Over the past decade, the gay community has come out of the closet – and by extension, I have seen more openly gay and bisexual men in my urology practice in recent years. I’ve been pleased to see that these men’s willingness to be open about their sexuality also makes them more willing to talk about their health concerns. So what do gay men ask about when they visit their urologist? In my experience, the most common questions are the same for all men regardless of sexual orientation – erectile dysfunction, prostatic obstruction, and prostate cancer.
Erectile dysfunction (ED) is the single most common issue my patients worry about. Why, they ask, does it get hard on Mondays and Wednesdays but not on Tuesdays and Thursdays? The most common causes of ED are performance anxiety in younger men and atherosclerosis, which narrows the blood vessels, in older men. No matter the reason, “magic pills” like Viagra and Cialis are almost universally helpful, and taking them is not a sign of weakness. Although these are not drugs of desire, they will certainly help with your performance.
ED pills are safe in and of themselves, but it can be dangerous to combine them with other drugs. Unfortunately, ED drugs and narcotics are often abused together in the gay community. The combination of these drugs can result in serious cardiac or neurological problems and is also associated with the spread of sexually transmitted diseases, including HIV and AIDS. Men who take nitroglycerine for coronary artery disease should avoid ED pills, and men taking medication for HIV infections are extra sensitive to the effects of oral ED pills and should therefore discuss the safest dosages with their doctor.
Another common urologic concern among older men is prostatic obstruction, also known as benign prostate hypertrophy (BPH). This frustrating and sometimes painful condition occurs when the prostate enlarges with age to the point that it obstructs the flow of urine from the bladder. The telltale symptoms include more frequent urination (especially at night), incomplete bladder emptying, and dribbling. If you experience these symptoms, your physician can perform a series of examinations in-office and determine your best treatment option: medications, microwave therapy, or a prostatectomy.
The third health concern all men share is prostate cancer. Though the US Preventative Services Task Force has relaxed its prostate checkup recommendations in recent years, I urge all men over forty years old to get an annual digital rectal exam and a PSA (prostate-specific antigen) blood-screening test. The PSA test is the best way to make an early diagnosis of prostate cancer and increase your odds of beating this disease. Though bringing up the subject of cancer can feel scary, asking for a PSA screening is one of the best ways you can protect yourself.
Gay men, bisexual men, and straight men are all basically the same. They all have the same anatomy. They all have the same urologic concerns. They all have the same self-doubt and occasional insecurity. If you are a gay or bisexual man, don’t be shy asking questions about your body – coming out about your sexual health will not only help you conquer any serious medical issues that may arise but also keep you sexy and potent for life.
Dudley S. Danoff, MD, FACS, is a Diplomate of the American Board of Urology and Fellow of the American College of Surgeons. He graduated from Princeton University summa cum laude, Phi Beta Kappa, and from the Yale University School of Medicine. Dr. Danoff completed his urologic training and fellowship at Columbia University Presbyterian Medical Center. He served as a major in the U.S. Air Force, after which he joined the Clinical Faculty at the UCLA School of Medicine. He is currently the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group. Dr. Danoff and his wife, Israeli singer Hedva Amrani, live in Beverly Hills and have two children.
Years ago, he developed a keen interest in erectile dysfunction based on his disturbing observation that an increasing number of men were suffering from what he calls “penis weakness,” or PW. He noted that there was very little discussion within the urologic community about the significance of this problem in male genital health.
As he looked deeper into this major issue, he realized that the stigma surrounding erectile dysfunction and other penis problems was a force that had been plaguing not only men in modern times but also probably men throughout all of history. He began to speak out and write about the principal characteristics of this alarming pandemic and discovered a deep reality about men and their relationships to their penises: the vast majority of males were severely undereducated about their penises, from its physical function to its effects on their psyche. And for too many years, men who have suffered from self-doubt and anxiety caused by PW have done so without any guidance from the medical community—especially not from the professional urologic community.
Coming to the realization that something needed to be done, he set out to write what he hoped would be the all-inclusive guide to the major factors affecting male sexual health. His aim is to replace ignorance and mythology with factual information and to replace self-doubt with confidence. His goal is to help every man realize and achieve the sex life he desires.
As a busy urologic surgeon in Los Angeles, California, he has seen more than 200,000 penises in his professional lifetime. While each is unique, just as hands and feet are unique, they are also remarkably alike anatomically. However, there is enormous variation in how they function in their sexual capacities. He has observed that these differences in functionality and capacity have very little to do with the anatomy of a particular penis or even with a man’s size, looks, level of success, wealth, or status.
Mainly, functionality and performance is about how men perceive their own penises. In addition to understanding its biological functions, every man must learn that his penis is an organ of expression. What gives it its power is much more than the condition of its blood vessels and nerves.
The Ultimate Guide to Male Sexual Health advocates a transformative concept based on positive thinking. Applying the power of positive thought to your penis can change your entire life.