The New Naked: The Ultimate Sex Education for Grown-Ups (14 page)

This may seem like a no-brainer, but you wouldn’t believe how many people do this. First of all, it’s illegal to sell prescribed medications to Americans over the Internet without a prescription. Just because websites and spam emails advertise these drugs, many of which are controlled substances, doesn’t mean these sites are legitimate.

Aside from encouraging buyers to self-medicate, which can cause further medical issues or even be lethal, the biggest problem with these websites is that the buyer has zero ability to verify if these drugs have been manufactured properly or are the real things. Many come from countries like India, where regulations in the drug-manufacturing industry are minimal at best and, in many cases, nonexistent.

Drug manufacturers looking to cut corners might make pills that are not much more than placebos, with little if any of the active compounds you’re looking for. Or you could get something laced with arsenic, concrete, or other harmful substances due to a deliberate lack of manufacturing quality control. Not only that, but these sites will then have your credit-card information and can sell it to the unscrupulous. You could end up with a bad erection, along with a bad case of identity theft.

It’s never worth risking your physical and financial health to get
prescriptive drugs or treatments through these sites. Find a doctor you like and trust, and be aware that what you don’t know about your meds can not only kill your sex life—it can kill
you
.

In this section, I’m going to discuss the D topics—you know, the problems that often happen when you live in denial about your health. I’ve seen umpteen patients over the years who are smart, successful, loving, generous men but who just don’t want to know what’s going on with their bodies. Often that doesn’t change until I tell them that a man who has health issues is not a man who wants to have sex—or is capable of having great sex!—and that it’s time to get serious about their bodies.

Getting a man to the doctor for his five-point checkup (see the box,
“Basic Blood Tests Every Man Needs”
) is not always an easy task. Women tend to be much more attuned to their bodies, and I think that because they see their gynecologists for regular checkups, they have a better gauge of their overall health. Men, on the other hand, can be stubborn creatures who take body denial to a whole new level, one so high that they can put themselves at grave risk of becoming seriously ill or even dying.

Recently, I heard about a Princeton PhD who had an extremely high PSA (prostate-specific antigen) number but dismissed it because false positives are common with that test. When he collapsed over a year later, he underwent several months of intrusive and painful testing only to discover that he had Stage IV prostate cancer, the most advanced level. Had he (and his doctor) used common sense and repeated the original PSA test just in case, he might have discovered the cancer before it metastasized and went into his bones.

Before starting any course of medications, a man should always ask his doctor what these meds can do to his libido.

While many drugs prescribed for non-sex-related medical issues are necessary for health reasons, they can be extremely detrimental to a man’s sexual health and fertility. Certain painkillers, like those containing codeine, can lower testosterone levels, for example. Drugs prescribed to control urinary flow affect ejaculation. Meds that should be avoided overall, such as anabolic steroids, cause shrinkage of the testicles. Antidepressants are notorious for lowering libido in men and women.

If drugs like these need to be prescribed, the man (or woman) should have a candid discussion with his doctor or therapist about the severity of his condition, how long he might need to be on the medication, and what he should do if his libido is affected but his partner’s isn’t.

Options for switching the medication should be discussed, too. Some medications are easier to switch than others, depending on your condition and potential side effects. It’s a constant balancing act between needing to take care of specific issues and being aware that other aspects of your life might be affected for the short term. I’ve found that a lot of patients find it much easier to
deal with a potential lessening of libido if they are told that it’s only for a few months, rather than for years, and that they should concentrate on dealing with one medical condition at a time.

Furthermore, people often don’t realize that over-the-counter drugs can have the same inhibiting effects on sexual health as certain prescription medications. This goes for some of most innocuous meds that many people take on a regular basis. For example, Sudafed or similar medications like Claritin D with pseudoephedrine can also cause erection problems by not allowing the blood flow to get into the penis. These drugs work by decreasing the blood vessels in your nose, which means they have an effect on blood vessels found elsewhere in the body (like the penis). Prescription pain relievers that are narcotic analgesics, like codeine, can cause pituitary suppression in men, which causes their testosterone levels to drop like stones thrown into a pond.

You already know that I seriously discourage self-diagnosis. This is why good doctors always ask their patients for a comprehensive list of all the meds they’re taking, including vitamins—so don’t be embarrassed if you take OTC meds or herbal supplements. Don’t forget to list everything, including any OTC meds you swallow regularly, such as aspirin or allergy medicines. You certainly don’t want to be misdiagnosed as having a serious medical condition or sexual dysfunction caused by an illness when the actual cause is triggered by your OTC meds.

This section is short but not so sweet, because if a man abuses drugs or alcohol, he’s eventually going to have serious problems in bed. Not just because he’s passing out or too high or plastered
to take care of himself (or you!), but because these substances depress the central nervous system. This can disrupt the proper flow of blood to the penis, leaving a man unable to have or maintain an erection. Ditto with smoking because it also constricts blood vessels (and who wants to kiss a chimney?). That means he may get aroused but he won’t be able to be a satisfactory lover.

In addition, drugs like marijuana or cocaine, or even a few cocktails, lower inhibitions. They affect the pleasure centers in your brain. Consequently, harder drugs like heroin or other opiates usually make erections practically impossible.

If your partner’s in the mood yet feels that he can’t have sex without a prop in the form of a few drinks, a few pills, or a few smokes or snorts, then something is wrong. You need to talk, and he needs to be sure he’s eating good food, getting good exercise, managing his stress as best he can, and getting enough sleep. If the problem persists, he should probably get professional help from his doctor or a therapist.

You don’t need me to go into all the reasons why excessive drugging and drinking are bad for anyone’s overall health, mentally and physically. As with other health issues previously discussed, it’s not just your sex life you save—it’s your life, period.

The number one reason why people are tired is that they don’t get enough sleep. The average man or woman needs seven to nine hours of sleep a night, according to the National Sleep Foundation (NSF). Do you get that much? Judging from the flurry of sleep studies and media surrounding sleeping issues, I bet you don’t.

In fact, the NSF reported that between 1959 and 1992, the average amount of sleep decreased from eight to nine hours per night to seven to eight hours, and those numbers continue to decline. We’re stressed, we’re worried about the economy and taking care of our families, and we can’t turn off those electronic devices that keep our minds too engaged to drift off to the Land of Nod.

When you’re exhausted, usually the last thing on your mind is sex. Sex requires mental and physical energy, and all you want is the sweet oblivion of deep, restful, blessed sleep…where
your guy won’t disturb you with his morning erections, the baby won’t be screaming, and your boss won’t call at 6:00 a.m. to remind you that you promised to cover for a colleague who is a notorious slacker.

Lack of sleep is not just something to joke about, though. It is devastating. People who are tired are less productive. Their reflexes are off. They are more prone to accidents and mistakes. Kids don’t do as well in school. Parents mess up at work. And, of course, when you’re exhausted, it’s harder to manage everything. Like your temper. I can’t tell you how many patients have told me about fights at home, all triggered because someone was ready to collapse from sleep deprivation and just snapped.

So what does this have to do with a man’s sex drive? First of all, testosterone is manufactured during the deepest levels of sleep. Without it, a man’s libido can plummet. He not only won’t want to have sex but also will have a difficult time achieving an erection.

Sometimes men are sleep deprived because they’re getting up several times during the night to use the bathroom. This increased nighttime urination might be a sign of prostate problems. But I’m usually more worried about their sleeping patterns than their prostate. My hunch is that many overly tired men are suffering from sleep apnea.