Sexual Health For Men: The Complete Guide.

Sexual Health For Men: The Complete Guide. Sexual Health For Men: The Complete Guide By Richard F. Spark, M.D.Perseus Publishing (2000); ISBN: 0-7382-0206-1; 440 Pages, Paperback; US$20.00; CAN $29.95; The Author Richard F. Spark, M.D., F.A.C.E. is an Associate Clinical Professorof Medicine at Harvard Medical School Harvard Medical School (HMS) is one of the graduate schools of Harvard University. It is a prestigious American medical school located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts. and Director of the SteroidResearch Lab at Boston's Beth Israel Deaconess Medical Center Both an international and regional referral center, Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts is a major teaching hospital of Harvard Medical School. It was formed out of the 1996 merger of Beth Israel Hospital (founded in 1916) and ,where he continues an active research program. The author of two otherbooks on male sexuality and fertility, he has written for The New YorkTimes Magazine and The New Republic on health related issues and haspublished widely in major medical journals. A Fellow of the AmericanCollege of Endocrinology and the American College of Physicians, and amember of the Endocrine Society, the Andrology Society, and theFederation of Clinical Research, he has a private practice in ChestnutHill, Massachusetts Located six miles west of downtown Boston, Massachusetts, Chestnut Hill is a wealthy suburban village notable for its stately old houses, scenic landscape, and the historic campus of Boston College. . Criticism The book contains a wealth of information related to men'ssexual health, with merely a few minor shortcomings worth mentioning: 1) "Impotence" with its negative connotation suggestingweakness, is used throughout the book. The terms "erectiledifficulty (ED)" or "erectile dysfunction" would havebeen preferable; the latter of these is only used a few times. 2) According to the book cover, Dr. Sparks' wants to addressmen in general and of all age groups. However, the focus is largely onheterosexual men, ignoring the homosexual population. Sex is oftendescribed as heterosexual sex between a man and his female partner, andnone of the case stories or references to couples mentions homosexualmen and couples. 3) As a sex therapist who helps clients focus on intimacy andpleasure without emphasizing sexual performance, some of the remarks Idisagree with: "....Ideally, the duration of thrusting will besufficient to allow the man and his partner to achieve orgasm at aboutthe same time (page 49)." It is implied that not only should one"ideally" achieve orgasm during sexual activity, but also itis desirable to climax simultaneously. This is in direct contrast to themessages I usually extend to my clients: that it is O.K. to have sexwithout climaxing at all, that instead of focusing on performance andgoals such as "achieving" orgasm, it is more important tosimply enjoy the existing intimacy between partners, whatever form itmay take. The statement "... the sexual act does not end withpenetration. Ejaculation must occur (page 76)" is a strong argumentand in my opinion not true. 4) References to only selected chapters are listed in the back andwithout numerical links in the text. This makes it impossible toidentify the exact origins of some of the statements made. In thesection on the risk of heart disease and sex, I was surprised that arecent study by Mueller et al. (1996) was not cited. Research has shownthat patients after a myocardial infarction (MI) benefit from enrollinginto a cardiovascular rehabilitation program. The low risk of triggeringa MI during sexual activity is nearly unchanged whether one has ahistory of heart disease or not. Regular exercise can reduce the riskeven further. 5) Incorrect terms such as "alpha impulses (page 25)","nerves of the alpha type (page 253)" and "alpha signals(page 253)" are used to describe physiological events duringarousal/erections. Maybe the author intended to present complex cellularevents in an easy, understandable language, but I believe that he hasintroduced confusing terms. Also, the substances nitric oxide (NO) andcyclic guanosine monophosphate cyclic guanosine monophosphaten.Cyclic GMP. (cGMP) are incorrectly described ashaving separate effects on smooth muscle cells (pages 26 and 104, table11.1). To my knowledge, as described in my appendix which follows, NOexerts its effects through the intracellular second messenger cGMP, andtherefore the two substances act through one and the same mechanism.Using correct terms, and based on recent research the mechanism oftumescence/detumescence is described in the appendix. The reasons why Viagra is not recommended (contraindicated) forpeople taking nitrates should have been mentioned following the section".... Men who routinely use a class of medication called nitrateslike nitroglycerine or isosorbide (Isordil), commonly prescribed toprevent or alleviate a form of heart pain called angina pectoris, shouldnot take Viagra. No ifs, ands, or buts (page 117)." The paragraphends here. In my opinion, an explanation, such as that given in theappendix related to why Viagra should be avoided in these cases wouldhave been appropriate. Positive Comments Sexual Health For Men deserves much praise. Dr. Sparks clearly is avery experienced endocrinologist with a thorough understanding of thefunction of male hormones. His section on the origin, release,metabolism and function of male hormones such as testosterone,dihydrotestosterone dihydrotestosterone/di��hy��dro��tes��tos��te��rone/ (DHT) (-tes-tos��te-ron) an androgenic hormone formed in peripheral tissue by the action of 5 on testosterone; thought to be the androgen responsible for development of male primary sex (DHT (Distributed Hash Table) A method for storing hash tables in geographically distributed locations in order to provide a failsafe lookup mechanism for distributed computing. ), dehydroepiandrosterone (DHEA DHEAdehydroepiandrosterone. DHEAabbr.dehydroepiandrosteroneDHEA,n dehydroepiandrosterone, a hormone precursor, exists naturally in yams. ), and anabolicsteroids is captivating, and the reader learns how male hormones affectprostate growth, hair loss, muscle mass and other bodily changes. Itbecomes clear how popular drugs such as Finasteride FinasterideDefinitionFinasteride is a drug that belongs to the class of androgen inhibitors, which means that it blocks the production of male sex hormones. It is sold in the United States and Canada under the brand names Proscar and Propecia. (Proscar, Propecia)exert their effects in the male body. This section of the book is trulyeducational, and the clinical vignettes make it entertaining. The chapters on different treatment options for erectiledifficulties, such as penile injection, vacuum devices, and penileimplants are informative as well. The author offers thorough and richlyillustrated explanations for how individual treatment options function.The book constitutes a valuable source of information for readers whowant to learn about contemporary treatment for erectile dysfunctions. Two other sections deserve praise: the chapters on the prostate andits problems, including prostate cancer; and the chapter on fertility.Again, readers may find valuable and up-to-date information on thesetopics, including detailed descriptions of physical exams, tests andtreatment options. In a separate chapter, The Lure of Alternative Medicine, Dr. Sparkoffers a fair discussion of why some alternative medicines work andothers do not. Ginseng, Vitamin E, Zinc, Yohimbine yohimbine/yo��him��bine/ (yo-him��ben) an alkaloid chemically similar to reserpine, from the bark of the yohimbe tree; it possesses alpha-adrenergic blocking properties and is used as the hydrochloride as a sympatholytic and mydriatic, and , and over-the-countermale hormones such as androstendione and DHEA are thoroughly discussed. The book ends with a discussion on normal ageing, the issue ofwhether or not to restore youthful hormone levels in mature men, andfinally an outlook on what is next for men in the new millennium. Conclusion Sexual Health For Men is truly a complete guide, an important andup-to-date resource for information about this wide topic. My praise forthis substantial book far exceeds my criticisms. I recommend SexualHealth For Men highly. Appendix by Dr. Owens: Physiological cellular events duringarousal/erections: The smooth muscle cells in segments of the penis (corporacavernosa) can either 1) relax, thereby allowing increased blood flow tothe penis, or tumescence tumescence/tu��mes��cence/ (too-mes��ens) swelling. tu��mes��cencen.1. A swelling or an enlargement.2. A swollen condition.3. A swollen part or organ. , or they can 2) contract, resulting indetumescence detumescence/de��tu��mes��cence/ (de?tu-mes��ins) the subsidence of congestion and swelling. de��tu��mes��cencen. , or the flaccid state of the penis. Both events may beinitiated in different ways, and it is ultimately the degree ofcontraction or relaxation of these smooth muscle cells that determineswhether the penis is flaccid or erect. Nerves to the penis release the neurotransmitter noradrenaline noradrenaline/nor��adren��a��line/ (nor?ah-dren��ah-lin) norepinephrine. noradrenaline (nōrˈ· (acatecholamine), causing stimulation of alpha-receptors on the surface ofadjacent smooth muscle cells. This leads to smooth muscle cellcontraction, allowing only limited blood flow into the penis, which isnow in the flaccid state, or undergoes detumescence if it was previouslyerect. Catecholamines CatecholaminesFamily of neurotransmitters containing dopamine, norepinephrine and epinephrine, produced and secreted by cells of the adrenal medulla in the brain. can also be released during stressful situationsassociated with sexual activity such as fear of failure, performanceanxiety, anger, shame, or embarrassment (Goldstein, 2000). Or they maybe released in painful situations such as genital pain from infection ofthe prostate, epididymitis, and Peyronie's disease, or non-genitalpain such as headache (Goldstein, 2000). In either case, smooth musclecells are stimulated to contract, resulting in reduced blood flow to thepenis and detumescence. To complicate matters further, different types of alpha-receptors(alpha-1 and alpha-2-subtypes) are located not only on the smooth musclecells, but also directly adjacent on the nerve-buds, from wherecatecholamines and other neurotransmitters are released. From thislocation alpha-receptors modify how much of the transmitter substance isreleased from the nerves, and then reaches the smooth muscle cells(Crenshaw and Goldberg, 1996). By blocking alpha-receptors on the smooth muscle cells with drugslike phentolamine phentolaminea potent a-adrenergic blocking agent; it blocks the hypertensive action of epinephrine and norepinephrine and most responses of smooth muscles that involve a-adrenergic cell receptors. (Regitine, Vasomax, mentioned on page 136),contraction of the smooth muscle cells can be prevented or at leastreduced, allowing an erection to persist longer. This is why the drugphentolamine is effective in the treatment of ED and is currently beingtested for possible FDA-approval as such a treatment option (Goldstein,2000). The drug is already used as a blood pressure lowering medicationfor people with pheochromocytoma PheochromocytomaDefinitionPheochromocytoma is a tumor of special cells (called chromaffin cells), most often found in the middle of the adrenal gland. , a condition where excesscatecholamines are produced in the body. Alpha-2-receptors are blocked by Yohimbine, an alkaloid obtainedfrom the bark of the African tree, Coryanthe yohimbe yohimbe (yō·himˑ·bē),n Latin name:Pausinystalia yohimbe; (Crenshaw andGoldberg, 1996; Morales, 2000). For over a century Yohimbine has beenused as an aphrodisiac, and only recently has it become clear thatYohimbine has central effects (in the brain), increasing sexual arousal,as well as peripheral effects, blocking the catecholamine inducedcontractility in the smooth muscle of the penis (Bancroft, 2000).Alpha-2 receptors are located throughout the body on blood vessels andin the intestines as well, which explains some of the side effects(indigestion, nausea, dizziness, headache) experienced following theintake of Yohimbine (Crenshaw and Goldberg, 1996). There are other ways smooth muscle cells in the penis can relax,resulting in an erection: During sexual arousal penile nerves releasenitric oxide (NO), which activates the smooth muscle cells to releasethe messenger cyclic guanosine monophosphate (cGMP) inside the cells. Itis this messenger signal which tells the contractile proteins inside thesmooth muscle cells to stop contracting and to relax. The more of themessenger cGMP that is available inside the cells, the more they relax,and the more blood is channeled to the penis through widened pass ways,causing tumescence and erection. Viagra enhances erections by increasing cGMP levels in erectiletissue smooth muscle cells. It increases the amount of intracellularcGMP by inhibiting its breakdown through the enzyme type 5phosphodiesterase phosphodiesterase/phos��pho��di��es��ter��ase/ (-di-es��ter-as) any of a group of enzymes that catalyze the hydrolytic cleavage of an ester linkage in a phosphoric acid compound containing two such ester linkages. (PDE 5). Viagra only works in men who are sexuallyaroused (take a Viagra, mow the lawn, and nothing happens) and whoproduce some cGMP on their own. The drug can enhance a minor erection bymaking sure that the cGMP produced stays around in the cells for a whilelonger, instead of being removed by PDE 5. For men taking heartmedication such as nitrates, Viagra can fatally potentiate po��ten��ti��atev.1. To make potent or powerful.2. To enhance or increase the effect of a drug.3. To promote or strengthen a biochemical or physiological action or effect. the medicineeffect and the cGMP released upon medicine intake may be increased todangerous levels, causing a potentially deadly drop in blood pressure.It is important to emphasize that this only applies to situations wheremen take Viagra while simultaneously being on nitrates, and that Viagraotherwise is a safe drug to use. It is of utmost importance that Viagrais prescribed by a doctor and is not shared or taken without adoctor's consent. References: Bancroft, J. (2000) Effects of alpha-2 blockade on sexual response:experimental studies with Delequamine (RS15385); International Journalof Impotence Research; Vol. 12, Suppl. 1, S64-S69 Crenshaw, T. L. & Goldberg, J. P. (1996) Sexual Pharmacology.Drugs That Affect Sexual Function. W. W. Norton & Company. New York.London; ISBN: 0-393-70144-1 Goldstein, I. (2000) Oral phentolamine: an alpha-1, alpha-2adrenergic antagonist for the treatment of erectile dysfunction;International Journal of Impotence Research; Vol. 12, Suppl. 1, S75-S80 Morales, A. (2000) Yohimbine in erectile dysfunction: the facts;International Journal of Impotence Research; Vol. 12, Suppl. 1, S70-S74 Muller, J.E. et al. (1996) Triggering myocardial infarction bysexual activity. Low absolute risk and prevention by regular physicalexertion; Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. ; 275, 1405-1409 Reviewed by Annette Fuglsang Owens, M.D., Ph.D.