A lot of interest has been generated because researchers have focused their efforts over the past several years on developing a male contraceptive similar to the female pill. Although this research has been going on for decades, the momentum seems to be increasing, and now scientists have potentially found an effective solution. The big question is, will guys take the pill (and will ladies trust them)?

Current efforts are focused on developing a pill that would block the function of vitamin A in the testes and, theoretically, reversibly turn off sperm production. After 50 years of work, researchers have learned that the conversion of vitamin A to retinoic acid in the testes can be blocked. The main concern is finding a way to block this conversion in the testes without affecting the function of vitamin A and retinoic acid in other tissues. Tests with mice have shown a 100 percent success rate.

Researchers have also found a hormonal-free way to prevent the testicles from producing sperm and are testing a drug that targets a particular protein that is critical for sperm production. The treatment is reversible—when mice were taken off the medication, they became fertile again.

In addition, there are two classes of drugs on the market that cause men to experience retrograde (backward) ejaculation, which, in essence, keeps men from emitting semen during orgasm. However, it is impractical to use these drugs in clinical practice because one is an antihypertensive and the other is an antipsychotic medication. Without modification, they would adversely affect blood pressure and mood.

Hormones delivered by implants, injections, gels, or pills have a profound effect on sperm production. Testosterone suppresses the production of sperm by working directly on the testicles, and progestin sends signals from the brain to the testes to stop producing testosterone. The long-term effects of these medicines are unknown, but current knowledge suggests that prolonged use could increase the risk of heart disease and prostate cancer.

A researcher in India is developing a method called RISUG (reversible inhibition of sperm under guidance), in which a polymer is injected into the vas deferens and blocks sperm transport. According to the developer, the procedure is reversible. RISUG does require a small surgical incision in the scrotum to access the vas deferens. In my judgment, this option does not seem any better than a vasectomy, but the jury is still out. The procedure is now in late phase 3 clinical trials in India.

Remember, no contraceptive measure is 100 percent effective—not even hysterectomy. (Abdominal pregnancies can occur even after a total abdominal hysterectomy.) RISUG may be a promising means of birth control for males, but it is too early to draw any conclusions. The current media hype is unwarranted. Science will have to run its course and complete well-designed clinical trials before this, or any other, method can be recommended.

There is no question that the true need for a male contraceptive pill is compelling. Men produce about 1,000 sperm a second. At the end of the day, the only effective methods of male contraceptives are vasectomies (successfully reversible in greater than 95 percent of cases), condoms, and the tried and true method of “keep your zipper up!”

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

I cannot reiterate this point enough: attitude is the key to penis longevity. My superpotent patients tell me that sex gives them as much joy at seventy as it did at twenty. Some say it is even better! From my clinical experience, I have concluded that equal pleasure can be obtained from occasional, prolonged intercourse with one orgasm as with frequent, rapid intercourse with multiple orgasms.

Many men give up their sex lives as soon as they start identifying themselves as “old,” especially once they retire. The idea that retirement equals nirvana is an unfortunate myth perpetrated in our modern culture. I have observed in my practice that retirement can lead to inertia, boredom, and stagnation. Many of my older patients, even those who are wealthy, choose not to retire. They may cut back their hours and delegate a lot of responsibility to others, but they remain active, both in work and in play. These individuals tend to be my healthiest, most superpotent patients. They live longer, and the quality of their lives seems better than those who stop challenging themselves and throw in the towel for retirement. Do not voluntarily retire your penis unless you are forced to by circumstances beyond your control, such as a serious illness.

Until recently, our society’s image of aging usually excluded sex. It had been considered unseemly for older people to talk about it, much less do it. I know elderly people who have to sneak around to have sex just as they did when they were teenagers because they know it will be frowned upon by their peers and especially by their own children. Other older people stop having sex altogether because they buy into the notion that they are supposed to give up sex. They suppress their sexuality because it somehow seems inappropriate to express it.

It is my hope that the generation I now see entering their senior years challenges all of that. They deserve active, healthy sex lives as long as they remain physically fit. It will not harm them unless they try to do things their muscles and joints are too weak to manage or they overextend themselves to the point of exhaustion. Do not expect to do at fifty what you could do at forty, or do at sixty what you could do at fifty, and so on. Adjust your sexual activities as your body changes, just as you adjust other activities. Look upon the adjustment as both a new challenge and a new opportunity. As you age, learn to use your mind and imagination to make up in creativity what you may lack in physical strength.

As long as you are able to breathe, move your extremities, maintain relative control over your bodily functions, remain alert enough to identify the date and day of the week, and sustain a positive mental outlook, you can continue to exercise your penis power indefinitely. You can help stay superpotent as you age by maintaining good overall health habits: exercising regularly; minimizing your consumption of fat and cholesterol; controlling your weight; refraining from smoking, excessive drinking, and drugs; watching your blood pressure; and seeing your physician regularly. If you stay physically fit and mentally alert, you can remain sexually active as long as you have the urge.

Most importantly, do not think old! Your body may produce less testosterone; your blood vessels may become partially obstructed and diminish blood flow to the penis; and your muscles and joints may begin to deteriorate. But if your mind is still strong, your penis can be strong, too. The key is not to lament what you have lost. Be grateful for what you still have and make the most of it. Age is not a deterrent to a superpotent man. Rather, it is a challenge and an opportunity. Think of yourself as a singer whose voice is not as powerful as it once was but who more than makes up for it with phrasing, feeling, and subtlety. Think of yourself as an athlete or a dancer whose legs are no longer as strong as oaks but who performs with added grace shaped by the wisdom that comes with experience. If you keep your enthusiasm, you can compensate for or even delay the effects of aging.

If you have penis power, you are young no matter what your age may be. The strenuous use of your penis will sharpen your mind, exalt your soul, and keep you feeling vigorous. In short, you do not stop having sex because you get old—you get old because you stop having sex!

In many ways, your later years should be the golden years for your sexuality. You do not have to get up and go to the office in the morning, you do not have to worry as much about kids and bills, you have less daily stress and fewer pressures, you have more privacy, you have more time, and you can afford the luxury of patience. This is an opportunity for a superpotent man to make the most of his penis power.

I would like to make a prediction. Based on my clinical experience and my understanding of current research, I am convinced that the future bodes well for the sex lives of people now entering their senior years and even better for those now middle-aged. I base this prediction on the burgeoning cultural view that the elderly can be active and fulfilled, even when it comes to sex. This is in addition to the amazing progress that has been made in extending the capacities of other bodily functions. The upper limits of what the body can do have been continuously broadened. In sports, what were once considered insurmountable barriers, such as the four-minute mile and the seven-foot high jump, are all now accomplished routinely. The peak years of athletes have been dramatically extended through unique conditioning procedures, nutritional advances, and medical science. There is no reason why the years of active sexuality cannot be similarly extended. There is no reason why penis power cannot continue to grow in aging men.

In this new century, people will be sexually active into their nineties! For one thing, lifespan will continue to increase. Impressive medical advancements, healthier lifestyles, and new discoveries in the field of genetics will continue. This research holds the promise to prolong life through drugs and genetic engineering. I predict that the quality of life in old age will improve geometrically. The elderly are far more vital and far more dynamic than ever before. In addition, society’s attitude toward sex and the elderly is becoming more permissive. It will no doubt become far more acceptable to be sexually active into old age, a trend that will probably accelerate as the generation that came of age during the sexual revolution approaches seniority. For men who are young now, the golden years will truly provide the opportunity for the enjoyable, leisurely exercise of penis power, as long as they are willing to use it.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

I have witnessed an increased development of penis weakness over the last forty years. It is worth analyzing the social conditions that have created this outbreak. One could argue that men have always struggled with this condition. It could also be argued that the increase in penis weakness in recent years is only because men today feel more comfortable talking about their sexual problems. This is not the case. Powerful social and historical factors have contributed to, and continue to create, penis weakness among men today. Each individual case must have an independent evaluation.

One factor that plays a major role in penis weakness is the increased level of stress found in modern society. Men in today’s business world work long hours without enough sleep, exercise, or relaxation. They are often psychologically drained and physically exhausted when they get home. Add financial anxiety, societal pressure, nervousness caused by the rapid-fire pace of modern life, traffic jams, conflicts with bosses, coworkers, or clients, and problems with spouses and children and one can see a picture of conditions that are not conducive to either maximum sexual performance or maximum happiness!

These effects are compounded by the media’s highly romanticized image of marriage and family life—an image that creates impossible expectations. Being at your best at anything, especially sex, is difficult when you feel out of sorts physically or your mind is someplace else, preoccupied by other problems.

Few issues have a more chilling effect on sex than anxiety. Stress, tension, and anxiety exact a heavy toll on an intimate relationship. These forces pollute the atmosphere and fill the bedroom with emotional toxins.

Stress has definite medical consequences that work against normal sexual function. During the stress response, blood moves away from the genitals to supply the large muscle groups of the arms and legs. Anxiety, including performance anxiety, can increase the activity of the sympathetic nervous system. Anxiety can boost the flow of norepinephrine, a chemical that constricts blood vessels. This condition is precisely the opposite of what is necessary for an erection—a smooth flow of blood to the penis through open vascular channels.

This problem is compounded when men use alcohol and drugs in an attempt to cope with stress. As Shakespeare wisely observed, alcohol “provokes the desire, but it takes away the performance.” The same is true of drugs, including nicotine and prescription medications. The drugging of the American male is a major factor in the decline of penis power. The new craze over “Vitamin V” (Viagra) is hardly the solution.

To men who suffer from penis weakness, the Women’s movement, for all its welcome advances, has also contributed to the problem. With increased awareness of female sexuality, female orgasm, and the generally open discussion of women’s sexual needs (by way of women’s magazines, the Internet, television, and films), men now have the added pressure of having to know all of the intricate secrecies of female sexuality. They are expected to perform with the expertise of a twenty-four-year-old pornography star. For some men, this might not be a problem. Sex in general may still be smooth sailing. For most men, however, sex is an obstacle course—a track filled with snares and hurdles in which one scores points for technique as well as for getting to the finish line. The goal is not just to satisfy yourself, it is also all about satisfying your partner. And, in many minds, the man has a responsibility not just to bring a woman to orgasm but to multiple, ecstatic, earth-shattering orgasms. Now that’s pressure!

Both men and women expect sexual satisfaction. Partners also have a responsibility to work together through communication and understanding in order to meet one another’s expectations and to achieve mutual satisfaction. Every man should cater to his partner’s pleasure if for no other reason than to enhance his own. It is important to acknowledge that both genders have been insensitive to the high level of performance anxiety brought on by the new rules. The situation is made even more complicated by the enormous range of variation in female sexuality.

Millions of relationships turn into no-win situations when people aim for some imaginary standard of satisfaction instead of attending to the unique nuances and preferences of their partners. From my clinical observations, the single biggest sexual worry of contemporary men is that they will not provide their partners with orgasms of spectacular quantity and quality. If a man has even one humiliating encounter with a dissatisfied partner, he can succumb to the vicious cycle that begins in self-doubt and ends in penis failure.

Another media-related factor is the idealized image of the sex act itself. And what happens when reality doesn’t measure up to the imagined ideal?

Men blame themselves. They assume something is wrong with them. They think they are failures. And what is the focal point of their disappointment? Their penises, of course. “What’s wrong with it? Why can’t it be bigger and harder? Why doesn’t it do what the throbbing pistons do on the big screen or in books?”

You might not hear men asking those questions, but I do almost every day. Men think they should have a two-foot-long shaft of solid steel between their legs—a shaft that can pump and pound for hours on end.

That’s not a penis. That’s a Home Depot pneumatic drill from aisle six!

Most men measure themselves against standards built on fantasy, not reality. They interpret normal, commonplace experiences as signs of personal failure. There is enormous variety among men with respect to sex drive, capacity, preferences, and standards of satisfaction. Yet men assume there is a state of being called “normal.” They worry that every little sexual idiosyncrasy they have is a sign of abnormality. Worse, if sex doesn’t go as desired, or if they have a disappointing or embarrassing experience, they usually panic. This experience can result in significant self-doubt. Self-doubt creates fear, anxiety, and inhibition. These feelings are bigger obstacles to sexual happiness than having a construction crew in your bedroom (maybe even bigger obstacles than having your mother-in-law in your bedroom!).

Every man I have ever known has, at one time or another, lost an erection or ejaculated sooner than he would have liked.

Every man is, at times, not interested in sex.

Every man has failed to satisfy a partner.

Men who take such events in stride know that they are perfectly normal. They march without hesitation to their next sexual encounter.

These are the men who have penis power.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

I asked him what the trouble was. “I met this great woman,” he said. “We had a terrific first date on Valentine’s Day. She invited me in, one thing led to another, and before I knew it we were in bed. But I . . . well . . . I couldn’t . . . you know . . .”

I knew all right. I had heard it so many times before from hysterical patients. Steve was terrified that something had gone wrong with his penis, when in reality his failure to get an erection with his terrific new woman had nothing to do with physiology. He had gone through a bitter divorce. It had taken him some time to get used to being single again. On the ill-fated date, it was the first time in many years that he had even kissed a woman in earnest other than his wife. Steve was not impotent, he was just plain nervous. The high romantic expectations related to Valentine’s Day, the newness of the experience, the excitement of meeting someone he liked, and his eagerness to please her and prove himself a worthy bed partner all conspired to create one of the greatest enemies of penis power: anxiety, or more precisely, performance anxiety.

More penis weakness occurs the first time a man is with a particular partner than at any other time. When it happens, men feel so humiliated that they sometimes find any excuse they can to avoid dating that person again, thereby depriving themselves of what might have been a good relationship. It is sad. I have even met men who, after several embarrassments, stayed away entirely from people who turned them on. They became, in effect, celibate prisoners of penis performance anxiety.

The first time with a new sexual partner can be an exciting experience. For some men, however, that very emotional excitement can lead to temporary penis weakness. It can spiral into a pattern of disaster. My advice is to take your time, be patient, stop pressuring yourself, and stop thinking you are inadequate. Find a partner who makes you feel comfortable and unthreatened. It worked for Steve, and it will work for you. You must be willing to face the challenge with the courage it takes to overcome performance anxiety.

Accentuate the Positive

What can be done if you do have performance anxiety? Let us start with the issue of anticipating the use of your penis. When you begin to feel anxious or fearful, you are programming your mind for failure. Stop what you are doing, calm yourself down, and remind yourself of what Franklin Roosevelt so elegantly and succinctly stated during his first inaugural speech at the depth of the Great Depression: “The only thing we have to fear is fear itself.” Losing an erection, unlike losing your job and home, is not catastrophic. What is the worst thing that could happen? You embarrass yourself? You can only be embarrassed if you let yourself be. If you think that a “real man” cannot possibly lose an erection or ejaculate too quickly, then you will be encouraged to know that these things happen to every man at some point in his sexual life. So why should you be embarrassed if it happens to you? And what if you are embarrassed? How bad is that really? Maintaining this positive point of view will keep you calm and lighthearted. If you feel that way, your penis is likely to behave accordingly. If you develop the ability to laugh at both yourself and that unpredictable appendage of yours, you will both be winners.

Get rid of fearful, negative thoughts altogether. There is no valid reason to entertain them. They are the natural enemy of your penis. Mobilize a battalion of positive thoughts, and let them take over your mind. Penis power is the power of positive thinking applied to your penis.

It is a fact that some men with a deeply rooted fear of penis failure need more than just a pep talk. Perhaps a prescription for Viagra, Cialis, or Levitra is just what is needed to break the vicious cycle. However, the “crutch effect” may result in dependence on these medications. I often suggest that patients talk to a psychotherapist and perhaps explore deeper reasons for their anxieties. In most cases, lack of self-esteem is the underlying cause. Their self-image is so low that it affects every aspect of their lives, not just sex.

Lighten Up, Dude

Okay, you are in bed with a sexy partner, whether it is your wife of thirty years or someone you just met. You feel tense. You start to worry that your penis will not get hard or that you might lose the erection that just popped up. What do you do? Your first reaction might be to panic. You might worry so much about your penis that tension builds. You get clumsy. You try to exert your willpower on your organ. You forget about doing all the things that might excite your partner. You cannot appreciate, or even feel, the kisses and strokes your partner is so lovingly giving you. One of two things is bound to happen next: your partner gets turned off and thinks she is doing something wrong or your penis goes limp. From my experience, it is usually both.

The minute you start to feel any anxiety, stop what you are doing immediately and tell your partner about it. Do not make excuses. Do not try to hide it. Own up to it. Explain openly that you are nervous, that this sometimes happens to you. It happens to all men. Tell your partner you want so much to please her, bring her satisfaction, and that her acceptance means a lot to you. Make sure she understands that it is not her fault, she is terrific, and she has not done anything wrong. Tell her it is all in your head, and it will surely go away.

Honesty is always the best policy in general, but when it comes to your penis, it should be the only policy. Ninety-nine percent of the time, candor will improve the situation by diffusing tension. If you have a healthy relationship, your partner will understand. Your partner will appreciate your integrity and your vulnerability. Most people want intimacy, affection, and closeness in bed, so if you communicate these qualities, your partner will not hold your anxiety against you. She will probably reassure you, calm you down, and take the pressure off. If your partner does not act this way, or if she gets angry, gets resentful, or demeans you in a castrating way, you should ask yourself if you are in bed with the right person.

And if you do fail to get an erection? If you do lose it at precisely the wrong moment? If you do ejaculate too quickly? What then? I say laugh it off! You are probably thinking, sure, that is easy for the doctor to say. But I mean just that. Joke about it. Lighten up! I assure you that “real men” can and do laugh at their own penises. They might say funny phrases to their partners like “Oh well, that rascal pulled a fast one on me,” “I cannot get him to behave sometimes, the unpredictable little devil,” or “Do not take it personally.” Remarks like that, expressed in your own words and your own style, should ease the tension and help your penis rise another day, or even the same day. Medically, I can practically guarantee it.

Your partner should appreciate the light touch and will be pleased to know that you are trying to improve your sexual ability. She might start thinking that something is wrong with her. She might be feeling guilty for failing you. She might know you feel ashamed but not quite know what to say or do about it. You can take the lead and break the ice with a good laugh. Who says sex has to be serious?

When you get right down to it, with all the unstated agendas, the physical clumsiness, and the childlike awkwardness, sex is just as suited for slapstick comedy as fine art or soft-focus cinematography. Many people say there is no better turnon than a good, hearty laugh in bed, and nothing sexier than a partner whose sense of humor is compatible with your own. Just do not take your penis so seriously. That is how the trouble starts in the first place.

If you do not succeed, try again and again and again. Do not shy away from using your penis if it falls down on the job once or twice—or any number of times. Do not give up on it. Practice makes perfect in sex, just as it does elsewhere in life. Perseverance is the only way to get over setbacks and gain the confidence you need to overcome your fear of failure. As a last resort, you can always turn to your urologist for the quick but temporary fix provided by medication.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

As a urologist, I cannot emphasize this point enough: do everything in your power to prevent sex from becoming a dull routine. Nothing will bring passion and romance back to a long-term relationship faster than a change in sexual practice or venue.

I remember a fifty-five-year-old patient who was married to a woman he loved for twenty-seven years. He had a bad case of sexual ennui (dissatisfaction resulting from boredom), which led to a brief fling with his dentist’s assistant. That made things even worse at home because he was now inhibited by guilt in addition to boredom. “Jack,” I said, “take Friday off and get your wife to cancel all of her plans. Rent a cabin in the mountains for a weekend. You have not done anything spontaneous and romantic in years. Do it. Tune out the world. No kids, no phone, no television, just the two of you and a fireplace.”

The weekend rejuvenated Jack and his wife, as similar escapes have done for countless couples. In other cases, I have advised patients to take the afternoon off and surprise their wives with flowers and a sunset tryst in a motel. Other couples have done things like pretend they have just met and are having a one-night stand. Or they simply vary their rituals. If you have been initiating sex after you are both washed, undressed, and in bed, try doing it before all of those bedtime rituals. When was the last time you and your partner undressed each other instead of starting out in your pajamas? When was the last time you necked in the living room and carried your partner into the bedroom? Or made love in the kitchen or the shower? Have you tried a different position in the last few years? Have you thought of using props? Browse in any sex shop and you will get countless ideas of how to invigorate your sex life. Above all, use your imagination and see what you come up with.

Hopefully, you will not have to go to extremes, like the wife in Woody Allen’s Everything You Always Wanted to Know about Sex But Were Afraid to Ask, who could only have sex in public places. For the majority of people, simply giving yourself permission to break your own boundaries will elevate your penis power several notches. You might have to do some cajoling to win your partner’s support. That could be translated into a surprising delight for both of you.

Some of my patients have to be told that it is okay to have sex at different times of the day. They have to be told that sex is not just a nighttime activity. Why engage in something as important as sex when your body is at its lowest energy level? Perhaps your penis problem is really a fatigue problem. The penis responds to different biorhythms, as do hormonal secretions and energy levels. This is an important aspect of understanding the intricate relationship between the penis and the body. Concrete scientific evidence to validate this observation is sparse at this time, but research in this area is ongoing.

I do not doubt that fatigue affects sexual energy. For this reason, I encourage my patients to pay close attention to the ways in which their bodies, and especially their penises, respond to different emotional and physical conditions. It is fundamentally important that you be aware of your body’s rhythm. Your sexual responsiveness will change with stress, fatigue, anxiety, or sickness. Your particular rhythms may be better suited to sex at unusual times of the day. Perhaps certain habits—for example, exercise, diet, work schedules—are affecting your sex drive in negative ways. Pay attention to the subtle clues your own body transmits, and you will know where to start making changes. Explore all of your options. Experiment, take risks, and mix things up until you find the right balance for your love life to flourish. What’s most important is not to feel burdened by sex. If your sex life is becoming run-of-the-mill and boring, then take the initiative to spice things up. You will not be disappointed by the results of reviving passion and romance in your relationship.

Millions of men think that something is wrong with them because they do not get “hard on demand.” The persuasive myth in our culture has it that a “real” man will be raring to go anytime, day or night. That proposition could not be further from the truth. A wide range of difference exists among men. Men have their own individual preferences and unique biological templates. There is simply no set time or place you are “supposed” to get aroused. No credible scientific book says you have to have sex a certain number of times a day to be a “real” man. I cannot count the variations. Some men tell me they feel sexiest in the morning, in the middle of the day, at night, or in the middle of the night. The real problem is that most men are just too inhibited to break their old habits or they are afraid their partners will think they are crazy or weird for trying something new. Even if your requests may seem odd, you still have the power to prove yourself to your partner through your performance. If you are passionate and exciting, your partner most likely will not complain.

Morning sex is an especially good way to break the routine. What a terrific way to start the day! So what if you have to skip jogging, rush through breakfast, or get to work a bit late? Morning sex can be just as invigorating as a morning jog and just as relaxing as a cool morning breeze. It is the best wake-up call. It clears the spirit of any tension and shakes the cobwebs out of your body. In fact, a lot of men like sex better in the morning because they wake up with the so-called morning wood or piss hard-on. The explanation for this morning erection is that a full bladder compresses the venous outflow from the pelvic vessels, holding blood in the penis longer than usual. The usual result is a morning erection. Be assured that after morning lovemaking, you will like what you see in the mirror. You will have set the right tone for a great day.

If you are a man who wants to enhance your penis power or if you are a partner who wants to learn how to increase your man’s penis power, then it behooves you to look into alternative sex practices. Countless volumes have been written on this subject, from the Kama Sutra to articles in Cosmopolitan. I will not try to reiterate information that’s already available. However, ask yourself these questions: When was the last time you tried something other than the missionary position? Have you tried letting your partner get on top and control the action? Have you tried “doggy style”? How about not having intercourse at all, but bringing yourselves to climax strictly with oral sex or mutual masturbation? The possibilities are endless. If you cannot conjure up some creative ideas on your own, do not be afraid to go out and find a book or ask a friend for some good tips.

Any change should add a fresh dimension to your routine. I can guarantee that both you and your partner will reap the benefits of a reinvigorated sex life.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Although the details of the governor’s illness have not been released, it seems apparent that his diagnosis was initially made because his PSA (prostate-specific antigen) level was elevated. The controversy surrounding the efficacy of PSA testing in a man 74 years old has been hotly debated, but in this case, the test seems justified.

Governor Brown’s oncologist was quoted as saying that “fortunately, this is early stage localized prostate cancer, which is being treated with a short course of conventional radiotherapy. The prognosis is excellent, and there are not expected to be any significant side effects.” This statement also indicated that the governor was “continuing a full work schedule.”

The only reliable way of diagnosing early-stage localized prostate cancer is with a PSA blood test. The digital rectal exam will almost always pick up a lesion in the prostate at an advanced stage but may not detect the type of lesion diagnosed in the governor. Although lesions detected in early-stage prostate cancer are often not treated but carefully monitored in a program called active surveillance, the governor’s urologist decided to proceed with radiation therapy. Both active surveillance and localized radiation therapy are treatment options that need to be carefully monitored. Active surveillance is increasingly favored for older men because prostate cancers tend to be very slow growing.

In my estimate, the reason Brown’s physicians chose to be a bit aggressive with limited radiation therapy despite his age is that the governor is healthy, he is in excellent physical shape, and his actuarial life expectancy is probably longer than that of the average 74-year-old. In addition, the side effects of the modern delivery system of radiation are very minimal, and survival data, which goes out about 15 years, is extremely favorable and compares to a more aggressive surgical approach as treatment.

According to Dr. Christopher Rose, a radiation oncologist at the Center for Radiation Therapy of Beverly Hills, “Conventional radiotherapy implies external beam radiation therapy, and is generally offered in a course of treatment lasting anywhere from 5 1/2 to nine weeks. However, accelerated treatments exist in which five treatments are delivered over the course of eight days.”

In describing the technical features of the treatment, Dr. Rose noted that “a three-dimensional model of the prostate—as well as organs that the oncologist wants to avoid—is pieced together using CT scans. The patient lies on his back and a 360-degree radiation source delivers beams of radiation to the patient in a way that targets the prostate but avoids other structures as much as possible. The beams can be delivered at differing degrees of intensity and in a concave shape so that the rectal tissues, lying near the walnut-shaped prostate, are avoided.”

Dr. Rose explained that “other advances allow a CT scan to be taken at each treatment session and lined up with the initial map so that the patient can be precisely positioned and the same tissue volume irradiated each time” and that “with these advances, the potential for a cure goes up and the potential for injuring adjacent organs goes down.”

Rose also noted that “with conventional radiation treatment, each session takes a matter of minutes and is performed on an outpatient basis. My patients all work through their treatments. Sometimes, 1 in 4 suffer fatigue but that usually occurs at the end of the day. Gov. Brown seems at the top of his game, and it probably won’t interfere with activities of daily life.”

The prognosis for the type of cancer that the governor apparently has is extremely favorable. His condition will be followed by monitoring the blood levels of PSA and perhaps performing biopsies in the future.

The takeaway message is that most men diagnosed with early-stage localized prostate cancer who choose either the active surveillance program or localized radiation treatment, as in the case of Governor Brown, die of something other than prostate cancer.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

The conundrum, however, is that the academy stopped short of recommending routine circumcision for all baby boys, saying the decision remains a family matter. For decades, families made the choice based on religious, moral, and ethical principles that were, at best, ethereal. The academy had previously taken a neutral position on circumcision.

It has been more than a decade since the AAP has issued a policy statement regarding newborn circumcision. The new statement, which appears in the journal Pediatrics, is important because the group’s guidelines greatly influence pediatric care and decisions about coverage by insurers. The academy said that circumcision should be covered by insurance.

The academy’s new policy position seems to be in direct conflict with the sentiment against circumcision, which is gaining strength in the United States and parts of Europe.

Circumcision rates in the United States declined to 54.5 percent in 2009 from 62.7 percent in 1999, according to one federal estimate. Last year, a ban on circumcision was placed on the ballot in San Francisco, but a judge ruled against including the measure.

In Germany, a government ethics committee recently overruled a court decision that removing a child’s foreskin was “grievous bodily harm” and therefore illegal. However, Germany’s Professional Association of Pediatricians called the ethics committee ruling “a scandal.”

In Austria, a provincial official told state-run hospitals in the region to stop performing circumcisions.

In the United States, the Medicaid programs in several states have stopped paying for the routine circumcision of infants. Furthermore, the Centers for Disease Control and Prevention has been examining the issue for several years, but it has not yet issued a position on circumcision recommendations or comments regarding the AAP’s new policy statement.

Dr. Douglas S. Diekema, a member of the academy’s task force on circumcision and main author of the new policy, said, “This is not really pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a better word. Really, what we’re saying is, ‘This ought to be a choice that’s available to parents.’”

Taking the opposite view is Georganne Chapin, founding director of Intact America, a national group that advocates against circumcision. “The bottom line is it’s unethical,” said Chapin. “A normal foreskin on a normal baby boy is no more threatening than the hymen or labia on your daughter.” Opponents of circumcision are vocal and maintain that no one—not even a well-meaning parent—has the right to decide to remove a healthy body part from another person.

The AAP updated its 1999 policy after the academy’s task force reviewed the medical literature on the benefits and possible harms of the surgery. The review began in 2007 and was completed in 2012. It included 248 citations in a 30-page report involving 14 studies that experts characterize as fair evidence that circumcision in adulthood protects men from HIV transmission from a female partner, cutting infection rates by 40 to 60 percent. The three largest studies were carried out in Africa, where HIV is spread primarily among heterosexuals.

According to Dr. Diekema, circumcision does not appear to reduce HIV transmission among men who have sex with men. “The degree of benefit, or degree of impact, in a place like the U.S. will clearly be smaller than in a place like Africa,” he said.

Conversely, two studies reviewed have found that circumcision actually increases the risk of HIV infection among sexually active men and women.

Although male circumcision is not associated with lower rates of gonorrhea or chlamydia or even syphilis, circumcision has been linked to low rates of infection with human papillomavirus and herpes simplex type 2.

One thing is certain: there is virtually no incidence of penile cancer reported in circumcised males, and the procedure has long been recognized as a factor in lowering urinary tract infections in early life.

The question of complications is always brought up, but the true incidence of complications after newborn circumcision is unknown. The procedure is relatively safe, but deaths are not unheard of, the review noted. The complication rate is about one in 500 procedures, and most complications are minor. Although rare, severe damage or even amputation of parts of the penis can occur.

The new policy statement by the AAP certainly carries considerable weight and may convince more families that newborn circumcision is advantageous, but clearly that decision remains controversial to its very core.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Slow changes to the body—including loss of muscle mass, reduced body hair, infertility, lowered sex drive, and decreased prostate size—are all symptoms of low testosterone. It is not uncommon to find hypogonadism in patients with infertility. The testicles actually produce testosterone, but the pituitary gland and the brain send signals to the testicles to regulate testosterone production. Although low testosterone levels can result from problems either in the pituitary or in the testicles, the most common cause is testicular dysfunction in the aging male. Less common causes for low serum testosterone are testicular injury, undescended testicles, the results of radiation or chemotherapy, and mumps infection affecting the testicles. Other factors resulting in low serum testosterone can include inflammatory diseases (such as tuberculosis), HIV and AIDS, opiate use, obesity, and type 2 diabetes.

Low testosterone levels not only affect sex drive and sperm function but may also have a negative impact on bone health, red blood cell production, and the development and distribution of muscle and fat.

The most common side effects associated with low testosterone include reduced strength, depressed mood, fatigue, anemia, cognitive problems, and hot flashes. The gold standard for diagnosing hypogonadism is to measure the total testosterone levels in the blood. The normal range for testosterone is 300-1,000 ng/dl (nanograms per deciliter). Anything below 300 is considered abnormal. It is important to draw the blood for testing in the morning, when testosterone levels are typically the highest.

Over the past several years, testosterone replacement therapy (TRT) has increased dramatically, and between 2003 and 2010, testosterone sales jumped more than 500 percent. Although initial studies by the National Institutes of Health could not find any major adverse effects from TRT, side effects can include acne and an increase in circulating red blood cell volume. TRT is contraindicated in men with normal circulating testosterone.

Contrary to common thinking, TRT does not cause prostate cancer. However, if a small, undiagnosed prostate cancer is present, TRT can accelerate the growth of the tumor. Men with a high PSA (prostate-specific antigen) level are not suitable for TRT. Patients receiving treatment need to have their serum testosterone and overall condition monitored on a regular basis. It is recommended that patients who respond well to treatment be monitored every 3-4 months during the first year of treatment. In men over 50 years of age, a prostate examination and PSA testing every 6-12 months is recommended.

Men with confirmed low testosterone levels who choose to undergo treatment have a number of options. Studies show that TRT can help rebuild muscle, restore sexual function, and prevent osteoporosis. Unfortunately, no simple pill exists that can be taken because the oral ingestion of testosterone is extremely toxic to the liver.

Treatment options include injection therapy, wherein testosterone is administered intramuscularly once every two weeks. The disadvantage of injections is that there is a strong surge in the level of serum testosterone shortly after the injection, and this level decreases dramatically at the end of the two-week cycle.

The good news is that a number of topical preparations are available. The testosterone is applied to the skin and is absorbed into the bloodstream at a constant level. A patch can be applied to any hairless surface on a daily basis. The disadvantage of the patch is that it can often cause skin irritation. Several gels that can be applied to the lower abdomen, upper arm, or shoulder are also available. As the gel dries, the testosterone is absorbed through the skin. The gel is less irritating than the patch, but patients should be advised not to wash for several hours after applying the gel and to avoid contact with their children and female partners. On the rare occasions that a pituitary tumor is found as the source of low testosterone, the patient may need surgery or radiation in addition to hormone replacement.

Most importantly, TRT is absolutely contraindicated in men with normal serum testosterone levels. If given in this setting, a patient is no better than a cheating jock attempting to get “juiced” for enhanced physical performance. The results can be disastrous.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Today, most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer. Oddly though, only a minority of urologists currently recommend it to their patients. Remember, urologists are basically surgeons.

A study presented at the North Central Section of the American Urological Association showed that 47 percent of urologists recommended surgery, 32 percent recommended radiation therapy, and only 21 percent recommended active surveillance for low-risk prostate cancer.

Not surprisingly, the physicians’ recommendations aligned with their specialties: Most urologists recommended surgery, and most radiation oncologists recommended radiation therapy. Oncologists were 10.7 times more likely to recommend radiation therapy than surgery, and urologists were 4 times more likely to recommend surgery than radiation.

Dr. Simon Kim, a urologic oncology fellow at Mayo Clinic in Rochester, Minnesota, assessed the attitudes and treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists. Between 2011 and early 2012, a survey was mailed to 1,494 physicians in the United States who are active in the treatment of prostate cancer. All of the surgeons were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk prostate cancer. Of the 722 physicians who responded to the survey, 72 percent thought active surveillance was effective for low-risk prostate cancer, and about 70 percent were comfortable routinely recommending this approach.

In spite of these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which would include surgery and radiation therapy. Part of the explanation for the higher rates of surgery and radiation therapy rather than active surveillance in the treatment recommendation for low-risk prostate cancer may also reflect patient preferences. Many patients are very uncomfortable “living with their cancer.”

Despite the push for the more aggressive treatments that physicians continue to promote, this current study suggests a positive trend toward active surveillance. Surgeons and radiation oncologists agree that this approach is entirely safe and does not decrease the survival rate from early-stage prostate cancer.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Proceeds from the US campaign go to the Prostate Cancer Foundation (PCF) and Livestrong. PCF funds high-impact research to find better treatments and cures for prostate cancer; Livestrong offers services to men with prostate and testicular cancer that help them and their families navigate the best treatment options. Since prostate cancer is my business and my life’s work, I am grateful that the roughly 240,000 new cases of prostate cancer that will be diagnosed in the United States in the coming year—and the 40,000 deaths that will occur from prostate cancer—will be affected in a positive way.

It is one thing for a doctor to pontificate about the need for financial support in the research and treatment of this deadly disease, but it is quite another thing for two guys sitting in a bar in Australia in 2003 to come up with the genius of Movember as a fund-raising vehicle with a twinkle.

Movember raised over $126 million globally during the 2011 campaign and over $15 million in the United States alone. The 2012 goal for the US campaign is projected at $25 million.

Movember participants are known as Mo Bros. The women who support their guys, or just love Mo’s, get involved and are referred to as Mo Sistas. Talk about grassroots support. Fun without running a 10K for dollars—the Aussies got it right.

Since 2003, a new generation of men and women has had its awareness elevated and has begun to take positive action with regard to men’s health, and an enormous amount of money has been raised. A woman would never miss her annual Pap smear and breast examination, but a man must be brought to his urologist kicking and screaming for his annual exam. I guess men are from Mars and women are from Venus.

The Movember movement has changed that mind-set. During the 2011 campaign, there were nearly 30 million visits to the Movember website and nearly 4 billion social media messages worldwide. More than 1.8 billion Facebook users were reached, and more than 110 million tweets on Twitter carried the Movember message around the world. All of this support—just by growing a Mo!

As a health professional, I am ready with my team, Dr. D’s Dudes, to “Mo up” and move the agenda forward in our war to conquer prostate cancer and raise the level of awareness across the board for men’s health issues. To join my team, go to http://us.movember.com/team/461665. A urologic surgeon in a white coat preaching from the mountaintop is not nearly as powerful as the Mo Bros and the Mo Sistas across the globe who grow and support the Mo’s in their lives.

Dudley Seth Danoff, MD, FACS

President and Founder

Cedars-Sinai Tower Urology Group

Author, Penis Power: The Ultimate Guide to Male Sexual Health (Del Monaco Press)

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!