Sexual Health


May 28, 2019

Last year, scientists reported that almost two-thirds of people with multiple sclerosis (MS) experience sexual challenges, with the most common problems being loss of libido, orgasm difficulties, and trouble with arousal (vaginal lubrication and erections).

While this rate is high, it doesn’t mean that people with MS can’t enjoy intimacy. But understanding the challenges, staying patient, and making adjustments will go a long way in keeping sexual relationships strong.

Mechanisms

How does MS cause sexual problems? Here are some of the mechanisms:

  • Poor message transmission. MS is a central nervous system disorder that attacks the myelin sheath, the coating that protects nerve cells. The result is a disconnect between the brain and other body parts, including organs involved with sexual function. For example, a man with MS might receive sexual stimulation (such as an erotic image or touch), but his brain might not “get the message” to start an erection. Similarly, a woman’s vagina might not lubricate because it doesn’t “know” about sexual stimuli. For some people, MS leads to decreased – or increased – genital sensation. In some cases, touch might become painful.
  • Depression and anxiety. An illness like MS takes a toll on one’s mental health as well. It can be hard to plan for the future, and people may miss doing things they used to do. They might also worry about their partner’s feelings and reaction to the situation. Communication between partners can break down. Together, these factors can diminish libido and make it more difficult to become aroused.
  • Incontinence. Some people with MS feel nervous about having urinary accidents, especially during sex.
  • Fatigue. With MS, it’s not unusual to feel too tired for sex.
  • Spasticity and muscle weakness. Trouble controlling muscle movements or feeling weak in the muscles may make some sexual activities difficult.

Problems for Women

In November 2018, a study in the Journal of Sexual Medicine provided some insight on how extensive sexual dysfunction is among women with MS. Researchers looked at data from nine other studies on MS and female sexuality. Overall, almost 1,500 women – roughly half with MS – were involved.

In the analysis, women with MS were almost twice as likely to have sexual problems than women who didn’t have MS. Trouble with arousal, lubrication, desire, orgasm, and pain were more common in women with MS. They also tended to have lower sexual satisfaction.

Problems for Men

Erectile dysfunction (ED) is a common problem for men with MS. Erections might not be firm enough for sex, or they might not occur at all.

Fortunately, men with ED have a number of treatment options:

Men might also experience trouble with ejaculation.

Next Steps

If you or your partner is struggling with MS and intimacy, consider these options:

  • See your doctor. As about treatments for sexual issues. For example, the solution for poor vaginal lubrication might be an over-the-counter product. And as noted above, there are several ways to treat erectile dysfunction. Many people feel awkward discussing their sex life with their doctor. But remember, your doctor is there to help you.
  • Seek other professional help. Seeing a counselor or sex therapist, especially one who works with people with MS, can give you some new ideas to try in the bedroom. He or she can also help you cope with any depression, anxiety, or relationship conflict you might be experiencing. (Learn more about sex therapy here.)
  • Talk to your partner. Have an honest, open conversation with your partner about any changes in your sexual relationship and how you’re feeling about them. He or she might be feeling the same way but be hesitant to bring it up. Work as a team to keep your relationship on track, emotionally and sexually.
  • Plan for sex. For people with MS, it isn’t always possible to have sex at the spur of the moment. But you can plan for romance and intimacy. Figure out when you and your partner can have time to yourselves to relax and enjoy being together. It might not be as spontaneous, but having that time to look forward to can be just as exciting.
  • Take your time. If it takes you longer to become fully aroused or to climax, that’s okay. Just enjoy the journey and don’t worry about timetables.
  • Experiment. You might need to try other types of sexual stimulation because what worked for years might not be as effective. Now is a great time to try something new. That “something new” could be a new type of touch, different sexual positions, oral sex, the use of sex toys like vibrators, sex at a different time of day, or sex in a new location. Be open to new ideas.

Resources

EverydayHealth.com

Vann, Madeline R., MPH

“How to Have a Healthy Sex Life When You Have Multiple Sclerosis”

(Last updated: December 21, 2016)

https://www.everydayhealth.com/multiple-sclerosis/living-with/maintaining-a-healthy-sex-life-when-you-have-ms/

International Society for Sexual Medicine

“How might multiple sclerosis affect a person sexually?”

https://www.issm.info/sexual-health-qa/how-might-multiple-sclerosis-affect-a-person-sexually/

The Journal of Sexual Medicine

Zhao, Shankun MD, et al.

“Association Between Multiple Sclerosis and Risk of Female Sexual Dysfunction: A Systematic Review and Meta-Analysis”

(Full-text. Published online: November 1, 2018)

https://www.jsm.jsexmed.org/article/S1743-6095(18)31215-3/fulltext

National Multiple Sclerosis Society

“Sexual Problems”

https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Sexual-Dysfunction

SexHealthMatters.org

“About Two-Third of MS Patients Have Sexual Problems”

https://www.sexhealthmatters.org/did-you-know/about-two-third-of-ms-patients-have-sexual-problems

WebMD

“Maintaining Intimacy With Multiple Sclerosis”

(Reviewed: April 24, 2016)

https://www.webmd.com/g00/multiple-sclerosis/multiple-sclerosis-maintaining-intimacy



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May 01, 2019

How do healthcare professionals make decisions when diagnosing and treating illnesses? Certainly, their continuing medical education helps, and most attend conferences and keep up with research in their field’s peer-reviewed journals.

But professionals also consult guidelines issued by medical societies, such as the International Society for Sexual Medicine (ISSM) or the American Urological Association (AUA). Society panels take a close look at the latest clinical trials and other studies and use that evidence to develop recommendations.

Over the last few years, testosterone replacement therapy has been a hot topic for medical societies. Back in August of last year, we covered new guidelines from the American Urological Society. Today, we’ll discuss a set of guidelines that were updated by the Endocrine Society, a professional group of over 18,000 hormone specialists.

Since testosterone is an important hormone for men, the list of guidelines can be an essential tool for sexual health specialists and primary care physicians who treat men with hypogonadism (low testosterone).

The Endocrine Society guidelines were originally issued in 2010 and updated in 2018.

(Note: For a primer on hypogonadism, please see the links at the bottom of this post.)

Why were the guidelines updated?

Scientists have conducted a great deal of research on testosterone therapy in recent years. The updated guidelines reflect new findings and address concerns.

In addition, more men are seeking help for issues related to testosterone deficiency nowadays, and “low t” gets a lot of media coverage. As a result, men are asking their doctors whether testosterone therapy could help them. It’s critical that prescribers fully understand the benefits and risks.

What do the updated guidelines say?

Highlights of the Endocrine Society’s updated guidelines on hypogonadism include the following points:

Diagnosis

  • In general, men shouldn’t be routinely screened for hypogonadism. However, a diagnosis of hypogonadism is recommended if a man has symptoms (such as low libido or fatigue), and a blood test reveals lower-than-normal testosterone levels.
  • Based on other hormonal measurements, men can be diagnosed with primary hypogonadism (caused by problems in the testes) or secondary hypogonadism (caused by problems in parts of the brain that trigger testosterone production).

Treatment

  • The recommended goals of testosterone therapy are to “induce and maintain” secondary sex characteristics that are driven by testosterone (such as facial hair and muscle mass) and to alleviate symptoms like low sex drive.
  • Testosterone therapy is not recommended for men who would like to father a child in the near future. Men with certain health problems (such as prostate cancer, breast cancer, untreated severe obstructive sleep apnea, and recent heart attack or stroke) should not take testosterone.
  • Testosterone therapy might not be appropriate for men between the ages of 55 and 69 who are expected to live at least another ten years. Doctors should discuss the benefits and risks with these patients.
  • Men over age 65 shouldn’t be prescribed testosterone routinely. Instead, doctors should consider each individual’s situation.
  • Men with HIV, low testosterone, and weight loss might undergo testosterone therapy to gain and maintain weight.
  • Men with diabetes and low testosterone should not use testosterone as a way to control their blood sugar.

Monitoring

  • Once testosterone therapy has begun, men should have regular checkups to make sure it is working well and there are no side effects.
  • During the first year of therapy, men with abnormal prostate cancer screening results should see a urologist.

What does this mean for patients?

While these guidelines are intended for healthcare professionals, they can be useful for men, too.

Understanding the guidelines for any treatment you receive helps you weigh the pros and cons of therapy as you make health decisions.

“The [updated Endocrine Society] guideline emphasizes the importance of patient engagement in a shared decision-making process, especially with respect to the choice of treatment regimens and prostate monitoring,” said Dr. Shalender Bhasin, head of the guideline development task force, in an interview with Endocrine News.

Learn more

For more information on hypogonadism and testosterone, please see these links:

Low Testosterone

Unpacking the Latest Testosterone Therapy Guidelines

What Should Men Know About Topical Testosterone?

Self-Injectable Testosterone Now Available

FDA Approves Testosterone in Pill Form

Resources

Endocrine News

“Q&A: Shalender Bhasin, MD”

(May 2018)

https://endocrinenews.endocrine.org/qa-shalendar-bhasin-md/

The Endocrine Society

“About the Endocrine Society”

https://www.endocrine.org/about-us

“Testosterone Therapy for Hypogonadism Guideline Resources”

https://www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/testosterone-therapy

The Journal of Clinical Endocrinology and Metabolism

Bhasin, Shalender, et al.

“Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline”

(Full-text. Published: March 17, 2018)

https://academic.oup.com/jcem/article/103/5/1715/4939465



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Apr 02, 2019

Justin was 24 years old and in his sexual prime. Or at least, he thought he should be. The last few times he wanted to have intercourse, his erection was rather…lackluster. It wasn’t firm at all, and while his partner didn’t say anything, he was sure his performance disappointed them both.

“I’m too young for this,” he thought. He had seen commercials for erectile dysfunction drugs on television, but the guys always seemed so much older. This type of stuff didn’t happen to younger guys, did it?

He didn’t go to the doctor often, and he couldn’t imagine calling for an appointment for this specific problem. But as time went on, his erections became less predictable. He knew he had to do something.

While surfing online, he found some websites that offered erectile dysfunction (ED) drugs that could be discreetly delivered to his home. He could talk to a doctor through video chat and get a prescription easily. Was this the route to take?

In this post, we’ll consider Justin’s question.

What is telehealth?

Technology has brought people closer together in ways we might not have imagined thirty years ago. And this includes doctors and patients, who can now use the internet to communicate through telehealth (sometimes called telemedicine). Patients can email their doctor, send relevant pictures, and have videoconference discussions of symptoms and treatment options without actually getting together in an office or exam room. These communications can take place on desktop and laptop computers, tablets, and smartphones. In some cases, patients can receive prescriptions through telehealth services.

Why might men with ED consider telehealth?

“Seeing” a doctor online is convenient. Patients can do so in the comfort of their own homes, without the hassle of traveling there, finding parking, or taking time off of work. In addition, many men feel awkward or embarrassed about sexual health problems. Telehealth might offer a degree of privacy, as long as the connection is secure.

Why should men with ED see a doctor in person?

While telehealth has its advantages, it is not a substitute for seeing a doctor in person. For men with ED, this is especially important.

ED is often a sign of more serious health conditions, like diabetes and heart disease. Sometimes, the links are complicated. For example, erections might be impaired by hardening of the arteries (atherosclerosis), low testosterone levels, or autonomic neuropathy (a form of nerve damage). To learn more about these issues, a physical exam is essential. Lab tests may also be ordered, and these can only be done during a traditional office visit.

In fact, ED diagnosis guidelines issued by the American Urological Association (AUA) stress the importance of a physical exam:

Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing.

In other words, a telehealth doctor may be able to prescribe an ED medication, but he or she will not have all the information necessary to determine exactly why a man has ED.

A comprehensive physical exam can reveal any underlying medical conditions, and treatment can begin immediately. Erections can improve, and the risk of any further complications can be reduced.

Dr. Hossein Sadeghi-Nejad, President of the Sexual Medicine Society of North America (the organization behind SexHealthMatters.org) contributed to the AUA guidelines on ED. In an interview with Business Insider, he pointed out that while not all men with ED are at risk for more serious health conditions, “but some are.”

“To lose that window of opportunity to address the bigger problem would be a pity," Dr. Sadeghi-Nejad added.

Next steps?

Some men might find it difficult to work up the nerve and mention ED to the doctor. But it’s worth making the call. It can lead to more satisfying, more confident sex. And it can help you and your doctor address any bigger health concerns that need attention.

Check out these links to learn more:

Erectile Dysfunction (overview of ED, including causes and treatments)

Young Men and Erectile Dysfunction

Possible Causes of Early Onset Erectile Dysfunction (ED)

How Do Certain Diseases Lead to Erectile Dysfunction?

Resources

American Urological Association

“Erectile Dysfunction: AUA Guideline (2018)”

(Published: 2018)

https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline

Business Insider

Court, Emma

“Hot startups like Hims and Roman are marketing Viagra to young men online, but their approach raises 2 big questions”

(February 25, 2019)

https://www.businessinsider.com/hims-and-roman-target-erectile-dysfunction-which-can-signal-health-issues-2019-2

DiversityNursing.com

Bettencourt, Erica

“TeleHealth Pros and Cons”

(January 11, 2019)

http://blog.diversitynursing.com/blog/telehealth-pros-and-cons

SexHealthMatters

“How Do Certain Diseases Lead to Erectile Dysfunction?”

(January 12, 2016)

https://www.sexhealthmatters.org/sex-health-blog/how-do-certain-diseases-lead-to-erectile-dysfunction



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Mar 10, 2019

Is it true that men with a smaller penis are more likely to be infertile?

The simple answer is no. A number of factors can contribute to infertility. A man can have a low sperm count, or his sperm might not be fully developed. He could have retrograde ejaculation, which causes semen (including sperm) to travel backward into the bladder instead of forward out of the penis when he ejaculates. Medications could affect his sperm production. But penis size is not a factor.

Last fall, however, some media outlets reported that men with small penises had lower odds of fathering children. Where did this notion come from? The news stemmed from a poster presentation at the 2018 Scientific Congress of the American Society for Reproductive Medicine in Denver.

Unfortunately, not all the facts were reported accruately. What happened? Let’s take a closer look.

The Study

Eight hundred fifteen men between the ages of 18 and 59 participated in the study, conducted by a research team from the University of Utah. Two hundred nineteen men were infertile; the remaining 596 men were not.

The researchers measured each man’s stretched penile length (SPL) – the distance from the pubic symphysis (a joint near the pubic bone, just above the penis) to the meatus (the urinary opening).

The infertile men’s average SPL was 12.5 centimeters (4.92 inches). The average SPL for the other men was 13.4 centimeters (5.28 inches).

The authors wrote the following conclusions:

This is the first study to demonstrate an association between a shorter SPL and infertility. It is unknown if reduced length is a result of genetic or congenital factors associated with infertility such as testicular dysgenesis syndrome or the result of underlying hormonal differences between the two groups. Further investigation is needed to better understand the association of shorter stretched penile length with male infertility.

The Media Coverage

Not long after the presentation, news outlets started sharing the news, sometimes with misleading headlines linking smaller penises directly to infertility.

But that’s not what the study found, lead author Dr. Austen Slade told Medscape Medical News, noting that he had not spoken to any of the reporters who wrote the misleading articles. (His contact information was included on the poster.)

“Headlines such as 'men with short penises can't father children' are just plain wrong," Dr. Slade said. "What we are saying here, and it would have been obvious if any of these reporters had contacted me, is that a shorter length may be an indication of something else going on."

"Fertility depends on many factors, but not on the size of a man's penis," he added.

As the abstract conclusion explains, penis size could be connected to hormonal, genetic, or congenital (present at birth) factors associated with infertility. The authors called for more research to better understand the study’s results.

Why were readers misled?

It’s possible that the news outlets saw the association between penis size and infertility but didn’t look beyond that for further explanation. Dr. Emily Barrett of Rutgers School of Public Health in New Jersey told Medscape, “anything with the word ‘penis’ is like a magnet for reporters.”

How can you know that health information is accurate?

Whether it’s a news piece or health information in general, there are steps you can take to make sure you’re getting accurate reporting.

  • Consider the source. Is it an outlet you’ve never heard of? Is it an organization you trust?
  • Check the date. How current is the information?
  • Look at how the information was gathered. Does it come from a respected medical journal? From scientists or healthcare providers? From patients?
  • Talk to your doctor. Don’t hesitate to show the article to a professional and ask questions.

See more tips for assessing health information (especially on the internet) here.

Resources

American Academy of Family Physicians

“Health Information on the Web: Finding Reliable Information”

(Last updated: January 4, 2018)

https://familydoctor.org/health-information-on-the-web-finding-reliable-information/

Fertility and Sterility

Slade, A., et al.

“Stretched penile length and infertility, a new association”

(Abstract presented at the 2018 Scientific Congress and Expo of the American Society for Reproductive Medicine. October 9, 2018)

https://www.fertstert.org/article/S0015-0282(18)31064-1/abstract

Healthline

“Pubic symphysis”

(Reviewed: March 19, 2015)

https://www.healthline.com/human-body-maps/pubic-symphysis#1

Medscape Medical News

Lowry, Fran

“Media Sensationalizes Small Penis Study, Upsetting Patients”

(October 16, 2018)

https://www.medscape.com/viewarticle/903512

SexHealthMatters.org

“The Internet and Sex Health Info”

https://www.sexhealthmatters.org/did-you-know/the-internet-and-sex-health-info

Time.com

Oaklander, Mandy

“Can You Really Trust the Health News You Read Online?”

(December 9, 2014)

http://time.com/3625626/health-news-accuracy/

Urology Care Foundation

“What is male infertility?”

https://www.urologyhealth.org/urologic-conditions/male-infertility



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Feb 05, 2019

Back in December, we brought you a blog post on men and masturbation, discussing the benefits, risks, and ways to enhance the experience.  

This month, it’s the women’s turn.

Do women masturbate as much as men do?

Female masturbation is sometimes considered taboo, an activity that isn’t meant for “nice girls” who aren’t supposed to enjoy sexuality. But times are changing.

Female masturbation has become more common over the last few decades. In 2017, a study of 913 French women found that 74% of survey respondents had masturbated at least once in their lives. In 2006, a rate of 60% was reported, and in 1970 the rate was just 19%.

Still, men masturbate more than women do, the study authors explained, noting that 95% of men said they had masturbated compared to 74% of women. Half of the men said they masturbated at least once a week, but only 14% of women maintained this frequency.

Why masturbate?

Masturbation, pleasuring oneself sexually, is a natural, healthy way to achieve sexual release. It can have health benefits, too:

  • It’s a stress reliever and mood booster. Simply taking time for yourself for an enjoyable activity can take your mind off stress and help you focus instead on pleasure. And if masturbation leads to orgasm, the body releases endorphins – powerful neurotransmitters associated with feeling good. (Note: Orgasm shouldn’t necessarily be the end goal of masturbation. If it doesn’t happen for you, don’t worry. It’s fine to just relax and enjoy the experience.)
  • It teaches you about your body. When you’re exploring your body privately, you can try new things that you might not try with a partner. You might find that touching areas like the nipples or ears can be just as exciting as touching the genitals. You might share these discoveries with your partner.
  • It helps keep your genitals healthy. This is especially true for older women. Estrogen is an important hormone for keeping the vagina moist and flexible. When estrogen levels drop at menopause, the vagina can become dry and brittle, making sex uncomfortable. However, masturbation improves blood flow to the area, which might help with lubrication. (Learn more about genital changes at menopause here.)
  • It is (generally) safe. Masturbation is a low-risk sexual activity, and women don’t need to worry about pregnancy or sexually transmitted infections. That said, it’s important to stay safe. Women should wash their hands before masturbating to avoid transmitting any bacteria to the genitals. Sex toys, if used, should be clean and appropriately sized to avoid injury. (Learn more about the sizing of dildos and vibrators here.) Also, if you find that masturbation is interfering with your day-to-day life, be sure to talk to your doctor.

How do women masturbate?

There is no right or wrong way to masturbate, as long as the practice does not hurt anyone. This is a time to treat yourself to new experiences along with the tried-and-true routines.

Here are some ideas to consider:

  • Lie on your back (or stomach) and rub your genitals and other erogenous areas. If you aren’t sure exactly where those areas are, let your hands wander and explore.
  • Squeeze your thighs together.
  • Use your imagination. Fantasize about a particular person or locale.
  • Watch an erotic movie or read a sexually-explicit book while masturbating.
  • Insert a finger or dildo into your vagina.
  • Try using a vibrator.
  • Let water from the shower massage your genitals. (You can also use a hand-held shower head.)
  • Take it slow. You don’t have to rush to orgasm. You don’t even have to orgasm at all. Just enjoy the journey.

Resources

EverydayHealth.com

McCoy, Krisha

“Health Benefits of Solo Female Sexuality”

(Last updated: October 15, 2014)

https://www.everydayhealth.com/sexual-health/female-masturbation-health-benefits.aspx

Healthline

Scaccia, Annamarya

“How to Masturbate with a Vagina: 28 Tips and Tricks for Solo Play”

(Reviewed: March 13, 2018)

https://www.healthline.com/health/womens-health/how-to-masturbate-for-women

Psychology Today

Mintz, Laurie, PhD

“Masturbation 102: How Women Pleasure Themselves”

(June 25, 2018)

https://www.psychologytoday.com/us/blog/stress-and-sex/201806/masturbation-102-how-women-pleasure-themselves

Self.com

Zoldan, Rachel Jacoby

“14 Benefits of Female Masturbation and Why Every Woman Should Do It”

(December 31, 2018)

https://www.self.com/story/13-reasons-every-woman-should-masturbate-besides-the-obvious

Sexologies via Science Direct

Kraus, F.

“The practice of masturbation for women: The end of a taboo?”

(Full-text. October-December 2017)

https://www.sciencedirect.com/science/article/pii/S1158136017300774

WebMD

Pagán, Camille Noe

“Female Masturbation: 5 Things You May Not Know”

(March 11, 2014)

https://www.webmd.com/women/features/female-masturbation-5-things-know#1



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Dec 31, 2018

If you’re a woman going through cancer treatment, you’ve probably had to adapt to a lot of changes in your life. You might have seen some dramatic changes in your sex life, too – changes you might not have been prepared for.

Maybe you’re not able to have sex the way you used to. Perhaps you’re experiencing hormonal changes that affect your level of desire. Maybe you’re feeling confused about your partner or your relationship. Or you might be feeling anxious about starting a new relationship after cancer treatment.

No matter what you’re experiencing, it’s normal to be concerned about your sex life. Your sexuality is a part of who you are. Today we’ll look at some of the issues female cancer survivors face and some strategies to cope with them.

Physical challenges

  • Hormonal changes.  For some women, cancer treatment causes menopause, the time when a woman’s ovaries stop producing eggs and her menstrual periods stop. Along with menopause come lower levels of two hormones, estrogen and androgen. Estrogen helps ready your vagina for sex by making it longer, wider, and lubricated. Androgen affects your sex drive. After menopause, these hormonal changes can cause vaginal dryness and tightness or a loss of desire. Talk to your doctor if you have any problems. For dryness, you may try water-based lubricants, a vaginal moisturizer, or vaginal hormones. For loss of desire, your doctor may prescribe small doses of androgens.
     
  • Pain.  Pain during sex is common for many women. Vaginal dryness and tightness or changes in the genitals from cancer treatment are common causes. Be sure to discuss any sexual pain with your doctor. He or she can give advice tailored to you. Talk to your partner about what does and doesn’t work for you. You may need to discover new ways of touching each other or try new positions and techniques to make the experience pleasurable for you. Try to be patient and open-minded.
  • Fatigue. Breast cancer and its treatment can be exhausting. You might just feel too tired for sex. Try planning intimacy for times when you have more energy, such as the early morning or afternoon.

Emotional challenges

Lots of women feel anxious about changes that result from cancer treatment and how they’ll be perceived by others.

  • Body image. Your body might look different from cancer treatment. Losing a breast or your hair, having scars from surgery, changes in weight – these can all make you feel less attractive. You may worry that these changes will turn off your partner. Some women feel better when they accentuate the positive. You might try a new style of clothes or makeup to give you a boost. Some women wear a breast form or try different skin treatments. Don’t forget that healthy eating and exercise can also make you feel better! Remember, too, that you are still you, beautiful inside and out. As the National Cancer Institute says, “Try to recognize that you are more than your cancer. Know that you have worth – no matter how you look or what happens to you in life.”
  • Dating.  Starting new relationships can be fun and exciting, but women in cancer treatment may feel anxious about it. When should you tell your partner about your cancer? How will he or she react? You can start by just enjoying time with your friends and family. Take part in activities you enjoy or try new ones. You might not meet a new partner, but it’ll boost your spirits and confidence to be out and about. When you do meet someone new, enjoy the experience. When the relationship becomes more serious, and when you feel that you trust the person, you can introduce the topic of cancer. Try practicing what you’ll say with a good friend and ask for feedback. Also think about the many ways that person may react and how you’ll handle them. Don’t assume that the person will reject you. If the relationship has a solid base with caring and trust, the person will likely want to be with you, cancer or not.

Other concerns

  • Is it okay to have sex? Many women wonder whether it’s safe to have sex during or immediately after cancer treatment. Your doctor can best answer this question. If you’ve just had surgery, sex could pull at the stitches, so it might be best to wait awhile. Unusual bleeding is another concern. Some cancer treatments, such as radiation and chemotherapy, can interfere with your immune system and make you more susceptible to infections. Ask your doctor about any precautions you need to take.
  • Radiation. Some women who have radiation therapy worry that they can pass along radiation to their partner. Again, this is a concern best addressed by your doctor. Generally, if the radiation comes from a machine outside your body, no radiation remains in your body. So in this case, you wouldn’t be passing radiation along to your partner. However, radiation from a radioactive implant placed in your uterus or vagina can be passed along to your partner, so it’s best to ask your doctor when you can have sex again.

Talk to your doctor.

Your doctor might not bring up sexual issues, but that doesn’t mean you can’t. Don’t hesitate to speak up! He or she may know the remedy. And even if your doctor doesn’t have all the answers, he or she can refer you to someone who does, such as a sex therapist or counselor. And there’s nothing wrong with seeing a specialist.

Talk to your partner.

If changes in your sex life are troubling you, be sure to talk to your partner as well. Together, you and your partner can brainstorm ways to adjust your sexual repertoire. For example, if vaginal intercourse is uncomfortable, try oral sex or kissing and cuddling. (Read more about sexual pain here.) 

You might also need more time to become fully aroused. If so, tell your partner what you need. Take advantage of that time to experiment and just enjoy each other.  

Your partner might be nervous about sex, too, afraid of hurting you or doing something “wrong.”  If an activity hurts, by all means say so. But if you miss an old activity or touch, let your partner know.

Consider therapy.

Know that you are not alone. Depression and anxiety, common in breast cancer patients and survivors, can take a toll on your sex life as well. If you think you need help, consider therapy or a support group. Couples counseling and sex therapy may also help you work out changes in your relationship.

Moving forward

Remember, your sex life was likely important to you before cancer. There’s no reason it shouldn’t be important now. Cancer and its treatment shouldn’t prevent you from having healthy, fulfilling sex.

To learn more about breast cancer and sexuality, see these links:

Breast Cancer Survivors Face Sexual Concerns

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

Special Therapy Addresses Body Image in Breast Cancer Survivors

Breast Cancer Treatment Could Preserve Ovarian Function

Breast Cancer Has Sexual Impact on Both Survivors and Partners

For Breast Cancer Survivors, Sexual Concerns May Last Years

 

Additional Resources

BreastCancer.org

“Changes in Your Sex Life”

(Last modified: June 13, 2017)

https://www.breastcancer.org/tips/intimacy/changes

Schwartz, Dr. Pepper via PRNewswire

“Breast Cancer and Intimacy: Advice for Survivors to Address Sexual Dysfunction and Regain Confidence”

(October 16, 2018)

https://www.prnewswire.com/news-releases/breast-cancer-and-intimacy-advice-for-survivors-to-address-sexual-dysfunction-and-regain-confidence-300731981.html

Updated: January 2, 2019



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Dec 04, 2018

You might recall a 1992 Seinfeld episode called “The Contest.”

At the beginning, friends Jerry, Kramer, and Elaine are sitting in their favorite coffee shop when fellow friend George walks in, looking upset. He reveals that his mother caught him masturbating and swears he will never do it again – anywhere.

His friends are not convinced, and George proposes a contest. Which friend can go the longest without masturbating? Bets are made, and then Elaine says she wants to join in too.

George and Jerry protest. “It’s easier for a woman not to do it than a man,” Jerry explains, adding, “We have to do it. It’s part of our lifestyle. It’s like, uh . . . shaving.”

Whether masturbating is part of the male lifestyle might be debatable, but research suggests that men masturbate more than women do. A 2010 study from the Kinsey Institute of Indiana University found that 1 in 4 men between the ages of 18 and 59 masturbated a few times a month to weekly. About 20% said they masturbated two to three times a week. In contrast, women masturbated once a week or less.

Masturbation is a healthy activity, for the most part. But there are things men should be aware of, and we’ll go over some of those today, along with ways to make the self-stimulation even better.

What are the benefits of masturbation?

We’ve come a long way from the old wives’ tale telling us that masturbation makes people go blind or gives them hairy palms. In truth, masturbation is natural, normal, and healthy.

Here are some of the benefits:

  • It’s (usually) a safe sexual outlet. You can relieve sexual tension without worries of an unplanned pregnancy or sexually-transmitted infection (STI). You can also get some sexual release if you’re single or if your partner is far away or unable to have sex.
  • It offers an opportunity to explore your own body and figure out where and how you like to be touched.
  • It can relieve tension and stress and might help you sleep better.

Could masturbation become a problem?

Some men masturbate more than others, and as long as it doesn’t interfere with your day-to-day life or your relationships, you probably don’t need to worry about the frequency.

However, men should be aware of some concerns:

  • Skin irritation. Masturbating too vigorously can cause the skin on the penis to become irritated.
  • Penile fracture. Excessive force or bending the penis during masturbation can lead to penile fracture, which is an emergency. If you hear cracking or popping sound, or experience bleeding or bruising, seek immediate medical care.
  • Premature ejaculation. Some men who bring themselves to climax quickly might find that their bodies adjust to this timing.
  • Needing more stimulation. If you masturbate more rigorously, or do so while viewing pornography, you might need more stimulation from your partner to become fully aroused and reach orgasm. Porn may also lead to unrealistic expectations for sex, as it does not depict what usually happens with everyday couples.
  • Addiction. Many men masturbate while watching pornographic videos or looking at adult magazines. This can become problematic if the time spent masturbating takes away from daily responsibilities or interferes with work, school, or relationships. Men who think they are addicted to pornography are encouraged to see their doctor or therapist. (Learn more about porn addiction here.)

Are there other ways to masturbate?

The process may seem pretty straightforward. But men can enhance their experiences by mixing things up. Here are some ideas to try:

  • Visualize other scenarios. While masturbating, close your eyes and imagine an erotic scenario that is different from what you usually experience. See where your mind takes you.
  • Use toys or props. Some men find that vibrators and artificial vaginas enhance their masturbation.
  • Use other media. Try listening to soft music or a suggestive audiobook or podcast.
  • Touch other areas of the body. The penis plays an important role in sexual excitement, but it’s not the only location. Try rubbing your chest, testicles, or perineum (the area between your penis and anus).
  • Try other locations or positions. If you typically masturbate in bed, try it in the shower. If you stroke with your right hand, try doing so with your left.

Ultimately, as long as your technique and practice doesn’t hurt you or others, just do what feels right and enjoy the pleasure.

Resources

Between Us Clinic

Sher, Daniel

“How to Masturbate Correctly – A Guide for Healthy Male Masturbation”

(November 6, 2018)

https://www.betweenusclinic.com/mental-impotence/how-to-masturbate-correctly/

International Society for Sexual Medicine

“Does masturbation cause erectile dysfunction (ED)?”

https://www.issm.info/sexual-health-qa/does-masturbation-cause-erectile-dysfunction-ed/

“What are some effects of sustained pornography use?”

https://www.issm.info/sexual-health-qa/what-are-some-effects-of-sustained-pornography-use/

“What can be done to help someone who has a problem with pornography?”

https://www.issm.info/sexual-health-qa/what-can-be-done-to-help-someone-who-has-a-problem-with-pornography/?ref_condition=sexual-dysfunction

“What is the “normal” frequency of masturbation?”

https://www.issm.info/sexual-health-qa/what-is-the-normal-frequency-of-masturbation/

Medical News Today

Nichols, Hannah

“Are there side effects to masturbation?”

(Last reviewed: December 7, 2017)

https://www.medicalnewstoday.com/articles/320265.php

SeinfeldScripts.com

David, Larry

“The Contest”

(First broadcast: November 18, 1992)

http://www.seinfeldscripts.com/TheContest.htm

VeryWellMind.com

Stritof, Sheri

“What are Some of the Myths About Masturbation?”

(Updated: May 23, 2018)

https://www.verywellmind.com/myths-about-masturbation-2300804

WebMD

Griffin, R. Morgan

“Male Masturbation: 5 Things You Didn't Know”

(Reviewed: January 28, 2017)

https://www.webmd.com/men/guide/male-masturbation-5-things-you-didnt-know#1



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Nov 07, 2018

After a cancer diagnosis, it’s not unusual to have questions swirling through your mind. How far has the cancer progressed? What is the prognosis? What will treatment be like? How will my family and I cope?

Often, questions about sexuality go on the back burner. It’s easy to understand why, when so many other issues may take priority. But keep in mind that sex is an important part of life. There’s no reason for your sexual relationships to stop just because of cancer.

Cancer and its treatment can have a huge impact on sexual function, even if the reproductive organs aren’t targeted. So it’s best to ask about your situation before your treatment begins.

Below, we’ve listed some questions you might consider asking your cancer care team. While not all of them will apply to you, they might trigger other questions you haven’t thought of. Be sure to bring a pen and some paper to jot down the answers. You might also have your partner or a trusted friend or relative go with you to your appointment. It can help to have a second set of ears, just in case you miss something.

Finally, don’t hesitate to ask questions, especially if your healthcare provider doesn’t bring up sexual health. Some people feel awkward discussing sex, but it’s entirely reasonable to wonder how treatment will affect your sex life.

We suggest that you print out these questions and put a mark next to the ones that apply to you. We’ve also included space for you to write down your own questions and answers at the end.

General

  • What are the sexual side effects of this treatment?
  • Will I be able to have sex the way I used to?
  • What should I do if my orgasms change?
  • What should I do if I lose interest in sex or have difficulty becoming aroused?
  • How might this treatment affect my sex hormones (e.g., testosterone and estrogen)?
  • Will I have to stop having sex for a period of time? (If so, when can I resume sexual activity?)
  • Are certain sexual activities or positions recommended over others?
  • Will sex feel different?
  • Will it hurt?  
  • Can you recommend some books or websites, so I can learn more?

For Men

  • Will my erections change?
  • Will I have erectile dysfunction (ED)? If so, will it be permanent?
  • What ED treatments would be best for me?
  • Will I need penile rehabilitation? What does that entail?
  • Will my testosterone levels decrease?
  • How does prostate cancer treatment affect gay and bisexual men?

For Women

  • What is surgical menopause?
  • Will I experience vaginal dryness?
  • If I have trouble with lubrication, should I try a lubricant or moisturizer?
  • Would hormone replacement therapy be an option for me?
  • Will surgery or radiation change the shape of my vagina?
  • Can vaginal dilators help stretch my vagina?

Body Image

  • How will cancer treatment change my appearance?
  • Where might I find items like wigs and breast forms?
  • Can plastic surgery help me? oHow wi
  • Should I consider prosthetics (such as prosthetic testicles)?
  • What can I do about surgical scars?

Partners

  • What should my partner know about sex and cancer?
  • Can my partner “catch” anything through sexual contact?
  • Is it safe for me to have sex if I’m having chemotherapy or radiation therapy?
  • Is help available for partners?
  • Should my partner come with me to therapy?
  • I’m single. When should I tell a new partner about my cancer treatment?
  • Will this treatment affect the way I speak, eat, or socialize?
  • Will this treatment make it more difficult to kiss my partner?

Contraception

  • If pregnancy is no longer a concern, do I still have to practice safe sex?
  • What type of contraception is best for me?
  • Can I use hormonal contraceptives?

Pregnancy and Fertility

  • Is it safe for me (or my partner) to become pregnant during my cancer treatment?
  • Will I still be able to have children?
  • Can I freeze sperm or egg cells for future in vitro fertilization?
  • Where can I find reliable information about surrogacy?
  • Where can I find reliable information about adoption?
  • How can my partner and I cope with infertility?

Emotional Health

  • I’m feeling very anxious about the future. Should I talk to a counselor?
  • Can you refer me to a counselor in my area?
  • Can you put me in touch with a support group or other patients who have had this type of cancer?

Your Questions

My Question

My Doctor’s Answer

 

 

 

 

 

 

 

 

 

 

Learn More

To learn more about cancer and sexuality, these links can help:

Sex After Cancer

Cancer and Sexual Problems

The Effects of Cancer on Women’s Sexuality

Cancer and Sex for Single Women

How Does Cancer Affect Men’s Sexual Health?

Fertility Options for Men with Cancer

How Does Prostate Cancer Treatment Affect Gay and Bisexual Men?

You can also find information by searching for a specific term on our site.



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Oct 08, 2018

It’s no secret that our bodies change as we age. We might not move as quickly, hear as clearly, or see as vividly as we did when we were younger. But while some changes might seem inevitable, getting older doesn’t mean we’re down for the count.

Sexual function is no different. As men get older, they might start having trouble with erections. It can take longer to get aroused or become more difficult to get a fully firm erection. Older men may also be more prone to health conditions that contribute to poor erections, like low testosterone, diabetes, and heart disease. Treatment for certain types of cancer, like prostate cancer, can affect erections, too.

The good news is that men with erectile dysfunction (ED) have many treatment options available. Pills, self-injections, vacuum erection devices, urethral suppositories, and penile implant surgery are all possibilities.

Unfortunately for older men in the United States, Medicare usually does not cover ED treatments, as they are not considered medically necessary.

Today, we’ll discuss some of the basics of Medicare coverage for ED. Please note that this is a brief summary. Medicare has many components, and we encourage you to see the Medicare website for complete details.

What is Medicare?

Medicare is a health insurance program for people age 65 and older in the United States. People under age 65 may qualify if they have certain disabilities. Patients with end-stage renal disease may be eligible at any age.

Generally, Medicare comes in three main categories:

  • Medicare Part A – This part helps cover people when they are in the hospital.
  • Medicare Part B – This part helps cover doctor’s visits and outpatient services.
  • Medicate Part D – This part covers some, but not all, prescription drugs.

ED and Medicare: A General Overview

Medicare’s ED coverage as of October 2018 is as follows:

Treatment

Examples

Covered?

Medication – Phosphodiesterase type 5 (PDE5) inhibitor pills

Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil), Stendra (avanafil)

If prescribed for ED: No

 

If prescribed for another condition: Maybe

Medication – self-injections

Caverject, Edex (papaverine, phentolamine and/or alprostadil)

No

Medication – urethral suppositories

MUSE (alprostadil)

No

Vacuum erection devices

 

No

Penile implant (prosthesis)

 

Under certain circumstances.  See below.  

Note: In general, Medicare covers penile implants when certain criteria are met. Medicare covers penile implants if erectile dysfunction is caused by an underlying medical condition, such as diabetes, coronary artery disease, or Peyronie's disease. It is also covered after radical prostatectomy, a surgical treatment for prostate cancer.

In addition, the patient must try other ED therapies, such as testosterone replacement therapy, injections, or PDE5 inhibitors first. If these approaches do not work, then implants may be covered.

Medications needed in connection with surgery might be covered under Medicare Plan D. 

Replacement of the implant may be covered if it breaks or becomes infected as long as the implant is still medically necessary and is not under warranty.

Patients should always confirm their coverage with their insurance provider before having penile implant procedures.

What can men do?

ED treatments can be expensive, and lack of coverage can be disappointing. But there might still be ways to receive treatment. Here are some steps to consider:

  • Talk to your doctor. ED is linked to a variety of chronic illnesses, such as diabetes and heart disease. Sometimes, treatment for those conditions, or even just changing your lifestyle, alleviates erection problems to some degree. Make sure you are doing everything you can to stay healthy. If you have diabetes, check your blood sugar regularly and follow your doctor’s diet recommendations exactly. If you are overweight, ask your doctor about weight-loss plans and exercise. If you smoke, inquire about smoking cessation programs. Medicare may cover conditions that lead to ED, even if it doesn’t cover ED treatments directly.
  • Talk to your health insurer. Find out if there are any other coverage avenues to try.
  • Look for coupons, discounts, and sales. Some drug manufacturers offer coupons and discounts for their products. For example, as of October 2018, Pfizer, the manufacturer of Viagra, is offering a 50% discount on up to 12 Viagra prescriptions per year. Pfizer also offers an assistance program. Other manufacturers might offer similar deals. Your pharmacist may know of other discount programs. Be sure to ask.
  • Consider contacting your State Pharmaceutical Assistance Program. Some states have programs that help their residents pay for their medications. Eligibility can vary from state to state. See more informationhere.

Remember…

While Medicare is fairly standard, people’s individual situations are different. What is covered for your neighbor might not necessarily be covered for you - and vice versa - so it’s always important to double check your benefits with Medicare and any other insurance organization.

Medicare planning can be quite complex, and rules can change. If you need help, don’t hesitate to contact Medicare directly. (You’ll also find information translated into over 20 languages.) You might also contact organizations for seniors, such as the National Council on Aging or the AARP. Your local senior center might offer help as well.

For more information about erectile dysfunction, please click here.

Resources

Blue Cross Blue Shield of North Carolina

“Medicare Part C Medical Coverage Policy Penile Implants”

(Reviewed: July 12, 2017)

https://www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/bluemedicare/medicalpolicy/penile_implants.pdf

Centers for Medicare and Medicaid Services

“Items and Services Not Covered Under Medicare”

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-and-Services-Not-Covered-Under-Medicare-Booklet-ICN906765.pdf

“Medicare Program - General Information”

(Page last modified: June 1, 2018)

https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html

GoodRx.com

“Muse Medicare Coverage”

https://www.goodrx.com/muse/medicare-coverage

Medicare.com 

(Note: Medicare.com is not the U.S. Government website for Medicare.  That website is www.Medicare.gov.)

Cross, Jory

“Does Medicare cover penile implants?”

(Updated: September 10, 2018)

https://medicare.com/coverage/does-medicare-cover-penile-implants/

Olmos, Mike

“What ‘Medically Necessary’ Means and How It Affects Your Medicare Coverage”

(Updated: September 16, 2018)

https://medicare.com/resources/what-medically-necessary-means-and-how-it-affects-your-medicare-coverage/

Medicare Interactive

“Drugs excluded from Part D coverage”

(https://www.medicareinteractive.org/get-answers/medicare-prescription-drug-coverage-part-d/medicare-part-d-coverage/drugs-excluded-from-part-d-coverage

National Council on Aging

“Medicare Part D Drug Plans: What They Must, May, and Cannot Cover”

(PDF. August 2017)

https://www.ncoa.org/wp-content/uploads/part-d-drug-coverage-rules.pdf

Pfizer

“Find Assistance That's Right for You”

https://www.pfizerrxpathways.com/

“Save 50% on brand-name VIAGRA for up to 12 prescriptions per year”

https://www.viagra.com/savings-offer

SexHealthMatters

“Self-Injection - Erectile Dysfunction”

https://www.sexhealthmatters.org/erectile-dysfunction/self-injection-erectile-dysfunction

WebMD

“Erectile Dysfunction: Penile Prosthesis”

(September 11, 2017)

https://www.webmd.com/erectile-dysfunction/guide/penile-prosthesis#1



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Sep 05, 2018

Sildenafil. Tadalafil. Vardenafil. Avanafil. These may sound like complex drug names, but you probably know them by their brands names: Viagra, Cialis, Levitra, and Stendra. They are all in a class of drugs called phosphodiesterase type 5 (PDE5 inhibitors), and for many years now, they have helped thousands of men with erectile dysfunction (ED) get their sex lives back.

But like any drugs, PDE inhibitors have their side effects and risks. In 2014, we reported on a possible link between one of the drugs – sildenafil – and melanoma, the deadliest form of skin cancer. At that time, more research was needed, and men were advised not to change any of their medications without talking to their doctor.

The following year, scientists concluded that ED drugs probably didn’t cause melanoma, although they still found a link. Lifestyle factors could play a role, they said. Here’s how lead investigator Stacy Loeb, MD explained it in a press release at that time:

What our study results show is that groups of men who are more likely to get malignant melanoma include those with higher disposable incomes and education—men who likely can also afford more vacations in the sun—and who also have the means to buy erectile dysfunction medications, which are very expensive.

Where does the issue stand today? In June 2018, the Journal of Sexual Medicine published a new report, which we’ll focus on today.

The Groups

Scientists analyzed information from a health records database, finding 610,881 men and women who were prescribed PDE5 inhibitors from 2007 to 2015. (Note: PDE5 inhibitors are used to treat more than ED. Patients of both sexes with pulmonary hypertension and lower urinary tract symptoms (LUTS) may take them, too. That said, in this study, 99.5% of this group was male.) On average, the patients’ first prescription was filled when they were about 51 years old.

The researchers also looked at records from over 2 million people with ED, pulmonary hypertension, or LUTS who were not prescribed PDE5 inhibitors. These people served as a control, or comparison, group.

The Findings

In the group that took PDE5 inhibitors, 636 – a tenth of one percent - developed melanoma. Among people who didn’t take the drugs, 8,711 melanoma diagnoses were made, representing less than a third of one percent of the total group.

The researchers found no link between PDE5 inhibitor use and melanoma in people who had pulmonary hypertension or LUTS. Similarly, no relationship was found for any of the women.

And the men who took the drugs for ED? Interestingly, the researchers did find a link – and not only to melanoma. The authors also reported higher risk for basal cell carcinoma and squamous cell carcinoma, two other types of skin cancer that are more common than melanoma.

However, the authors explained that lifestyle factors could be involved:

Lifestyle factors, namely sun exposure, in this group of men is the likely cause of this increased risk and not the use of PDE5 [inhibitors] given that there is no common mechanism to account for carcinogenesis [formation of cancer] among these varied cancer types.

They added that people who took the drugs for other conditions were not at higher risk for melanoma compared to the non-users with the same health problems.

“Our findings support the safety of PDE5 [inhibitor] use in the United States,” they concluded.

Protect Yourself from Skin Cancer

While the news is encouraging, it’s still important for people to protect themselves from skin cancer, regardless of whether they take PDE5 inhibitors or not. Here are some tips to reduce your risk:

  • Stay in the shade and wear protective clothing, like long sleeved shirts, long pants, and a sun hat.
  • Use liberal amounts of sunscreen (SPF 30 or higher). The American Academy of Dermatology recommends about an ounce of sunscreen – the amount that would fit into a typical shot glass – for the average adult. Wear sunscreen even on cloudy days and reapply every two hours if you’re swimming or sweating.
  • Keep in mind that water, sand, and snow can reflect the sun’s rays.
  • Don’t use tanning beds.
  • Check your skin regularly and see your doctor if you notice anything unusual.

Ask Your Doctor about ED

ED can be treated in a number of ways. If you’re having trouble with erections, call your doctor and schedule a checkup. And don’t hesitate to bring up any questions or concerns.

Resources

American Academy of Dermatology

“Prevent skin cancer”

https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent

“Types of skin cancer”

https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/types-of-skin-cancer

The Journal of Sexual Medicine

Shkolyar, Eugene MD, et al.

“Risk of Melanoma With Phosphodiesterase Type 5 Inhibitor Use Among Patients With Erectile Dysfunction, Pulmonary Hypertension, and Lower Urinary Tract Symptoms”

(Full-text. First published online: June 5, 2018)

https://www.jsm.jsexmed.org/article/S1743-6095(18)30978-0/fulltext

SexHealthMatters

“Study: Chances Are, ED Drugs Don’t Cause Melanoma”

(August 11, 2015)

https://www.sexhealthmatters.org/news/study-chances-are-ed-drugs-dont-cause-melanoma

“More Research Needed on Sildenafil/Skin Cancer Risk”

https://www.sexhealthmatters.org/did-you-know/more-research-needed-on-sildenafil-skin-cancer-risk/resources

“Sildenafil and Skin Cancer Risk”

(June 24, 2014)

https://www.sexhealthmatters.org/news/sildenafil-and-skin-cancer-risk



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