Can erectile dysfunction be caused by vascular disease?

DEAR DOCTOR K: My doctor says my erectile dysfunction is most likely caused by vascular disease. Can you explain the connection?

DEAR READER: Erectile dysfunction (ED) -- trouble attaining and sustaining an erection -- is quite common in men over age 40. Why, you might ask, would nature (evolution) not preserve something so important to the continued existence of the human race? The average life expectancy throughout most of human history has been less than 50 years. Guys, we were not built to last!

What can I do to make sex painless and pleasurable again?

DEAR DOCTOR K: I'm a man, and sex is often painful. Why? What can I do to make sex painless and pleasurable again?

DEAR READER: If you go by what you see on TV, the only thing standing between you and a satisfying sex life is erectile dysfunction. The truth is, pain during sex can also be an obstacle. I spoke to my colleague Dr. Michael O'Leary, a professor of surgery at Harvard-affiliated Brigham and Women's Hospital. He noted that while the reason for painful sex can be difficult to diagnose and treat, it's worth talking to your doctor. Together, you may be able to identify the problem -- and a solution.

What is the most effective way to treat premature ejaculation?

DEAR DOCTOR K: I've been experiencing premature ejaculation. What is the most effective way to treat this?

DEAR READER: Premature ejaculation (PE) occurs when a man reaches orgasm and ejaculates too quickly and without control. In other words, ejaculation occurs before a man wants it to happen. Several factors may contribute to this problem. Diabetes, problems with the thyroid gland or inflammation of the prostate are common culprits. Stress, depression and other emotional factors can also play a role. But most men with PE are healthy.

Restore sex drive by changing dose or kind of depression medication.

DEAR DOCTOR K: Last year I started taking an SSRI for depression. It has done wonders for my mood -- but it has really dampened my sex drive. Any suggestions?

DEAR READER: Since depression is so common, and since SSRIs are often used to treat depression, I've known many people who share your problem. Fortunately, there are several options that often help people restore their sexual desire and function. Selective serotonin reuptake inhibitors (SSRIs) are currently the most commonly prescribed antidepressants.

What is cervicitis and how do you get it?

DEAR DOCTOR K: My doctor diagnosed me with cervicitis. What is this? And how did I get it?

DEAR READER: Cervicitis is an inflammation and irritation of the cervix, the doughnut-shaped opening to the uterus. (I've put an illustration of the area affected by cervicitis, below.)

Cervicitis is usually caused by a sexually transmitted infection (STI). Most common are chlamydia and gonorrhea. Trichomoniasis and genital herpes can also cause the condition. In some cases, cervicitis may result from trauma, frequent douching or exposure to chemical irritants. Cervicitis often causes no symptoms. When they do occur, symptoms can include pain during intercourse.

When should I talk to my child about sex?

DEAR DOCTOR K: When should I start talking to my child about sex? And what topics should I discuss?

DEAR READER: Many parents are uncomfortable talking about sex with their kids, but they know the day will, and should, come. They often anxiously prepare in advance what they will say if their child asks a question about sex.

I’m a woman in my mid-50s — what could cause my decline in sexual arousal?

DEAR DOCTOR K: I'm a woman in my mid-50s. Lately I haven't been able to become sexually aroused. What could be wrong?

DEAR READER: Sex is complicated. You probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain. Likewise, the brain communicates with the genital organs. Desire in the brain causes changes in the pelvic organs. Perceiving these changes can, in turn, enhance sexual desire.

What are the different options of penile implants?

DEAR DOCTOR K: Can you discuss penile implants? I haven't had success with other treatments for erectile dysfunction.

DEAR READER: Medications, injectable drugs and devices such as vacuum pumps can effectively help most men who cannot get or maintain an erection. In particular, the three different pills for erectile dysfunction (ED) are effective about 70 percent of the time. Have you talked with your doctor about increasing the dose of the medicines you have taken? And has your doctor done tests to determine the cause of your erectile dysfunction?

I’m a woman in my 50s with a diminishing sex drive — what could be the cause?

DEAR DOCTOR K: I'm a woman in my 50s. I've always had a healthy sex drive, but lately it's gone bye-bye. What could be wrong?

DEAR READER: There aren't a lot of people with a take-it-or-leave-it attitude about sex. We are sexual creatures, and for most of our lives, we are well aware of having sexual desire. So when you notice that it's just not there, it is upsetting.

Which age-related sexual changes in men are normal?

DEAR DOCTOR K: I'm a man in my 70s. I still enjoy sex, but it's different than when I was younger. What changes are normal?

DEAR READER: As a man in the last half of his life, I would like to be able to tell you that nothing changes. However, even in healthy men, sexuality changes over time.