types of hormonal treatment usually effectively eliminate stimulation of the cancer cells by testosterone. Some tumors of the prostate, however, do not respond to this form of treatment. They are referred to as androgen-independent prostate cancers. The principal side effects of all of these hormonal treatments (that is, the side effects of androgenic deprivation) are enlarged breasts (gynecomastia) that often are tender, flushing (like hot flashes), and impotence.

The LH-RH agonists, leuprolide (Lupron) or goserelin (Zoladex), are given as monthly injections in the doctor's office. The anti-androgenic drugs, flutamide (Eulexin) or bicalutamide (Casodex), are oral capsules that are used usually in combination with the LH-RH agonists. The LH-RH agonists are often effective alone. The anti-androgenic drugs are added, however, if the cancer progresses despite the use of the LH-RH agonists. The hormonal treatments may have value, as well, when combined with radiation therapy. Studies are currently being conducted to determine if hormonal therapy enhances the therapeutic effect of radiation.

Generally, hormonal treatment is reserved for individuals who have advanced prostate cancer with local spread or metastases. Occasionally, an individual with organ-confined (localized) prostate cancer will receive hormonal treatment because he has severe associated medical problems or simply because he refuses to undergo surgery or radiation. Hormonal treatment is used in less than 10% of men with organ-confined (localized) prostate cancer. Remember that the intent of hormonal therapy usually is palliative. This means that the goal is to control the cancer rather than cure it because a cure is not possible.


What is cryotherapy for prostate cancer?
Cryotherapy is one of the newer treatments that is being evaluated for use in the early stage of prostate cancer. This treatment kills the cancer cells by freezing them. The freezing is accomplished by inserting a freezing liquid (for example, liquid nitrogen or argon) through needles directly into the prostate gland. The procedure is accomplished under the guidance of ultrasound images. Actually, cryotherapy is not a new technique. Rather, it is a modification of a procedure that was tried previously, but had an unacceptably high rate of complications. Thus, cryotherapy was used in the 1960s to freeze the lining of the stomach to treat ulcers, but was discontinued because it also severely damaged the lining of the stomach.

At present, cryotherapy is recommended for patients with locally advanced prostate cancer who, for whatever reason, are not candidates for the more established treatments. Cryotherapy is further being studied to determine which other patients might benefit from this treatment. For example, studies are underway to establish whether cryotherapy is beneficial as an initial treatment for organ-confined (localized) prostate cancer. The effectiveness of cryotherapy in eliminating prostate cancer, however, has not yet been proven. We do know that sometimes the freezing liquid fails to kill all of the cancer cells. Moreover, the potential side effects of this treatment include damage to the urethra and bladder. This damage can cause obstruction (blockage) of the urethra, fistulas (abnormal tunnels) that leak urine, or serious infections.



What is chemotherapy for prostate cancer?
Chemotherapeutic agents, or chemotherapy, are anti-cancer drugs. They are used (for hormone resistant prostate cancer) as a palliative treatment (palliation to relieve symptoms) in patients with advanced cancer for whom a cure is unattainable. Recall that the goal of palliation is simply to slow the tumor's growth and relieve the patient's symptoms. Chemotherapy is not ordinarily used for organ-confined or locally advanced prostate cancers because a cure in these cases is possible with other treatments. Currently, chemotherapy is used only for advanced metastatic prostate cancers that have failed to respond to other treatments.

Several chemotherapeutic agents have been used effectively to palliate metastatic prostate cancer. One such agent is estramustine (Emcyt). Another agent, mitoxantrone (Novantrone), has been shown to be effective in combination with prednisone for palliating androgen-independent prostate cancer. As mentioned previously, metastatic tumors that have not responded specifically to hormonal therapy are referred to as androgen-independent (hormone-refractory) prostate cancers.

The more common side effects of chemotherapy include weakness, nausea, hair loss, and suppression of the bone marrow. The suppression of marrow, in turn, can decrease the red blood cells (causing anemia), the white blood cells (leading to infections), and the platelets (resulting in bleeding).

New chemotherapeutic agents for prostate cancer are continually being studied for their effectiveness and safety in cancer centers throughout the United States and elsewhere. For example, cancer specialists (oncologists) have been evaluating paclitaxel (Taxol) or docetaxel (Taxotere) for metastatic prostate cancer. (These two drugs are effective in palliating metastatic breast cancer.) Another one of the newer chemotherapeutic agents under investigation for androgen independent prostate cancer is Suramin.


What about herbal or other alternative medicine treatments for prostate cancer?
Alternative medicine, also called integrative or complementary medicine, includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. A major problem with most herbal treatments is that their composition is not standardized. Moreover, the way herbal treatments work and their long-term side effects usually are not known.

One new treatment for prostate cancer, new at least in the United States, is an herbal medicine called PC Spes. The name comes from PC, which stands for prostate cancer, and Spes, which is the Latin word for hope. In some initial trials of PC Spes in men who have failed the traditional treatments (hormonal therapy and chemotherapy) for advanced prostate cancer, this herbal medicine appeared to be promising. More rigorous studies are ongoing to evaluate more fully the risks and benefits of this treatment.


What is watchful waiting?
Watchful waiting is observing a patient while no treatment is given. Such a patient usually has an organ-confined tumor and no symptoms. Understand, however, that although watchful waiting involves no actual treatment, the patient still needs close follow-up and monitoring. The follow-up involves frequent visits to the doctor, perhaps every three to six months. The visits include questions about new or worsening symptoms and digital rectal examinations for any change in the prostate gland. In addition, blood tests are done to watch for a rising PSA and imaging studies can be conducted to detect the spread of the cancer. If the history, examinations, or any of the tests signal the possibility of an advancing cancer, the watchful waiting usually is discontinued and treatment is recommended.

This option of watchful waiting actually has been chosen over a therapeutic intervention, such as surgery or radiation, in up to 30% of patients who have organ-confined (localized) prostate cancer. The main reason for taking a course of watchful waiting is that prostate cancers generally grow more slowly than most other cancers. Thus, many localized prostate cancers found at an early stage can take years or sometimes even decades to spread locally and metastasize. Therefore, watchful waiting seems to make sense for organ-confined (localized) prostate cancers in men who are elderly. It is also a reasonable decision in men who have tiny (seen only with a microscope) tumors and a low PSA (for example, in the 4-10 range or lower). Additionally, watchful waiting often is the most appropriate choice in men who are ill with other serious medical diseases, such as heart or lung disease, poorly controlled high blood pressure, diabetes, AIDS, or other cancers.

Watchful waiting in prostate cancer, however, remains controversial. Some medical authors have stated outright that it is not a good choice. They point out that few doctors would just watch other cancers to see whether they would spread without treatment. Furthermore, the treatment for an individual could become less effective in the future if and when the cancer does progress. Finally, one expert summarized some recently published information on watchful waiting. He indicated that among men with organ-confined (localized) prostate cancer, the development of distant spread (metastasis) and death from the cancer was 50% higher in those who received no treatment than in those who underwent surgical removal of the prostate (radical prostatectomy).


Can prostate cancer be prevented?
No specific measures are known to prevent the development of prostate cancer. At present, therefore, we can hope only to prevent progression of the cancer by making early diagnoses and then attempting to cure the disease. Early diagnoses can be made by screening men for prostate cancer. Screening is done, as mentioned previously, by routine yearly digital rectal examinations beginning at age 40 and the addition of an annual PSA test beginning at age 50. The purpose of the screening is to detect early, tiny, or even microscopic cancers that are confined to the prostate gland. Early treatment of these malignancies (cancers) can stop the growth, prevent the spread, and possibly cure the cancer.

Based on some research in animals and people, certain dietary measures have been suggested to prevent the progression of prostate cancer. For example, low fat diets, particularly avoiding red meats, have been suggested because they are thought to slow down the growth of prostate tumors in a manner not yet known. Soybean products, which work by decreasing the amount of testosterone circulating in the blood, also reportedly can inhibit the growth of prostate tumors. Finally, other studies show that tomato products (lycopenes), the mineral selenium, and vitamin E might slow the growth of prostate tumors in ways that are not yet understood.


What will be the future treatments for prostate cancer?
The treatment of organ-confined prostate cancer to date has involved cutting out, radiating, or freezing the gland in trying to cure the disease. In more advanced cases, the goal has been to control the cancer for at least some time by using hormonal treatment or chemotherapy. Earlier diagnosis and improved treatment techniques in recent years have certainly led to better results. In addition, other treatments are being sought. For example, microwave treatment of the prostate is being used for benign prostatic hypertrophy (enlargement of the prostate, BPH) in a minimally invasive (minimal cutting or probing), outpatient (outside the hospital) procedure. Studies may soon begin to evaluate this technique as a treatment for prostate cancer.

The key to curing prostate cancer, however, ultimately will come from an understanding of the genetic basis of this disease. Genes, which are chemical compounds located on the chromosomes, determine the characteristics of individuals. Accordingly, investigators at research centers have focused on identifying and isolating the gene or genes responsible for prostate cancer. For example, studies are being conducted in men who have a family history of prostate cancer to try to uncover the genetic links of the disease. The investigators ultimately will try to block or modify the offending genes so as to prevent or alter the disease. Finally, perhaps a vaccine to either prevent or treat prostate cancer will be developed in the future.
Prostate Cancer At A Glance

* Prostate cancer is the second leading cause of deaths from cancer among US men.

* While the causes of prostate cancer are still unknown, some risk factors for the disease, such as advancing age and a family history of prostate cancer, have been identified.

* Prostate cancer is often initially suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on the prostate gland during a routine digital (done with a finger) rectal examination.

* The digital rectal examination (starting at age 40) and the PSA blood test (starting at age 50) should be done at yearly intervals to screen men for prostate cancer.

* Refinements in the PSA test, including the PSA ratio, age-specific PSA, and PSA velocity or slope have improved the accuracy of the test.

* If one of the screening tests is abnormal, the diagnosis of prostate cancer should be suspected and a biopsy of the prostate gland is usually done.

* The diagnosis of prostate cancer is made when cancerous prostatic cells are identified in the biopsy tissue under a microscope.

* In some men, prostate cancer is life threatening, while in many others, it can exist for many years without causing health problems.

* The choice of treatment for prostate cancer depends on the size, aggressiveness, and extent or spread of the tumor, as well as on the age, general health, and preference of the patient.

* The many options for treating prostate cancer include surgery, radiation therapy, hormonal treatment, cryotherapy, chemotherapy, combinations of some of these treatments, and watchful waiting.

* Research is underway to identify the genes that cause prostate cancer.





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