The following is an excerpt from the introduction of the book “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain” by Deborah Coady, MD, and Nancy Fish, MSW.

If you have ever felt pain during or because of sex, you are not alone.

It’s estimated that 16 to 20 percent of all women have had sexual pain at some point in their lives—that’s one in every five or six women. Compare that with the percentage of adults (men and women combined) who have asthma (7.7 percent), cancer (8.2 percent), or heart disease (12 percent), and you’ll see how shockingly common sexual pain is.

If sexual pain is more common than asthma, cancer, and heart disease, why do we often feel so alone with it? Probably because—unlike asthma, cancer, and heart disease—sexual pain is hard to talk about, even with a doctor. Most women reveal their condition only to a trusted few, and many women feel they can’t tell anybody, not even their partners. Most doctors—even the most enlightened gynecologists—are not experienced in treating sexual pain, and they too are often very uncomfortable discussing the subject.

Talking about sexual pain with your doctor can sometimes make you feel even worse than keeping silent. If you’ve tried to speak with a physician about your condition, you may already have been told—perhaps several times—that your problem is “all in your head,” that it stems from your bad attitude toward sex, or that there’s nothing that can be done to help you.

We’re here to tell you that none of that is true. Sexual pain is almost always caused by an identifiable, verifiable medical condition; it can be treated; and it is not in your head. Very few doctors understand what needs to be done, so help may be hard to find. You may already have been to several doctors, and in your search for effective treatment, you may still have to visit up to a dozen more.

Yes, it is just that difficult to find a physician who is either educated about sexual pain or willing to become so. But help is out there, treatments do exist, and once you find the right person to work with, you have enormous reason for hope. Please don’t give up on yourself and your sex life, because we promise you, something can be done.

A full and complete recovery is often possible. In many cases, although you may face some recurring flare-ups of your condition, you can look forward to long periods with no pain or only minimal discomfort. Even in the most difficult situations, you can experience a significant reduction in your pain and can find help for reintroducing sex as a joyous and nourishing part of your life. We promise: Things can get better.

***

Our book, “Healing Painful Sex,” is the product of our passionate belief that all women with sexual pain need both physical and emotional support. Our goal is to help you understand:

• what is causing your pain;
• how to navigate a complicated medical system;
• how to treat your pain;
• how to cope with your emotions;
• how to deal with your family and friends; and
• how to move on to a fulfilling life.

We begin, in Part 1, with “Naming the Problem.” We believe that isolation is deadly—especially for the intense experience of sexual pain. Chapter 1 will help you find ways to share your situation with one or two people who can help you make medical decisions and work through the emotions that inevitably arise.

In Chapter 2, we move on to doctors. Many of our patients have had horrific experiences dealing with arrogant, uninformed, or downright abusive physicians, and many more have been massively discouraged as they move from doctor to doctor, seeking help they cannot find. Just as rape victims feel that insensitive treatment by police and lawyers often constitutes a “second rape,” so we feel that callous treatment by doctors who should know better becomes a painful “second trauma.” We’ll help you understand what to do when doctors get it wrong—from the well-intentioned to the inexcusably crass and unfeeling—in hopes of helping you to heal emotionally and move on.

In Chapter 3, we explain how to find a doctor who will offer you effective treatment, and how to work with such a doctor once you’ve found him or her. We know it’s not easy to find the right doctor for sexual pain, but we’ll talk you through what you need to do, every step of the way.

Finally, because your healing shouldn’t have to wait until you locate the right doctor, we explain in Chapter 4 what you can do to start healing on your own. We’ll talk about immediate steps you can take to feel better, both sexually and generally, and we’ll help you gather your strength and hope for the healing journey ahead.

Part 2 is devoted to “Understanding the Problem.” Here we talk through each one of the medical conditions that might be the source of your sexual pain. In Chapter 5, we explain the biology of pain, so you can understand exactly what’s happening in your body and brain. We also explain inflammation—a medical condition that accompanies almost every form of sexual pain, and one you can begin to treat with diet, exercise, and lifestyle changes even as you seek more specific treatments. Finally, we offer a list of symptoms that will help you identify which of the other chapters in this section might apply to you.

Chapters 6 through 13 each focus on a specific medical condition that might be causing sexual pain. Each chapter discusses the biology behind the conditions, explains how your physician should be diagnosing the problems, and provides the latest information about available treatments. You’ll also read stories of our patients who have battled through these conditions to find help.

In Part 3, we talk about “Overcoming the Problem,” with an eye on helping you recover and move on. Chapter 14 looks specifically at how you can restore joy to your sex life—whether you are single or involved, and whether you relate sexually to men or women. In Chapter 15, we talk about how to restore trust and intimacy to sexual partnerships, friendships, and family relationships—all of which may have been affected by your ordeal. Chapter 16 helps you see how to move forward into recovery, so that your sexual healing can be complete. We also acknowledge that for some women, the process of recovery is an ongoing one—in which life can get better, but in which pain is always a potential visitor. For these women too, a joyous future awaits, even if it is sometimes shadowed by pain.

After you have completed our book, we hope you will be fortified to face the daunting task of attaining sexual health. Remember, you are not alone in your travels, and you can use this book as a medical and psychological resource and support.

We’ve made it our life’s work to help women with pelvic pain, and we want to help you too. As you read this book, it is our deepest wish that it will give you the knowledge you need to ease your pain.

Please don’t give up hope—you can get better!

From the book “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing, and Treating Sexual Pain” by Deborah Coady, MD, and Nancy Fish, MSW. Buy the paperback book or the Kindle ebook on Amazon.

MORE LIKE THIS FROM EM & LO:

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Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

During intercourse with my partner he stated I need to strengthen my muscles. I guess my grip was weak. I’ve had 3 c- sections in the past; the last was on 10/10/2002. I’ve never had anyone say this to me before. I’ve always had partners who complained about my vaginal walls being tight. Just a little confused.

– Tense

Dear T,

I don’t like that your partners are complaining about ANYTHING about your vagina. “Too weak”? “Too tight”? Imagine how they would react if you gave your assessment of their penis—too skinny, too small, too limp—during sex!

But whether you’ve had children (via vaginal delivery or c-section) or not had children, the elasticity of the pelvic floor muscles which surround the vagina can lessen over time — it’s a natural part of the aging process.  The good news is that, like any muscle, they can be strengthened and toned with exercise at any age. The exercises specific to the pelvic floor muscles are called Kegel exercises, and there’s great step-by-step instructions here. There are also safe toys you can use to help you with these exercises, like Lelo’s Luna Beads, Fun Factory’s Smartballs and the Kegelcisor.

Kegels will not only improve your pelvic tone—leading to less pee leakage as you age—but can make sex feel better for you as well. But like any work-out, it takes dedication and discipline, over time, to see results. So only do it if YOU want to.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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Every month, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

My erection isn’t at as high an angle as it once was (it’s a little droopier). Is there anything I can do to get that standing-at-attention look back?

– Droopy Dog

Dear D.D.,

The firmness of your erection is based upon a number of factors -– nerve stimulation, blood supply, and psychological attitude.  Depending upon your age, deficiencies in any, or all, of these components can lead to weaker erections.  This decrease in turgor will cause your erection to appear a bit “droopier.”  Let’s get one thing straight, though.  As men age, erections weaken a bit – that’s just an unfortunate fact.  While a healthy man should be able to attain erections adequate for sex for his entire life, the strength of that erection is unlikely to be the same at 50 as it was at 18.  So don’t be too critical with yourself.

First off, have you had any recent trauma, especially to the lower back or the groin area?  Have you been diagnosed with any medical problems, especially diabetes or high blood pressure?  Many medical conditions can lead to disruption of the nerve stimulation or blood flow required for an adequate erection.  In fact, erectile dysfunction is known to be one of the first signs of cardiovascular disease, and it is associated with an increased risk for a heart attack in the future.  If you have (or suspect you have) a medical problem, your first step is to have these conditions evaluated and properly treated by a medical professional.

If you are otherwise in decent health, an exercise program can certainly help.  Strong erections require adequate blood flow to the penis.  Just as regular cardiovascular conditioning can improve blood delivery to your heart and muscles, it can also improve blood flow to your penis.  And, if you smoke, quit.  Besides being probably the best thing you will ever do for your overall health, quitting smoking may help you regain that ready-to-go look.

While you’re getting in shape, be sure to exercise your pelvic floor muscles too. Most people assume kegels are just for women, but as men age or gain weight, the muscles surrounding the genital structures can begin to atrophy. Contracting and relaxing these muscles regularly may result in stronger erections, increased stamina, and more intense orgasms.

Don’t underestimate psychological factors.  We men are sensitive creatures.  Stress in any form can lead to decreased libido and erectile strength.  Financial difficulties, relationship problems, job pressure, boredom with or lack of attraction to your partner – all can weaken the ol’ fella.  If you think stress is playing a role, attack that problem first, or see a counselor if you have complex issues to address.  A little time off, if possible, may help.  Decreased anxiety is one of the reasons vacation sex is so great.  Alcohol, on the other hand, is not a good solution.  While a drink or 2 may loosen you up, too many drinks can cause “whiskey dick,” and excessive drinking is bad for you in general.

Finally, if none of these remedies help and your erection isn’t firm enough for intercourse (which actually doesn’t like your problem), you may be a candidate for pharmacologic treatment.  Phosphodiesterase inhibitors, such as Viagra®, work by amplifying the neurological signal from the brain.  This signal stimulates increased blood flow to the penis.  While these medications are indicated for those with physiological conditions leading to weakened erections, they also work very well (and are commonly prescribed) for men with psychosocial stressors.  There are a number of contraindications and side effects with these drugs, so see a doctor before using them (check out my article).  By the way, an abundance of “male enhancers” are marketed in nutrition stores and online, but I don’t know of any herbal or over-the-counter remedies that have been clinically proven to improve erections.

So, to simplify: eat well, exercise, get adequate sleep, quit smoking, limit alcohol consumption.  If these measures don’t work – see a doctor.

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

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• Everything You Wanted to Know About Kegels But Were Too Lazy to Ask
• Ladies-Only Poll: How Often Do You Kegel?
• How to Do Kegels (for HER)
• Dear Dr. Vanessa, What’s Up with Kegels?
• Dear Dr. Kate, How Do I Tighten Up Down There?
• Sales of LELO’s Luna Beads Soar Thanks to Fifty Shades of Grey

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I went to the gynecologist the other day and she said she could tell (during the internal examination) that I hadn’t been doing my kegels (I had a kid a few years back). Is this really true? Also, if I do start doing kegels, is it something I’ll need to do every day for the rest of my life, or is it something that you can do for a while to “get back in shape” and then stop doing?

– Elastica

Dear E,

Yes, your gynecologist would be able to tell if your pelvic floor muscles are weak.  There are several ways we can test the strength of a woman’s pelvic floor muscles.  Your doctor may have placed fingers in your vagina and then asked you to squeeze down on them.  Or she may have asked you to cough or bear down as she examined the outside of your vagina (your vulva), and noticed urine leakage.

The good news is that Kegel exercises are effective.  They strengthen the pelvic floor muscles that support the rectum, vagina, and bladder.  As your doctor probably told you, you know you are exercising the right muscles if you can stop your urine stream in the middle of urinating.  Once you practice enough when urinating, then you should switch to doing Kegels several times during the day when you are not urinating.  It is recommended that you contract your pelvic floor muscles for a count of 10, for five to 10 times, several times a day.  If you haven’t done them in a while, it may be hard to hold for 10 seconds, but with practice, you’ll be able to work up to holding them for that long.  Kegels are important because they can prevent or alleviate stress urinary incontinence — urine leakage from exercising, coughing, sneezing, or bearing down.

When Kegel exercises are done correctly, the pelvic floor muscles can stay strong for a long time.  One small study showed that five years after starting Kegels for stress urinary incontinence, 75 percent of women had no urine leakage.  Many of these women were either no longer doing Kegels or had dropped down to doing them once a week.  So, doing your Kegels can really pay off!

Kegels are also suggested to women and men as a way to improve orgasm — a whole other added benefit!

Best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.

*Neither Dr. Cullins nor Planned Parenthood endorse any products featured on EMandLO.com*

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• How to Do Kegels (for HER)
• How to Do Kegels (for HIM)
• Dear Dr. Joe, How Do I Strengthen My Erection?
• Everything You Wanted to Know About Kegels But Were Too Lazy to Ask
• Ladies-Only Poll: How Often Do You Kegel?
• Men-Only Poll: What Do You Know About Kegels?
• Dear Dr. Kate, How Do I Tighten Up Down There?
• Sales of LELO’s Luna Beads Soar Thanks to Fifty Shades of Grey

photo by robbie_jim

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City who answers your medical questions here once a week. To ask her your own question, click here.

Hello Dr. Kate,

My question is about the taste of my vagina. Both from what my boyfriend has said/his reactions and my own taste-tests, I know that sometimes I taste of nothing and sometimes almost bitter (even after showering). Is this change due to hormones, or is it like with men where the foods you eat affect your taste? Thank you so much!

– (Would Rather Be) Tasteless

Dear Tasteless,

Every woman has a unique taste that changes based on many things. At different times in your cycle, your taste can change from sweet to salty to sour. When you’re aroused, or if you’re sweating (or both), the flavor can also be different. And certainly having an infection (yeast or vaginosis) can cause your taste to change.

It’s unclear if diet can really change the taste of vaginal secretions — unsurprisingly, it’s hard to get funding to do such research. But anecdotally, different foods in your diet can change how you taste. The foods I hear about most: raw garlic, citrus fruits (particularly pineapple), strawberries, coffee, and asparagus. Even alcohol, nicotine and vitamins have the potential to change your taste. Violet Blue goes into further details that she learned while researching her book on cunnilingus.

I’d love to hear about this from you all… Have any of you (or your partners) noticed a change in your vaginal taste? What do you think it’s due to?

– Dr. Kate

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions on EMandLO.com. To ask her your own question, click here.

Dear Dr. Vanessa,

No matter how hard I try, I cannot female ejaculate. Is there something wrong with me (like a psychological issue that’s holding me back)? Or are some women just not built that way?

– Sally Sahara

Dear SS,

Female ejaculation is the spurting of fluid out of the urethra, the tube from the bladder to outside the body, during intense sexual excitement or orgasm. The fluid is most likely secreted by the Skene’s glands, which are located near where the urethra opens to the outside of a woman’s body. Female ejaculation occurs in one out of 10 women. Some authorities believe that female ejaculation is related to stimulation of the G spot. Others disagree.

Some authorities believe that many more women experience female ejaculation, but that the amount of liquid is so small it is not perceptible to the woman or her partner. But most women do not experience female ejaculation in any perceptible way when they have an orgasm or at any other time during sex. So, not experiencing female ejaculation is common and normal and will not prevent you from having an intense orgasm.

Some women think ejaculating heightens their orgasm. Others who ejaculate say it makes no difference in the quality of their orgasm. Some women find female ejaculation messy and entirely embarrassing and wish it didn’t happen. Some find it very enjoyable and sexy. Some partners like it. Some don’t.

A lot of people write about female ejaculation, and there are a lot of myths about it. Because of all the mythology about female ejaculation, some authorities worry that women who do not experience it will become anxious and think they have a sexual disorder, which is entirely wrong thinking.

Perhaps you have put it best yourself: some women are just not built that way. We do know that women’s sexual satisfaction is not associated with whether or not they ejaculate. There are very satisfied women out there who have never experienced female ejaculation.

In the meantime, best wishes for your good sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America. She generously shares her medical wisdom with EM & LO readers every few weeks.

Dear Dr. Kate,

Every time my boyfriend tries to give me a G-spot orgasm, it feels really good for about a minute. Then I get intense menstrual-like cramps and nausea and he has to stop so I can lay in the fetal position for a while till I can move again. The cramps dont stop for at least a few hours and I feel so stupid when it happens. Please help me!

– G-Whiz

Dear GW,

You’re not the only one who gets pain after orgasm. Called dysorgasmia by some, the pain is caused by intense muscle cramping that can spread to your back or even your rectum, and can last for minutes to hours. Nausea and even vomiting aren’t uncommon with the pain as well. I don’t know how widespread a problem like dysorgasmia is, because it doesn’t appear in the medical texts or literature – I’ve learned more about it from the internet and my patients than anywhere else. For some women it’s a sign of endometriosis, and suppressing their menstrual cycles helps. For others, reducing caffeine and taking an anti-inflammatory (high-dose ibuprofen or naproxen) two hours before sex seems to help. And some women have had to change their birth control method altogether to find relief. If the pain comes anyway, try heat – a heating pad, hot water bottle or soaking in a really hot bath as soon as the pain starts. If none of these measures work, please see your gyno.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions on EMandLO.com. To ask her your own question, click here.

Dear Dr. Vanessa,

What should I be doing (or not doing) to have the healthiest vulva/vagina? (Foods, cleaning, etc.)

– Spring Cleaning

Dear S.C.,

Treating your lady parts to a little TLC by backing off the multitude of vulvar and vaginal cosmetics that stack drugstore shelves is a great place to start. A lot of women don’t understand what is best for the good health of their vulvas and vaginas. They get all kinds of conflicting ideas from friends and relatives. Many women, for example, douche. Douching can cause vaginitis, so the first rule is: don’t douche unless your doctor or nurse advises you to do so.

Nobody wants a stinky bottom. Wipe well, always from front to back, after urination and bowel movements. Always make sure that you are not contaminating your vaginal opening or opening to the bladder with bowel movement. You may even consider fragrance-free wipes for use when you experience a particularly messy toilet experience or for more regular use when you are on your menstrual period or if you experience particularly heavy bleeds. Wash your vulva (the outside of your vagina) daily with mild soap and water. Rinse well and dry thoroughly after washing. Let towels dry between uses, and don’t share them. Keep the area around your genitals as dry as possible, so avoid sitting around in a wet bathing suit or gym clothes for prolonged periods of time, since the constant moisture might cause irritation or infection.

To keep your bottom dry, avoid wearing underwear and panty hose without cotton crotches or any kind of tight pants, pantyhose, or underwear that will prevent sweat from drying.

For more protection, avoid chemicals in perfumed or deodorant soaps, detergents, fabric softeners, bubble baths, powders, tampons, panty liners, and vaginal sprays. Also, you may want to forgo your next Brazilian bikini wax. It’s fine to remove hair from the area that is exposed while wearing a swimsuit, but a little hair down there is actually a good thing when it comes to protecting the vulva and preventing irritation.

Before or when you have sex, try to check your partner’s genitals for sores or discharge. Use a latex condom every time you have intercourse, unless you and your partner have no infections and no other sex partners.

In terms of dealing with infections that can irritate your vulva, eating plain yogurt containing live acidophilus cultures or taking tablets with acidophilus may reduce the risk of yeast infections. Remember, if you are being treated for vaginitis, be sure to use your entire prescription even if your symptoms have stopped. And don’t use anybody else’s medicine or medicine that has expired, as it won’t be powerful enough to take care of the infection. Use your medicine even if you get your period, and be sure to return for all your checkups.

Vaginitis is one of the most common reasons women seek health care. You should see your doctor or nurse whenever you have abnormal vaginal discharge and/or odor, irritation, bleeding, or pain, or whenever your symptoms have not been diagnosed or if your treatment is not working. It is best if you avoid intercourse during treatment. Having sex, especially if no condom is used, may aggravate your symptoms and interfere with the effectiveness of treatment. And remember, some medications for vulvar and vaginal infection are in an oil base which can weaken condoms and cause them to break — so not having sex until all medication has been used and the infection is gone is the best course of action.

Remember, in terms of daily care, for most women washing with mild soap and water once a day is all that is needed.

Thanks for the good question, and here’s to your continued sexual health,

Vanessa

Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America. She generously shares her medical wisdom with EM & LO readers every few weeks.

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions every few weeks on EMandLO.com. To ask her your own question, click here.

Dear Dr. Kate,

I’m a fully grown woman, about to turn 32. I’ve just noticed my vagina has changed ‘tone’, it appears I have begun to smell more like a woman in her 30′s, it’s hard to describe but definitely a change. Is this normal? Am I imagining things?

– Je Ne Sais Quoi

Dear JNSQ,

All vaginas don’t smell, or taste, the same…but they do all smell. Odor tends to come from sweat – the vulva and vagina have sweat glands, too. And the scent may change as our menstrual cycle progresses, in response to hormones, or at the end of the day. It’s also possible that it changes over time or with changes in diet. Noticing vaginal odor, if it’s your normal one, does not mean you don’t have good hygiene or (god forbid) should start douching. No need to buy those scented sprays, either – the chemicals may give you a bad reaction, and do you really want to smell like a spring meadow? So if you think your odor is different in a bad way, head to your gyno – make sure it’s not vaginosis, a lost tampon or condom (don’t laugh, it happens), an STD, or a bit of urine leakage.  But if you’ve been checked out by your gyno, then rest assured that your scent is normal.

– Dr. Kate
Gynotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. She generously shares her medical wisdom with EM & LO readers every few weeks. Check out more of her advice and ask her a question at Gynotalk.com.

Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

My erection isn’t at as high an angle as it once was (it’s a little droopier). Is there anything I can do to get that standing-at-attention look back?

– Flopsy

Dear Flopsy,

Okay, first things first. Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. That doesn’t sound exactly like your problem, but you may be on the way, so listen up.

Here’s how we get an erection. Excitement starts in our brains, causing arousal, and the brain sends a signal via the nervous system to the penile arteries. That signal says: open up and let the blood in. Blood flows in, and a chubby ensues.

A breakdown in this process at any point results in weakened erections and possibly erectile dysfunction. If the problem is in our heads (anxiety, lack of sexual interest, stress, etc.), then it is psychogenic. Brain can’t send the signal down to the arteries? Neurogenic. The signal arrives, but the arteries just don’t do their job? Well, that’s vasculogenic. Neurogenic and vasculogenic ED, frequently lumped together and labeled “organic” erectile dysfunction, imply that there is a physical problem, not just a psychological one.

Now, while it’s not “normal” to have erectile dysfunction, it certainly is very common – about 50% of men aged 40-70. And truthfully, a little decrease in your turgor with age is probably expected. We can’t be 18 forever! The most common etiology for erectile problems is vascular in origin, but in younger patients, I tend to see a lot of psychogenic erectile dysfunction as well.

So how can you get your stiffy back up to snuff? In essence, improving your erections involves reversing the abnormal process that is causing them. As you can imagine, that is not the easiest question to answer, given the variety of causes. But here’s some general advice:

Get enough sleep. Control stress. Get out of a bad relationship. Find a partner that you actually find attractive and care about. Stop smoking. Cut back on alcohol or quit altogether. Stop using recreational drugs. Try to minimize prescription medications if possible. Lose weight if necessary. Improve your diet. Exercise (both cardio and resistance).

Basically, improve your health. In fact, your erectile strength is a decent measure of your overall health, especially your cardiovascular health. Most of us have a pretty good idea about our unhealthy habits, so it’s up to us to have the discipline and motivation to change them.

Finally, please consider seeing a physician. ED is associated with obesity, diabetes, heart disease, high blood pressure, high cholesterol, and a myriad of other medical conditions. Get checked out — diagnosing problems early often finds them treatable and even curable. Your doctor might even offer some magic blue diamonds to help see you through some tough times…

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.