Sexual Health & Overall Health

As the saying goes, the best measure of a man's character is the company he keeps. But what about his health? According to Steven Lamm, MD, the best measure of that is his erect penis.

"There's an incredibly important link between a man's health and sexual performance," Lamm, an assistant professor of medicine at New York University, tells WebMD.

Lamm's recent book, The Hardness Factor, is a flashing neon sign pointing to that link.

It is well known that heart disease, as well as diabetes, depression, obesity, substance abuse, and many other health problems can quash erections. Getting an erection isn't crude mechanics, like inflating a balloon. It's a complex process in which blood vessels, muscles, hormones, the nervous system, and the psyche all work together. If one part isn't working well, it affects the whole apparatus.

This isn't another book touting Viagra, like Lamm's The Virility Solution, published in 1998, the same year Viagra hit the market. Lamm says The Hardness Factor is not for men who are already dealing with erectile dysfunction (ED). His aim is to convince young, healthy men to take better care of themselves by speaking to their penises.

"If you want a 28-year-old man to stop smoking, let him read the book," Lamm says.

Heart Health and Sexual Health

Others in the field of sexual medicine agree that erectile function can be closely related to overall health, especially heart health.

"When men who are otherwise healthy ask what they can do to prevent ED, certainly the very things we recommend for cardiovascular fitness are exactly the same things they should be doing," Drogo Montague, MD, a urologist at the Cleveland Clinic, tells WebMD.

To get erect, the penis must become engorged with blood. Atherosclerosis, a condition in which fatty deposits build up inside arteries, may restrict blood flow to the penis and cause erection difficulties. Diets high in fat and cholesterol, high blood pressure, obesity, diabetes, and smoking are the main causes of atherosclerosis.

"It's very appealing to say that if you don't have those unhealthy factors in your lifestyle, then you're less likely to develop erectile dysfunction," says Ira Sharlip, MD, a urologist at the University of California, San Francisco.

"There are pretty strong suggestions that those things are true," he tells WebMD.

One persuasive piece of evidence appeared in the April 2004 issue of the Journal of the American College of Cardiology. Between 1972 and 1974, researchers in California surveyed 1,810 men about their risks for heart disease. In 1998, researchers contacted 844 of them who were still alive and asked them about their erectile function. The men who had risk factors for heart disease in the '70s were much more likely to have ED 25 years later.

If men with heart disease are more likely to develop ED, it stands to reason that having ED could be a warning sign for heart disease, too.

The Erectile Continuum

ED becomes more common as men age, but aging itself is not the cause. "We never expect a healthy man to develop ED as a result of aging alone," Montague says.

A very healthy octogenarian can have erections. But Montague says even in the fittest men, some changes occur with age. An erection is still possible, but it may take some coaxing.

"As men get older they require direct genital stimulation from their partner or from themselves. A young man can just daydream and get an erection," he says. "Those changes by themselves, though, don't prevent performance."

By definition, having ED means a man cannot get an erection hard enough for penetration or one that lasts long enough for him to reach orgasm. But in Lamm's opinion, there are shades of gray between normal sexual performance and dysfunction.

"You don't go from being 'normal' to having ED. What you end up having is a transition," he says.

Usually doctors assess erectile function by the International Index of Erectile Function, a set of five questions such as, "How do you rate your confidence that you could get and keep an erection?" A patient's answers are scored, and that score determines whether or not he has ED.

Lamm says he thinks a better way to measure erectile function is with a new tool called a rigidometer. A man presses the head of his erect penis against a sensor attached to the digital device, which measures the precise hardness of his penis in grams of pressure. According to the manufacturer, 400 grams is limp; 400-500 is "borderline," and 500-1,000 is sufficient for sexual activity. A number over 1,000 is considered optimum.

Living a Hard Life

Lamm thinks men want harder erections, even if they don't have ED. The rigidometer can show a patient objectively how hard his penis is -- hard enough for penetration, maybe, but not as hard as it could be. The number might be an incentive for him to improve his overall health in order to make his penis harder.

Having a very hard erection, Lamm says, can enhance a man's sexual pleasure, or at least boost his self-esteem. Many men are definitely interested in their penis size, and a more fully engorged erection is the only thing shy of surgery that can actually make it bigger.

Sharlip's experience, however, leads him to doubt that degrees of hardness beyond hard enough matter to most men. "I don't think it's important at all," he says. "As long as it's hard enough to get it in ... I don't hear patients complaining about rigidity."

The Hardness Factor details a wellness program that Lamm says will show positive results on a rigidometer in six weeks. It involves exercise, eating healthy meals, sleeping well, and taking vitamins and supplements. The book describes the cases of some patients of Lamm's New York City practice who followed the six-week program and had good results.

But Lamm stresses that his program is only intended to kick-start a lifelong commitment to healthy living.

"Don't rely on the restoration of your penis' health with drugs such as Viagra, Levitra, Cialis," he says. "Do whatever you can to preserve and enhance its function."

SOURCES: Steven Lamm, MD, clinical assistant professor, NYU School of Medicine; author, The Hardness Factor. Drogo Montague, MD, director, Center for Sexual Function, The Cleveland Clinic. Ira Sharlip, MD, assistant clinical professor, University of California, San Francisco. Journal of the American College of Cardiology, April 2004. Bandolier Journal, August 2001.

By Martin F. Downs
Reviewed by Michael W. Smith, MD
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