By Marc Braman, MD, MPH

MB (Marc Braman, MD, MPH):

We have this wonderful thing called sex. We make more humans with it. Sometimes we use it as a weapon of war. It is a powerful thing.

We are wired for pleasure, of which sex is one of the most intense. We focus a lot on sex, even though it actually makes up only a very tiny percentage of our lives. And, unfortunately, it often doesn’t work so well for us in today’s world.

Overall rates of sexual dysfunction for men is about 30-40%, and is more common with older age. Women experience sexual dysfunction as much or a bit more than men: 40% have “concerns,” and 12% have really distressing sexual problems.

The tabloids at the checkout stands always seem to have sex-help cover stories. Apparently sex sells – including sex problems or how to have better sex. It is very much on people’s minds.

To get the scope of sexual problems, here is the basic breakdown:

Low libido 5-15%, increasing with age.

ED 8-37%, increasing with age
It is the most common sexual dysfunction, across countries about 8% of 20-30 yo men and 37% in 70-75yo men, averaging about 16% overall.

Premature Ejaculation:
4% by strict definition, up to 30% complain of ejaculating too soon.

Lack of sexual desire (39%),
Impaired arousal (26%),
Inability to achieve orgasm (21%), (but only for about 20-30% of these last two conditions does it actually cause distress for women)
Pain with sexual activity (14-16% overall, sex uncomfortable postmenopausally in 40%)

As we get into sexual dysfunctions and the lifestyle remedies, it is important to understand how common these issues are, that you are not abnormal and you are not alone.

It is important to understand that there is a big difference between things not working as well as we would like or mild and occasional problems, and more serious sexual problems. Of course we all want great sex and that is a very good thing.

To understand sexual problems we really must be clear on what is healthy and what we are designed for. Sex is fundamentally about procreation or reproduction. We will assume you know about the birds and the bees — boy parts and girl parts get together, have a great time, polliwogs called sperm go and find the egg up inside the woman, and a new human being is started. The more those those two people are able to keep having such wonderful experiences and remain together in a healthy, stable relationship, the more successful they are likely to be in raising healthy children for the next generation. Good sexual function is directly proportional to good relationships and situations.

We need to understand the primary systems involved in sexual function so we understand why sex does or doesn’t work well:

The two big systems at play are the brain and the vascular system. It is kind of like NASA – the brain is “command and control” headquarters and the vascular system is what operates the rocket on the launch pad. Other systems are important too but often play lesser roles: nerves carrying the signals, hormones that support sexual function, and so forth.

If nature is getting what it wants, these systems work very well. We are going to share with you how to use lifestyle as medicine by identifying and addressing the vast majority of the causes of sexual dysfunctions.

Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. J Urol. 1994 Jan;151(1):54-61.

Sexual dysfunction in the United States: prevalence and predictors. Laumann EO, Paik A, Rosen RC. JAMA. 1999 Feb 10;281(6):537-44. Erratum in: JAMA 1999 Apr 7;281(13):1174.

Sexual problems and distress in United States women: prevalence and correlates. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Obstet Gynecol. 2008 Nov;112(5):970-8. doi: 10.1097/AOG.0b013e3181898cdb.

Changes in sexual function in middle-aged and older men: longitudinal data from the Massachusetts Male Aging Study. Araujo AB, Mohr BA, McKinlay JB. J Am Geriatr Soc. 2004 Sep;52(9):1502-9.

Men’s Attitudes to Life Events and Sexuality (MALES) Study. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Rosen RC, Fisher WA, Eardley I, Niederberger C, Nadel A, Sand M. Curr Med Res Opin. 2004 May;20(5):607-17.

Premature ejaculation: an observational study of men and their partners. Patrick DL, Althof SE, Pryor JL, Rosen R, Rowland DL, Ho KF, McNulty P, Rothman M, Jamieson C. J Sex Med. 2005 May;2(3):358-67.

Correlates to the clinical diagnosis of premature ejaculation: results from a large observational study of men and their partners. Rosen RC, McMahon CG, Niederberger C, Broderick GA, Jamieson C, Gagnon DD. J Urol. 2007 Mar;177(3):1059-64; discussion 1064.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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