Men's Health Guide to the Best Sex in the World

CHAPTER 11. BE THE WORLD'S MOST VIRILE MAN

Find the Most Effective Performance Enhancers

Nothing makes a man quite so uncomfortable as the idea of his equipment not working as well as it should. So we're going to do this as painlessly as we know how. Listen up.

The bad news is that our survey revealed that American guys lead the world in popping performance-enhancing pills. The good news: This chapter shows you how to avoid those prescription copays and uncomfortable transactions with the pharmacist by utilizing natural remedies and aphrodisiacs from around the world. Get ready to learn about the foods, supplements, and exercises that will help ensure optimum potency and function.

I Have Seen the Enemy, and His Name Is ED

There are two basic categories of male sexual dysfunction: ejaculation dysfunction, which usually refers to spontaneous or premature ejaculation, and erectile dysfunction (often abbreviated ED), the inability to achieve or maintain an erection long enough to have mutually satisfying intercourse. Not to jinx you or anything, but most men have at some point in their lives experienced one or both of these. Which means that if you haven't needed the information in this chapter yet, you probably will. And if you have, you're in good company.


QUICKIE STATS

Percentage of men who've taken a performance-enhancing pill:

1.

United States

21.0 percent

2.

South Africa

14.9 percent

3.

United Kingdom   

14.7 percent

4.

Netherlands

12.8 percent

5.

Philippines

12.5 percent

 

World average

11.0 percent


That said, there are a couple of ways to look at the vagaries of the penis. You can take them in stride, as a normal part of doing business, or you can cripple yourself with performance anxiety—which is pretty much a surefire way to make sure it turns into a real problem, not just the occasional fluke occasioned by stress, sleep deprivation, or other temporal causes.

We really can't caution you strongly enough against the second approach. “The men who are writing to me with their concerns about failed erections are getting younger and younger,” says Valerie Gibson, sex and relationships columnist for the Toronto Sun, “and I can't help but think that it's a function of their tremendous performance anxiety.” And we're not going to take away your porn, but it's possible that always being just two clicks away from a 10-incher jack-hammering away on command hasn't helped.

There is no need for any man to think that he is doomed to spend the rest of his life in celibate misery.

“It's hard on men because everything ‘hangs out,’ so to speak,” says Mike Perring, MD, the medical director of Optimal Health of Harley Street in London. “If you can't get or maintain a good erection, it's on display for the world (or at least you and your partner) to see.”

But don't despair. The one thing we have learned from interviewing both regular guys and experts, is that there are a lot of safe treatments available to you. “Providing he is prepared to seek help, there is no longer any need for any man who is worried about his virility to think that he is doomed to spend the rest of his life in celibate misery,” says British expert Graham Masterton, former editor of Penthouse and Penthouse Forum and author of Up All Night. So let's take a look at the disorders, how and why they happen, and what you can do about it.

Spontaneous Ejaculation

Sometimes men report coming without any sexual stimulation at all. Sounds like a good thing, no? Actually, no—it can happen during a very stressful situation, at the gym, or completely out of the blue. “I came a couple of times at the gym when I was lifting heavy weights. I wasn't even hard! It was incredibly embarrassing, and freaked me out big-time,” confesses Lachan, an Irish sales rep for a software company.

When you contract your pelvic muscles—as when lifting a heavy weight—they exert pressure on the prostate and seminal vesicles and can squeeze out some seminal fluid. And experts believe that spontaneous ejaculations under stressful conditions, such as during a stressful meeting, may be the body's way of trying to get you to relax. Spontaneous ejaculation is also sometimes a side effect of antidepressants. While it isn't as common as some other sexual side effects (such as delayed orgasm), it certainly has been documented as an effect that some men do experience.


TAKING GOOD CARE

Your wife or girlfriend examines her breasts once monthly. Why aren't you doing the same for the family jewels?

Although relatively rare, testicular cancer has a 97 percent cure rate when discovered early. So you should be on the lookout for it. When your balls are loose (chillin’-on-a-fine-summer's-day-type loose), gently roll each testicle between your fingers. It should be smooth and oval-shaped, feeling kind of like a hard-boiled egg without the shell. Compress it gently, searching for any hard areas or lumps that don't feel like the surrounding tissue. (The bump you'll find behind each testicle is simply the epididymis, the tube that carries sperm; no cause for alarm.) If you detect anything unusual, see your doctor.

And take yourself in for a yearly inspection. Once your equipment reaches age 40, have your prostate checked annually. This gland surrounds the urethra like a doughnut and, if allowed to enlarge, can reduce your urine stream to a dribble. Prostate cancer is also a concern. Both of these problems can be avoided if detected early.

A complete yearly inspection should include three things: (1) a digital rectal exam (yeah, sorry—digital as in “finger,” not “pixel”); (2) a blood test for prostate-specific antigen (PSA), an early warning sign of trouble; and (3) an ultrasound to create a visible image of the tissue.

Fun? Not particularly. But the alternative is even less so, so close the book and make an appointment. Or leave this page open and the woman in your life will do it for you.


The first line of defense? “Ejaculate more often,” says Laurence Levine, MD, director of the male sexual health and fertility program at Rush Presbyterian–St. Luke's Medical Center in Chicago. If that doesn't work and you're concerned, talk to your doctor or a sex therapist. But know that spontaneous ejaculation doesn't mean you're necessarily prone to premature ejaculation.

Erectile Dysfunction

Erectile dysfunction is defined as the inability to get or to sustain an erection. It is also “the principal cause of sexual unhappiness, bar none,” says Masterton.

As you know, the best defense is a good offense, and there's a considerable amount that you can do—right now—to reduce the risk of ED. Before we begin, let's review the basics. Your penis is equipped with twin hydraulic chambers called the corpora cavernosa. During sexual stimulation, these fill with blood until the penis grows firm and erect. After stimulation ends or there's ejaculation, blood leaves these chambers and the penis softens again. Blood goes in, blood stays in, blood goes out: An erection is all about bloodflow.

So it turns out that everything your doctor has been telling you for years—drop 10 pounds, watch your cholesterol, start a workout regimen—is good not just for your heart but for the Bald Avenger. It's probably no mere coincidence that Americans lead the international pack in the use of performance-enhancing drugs, given that we're world beaters in rates of obesity and related diseases as well.

There's an easy correlation between health and sex, summed up thusly: If it's good for your heart, it's good for your penis. Here's the list of do's and don'ts to prevent systems failure from becoming a problem.

Lose weight. If you're overweight—even a little—losing weight is the single best preventive act you can take to make sure you've got strong wood all the days of your life. Why?

image Weight loss will help you prevent atherosclerosis. In a great medical irony, being hard in the arteries can leave you soft in the shorts; atherosclerosis, or hardening of the arteries, is one of the leading causes of erectile dysfunction. “ED stands not only for erectile dysfunction but also for ‘early diagnosis,’ because you can use ED to predict a heart attack, potentially by years—arterial damage from cardiovascular disease affects the small arteries in the penis first,” says Christopher Steidle, MD, clinical associate professor of urology at the Indiana University Medical Center at Fort Wayne. Every one-point gain in total cholesterol correlates to an almost 1.5 times greater risk of erection problems. If that thought doesn't have you choosing the egg white omelette over the Lumberjack special, what will?

image Weight loss will lower your estrogen levels. “We know that heavier men convert testosterone to estrogen, and that a lower level of testosterone and a higher level of estrogen are not good for erectile function,” says Larry Lipshultz, MD, a Men's Health advisor and chief of male reproductive medicine and surgery at Baylor College of Medicine. Fortunately, even moderate weight loss can rid you of excess estrogen and put your sex life back on track. A study published in the Journal of the American Medical Association found that one-third of clinically obese men—body mass index (BMI) of 30 or higher—with erectile dysfunction showed improvement after losing 10 percent of their body weight. To calculate your BMI, multiply your weight in pounds by 703, and divide the result by your height in inches squared. If your BMI comes in close to or over 25, you may be carrying just enough lard to drag down your erections. In a 2003 Harvard study of more than 30,000 men, guys with BMIs over 28 had more than a 30 percent higher risk of ED than did men whose BMIs were less than 23.

image Losing weight will help you avoid diabetes. Besides the monastery, the quickest route to a lifetime of celibacy is to develop diabetes. In fact, more than 50 percent of all men with diabetes are impotent. The disease hits the penis with a double whammy. It speeds arterial disease and slows the transmission of stimuli along nerves throughout your body. A numb penis is not a happy penis. Staying trim is the best way to avoid diabetes. If it's too late for that, be vigilant in checking your blood sugar (talk to your doctor about the best methods). Men who are sloppy about controlling their levels have 70 percent more erection problems than those who stay on top of it, according to a recent Italian study.

Treat high blood pressure. “High blood pressure is an important cause of arteriosclerosis—and arteriosclerosis blocking the arteries to the penis may be the most common cause of erectile dysfunction,” says Thomas Lee, MD, professor of medicine at Harvard Medical School. But make sure to ask your doc for an anti-hypertension med that won't leave you limp.

Exercise. After studying more than 31,000 men, researchers at the Harvard School of Public Health reported that those who were physically active had a 30 percent lower risk for erectile dysfunction than men with little or no physical activity. If the opportunity to lose that spare tire isn't enough to drive you to the gym, perhaps the thought of losing your erection is.

And in another study, researchers found that men who walked just 2 miles a day had half the rate of erection problems of more sedentary men. (Twenty minutes of jogging or 30 minutes of weight training will work, too.)

Researchers reported that men who were physically active had a 30 percent lower risk for ED.

“Guys tend to think of their arteries as simple pipes that can become clogged, but there's a lot more going on than that,” says Dr. Levine. “The linings of those blood vessels are very biologically active areas where chemicals are being made and released into the bloodstream.” The more you exercise, the healthier, cleaner, and more flexible those linings become.

Don't smoke. If you still light up, you've probably accepted your increased risk of heart disease, stroke, lung cancer, and bladder cancer. But if the stinking clothes, yellow fingers, and chunks of lung hacked into your palm haven't convinced you to stop smoking, what about coming up soft in bed?

Consider the evidence:

image A study from the New England Research Institutes in Watertown, Massachusetts, shows that around 30 percent of smokers experience impotence. The good news? Quitting now may lower your flop risk to where it was in your pre-smoking days.

image A study published in the Journal of Urology found that smoking causes arterial damage that doubles a man's risk of total erectile dysfunction. But, “if men quit in their fifties or earlier, we can usually reverse the damage,” says Andre Guay, MD, director of the Lahey Clinic for Sexual Function in Massachusetts. When Dr. Guay measured nighttime erections in 10 impotent smokers (average age 49), he noted a 40 percent improvement after just 1 smoke-free day. Swap the cancer sticks for fish sticks: Researchers at the Royal College of Surgeons in Ireland discovered that taurine, an amino acid found in fish, helps heal smoke-damaged arteries.

image In a study conducted at the University of Kentucky, researchers found that when asked to rate their sex lives on a scale of one to 10, men who smoked averaged about a five—a far cry from nonsmokers, who rated theirs at nine.

image There's some evidence that smoking affects erection size. In one study, researchers found that smokers’ penises are significantly smaller than non-smokers’. “In addition to damaging blood vessels, smoking may cause damage to penile tissue itself, making it less elastic and preventing it from stretching,” says Irwin Goldstein, MD, a urologist at the Boston University Medical Center. We have yet to hear a better reason to quit.

Don't freak out. Everyone knows that stress is a psychological cold shower. But untamed tension also works in a more insidious way—by releasing epinephrine, a type of adrenaline that goes straight to your arteries and slowly wreaks havoc there. “Stress in the long term can contribute to hardening of the arteries,” says J. Stephen Jones, MD, author of Overcoming Impotence: A Leading Urologist Tells You Everything You Need to Know.

The fix: Force yourself to concentrate on each of your five senses for a few minutes every day—the feel of the steering wheel in your hands, the sound of the engine revving to redline, the sight of the hot brunette in the next car. . . . “Obsessing on stressful thoughts will increase your epinephrine,” says Jay Winner, MD, author of Stress Management Made Simple. “On the other hand, if you focus on current sensations, it decreases the epinephrine and ultimately improves your ability to have an erection.” Or do the relaxation exercise featured on page 210 a couple of times a week.

Strap your boys in. You wear a helmet when you ride your motorcycle; you wear a seatbelt every time you get behind the wheel of a car. So what are you thinking when you take to the court for your weekly pickup game wearing only briefs?


ANOTHER REASON LEISURE SUITS WENT OUT OF STYLE

Wearing polyester underwear may contribute to impotence because of the static electricity generated by man-made materials. Loose, 100 percent cotton shorts are recommended instead. Time to get rid of that tiger-striped boulder holder.


A recent study in the Clinical Journal of Sports Medicine found that 47 percent of high-school and college male athletes involved in contact sports do not wear any kind of genital protection. The upshot? These Darwin Award winners are less likely to breed and pass on their genes.

It's highly recommended that you wear an athletic supporter for activities that involve running, jumping, and sudden movement. This device tucks the testicles close to the undercarriage to protect them from jarring. For complete security, wear a cup.

If you do take a ball—or a knee—to the groin, lie down, apply an ice-packed cloth, and take some deep breaths. If there's swelling and the pain doesn't subside within a few minutes, continue the icing and get to a hospital. A severe groin injury can cause sterility.

Talk to your doctor about your medications. “A lot of prescription drugs may be associated with sexual dysfunction,” says R. Taylor Segraves, MD, PhD, coauthor of Sexual Pharmacology. Open your medicine cabinet, write down the names of the prescription drugs you pop, and go to www.MensHealth.com/drug for a full list of erection offenders.

You're going to be surprised at how long the list is, and the popularity of many of the drugs on it. For instance, one possible culprit is the cholesterol-lowering drug simvastatin, brand name Zocor. If you're taking one of the drugs on the list (or anything else you suspect might be causing a problem), talk to your doctor. Often, a similar pill, sans side effects, is on the market.

Get a vasectomy. If you're finished producing offspring (or you're 100 percent sure you don't want any in the first place), consider investing in permanent renovations at the sperm factory. “The risk of a contraceptive failure can be a big source of anxiety for some men, especially those who've had a birth-control disaster—or a scare—in the past,” says Karen Donahey, PhD, director of the sex- and marital-therapy program at Northwestern University. That anxiety can, in turn, lead to erection problems—and cause the same vicious circle that makes performance anxiety such a mood killer.

Do your Kegels. Go figure—one of the best ways to treat erectile dysfunction is to pretend that you suffer from premature ejaculation. British researchers discovered that the traditional treatment for a hair trigger—strengthening the pelvic floor muscle—is also a remedy for men who can't point their pistols. In the study of 55 impotent men, 40 percent of those who practiced pelvic floor exercises, a.k.a. Kegels, every day for 6 months regained normal sexual function. Apparently, the same muscle contraction that's used to stop peeing midstream can also prevent blood from escaping during an erection. Researchers at the University of Milan in Italy also found that stronger pelvic muscles lead to stronger erections.

Contract and relax your pelvic muscles anytime you're sitting or lying down. Work up to doing 18 contractions daily, holding each one for 10 seconds. Or, every time you get an e-mail at work, do six quick flexes. Hold the last one for 5 seconds.

Get lots of sleep. We know—you hate to give up on one minute of postcoital pillow talk, but ultimately you're going comatose for her benefit. Your penis needs as much shut-eye as it can get. Every night while you sleep, you have between three and five hour-long erections. You probably noticed this phenomenon the last time you had to pee at 4:00 a.m. Those erections are not there just to make life interesting for your bedmate. They work to recharge your penis—keeping it well nourished with oxygenated blood. “Theoretically, the more nocturnal erections you have, the more flexible your erectile tissue will become. And that may help keep erections strong as the years wear on,” says Marc Goldstein, MD, professor of reproductive medicine and urology at Cornell University Medical College.

But don't snore. Snoring can sabotage a night of sex, and not just because it's difficult to engage in foreplay from the couch. “All of your tissue needs oxygen to be healthy, and the penile tissue is especially sensitive,” says Dr. Jones. “When you snore, you're depriving your tissue of that oxygen.”


NONE FOR THE ROAD

Operating your penis while under the influence of alcohol can severely impair its performance. If this has been an issue for you in the past, try alternating an alcoholic drink with a glass of water if you suspect that the evening will end up in naked revelry. (And order wine, not champagne; bubbles speed absorption of alcohol, depressing your testosterone levels and decreasing penile blood flow.)


Roughly half of men who snore also have problems with erections, according to Mansoor Madani, DMD, a sleep apnea expert at the Bala Institute of Oral Surgery in Bala Cynwyd, Pennsylvania. When you snore, tissues in your throat vibrate and can block your windpipe, temporarily stopping your breathing. This can impair bloodflow to other vital areas, says Dr. Madani.

That said, don't waste your money on over-the-counter snore stoppers; research by the US Air Force shows that these products aren't effective. Instead, try placing bricks under the bedposts at the head of the bed. “Snoring has a lot to do with gravity,” says Phillip Westerbrook, MD, founder of the sleep-disorders center at the Mayo Clinic. “If you elevate the torso without bending the neck, it changes the effect of gravity on the soft tissues of the throat.”

If that doesn't work, snoring can usually be cured by outpatient laser surgeries that take 15 minutes and reduce snoring by more than 70 percent. Now if they could only do something about night drool.

Don't do drugs. Another reason to just say no. Cocaine may enhance sexual pleasure and delay ejaculation, but prolonged use will compromise function, while heroin and other morphine-type drugs neutralize sexual interest and ability right off the bat. This is your penis. This is your penis on drugs. . . .

Don't sleep around. It's common for men who start having affairs to stop having erections—so common, in fact, that doctors who treat erectile dysfunction often ask their patients if they're getting any action on the side. Unless your wife knows about, approves of, and participates in your new sex life—in which case, we'd like to meet her—you're bound to feel at least a little guilty about it when you're with her. Guilt can turn to anxiety, and that can kill an erection.


IT REALLY DOES HAPPEN TO EVERYBODY

And it really is a bigger deal to you than it is to her. So shake your sulk and salvage the evening by focusing your energy entirely on her. Let your fingers and tongue do the walking. This will waylay her silent worry that it's her, not you. And her expressions of gratitude might just be the magic you need. At the very least, you guarantee that she'll be talking about what you did, not what you didn't do, over Cosmopolitans tomorrow.


Turn on the lights. Men need visual stimulation to become really excited. In fact, in a Men's Health survey, that annoying female preference for making love in the dark was the number-one complaint men had about women in bed. If that 500-watt deer lamp you hung in the bedroom makes your partner self-conscious, then compromise with some soft candlelight or perhaps a black light, which makes skin look tan and sexy.

Okay, so we've reviewed your preventive options. Following most of them is good advice anyway. But what if you're regularly experiencing difficulties getting or maintaining an erection? It's still not time to panic. In fact, as Dr. Perring says reassuringly, “There's quite a lot that we can do for people.” Here are some strategies.

Get help. In the same way that your penis is a barometer of your general physical health, it can also be a pretty accurate indicator of your mental state. Depression, anxiety, relationship problems, and stress are all leading causes of erectile dysfunction. While medications and some of the other solutions to follow can help you to perform no matter what, it would be foolish to ignore such a clear warning sign that you're in a troubled state of mind. Your doctor can refer you to someone to talk to, or you can contact the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) at www.aasect.org.

Relax. The ability to truly let go is a skill that's increasingly hard to master in our fast-paced culture. Think about how you reacted the last time you were stuck in traffic, missed your train, or ended up on the losing side of an argument with a colleague or your spouse. Work worries, financial anxiety, relationship troubles, exhaustion—all of these can mess with the working order. “For me, especially as I have gotten older, tension is a boner-killer,” says Liam, an Irish lawyer. “If I am stressed about work, annoyed at my wife, worried about the children, I have difficulty getting cooperation from my penis. The best remedy for me is relaxation—a vacation, a massage, just to breathe.”

Depression, anxiety, relationship problems, and stress are all leading causes of erectile dysfunction.

Easier said than done, perhaps, but we've said it before, and we'll say it again: Just about every man experiences the occasional problem. Worrying about it will just make the whole situation worse the next time—and can lead to a serious psychological problem: Tension and pleasure don't mix.

Relaxation is so important that sex surrogates trained to work with men with sexual dysfunction often open with a relaxation exercise. Select a place where you won't be disturbed, lie on your back, and close your eyes. Starting from the tip of your toes and working up, tense and relax every muscle group you encounter. When you're done, stay there, listening to your breath, for about 15 minutes. It's like a vacation, honestly.

Enter softly. In their book The Multi-Orgasmic Man, Mantak Chia and Douglas Abrams describe a Taoist sex practice used as a treatment for impotence. The solution? Have sex anyway. It's called “soft entry.”

Making sure that your partner is well-lubricated, create a ring with your thumb and forefinger around the base of your penis, pushing the blood into the tip. Keeping your fingers where they are, insert your penis into your partner's vagina and begin to move. Squeeze your buttocks and perineum in order to move blood into your penis. In most cases, your penis will become engorged, and you can remove the finger ring.

Get pricked. Sometimes it is all in your head. If you think that you, well, think too much, see an acupuncturist. The results of a study published in the International Journal of Impotence Research suggest that acupuncture can help treat psychologically induced erectile dysfunction. (Relax—the prick points are all in your back.)

“In psychogenic erectile dysfunction, the patient has trouble with the balance of his sympathetic and parasympathetic nervous systems,” says Paul Engelhardt, MD, the study author. “Traditional Chinese medicine tries to restore that balance.” Sure, it sounds like using feng shui for your underwear drawer, but it works—64 percent of the men who underwent 6 weeks of acupuncture regained sexual function and needed no further treatment.

Score some herb. “The use of herbs to treat afflictions, sexual and otherwise, is as old as mankind,” says Cynthia Mervis Watson, MD, author of Love Potions: A Guide to Aphrodisiacs and Sexual Pleasures. Most herbal aphrodisiacs work on both brain and bloodflow—the placebo effect is very powerful, and many of these substances do increase circulation, always a good thing for the penis. Some of them are also effective because they contain sterols, chemicals similar to the steroids found in professional baseball: They give you a hormonal jump on the competition—without all the shame and ‘roid rage.


SIZING UP HERBAL REMEDIES

There's a lot of garbage out there. Follow these anti-B.S. guidelines when sizing up an herbal remedy.

“Studies show . . .” Well, studies can show a whole lot of things. If those studies aren't large, placebo-controlled, double-blind studies, then they're actually not worth the paper they're printed on. (These catch-phrases mean that neither the researchers nor the participants knew who was getting the real stuff and who was getting the sugar pills.) Ask the company if it doesn't say on the packaging.

“It changed my life!” Those testimonials can be very compelling, but they're hardly scientific. In fact, the people who are so effusively kvelling about the product may even believe what they're saying—but that doesn't necessarily make it true. “The placebo effect is responsible for about 30 percent of improved symptoms in studies,” says Donald D. Hensrud, MD, of the Mayo Clinic. The power of suggestion is especially strong with herbs, since most promise subjective benefits, such as increased energy. “It worked for me” endorsements are worthless, except to the person who was paid to make them.

“This ancient remedy, used in [insert faraway land here] for thousands of years . . .” Many of these remedies have been used for thousands of years. So that might be true—but it doesn't mean that the stuff works, or that it won't kill you in the process. Our forefathers thought asbestos was a good idea too.

Clear it with your doctor. If you're interested in herbal remedies, it's worth finding a doctor who's knowledgeable about them. Before you pop a pill, call and ask whether there's any danger in taking the herbal remedy; remind the doctor of the other drugs you take, both prescription and over-the-counter. Then double-check with the pharmacist. It's not that much trouble when the alternative may be liver failure.

Look for the words “Guaranteed Potency Herb.” Not every herb on this list will be standardized, but many of them are, and it's worth it to buy them, says Cynthia Mervis Watson, MD, author of Love Potions: A Guide to Aphrodisiacs and Sexual Pleasures, so you know what—and how much—you're getting. Also choose organic whenever possible, and buy from reputable companies. She recommends those from Herb Pharm, Eclectic Institute, Gaia Herbs, and Zand Herbal Formulas.


Here's an overview of the best from around the world.

image Ashwaganda. The 3,000-year-old tradition of Indian medicine, Ayurveda, prescribes the dried root of the ashwaganda plant for many ailments. The herb is so versatile, it's used in remedies for everything from rheumatism to treating sexual dysfunction. It contains plant sterols and has been known to increase muscle mass. Administered to both men and women who suffer from low libido, it is said to rebuild lost sexual vitality and reinvigorate sexual function. The sex-enhancing powers of ashwaganda are thought to be dependent on the herb's unquestionable ability to fight stress. In the United States, it can be found in powdered and extract form.

image Catuaba. The bark from the Catuaba tree of the Amazon forest is used by Brazilian herbalists as an aphrodisiac, a nerve tonic, and a stimulant to flagging libido. To the Topi Indians found in the region, “when an older man has a child, it's said to be Catuaba's child,” says Dr. Watson. There is little scientific research as to how or why the bark from the Catuaba tree works to improve sexual function, but in 1992, Japanese researchers found that, aside from its sex-enhancing ability, Catuaba extract seemed to protect mice from E. coli and staph infections and prevented the HIV virus from entering cells. You'll often find it mixed with ginseng or muira puama.

image Damiana. It's said to heighten sexual desire and improve sexual performance—that's why it's been used in folk medicine for centuries. Like most herbs considered to be aphrodisiacs, damiana increases bloodflow by widening blood vessels, an action that would relieve male impotence by varying degrees. Dr. Watson notes that it is also reputed to induce erotic dreams when drunk at bedtime. She recommends steeping an ounce of dried damiana leaves in 1 pint of vodka for 5 days, straining the results, and soaking the leaves in 3/4 pint of spring water for another 5 days. Strain this, and heat the water just enough to dissolve ½ cup of honey (or more, to taste). Cool, then add this mixture to the vodka. The potion will keep for a few months; Dr. Watson says that drinking a small glass every night before bed will reap “delicious results” in about 5 days.

image Deer antler. The Chinese have used this for centuries—and with good reason. It's nutritionally rich, loaded with minerals, fatty acids, and amino acids. It's used as a rejuvenating tonic—and one of the things it rejuvenates is your sex drive. Dr. Watson recommends choosing deer antler from New Zealand, and says that 500 milligrams daily should be enough. If you're worried about hurting Rudolph, don't be. These antlers regenerate after they've been clipped, and they're taken from well-treated herds that are raised to provide them.

image Ginseng. How much would you be willing to spend for a ginseng root that looks a lot like, hmm . . . another kind of “root”? In Asia, ginseng roots resembling the human penis sell for as much as $500 a pound, and the older the root, the more valuable. One collector paid $180,000 for an aged, anatomically correct root! Ginseng increases testosterone levels, lifting libido and suppressing the production of prolactin, a hormone that can cause impotence. (The rare red Korean Panax ginseng type is the only one that has been shown to help guys defy gravity.) In a recent study of men with erectile dysfunction, researchers found that 60 percent of those who took 900 milligrams of red Korean ginseng three times daily had improved erections, compared with only 20 percent of the placebo poppers. You can find red Korean ginseng in most health food stores. To increase your chances of getting authentic ginseng, find a product that includes 100 to 125 milligrams of ginseng extract standardized to contain 4 to 7 percent ginsenosides (the key component of ginseng). If this is on the label, the odds are better that you've found a reputable manufacturer.

image Horny goat weed. An herb that actually includes “horny” in its name? Horny goat weed gets the blood flowing to the genitals and boosts sexual energy. It's said to work for both sexes, which explains the herb's Chinese name: yin-yang, representing both female and male energy. (It is also known as epimedium.) This leafy plant has been used for over 2,000 years to improve the fatigued libido with testosterone-like plant alkaloids. Legend claims that horny goat weed got its English name when a surprised goat herder noticed the amorous tendencies of his herd after the animals feasted on the plant.

image Maca. Also called “Peruvian ginseng,” though it's not related to that other herb, maca is regularly used in Peru for its many health benefits. And it tastes great! The annual Maca Festival hosted in Churin, Peru, is home to cookies, cakes, and chips all made from the aphrodisiac. Maca's reputation for enhancing strength, libido, and fertility is growing as more people discover that the plant really does add a bit of combustion to their sex lives. It's common knowledge that the more maca you consume, the more benefit you'll get from the substance. And no harm will come of it—toxicity studies conducted in the United States found that maca had no adverse effects, although Dr. Watson warns people with hormone-sensitive cancers (such as prostate or breast cancer) to stay away from it.

image Muira puama. Yet another aphrodisiac with roots in South America. Although this hasn't undergone rigorous testing, Dr. Watson reports that men in a study done by the Institute of Sexology in Paris did experience improvement in sexual function. She recommends boiling 2 tablespoons of the powdered wood for 15 minutes in a pint of water; drink 1 fluid ounce before making love. If you don't mind the alcohol, you can also infuse 1 ounce of muira puama in 2 cups of vodka for 2 weeks, shaking daily. Take 1 ounce before hopping into the sack.

image Yohimbe. The African Bantu people have traditionally used yohimbe as a hallucinogen in marriage rituals that include 15-day orgies. So it's up for whatever you're going to throw at it. Research has shown that the active ingredient, yohimbine, helps relax the smooth-muscle cells of the corpora cavernosa, allowing more blood to flood these love chambers. A recent review in the Journal of Urology of seven clinical trials including 419 impotent men found that a prescription version of the herb was more effective in producing erections than a placebo was. (A prescription version of the drug, called Yocon, is available.) Yohimbe can either raise or lower blood pressure depending on the person taking it, so it should be avoided by people with heart or liver disease, and by anyone taking MAO inhibitors. Some other cautions: It should not be taken with a variety of foods, including cheese, liver, red wine, chocolate, beer, nuts, aged or smoked meats, sauerkraut, and yeast. Yohimbe interferes with how the body interacts with tyramine, a substance found in all of these foods. Dr. Watson also warns that some users experience hallucinogenic sensory effects, as well as nausea, irritability, sweating, and palpitations. Because of these, she recommends it as an ingredient in an aphrodisiac preparation, not something for daily use.

Medical Interventions

If you and your doctor decide that the severity of your sexual dysfunction warrants more drastic measures, here are some solutions you can try.

Testosterone: Testosterone is the potent male hormone, manufactured chiefly in the testicles, that fuels sexual thoughts and fantasies. If you have low desire, you may have low circulating levels of what's called “free testosterone.” Deficiencies are a main contributor to erectile problems and flagging desire. Studies show that your testosterone levels can drop by 1.2 percent each year of your life, with a more dramatic step-down after age 50. Your doctor can easily determine your level by doing a series of blood tests.

Testosterone is available by prescription, but there are other, more enjoyable ways you can pump it up—just thinking about sex, for instance. You can also increase it by having more sex, eating meat, and playing General Maximus in Gladiator. And although stress does release cortisol, an erection offender, a stressful job (or even a dangerous one) involving some level of competition, as in law or sales, can actually improve testosterone levels. “Real competition can drive up testosterone, which boosts libido,” says Helen Fisher, PhD, research professor in the anthropology department at Rutgers University in New Jersey and author of Why We Love. “Being amped up by a high-powered, high-stress job is more likely to make you more sexually active” than idling in a cushy, low-key career.


BE CAREFUL WHAT YOU WISH FOR!

Priapism is a persistent, painful erection that lasts for several hours and isn't relieved by ejaculation. There's a one in 40,000 chance that it'll happen to you. Usually caused by a blockage in the penis, or by needlessly taking a drug like Viagra, priapism isn't something to mess around with. Rush to an emergency room if it happens, as the condition can cause tissue damage and impotence. And be careful with rubber bands. That's all we're saying.


If work doesn't fire you up, seek a testosterone jolt in a recreational sports league. Men who get game increase testosterone levels by 15 percent, according to a Pennsylvania State University study. Even better, make her your steady doubles partner. The same study showed that women increased their libido-regulating testosterone by 49 percent during competition.

What about the risks of taking a prescription? “There's no evidence that testosterone causes cancer, although there is some evidence that it makes existing cancer worse, and the real problem with that is that it may activate a latent cancer that might never have caused a problem at all,” says Dr. Perring. If you are going to go on a long-term course of testosterone, your treatment needs to be supervised by a doctor, and you'll need follow-up tests.

Viagra, et al: There are a variety of medications available to stimulate bloodflow to the penis, including Viagra, Levitra, and Cialis. Viagra was a runaway success pretty much instantly, for obvious reasons: This category of drugs gave sex lives back to men who thought they'd never get wood again. “It's like a second chance at life,” says Manuel, a Costa Rican lawyer.

These aids have been a particular boon to people of a certain age. “The chemical aids are worth about 10 years,” says Dr. Perring. “In other words, with Viagra or Cialis, a 70-year-old man can do approximately what a 60-year-old can do without it.”

“There's no question that these medical interventions have changed the face of midlife sexuality,” says Gibson of the Toronto Sun. “There is life after 45, 55, 65—and there is sex!”

And who knows what miracles might happen once you prime the pump a few times? “What a lot of men find is that once they start these medications, they may not need them for every episode of sexual activity—they may need them only now and then,” Dr. Steidle says.

Similarly, if you suffer from performance anxiety, a drug-fueled romp or two may be just what the urologist ordered to restore confidence. And while all three erection medications have the power to prevent you from psyching yourself out in the sack, Cialis's ability to work for up to 36 hours may provide an advantage, says Julian Slowinski, PsyD, assistant professor of psychiatry at the University of Pennsylvania School of Medicine. “This gives a man and his partner a lot of time over the weekend to be more spontaneous.”

Doctors are wary about patients purchasing these meds on the Internet, so open up at your next office visit if you feel you could use a little boost. “I'm not a salesperson for the chemical aids, but in my practice, I certainly don't restrict my use of Viagra to people with no function at all,” says Dr. Perring. “It helps lots of men get a better erection, and with a better erection you have more sensation, and with more sensation you have a better orgasm. In short, it allows people to perform better and enjoy it more.”


ANOTHER DIAMOND SHE'LL WANT TO HOLD ON TO

In Novo Santo Antonio, Brazil, the town's mayor is handing out free Viagra to men of a certain age. Project Pinto Alegre, or “Happy Penis,” was designed to cheer up the town's elderly inhabitants.

It worked—but perhaps not as intended: Immediately, the incidence of extramarital affairs skyrocketed. Apparently, once armed and dangerous, the senior men of Novo Santo Antonio went a-courting. The mayor has changed course, distributing the pills instead to the geezers’ wives, for dispensing at the women's discretion.


Word to the wiseguy: A number of sex therapists told us about desperate calls made from bathrooms: “It's not working, doc!” But pills aren't on-off switches—you do need to be stimulated for them to work. Jump in bed with your lady or look at some pictures to prime the pump, and we think you'll be happy with the results.

Injectables: Certain drugs can be injected directly into the penis, either with a syringe or with a plunger that inserts a small pellet of medication into the tip of the penis. These drugs produce long-lasting erections within moments. When you stop wincing, talk to your doctor about the options.

Implants: If the problem persists, you may also want to ask the doc about penile prostheses or implants that can be surgically placed inside the penis to make it firm enough for intercourse. There are two different types:

image A nonhydraulic implant consists of a pair of flexible silicone rods that can be bent up or down by hand. It's the simplest design, but the penis remains semi-rigid at all times.

image A hydraulic implant includes a pair of hollow rods, a reservoir of saline solution, and a pump, all concealed within the body. For an erection, you simply squeeze your scrotum to inflate the penis.

Vacuum constriction device: When the penis is inserted into this cylinder and the attached pump engages, a vacuum is formed that causes blood to flow into the penile shaft. A rubber ring is then slipped onto the base of the penis to trap the blood in the shaft.

Sex Surrogates

Surrogates have a 90 percent success rate in treating sexual dysfunctions, according to Ted McIlvenna, PhD, president of the Institute for Advanced Study of Human Sexuality in San Francisco. Although surrogates treat a variety of sexual problems, Dr. McIlvenna says they are most adept at curing three things: erection difficulties, lack of desire, and poor body image. Surrogate therapy works best when the problem is psychological rather than physical.

If you have tried traditional therapy and think a surrogate might be the next step, ask your therapist for a referral or contact the International Professional Surrogates Association at www.surrogatetherapy.org. Experts advise that you choose a surrogate who works only in conjunction with a certified therapist. For a list of therapists who work with surrogates, contact the Bay Area Surrogate Association, PO Box 60971, Palo Alto, California 94306.


YOU'RE NOT THE ONLY ONE:

FEMALE SEXUAL DYSFUNCTION

Jennifer Berman is an MD specializing in female urology; her sister Laura Berman, PhD, works as a sex therapist. Together, they run the Berman Center in Chicago and the Network for Excellence in Women's Sexual Health at UCLA, where they specialize in the study and treatment of female sexual dysfunction. The Bermans estimate that 43 percent of American women suffer from some type of sexual problem. “Our main mission is to get the word out about female sexual dysfunction,” says Laura. “Women shouldn't be embarrassed about seeking help.”

Unfortunately, doctors tend to dismiss women's sexual complaints as psychological or emotional. But many common sexual complaints—such as low libido or inability to reach orgasm—have physical causes. Complaints of genital pain are dismissed as hysterical, or the result of a long-ago (and perhaps suppressed) negative sexual experience, says Marianne Legato, MD, New York–based author of Why Men Never Remember and Women Never Forget. Dr. Legato believes that a complaint of this type always merits further investigation. There are a number of physical causes for genital pain, and they're not uncommon.

“All this research into female sexual dysfunction will help solve problems in male sexuality,” says Dr. Jennifer Berman. Let's say your girlfriend or wife has an undiagnosed condition that's causing her to lose interest in sex or be unresponsive—you don't think that's going to affect your sex life? Best-case scenario, you're whining for something she doesn't want to give you. Worst-case scenario, her constant rejection of you is going to worm itself into your head—and that can lead to low libido, premature ejaculation, and erectile dysfunction. So if your lady is complaining, make sure she sees a doctor who will take her complaints seriously.