Last week, the New England Journal of Medicine (NEJM) published a review article on the treatment of erectile dysfunction.  Before you read the article (the link is provided below), I'd like to make a few observations:

1.  Just two days ago, I sat in my office while a man in his 40's told me, "Doc, I love this woman but I'm afraid to get too close to her because I don't think I can perform in bed."

Yesterday, a woman came to my office for weight loss, but as we spoke, she began to cry.  "Doctor," she said, "my husband just can't have sex anymore.  I'm going to leave him.   He sleeps in another bedroom and won't even discuss the issue any more.  Before I leave him, I want to lose about 15 pounds because I want to be more confident about undressing for another man."

Both of these discussions are common in my practice where I make it comfortable for people to  talk to me about sexual problems.  But here's the tragedy, the second paragraph of an article in the New England Journal of Medicine (just last week!) reads, "Erectile dysfunction was once considered to be psychogenic in origin and was frequently neglected by health care providers.  More recently, there has been increased recognition of the many physiological causes of the condition and of the potential for therapy to improve a patient's quality of life, self-esteem, and ability to maintain intimate relationships." 

The tragedy is not in the article; I'm grateful for Dr. McVary's very elegant review of erectile dysfunction and for his clarity of description, but it seems a tragedy to me that in 2007 we're reading in the New England Journal that "recently" doctors are recognizing that having a good erection improves a man's life and ability to maintain intimate relationships.  "Recently" in 2007!?

I think there's an uncoscious fear that if you give a man excellent sexual capacity that he will be out and about town leaving the poor wife at home.  And there is a very real attitude among those who deal with life and death situations (I did ER Medicine for 12 years) that difficulty with sex just isn't a big deal.

Such may be the case with some but more often in my practice I see strained relationships, depression, broken families, and broken children as a side effect of the father's ability to have an erection. 

Unfortunately, even with such articles in the New England Journal, I can testify  first hand that if you are a physician that makes an art of being very good at helping people with sexual function you risk be labeled with many different labels that do not compliment. 

And if you write prescriptions for testosterone, since it is now classified by the DEA as a narcotic, you risk very close scrutiny and even loss of license if you are not extremely careful with your records.

Try to do something as novel as manipulate prolactin or estrogen levels and you'd think I was suggesting that there are moons that revolve around Jupiter rather than around the earth.

For a link to that takes you to this review and to another recent review from one of the endocrine journals click on this link now:  Review of erection enhancement.

Peace & Health,

Charles Runels, MD

Still the best selling sex manual on Amazon.com, Anytime-for as Long as You Want:  Strength, Genius, Libido, & Erection by Integrative Sex Transmutation (A 15-Day Plan for Men to Improve Life & Sex).