Aaron Spitz, MD http://www.aaronspitz.com Aaron Spitz, MD, America's favorite penis doctor Fri, 04 Aug 2017 23:45:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.8.3 111567307 There’s an App for That: 4 Apps for Better Sexual Health http://www.aaronspitz.com/blog/theres-app-4-apps-better-sexual-health/ Wed, 09 Nov 2016 22:55:16 +0000 http://www.aaronspitz.com/?p=6119 Technology is everywhere these days—including in the bedroom. That’s right; if you’re looking for anything from basic sexual health information to tips on how to have better sex with your partner, there’s probably an app for that. None of these apps replaces a good old visit to the doctor, of course. But they’re a great […]

The post There’s an App for That: 4 Apps for Better Sexual Health appeared first on Aaron Spitz, MD.

]]>
Technology is everywhere these days—including in the bedroom. That’s right; if you’re looking for anything from basic sexual health information to tips on how to have better sex with your partner, there’s probably an app for that.

None of these apps replaces a good old visit to the doctor, of course. But they’re a great place to start. And the movement to make sexual health information easier to access via technology like telemedicine and apps is definitely worth paying attention to.

Here are some examples of up and coming sexual health apps.

Sex Positive app screenshotSexPositive (for iPhone and Android)

Brought to you by the University of Oregon, SexPositive uses a simple wheel format that lets you match up parts of the body to see what happens when those parts touch each other. It also offers relationship communication advice and everything you need to know about STIs and safe sex.

The app’s website explains the creators’ mission:

“First, we want folks to examine their motivations for having sex and consider whether they’re ready for sex. Second, for users who are ready for sex, we want them to understand that a ‘yes’ to one sexual act is not a ‘yes’ to every sexual act. Third, we want users to consider a variety of personal boundaries before finding themselves in a high-pressure situation. Finally, we want to model the many ways to express and obtain explicit consent.”

 

Screenshot of My Sex Doctor AppMy Sex Doctor (for iPhone and Android)

At first glance it might look like the target audience for this London-based app is teens. You’re not wrong—My Sex Doctor does include a glossary of terms as well as information on puberty and anatomy for the younger set.

But hey, you’re probably going to have to talk about the birds and the bees with a young person in your life at some point, right? Now you’re prepared for all their tough questions!

There are actually three versions of this app: one for users under 17 (“My Sex Doctor Lite”) and two for adults (one free with ads, one paid without ads). So no matter what your age, you can learn something new.

You might even pick up a few good tips on improving your flirting skills!

The info is vetted by government websites, academics, and healthcare professionals.

 

Sexual Health Guide app screenshotSexual Health Guide (for iPhone and Android)

This app comes from Ireland’s Global Internet Radio Technologies and serves as a huge encyclopedia of terms and tips. Topics range from contraception to myths about sex to sexual problems both men and women might encounter.

Not much of a reader? No problem! The Sexual Health Guide app includes both text and video.

It also happens to be the first sexual health app created in Ireland.

Like My Sex Doctor, its target audience skews a bit young, but there’s plenty of useful information for people of all ages here.

 

 

Explore Women's Sex app screenshotExplore Women’s Sex (for iPhone)

Gents, don’t think you can sit this one out!

Explore Women’s Sex isn’t just for the ladies. It has a selection of great info for both men and women on sexual orientation, safe sex, contraception, and how drugs and alcohol can affect your sex life.

Created by Dr. Vivienne Cass, a clinical psychologist and sex therapist, this app uses diagrams, quizzes, and short articles to teach you everything you need to know about women’s bodies—whether you have one or your partner does.

(You won’t want to miss the “turn on tips” to shake up your bedroom activities!)

Unfortunately, this one’s only available to iPhone users at the moment.

 

Of course, these are only a few examples of the sexual health apps out there. Do you use any of these apps or others not listed to improve your sexual health or knowledge? I’d love to hear from you!

As technology continues to improve, more options will inevitably appear—some better than others. And while none of these can (or should!) replace those regular check-ups with your doctor, they can be a great source of information…or even a good conversation starter!

 

The post There’s an App for That: 4 Apps for Better Sexual Health appeared first on Aaron Spitz, MD.

]]>
6119
The Blue Pill and You: How Viagra Works http://www.aaronspitz.com/blog/blue-pill-viagra-works/ Wed, 02 Nov 2016 18:22:54 +0000 http://www.aaronspitz.com/?p=6116 If you watch TV or surf the internet, you’ve probably heard about a little blue pill that does wonders for men who are struggling to keep up in the bedroom. Yes, many people think of Viagra as a wonder drug. And it’s true that Viagra—and similar drugs that help men with erectile dysfunction—have done some […]

The post The Blue Pill and You: How Viagra Works appeared first on Aaron Spitz, MD.

]]>
Pile of blue pills

How does that little blue pill actually work?
Image: Shutterstock

If you watch TV or surf the internet, you’ve probably heard about a little blue pill that does wonders for men who are struggling to keep up in the bedroom. Yes, many people think of Viagra as a wonder drug. And it’s true that Viagra—and similar drugs that help men with erectile dysfunction—have done some great things.

So how does it work, exactly?

Viagra reminds Mr. Happy how to be, well, happy. And what makes him smile? Blood flow. As you probably remember from my video about how erections work, blood flow is vital for a healthy erection. Drugs like Viagra make sure the pathway for that blood flow is clear and ready to go within 30-60 minutes, according to the Viagra website.

After sex, Viagra leaves the body naturally via feces and urine.

What Viagra doesn’t do, however, is get your brain in the game when it comes to sexual arousal. You’ll still need to set the mood on your own. But if you’re suffering from erectile dysfunction, Viagra can make sure your body is cooperating as well.

It’s important to note that Viagra and similar drugs don’t cure ED. They just help your body produce a temporary erection long enough to get the job done. (If the erection lasts longer than that, it’s time to see a doctor!)

As with any medication, there are side effects and other potential dangers to be aware of. Some are fairly innocuous—flushing or redness, nausea, headache, runny nose, indigestion. Some are more serious—a decrease in blood pressure, exacerbating cardiovascular disease. If you’ve had a stroke or heart attack, or you’re taking medications that include nitrates, it’s best to check with your doctor before trying Viagra.

One of the more interesting potential side effects of Viagra has to do with the drug’s effect on the retina. Yes, that’s right; the little blue pill can actually make you see the world with a little more blue (and green) than normal for a few hours after you take it. That’s why pilots aren’t allowed to take Viagra within six hours of a flight.

While the little blue pill is probably the most famous, there are other similar medications on the market these days, including Cialis and Levitra. They’re not interchangeable, but their composition is somewhat similar, and they perform the same function of increasing blood flow to the right places.

Drugs like Viagra that are used to help people suffering from ED can definitely make things in the bedroom go more smoothly. As always, however, talk to your doctor about what would work best for you.

The post The Blue Pill and You: How Viagra Works appeared first on Aaron Spitz, MD.

]]>
6116
Getting in the Mood: How Antidepressants Can Affect Sexual Function http://www.aaronspitz.com/blog/antidepressants-sexual-function/ Wed, 26 Oct 2016 16:21:27 +0000 http://www.aaronspitz.com/?p=6112 You probably remember hearing that the brain is the largest sex organ. Genitals may take the starring role when it comes to sex, but all those hormones and neurotransmitters definitely play an important part when it comes to getting you ready for playtime between the sheets. But what happens when hormones and neurotransmitters aren’t working […]

The post Getting in the Mood: How Antidepressants Can Affect Sexual Function appeared first on Aaron Spitz, MD.

]]>
Man lying in bed

If you’re taking antidepressants, you’ll likely see some effects on your sex drive–but don’t despair!
Image: Shutterstock

You probably remember hearing that the brain is the largest sex organ. Genitals may take the starring role when it comes to sex, but all those hormones and neurotransmitters definitely play an important part when it comes to getting you ready for playtime between the sheets.

But what happens when hormones and neurotransmitters aren’t working properly?

According to the US Department of Health and Human Services, one in five adults in the United States suffers from clinical depression. And if they’re taking antidepressants, they could be suffering from side effects, too. Feeling lousy and having trouble with sexual function? Definitely no fun!

Here’s the problem: Most commonly-used antidepressants are from a drug family called selective serotonin reuptake inhibitors, or SSRIs (think Paxil, Prozac, Zoloft, and others). These drugs act on the neurotransmitter serotonin, raising levels in the brain so that patients feel calmer and have less anxiety.

But that sort of calm can also lower libido and cause difficulty getting and maintaining an erection. They can even delay or block orgasm. And Celexa has been known to cause a man’s sperm count to drop to almost zero! That’s aside from the other common side effects of antidepressants—weight gain, nausea, dizziness, and feeling sluggish.

Of course, not everyone taking antidepressants will have these side effects. But studies have shown that it is fairly likely patients will experience at least some of them.

Now, you may be thinking you can just go off your meds and everything will be fine in the bedroom, right? WRONG! You should never quit your meds cold turkey and without supervision from your doctor.

So if you’re on antidepressants, are you doomed to a seriously sad sex life?

Not at all!

The first step is to make sure your doctor knows about any and all side effects you’re experiencing. Then you can discuss options. Maybe you can lower your medication dosage or try a completely different one. (Welbutrin and Remeron, for example, have been shown to have fewer sexual side effects than other SSRIs.)

It might also be possible to change the time of day you take your medication. If you take it after you generally have sex rather than before, it will have less effect on your sexual function. Sure, it means sex might be a little less spontaneous…but it might feel a whole lot better, too.

Sex is more than just inserting tab A into slot B. Desire, arousal, orgasm, and resolution all play their parts. And your mood can make or break, well, the mood. If you’re taking antidepressants and experiencing issues with your sex life due to side effects, you should definitely talk to your doctor and review your options.

 

 

 

The post Getting in the Mood: How Antidepressants Can Affect Sexual Function appeared first on Aaron Spitz, MD.

]]>
6112
Mary Jane and Junior: Can Smoking Marijuana Affect Fertility? http://www.aaronspitz.com/blog/marijuana-affect-fertility/ Wed, 19 Oct 2016 18:34:23 +0000 http://www.aaronspitz.com/?p=6108 You probably know you are what you eat when it comes to adopting good nutrition to support your sexual health. But are you what you smoke as well? The jury’s still out when it comes to an official answer on how smoking marijuana can affect fertility. But a number of studies show that it’s pretty […]

The post Mary Jane and Junior: Can Smoking Marijuana Affect Fertility? appeared first on Aaron Spitz, MD.

]]>
Man rolling a joint

How does smoking marijuana affect your changes of having a baby?
Image: Shutterstock

You probably know you are what you eat when it comes to adopting good nutrition to support your sexual health. But are you what you smoke as well?

The jury’s still out when it comes to an official answer on how smoking marijuana can affect fertility. But a number of studies show that it’s pretty likely pot can cause some negative changes in your body.

Testosterone meets Mary Jane

Some studies have shown that smoking pot can impact testosterone levels. While that data is from studies done on animals as opposed to people, experts believe the same is true for humans. Chronic smokers can expect to see more potentially negative side effects than casual smokers, but researchers note the deviation in testosterone isn’t so far away from normal levels.

Luckily, studies have also found that pot’s effect on testosterone is temporary. So all you have to do to return to regular levels of testosterone is to refrain from smoking while you and your partner are trying to conceive.

The sperm assembly line on pot

A recent study from the University of Copenhagen found that men who smoked marijuana more than once a week lowered their sperm count by about one third—more if they were taking other drugs like cocaine or ecstasy as well.

And it’s not just the production of those little swimmers that takes a hit—their ability to reach and fertilize an egg is harmed, too. Sperm, as you probably know, are extremely tiny, and they they have a long way to go up the vaginal canal before they meet the egg. Normally, they start out by riding the wave of semen for part of the way, which means they have less space to cover by swimming alone (a process called hyperactivation). But when THC, the active ingredient in marijuana, is introduced into the body, sperm skip the ride and start swimming immediately…which means they tire out quickly and never reach the egg. No sperm-egg meet-and-greet, no baby.

Mr. Happy at 420

Did you know your penis can get high? A 2011 study published in the Journal of Sexual Medicine found what might be a link between marijuana use and erectile dysfunction. When you ingest THC, it interacts with cannabinoid receptors, which are proteins in your brain. Basically THC slightly hinders your brain function. Those cannabinoid receptors have also been found in penile tissue, which potentially means THC can do the same thing to the penis, making it more difficult to get an erection.

More scientific research is definitely needed to confirm the results of the studies already completed. But from what researchers have gathered so far, it looks like smoking marijuana can be a pretty big roadblock for a couple trying to have children. So lay off the blunts if you’re trying for a baby!

The post Mary Jane and Junior: Can Smoking Marijuana Affect Fertility? appeared first on Aaron Spitz, MD.

]]>
6108
Super Swimmers: How Sperm Production Works http://www.aaronspitz.com/blog/super-swimmers-sperm-production-works/ Wed, 12 Oct 2016 16:00:25 +0000 http://www.aaronspitz.com/?p=6103 Now that the Olympics are over and the medals have been awarded, let’s turn our attention from famous and infamous swimmers (Ryan Lochte) to a different bunch of super swimmers—yours! When it comes to reproduction, the competition is way more intense than at Rio. In fact, of the 1,500 sperm a second that are produced, […]

The post Super Swimmers: How Sperm Production Works appeared first on Aaron Spitz, MD.

]]>
Sperm swimming toward egg

These super swimmers have an Olympics of their own to compete in.
Image: Shutterstock

Now that the Olympics are over and the medals have been awarded, let’s turn our attention from famous and infamous swimmers (Ryan Lochte) to a different bunch of super swimmers—yours! When it comes to reproduction, the competition is way more intense than at Rio. In fact, of the 1,500 sperm a second that are produced, only one will get the gold—the egg. And there is no silver or bronze on that podium! So let’s take an “up close and personal” look at the making of a champion!

Farm team
The testicles are where the sperm grow and form. They are completely filled with extremely thin, long, coiled up tubes like hollow spaghetti with special cells that support the forming sperm like soil supports a sprouting seed. If stretched end to end, the length of these tiny tubules is about 300 meters. It takes about two months for a sperm to go from its very beginning form to a mature sperm with a tail. This growth and development relies on two key hormones. One is called Follicle Stimulating Hormone (FSH), which is pumped out by the pituitary gland, a pea-sized gland that sits between the eyes behind the top of the nose. The other is testosterone, which is made by leydig cells, which are scattered between the tiny tubes.

The result is the little swimmers we know as sperm. Each sperm is about 1/20th of a millimeter long and about as narrow as a red blood cell. It has a head that contains the nucleus, and a neck connects the head to the tail, which is in charge of motoring the sperm toward the egg it hopes to fertilize.

Swim Lessons
Once the sperm have fully formed, they have actually split twice so that one cell becomes 4 sperm with tails. These “mature” sperm then are released and float along until they exit the tesicle into a special, larger tube called the epididymis. The epididymis is another really long, twisty-turny tube where swim lessons take place. This structure is about an inch and a half long, but if the tube were stretched out, it would be about 20 meters long! Over the next two weeks after the sperm arrive, they learn to swim.

This process is ongoing and continuous from puberty to the end of a man’s life.

Race Day
Once the sperm have become expert swimmers, they wait about a month for their Olympics. If they don’t get a chance to fertilize an egg in that time, they die off and dissolve.

On race day—that is, when a man ejaculates—the sperm are dumped into a much larger tube surrounded by muscle called the vas deferens. The sperm is squeezed up this tube by the muscular contractions until they reach the urethra inside the prostate, which is like a tunnel between the bladder and the urethra of the penis.

The prostate expels some fluid from its walls into the tunnel to make some of the semen, but the majority of the semen fluid is secreted from the seminal vesicles—two sacs that attach to the tunnel, each about an inch or two long. The seminal vesicles also provide the sugar that the sperm need to power up. Ultimately, semen is made up of 80% fluid from the seminal vesicles, 10% fluid from the vas deferens, and 10% from the prostate.

At the same time the sperm and other semen fluids enter the prostate tunnel, the bladder closes so the fluids of the semen don’t go in there. Muscles at the base of the penis start pumping the semen out through the urethra and out the tip of the penis. If the sperm are lucky that day, they’re pumped into the vagina. Once in the vagina the sperm must swim along the walls and make it past the cervix to find the egg and fertilize it. The sperm don’t know where the finish line is, and only one will cross it. They can “tread water” for many days as they look for the egg or wait for the egg to drop down.

So much for the basics. Now here are some interesting tidbits about those sperm that you may not know:

  • 90% of ejaculated sperm is deformed. We’re talking two heads, two tails, pin heads, coiled tails, etc. While these deformities may affect a sperm’s ability to make it to the egg, they don’t necessarily mean that the man is infertile.
  • Sperm need to stay cool. They’re about 4 degrees Fahrenheit cooler than the rest of the body. Muscles in the scrotum raise and lower the testicles to keep them at the best distance from the body for the best temperature.
  • Not all sperm are “male.” In terms of chromosomes, sperm can be either “male” or “female”—in other words, some carry an X chromosome (female) and others carry a Y chromosome (male). Female sperm tends to be stronger than male sperm, which means it’s more likely that a female sperm will make it to fertilization. If a dad provides an X chromosome, the resulting baby will be female. If he supplies a Y chromosome, the baby will be male.
  • No second testicle? No problem. Having only one testicle doesn’t necessarily mean you’re infertile. According to the Mayo Clinic, a single testicle can take over the entirety of sperm production.

Sperm are quite amazing, and there are many factors which can influence their production. A healthy diet filled with fresh fruits and vegetables and light on simple sugars or animal products is the best way to keep these swimmers in the fast lane.

The post Super Swimmers: How Sperm Production Works appeared first on Aaron Spitz, MD.

]]>
6103
A Disruption in the Plumbing: Ejaculatory Disorders http://www.aaronspitz.com/blog/ejaculatory-disorders/ Wed, 05 Oct 2016 18:57:45 +0000 http://www.aaronspitz.com/?p=6098 With the popularity of ads for Viagra and similar products, it’s easy to think erectile dysfunction is the most common problem Mr. Happy can possibly face. In reality, ejaculatory disorders are the most prevalent, even if we’re still learning how and why they happen. Ejaculatory disorders fall into four categories: Delayed Ejaculation: it takes a […]

The post A Disruption in the Plumbing: Ejaculatory Disorders appeared first on Aaron Spitz, MD.

]]>
Man with wrench fixing pipes

Ejaculatory disorders can disrupt the plumbing–but they can also be treated.
Image: Shutterstock

With the popularity of ads for Viagra and similar products, it’s easy to think erectile dysfunction is the most common problem Mr. Happy can possibly face. In reality, ejaculatory disorders are the most prevalent, even if we’re still learning how and why they happen.

Ejaculatory disorders fall into four categories:

  • Delayed Ejaculation: it takes a prolonged period of stimulation to cause ejaculation
  • Premature Ejaculation: ejaculating too soon
  • Retrograde Ejaculation: the semen enters the bladder instead of exiting through the urethra during ejaculation
  • Anejaculation: the inability to ejaculate at all

As you might expect, none of these is fun for either partner!

The reasons behind these disorders can be both psychological and physical.

On the physical side, levels of neurotransmitters in the body can affect a man’s ability to ejaculate. Dopamine, for instance, facilitates the entire ejaculation process, with levels rising throughout sex and reaching their highest point right before ejaculation. If something interferes with dopamine levels—a spinal injury or an illness like multiple sclerosis, say—that can affect a man’s ability to ejaculate normally. Medications that interact with neurotransmitters like serotonin or oxytocin (think antidepressants) can also cause ejaculatory problems.

In addition, there are the natural processes of aging. Decreased penile sensitivity and a decline in fast-conducting peripheral nerves can both lead to ejaculatory disorders. This is why you often see ejaculation issues in older men.

It’s not just a physical thing, though. Psychology plays a big part when it comes to sex. You’ve heard how the brain is your biggest sex organ, right? Well, if your brain isn’t on board, the rest of your body has trouble following. Being caught up in intense emotion such as repressed anger or aggression can be enough to throw you off your sexytime groove. Your body can also react negatively to more long-term emotional issues, such as fears about having a child with your partner or feeling pressured to sexually perform in a certain way. Even your religious or spiritual beliefs can affect your sexual health.

Then there’s the one-two punch combo: both physical and psychological discomfort. This can happen when a man is used to achieving greater arousal from masturbation and has difficulty duplicating the feeling with a partner. While there’s nothing inherently wrong with masturbation, it can train you to respond to a very specific sort of stimulation (both mental and physical) that’s different from full-blown sex with a partner.

Now for some good news: The upside of ejaculatory disorders being common is that they come with a variety of potential solutions:

  • Selective serotonin reuptake inhibitors (SSRIs) have been shown to positively affect men suffering from premature ejaculation. Viagra, often used along with a cream to reduce sensitivity, can also help.
  • Behavioral therapy can help with the emotional/psychological side of things. It’s particularly helpful to have your partner join you in therapy so that you can improve your sex life together as a couple.
  • Penile Vibratory Stimulation (PVS) can increase sexual friction, making ejaculation at the right time easier to achieve. While PVS has been used by sex therapists for more than thirty years, it’s generally been applied in situations where a couple wants to increase their fertility, such as when the man has a spinal cord injury but the couple still wants to have a child.

Suffering from an ejaculatory disorder doesn’t mean you’ll never have enjoyable sex again! It does mean you should talk to your doctor about your symptoms and your treatment options. Together you can come up with a plan to get the plumbing working again in no time.

The post A Disruption in the Plumbing: Ejaculatory Disorders appeared first on Aaron Spitz, MD.

]]>
6098
The Penis and the Bling http://www.aaronspitz.com/blog/penis-bling/ Wed, 28 Sep 2016 17:27:49 +0000 http://www.aaronspitz.com/?p=6095 Genital piercings aren’t anything new—they were written about as early as the second century in the Kama Sutra. In the 1990s they experienced a resurgence, and today, having a bit of bling below the belt is more common than ever. But there’s also a lot of contradictory information out there when it comes to “intimacy […]

The post The Penis and the Bling appeared first on Aaron Spitz, MD.

]]>
Jewelry for piercings

How do genital piercings affect your health?
Image: Shutterstock

Genital piercings aren’t anything new—they were written about as early as the second century in the Kama Sutra. In the 1990s they experienced a resurgence, and today, having a bit of bling below the belt is more common than ever.

But there’s also a lot of contradictory information out there when it comes to “intimacy piercings.” Do they increase your chance of getting an STD? Do they actually increase your sexual pleasure? Are there other side effects? Or are genital piercings entirely benign?

When it comes to genital bling, the penis gets more attention. With far more surface area available, men can choose between eight different styles. The most popular is the Prince Albert, which involves inserting jewelry through the external urethra and out the base of the frenulum. It’s believed to increase a female partner’s pleasure, since in some positions, the piercing would stimulate the G-spot directly.

But women aren’t left out of the piercing game, either: their options include clitoral hood piercings, which have been shown in one study to enhance a positive sexual experience.

Recent research shows that about 2% of men and 0.8% of women between the ages of 18 and 50 have at least one genital piercing. When interviewed, people generally say they got a piercing to please their partner.

It’s not all sunshine and orgasms, though. While the rate of STIs contracted by individuals with piercings is lower than expected (a 2005 study found that, of 445 men with piercings, 18% reported STIs after being pierced), it’s still definitely a concern. And it’s not the only one: piercings can result in irritated skin, non-sexual infections, and ripping or tearing at the piercing site. That’s leaving aside the propensity for the piercing to poke holes in a condom or dislocate a diaphragm.

Other potential problems include hyper sensitivity in the piercing area and changes in urinary flow. In that previously-mentioned 2005 study, some respondents reported trouble aiming or even having to sit down to urinate after getting their genital piercing.

There’s a more insidious concern, too: Men generally look online for information about genital piercing instead of talking to their doctors about it. While it’s definitely possible to find good information online, there’s no guarantee that any particular website will include important information on hygiene and safety when it comes to genital piercings.

So it’s great that you’re reading this article… but make sure you talk to your doctor before installing any genital bling! You’ll want to be up to date on all the facts before deciding if and how you want to decorate down there.

The post The Penis and the Bling appeared first on Aaron Spitz, MD.

]]>
6095
Infertility: The Cultural Taboo http://www.aaronspitz.com/blog/infertility-cultural-taboo/ Wed, 21 Sep 2016 17:41:32 +0000 http://www.aaronspitz.com/?p=6090 For couples who are struggling with infertility and want to start a family, IVF may seem like a perfectly valid option. And it is—for those who can afford it. In many parts of the world, access to infertility treatments is impacted not only by cost, but by religious restrictions and long standing social biases. In […]

The post Infertility: The Cultural Taboo appeared first on Aaron Spitz, MD.

]]>
Parents sitting on floor playing with baby

Infertility can be a cultural taboo that makes starting a family more difficult.
Image: Shutterstock

For couples who are struggling with infertility and want to start a family, IVF may seem like a perfectly valid option. And it is—for those who can afford it.

In many parts of the world, access to infertility treatments is impacted not only by cost, but by religious restrictions and long standing social biases.

In the Middle East, infertility specialists have noted a rise in infertility. The Muslim culture places a high priority on families and raising children such that the inability to have children may result in many instances of social and cultural exclusion.

Additionally, there is a religious bias against adoption. In-vitro fertility is available to varying degrees, but there are religious constraints on the use of donor sperm and, to a lesser degree, on donor eggs in many locations. Iran and Turkey are the most liberal when it comes to donors, but even so, the social pressures relegate these treatments to a high degree of secrecy, particularly with donor sperm, even from one’s own family members. In some cases inheritance can be thrown into question if it is discovered that donor sperm had been used.  Cost is another big barrier, but progressive policies in Egypt and Turkey have provided subsidized IVF for many couples. Meanwhile, limited resources make access and affordability a major obstacle to many other couples throughout the region.

Throughout much of the world, there is an association between male fertility and masculinity.  There is a misconception that if a man is infertile, he is probably impotent, since, in simple terms, having sex is what results in pregnancy.  In many African nations this stigma often prevents men from seeking evaluation. Furthermore, this tendency results far too often in casting blame on the woman for the infertility, when in many cases she is normally fertile.

Unfortunately this can spill over into domestic violence in extreme cases of ignorance and frustration. In Kenya, a recent domestic violence incident made the news when Mwende, who lives 35 miles southeast of Nairobi, was the victim of assault by her husband. After nearly five years of marriage hadn’t resulted in a child, Mwende’s husband allegedly attacked her with a machete and cut off her hands. His fear of the social stigma surrounding infertility was that severe—possibly in part because Mwende’s husband had been told by a local clinic that the infertility was on his side.

In other countries, however, male infertility is slowly becoming more of a topic open to discussion. A man from Tajikistan, interviewed by Radio Free Europe, noted that his “masculinity was hurt” when he learned that the reason he and his wife couldn’t have children was because of his own infertility. Whereas the traditional solution for childlessness in Tajikistan is to find a new wife, this military man opted to get medical treatment. Today, he and his wife have two children—one biological and one adopted.
According to the Radio Free Europe investigators, one in five marriages in Tajikistan are affected by infertility. Because of cultural taboos, these cases generally lead to divorce rather than medical assistance.

Luckily, there are increasing opportunities for infertile men in the country to receive confidential treatment that can help them start the families they want.
Cultural taboos surrounding infertility aren’t just happening abroad, either. In the US, assumptions about race and culture can be a significant factor when it comes to dealing with fertility issues. Lawyer Heather Lawson described to The New York Times her issues with being the only black person at fertility clinics. She also noted having to deal with the assumption that black families have no trouble having children—despite the fact that more married black women suffer from infertility than married white women, according to the National Survey of Family Growth.

Infertility can happen to both men and women no matter where they live or what their cultures believe about it. Building a family despite infertility can be a challenge, but there are options out there despite the barriers many couples have to overcome.

The post Infertility: The Cultural Taboo appeared first on Aaron Spitz, MD.

]]>
6090
In the Beginning: Why Boys Have Penises http://www.aaronspitz.com/blog/beginning-boys-penises/ Wed, 14 Sep 2016 17:12:43 +0000 http://www.aaronspitz.com/?p=6087 Men and women have basically the same vital organs, blood vessels, flesh, and bones…but somehow, our genders are different. Why do men develop penises, and women don’t? Lets start at the beginning—of life. According to a report in IFL Science, the penis evolved as part of the process of procreation on land. Reptiles, for instance, […]

The post In the Beginning: Why Boys Have Penises appeared first on Aaron Spitz, MD.

]]>
Baby lying on bed

Why do some babies develop penises and others don’t?
Image: Shutterstock

Men and women have basically the same vital organs, blood vessels, flesh, and bones…but somehow, our genders are different. Why do men develop penises, and women don’t?

Lets start at the beginning—of life.

According to a report in IFL Science, the penis evolved as part of the process of procreation on land. Reptiles, for instance, often develop penises in twos, originating in the tissue that also becomes legs (a pair of legs = a pair of penises, apparently). Mammals, on the other hand, only get one, since our penises evolve from tail-bud tissue (one tail = one penis).

That’s evolution—now what about how those mammalian penises actually develop?

A baby’s genitals start to form during the 9th week after conception. Up until now, the baby has been neither male nor female. The baby only has what are called “indifferent gonads,” which have the potential to become either ovaries or testicles. At the same time, other internal features of both sexes develop–the Mullerian (female) ducts and the Wolffian (male) ducts.

The developing baby begins to form testicles if there is a y chromosome. The testicles release chemicals that turn the developing fetus into a boy. Testosterone, which is made by the testicles, makes the labia fuse together to make the scrotum and the penis. The clitoris becomes the glans (head of the penis), and the urethra lengthens. Mulerian inhibiting factor (MIF), also made by the testicles, makes the developing female ducts disappear—the vagina, uterus, and fallopian tubes go away. (Without testosterone and MIF we would all have female genitals.)

Although chromosomes provide the basic genital blueprints, the environment of the developing baby can also influence the end result. In addition, environment can have a significant impact on the “brain” sex of the person, or how the person identifies themselves in the spectrum from masculine to feminine. These “influencers” include the mother’s natural hormone levels, her exposure to medications and toxins, and even stress.

There is also evidence that the male brain is different in some ways than the female brain. For example, some scientists say that there is an area of a boy’s brain that makes him more interested in toys that propel, while a girl’s brain is wired more toward nurturing toys. There are also theories about differences in learning styles and strengths—men being hardwired to be better at spacial reasoning, for instance. Of course, there are societal pressures at work here as well, so the specifics of gendered brains are still uncertain, and the research continues.

For boys, the key element that shapes the brain is testosterone. It strengthens some brain connections and pares down others. But even if some structures of the brain are typical of males or females, every brain has both “male” and “female” elements.

There are some known conditions that affect gender, including “androgen insensitivity syndrome.” In this condition, the developing baby is genetically male with a y chromosome, but his tissues are not sensitive to testosterone. This means he doesn’t develop male genitals—but he doesn’t develop female internal organs such as ovaries, either. Instead, these individuals have female external genitals (labia and clitoris) but the vagina is short, and there is no ovaries, uterus, or fallopian tubes. They have testicles that are not descended since there’s no scrotum to descend into. They also experience female-like breast development due to testosterone being converted to estrogen.

Another condition, known as “Guevedoce,” or “penis at twelve,” is a genetic condition most commonly seen in the Dominican Republic. One out of every 90 boys is known by this term, which means they don’t develop a penis until age twelve. Until then, they appear (and are raised as) female.

These boys are deficient in an enzyme called 5-a-reductase, which usually converts testosterone into dihydro-testosterone, which is even more powerful than testosterone when it comes to stimulating the formation of the penis and scrotum from the labia and clitoris. As a result, the babies are born with female appearing genitals. When puberty comes around, the child gets a much bigger hit of testosterone from his testicles, resulting in the completion of the formation of the penis. .

Beyond this nontraditional start to life, the Guevedoce don’t experience any sort of negative physical side effects. They go on to live normal lives as men, though their facial hair is a bit sparse, and their prostates are a bit smaller.

There are other instances of unusual gender presentation, too. Congenital adrenal hyperplasia, a disorder of the adrenal glands, can cause a female baby to have a high amount of the male sex hormone testosterone in their bodies. For female children, this might manifest in female genitals that look more like a penis at birth. All of this can lead into the controversial topic of gender reassignment surgery in newborns. Should babies with atypical genitals undergo surgery to look more “male” or “female”? It’s an issue that’s under a lot of scrutiny these days.

The process of development may be a bit different from individual to individual, but in the end, gender comes from a variety of places both on the inside and the outside of the body. Complex interactions between hormones and chromosomes create, for some, the penis. Keep it healthy and happy, and you’ll have a lifelong companion.

The post In the Beginning: Why Boys Have Penises appeared first on Aaron Spitz, MD.

]]>
6087
When Low Testosterone is Keeping You Down http://www.aaronspitz.com/blog/low-testosterone-keeping/ Wed, 07 Sep 2016 16:00:39 +0000 http://www.aaronspitz.com/?p=6083 One of the sneakiest culprits behind erectile dysfunction is low testosterone. I say “sneaky” because low testosterone can cause a plethora of problems when it comes to both your general health and specifically how happy Mr. Happy actually is. That makes it tricky to diagnose and treat. But it is possible, particularly if you take […]

The post When Low Testosterone is Keeping You Down appeared first on Aaron Spitz, MD.

]]>
Folder with "low testosterone" printed on front and stethescope lying on top

Low testosterone can be caused by a variety of things.
Image: Shutterstock

One of the sneakiest culprits behind erectile dysfunction is low testosterone. I say “sneaky” because low testosterone can cause a plethora of problems when it comes to both your general health and specifically how happy Mr. Happy actually is. That makes it tricky to diagnose and treat. But it is possible, particularly if you take a holistic view.

The connection seems easy at first: low testosterone means less of this all important sex hormone, which means less sexual desire, which means getting and maintaining an erection is harder.

But low testosterone can also cause a general reduced sex drive, anxiety, irritability, difficulty concentrating, and depression. So deducing the specific illness and how to treat it can be tricky.

Low testosterone can be caused by a variety of health issues, including high blood pressure, high cholesterol, pituitary or thyroid issues, kidney problems, obesity, steroid exposure, type 2 diabetes, and many more. It can start as a problem with the testicles or even with signals from the brain that aren’t getting through quite right.

And it’s not necessarily an illness, either; as men age, they naturally produce less testosterone over time. According to the American Association of Clinical Endocrinologists, about 30% of men over age 75 have low testosterone.

If a qualified doctor has run tests and determined that low testosterone is the underlying issue, treatment is absolutely possible. You may have heard of testosterone replacement therapy (TRT) for erectile dysfunction.

“Clinical research data has explored the influence of testosterone replacement therapy on erectile dysfunction and found that in many men with identified low testosterone, testosterone replacement therapy can provide a positive influence on erectile function,” says J. Aaron Davis, ND, director of the Low T Center in Indianapolis. In some cases, TRT alone may solve the problem; in more severe cases, however, treatment requires a combination of efforts, including TRT, lifestyle changes, and medication.

There are actually two kinds of low testosterone: primary and secondary. Primary is caused by a problem with the testicles, such as:

  • Undescended testicles. If a young boy’s testicles don’t descend from his abdomen into the scrotum and the situation isn’t fixed early on, the testicles can malfunction and have problems producing testosterone.
  • Klinefelter syndrome. Sometimes a boy is born with an extra X chromosome, which causes the testicles to develop abnormally. The National Institutes of Health (NIH) says one in 500 men suffer from this problem.
  • Mumps orchitis. If you had mumps after puberty and the infection reached your testicles, they may produce less testosterone over time even after you’ve recovered.
  • Too much iron being absorbed into the body—one of the side effects of hemochromatosis—can affect testosterone production.

Secondary causes of low testosterone originate in the brain—the hypothalamus and pituitary gland, to be precise. These kinds of problems include:

  • Kallmann syndrome. This genetic disorder means delayed puberty—or even no puberty at all. One result of the syndrome is reduced testosterone production.
  • Pituitary disorders. Given the importance of the pituitary gland in regulating hormones, if something is wrong, it can easily lead to low testosterone.
  • Inflammatory disease. Diseases like sarcoidosis (inflammation of tissues, particularly the lungs), histiocytosis (overproduction of white blood cells), and tuberculosis can affect the hypothalamus and pituitary gland, leading to low testosterone.
  • Obesity and stress. Your habits can have a big effect on your testosterone production. Things like obesity and stress have been shown to lower testosterone levels in some cases.

Erectile dysfunction may not be your favorite topic at dinner parties, but it’s definitely something you want to discuss with your doctor. If low testosterone is behind it, there are steps you can take to treat the underlying situation and get back to optimal health—not to mention fun in the bedroom.

The post When Low Testosterone is Keeping You Down appeared first on Aaron Spitz, MD.

]]>
6083