Back By Popular Demand: Sex, the Heart, and ED

Today, I proved what I suspected: if you want readership, write or Tweet about sex and the heart.

Needless to say, in a little over 30 minutes, I garnered 30 new Twitter followers by live-tweeting what I learned in the "Sex, the Heart, and Erectile Dysfunction (ED)" session at the American College of Cardiology meeting in Atlanta. For those who might have missed it, I have organized the tweets in chronicalogical order for your enjoyment benefit:

Okay, at Sex/Heart session: Standing room only. Docs, pharma here. Um, will doctors attending please stand up? #acc10

NEWS! Most people with CAD have ED! Up next: Cardiac response to sexual activity... #acc10

10 healthy married couples studied: all kinds of positions and O2 consumption measured. #acc10 orgasm rocks the heart rate up 72%!

Guys on top: MUCH more exertion for men. Who knew? #acc10 Large variability of HR & VO2 - younger men a bit more, um, vigorous.

Man on top: 3.3 Mets, partner on top 2.5 Mets. Uh oh: Topic now not PG-13 rated... #acc10

Extramarital sex: HR 96->150; later same day w/wife: HR 62->92. REAL data. Conclsn: extramarital sex more risky #acc10< In more ways than 1

2 flights of stairs w/o stopping equals one romp in the hay in terms of workout #acc10

Oops, seems 6 Mets of exertion on treadmill tolerated means sex is safe. #acc10 Rock on, folks!

RT @gruntdoc: twitter rank skyrocketing. NEWS! Most people with CAD have ED! Up next: Cardiac response to sexual activity...< heh #acc10

OMG! Lots of therapeutic options if meds don't work: topical, intrcavernosal or intrarethral options; implants too. #acc10 Can I go now?

Remember nitrate warning...wait 48 hrs after stopping nitrate b4 using Viagra or Cialis or Levitra. #acc10 Now if u have CP, don't call me.

RELAX trial: randomized trial (evaluating use of ED drugs) looking at "stiff hearts" (diastolic dysfn) underway. #acc10 Wait, I thought stiff was good.... [kidding]

Revatio 20tid & Adcirca 20 qd used for pulmonary HTN to decrease pulmonary pressures. #acc10 Looks like juicy sex stuff has to wait.

Email inbox full after twittering sex/heart info. #acc10 (well, not quite, but 13 new followers in under 30 min) < Proof that sex sells!

Zzzz. Discussing sildanefil (Viagra) in mice. #acc10 Mice have enough sex, can we move on?

Great! A woman is about to speak! #acc10 Endocrine aspects of sex - awww, talking about male hypogonadism. Sorry ladies...

Yikes! 2000 men with low testosterone had higher mortality in Europe. #acc10 Arnold (Swartzenegger) is safe.

Peak testosterone level in men is age 28! #acc10 I'm dyin'.... [scratch that] I'm dead.

Can we use ED to prevent heart disease? #acc10 ED is assoc w/ incr CV death. ID of pts offers opportunity to steal cases from urologists!

ED is, after all, a VASCULAR disease. #acc10 I've heart of a throbbing heart but... er, never mind. (Urologists beware).

Asking about ED is as good as drawing CRP level in men! #acc10 hey, great way to save $$$$!

We were introduced to a new concept: A cardiac sexologist! #acc10 I'm in!

Q: what about women? A: Women getting Viagra. Women w/pulmonary HTN report greater sexual activity #acc10 honey, you're script's waiting 4u!

So there you have it.

I must admit, that was, by far, the most fun I've ever had attending a scientific session.

-Wes

Name Alert! Treating PE

My entire medical career "PE" used to be about a pulmonary affliction where a blood clot goes to the lungs: pulmonary embolus. Now, thanks to the power of marketing gurus who have little regard for medical nomenclature, there's a new "PE" in town involving the same organ as the heavily marketed malady, "ED."

Sheesh.

Talk about the yin and yang of urology...

-Wes

Bicycling and ED

I've never liked bicycle seats, and now my worst fears have been confirmed:

When urologist Dr. Irwin Goldstein declared in 1997: "There are only two kinds of male cyclists -- those who are impotent and those who will be impotent," many bike riders scoffed. Saying the equipment housed in their spandex shorts worked just fine, they optimistically kept riding. Several prominent urologists dismissed Goldstein's claims, saying that they were based on a small sample of riders and that the cardiovascular benefits of cycling outweighed any risk of impotence.

Ten years later, more than two dozen published studies, including several by Goldstein, have confirmed the connection between cycling and sexual dysfunction. Problems can range from impotence -- the complete inability to penetrate -- to an erection that doesn't last as long as desired.

The data seem slight, but then, any harm to "Mr. Microphone" might be significant:

Not all male riders, or even the majority of male bicyclists, are likely to experience erectile dysfunction. A study presented to the American Urological Association in 1997 found that 4.2 percent of cyclists had moderate to complete ED, compared with 1.1 percent of runners. That study compared 738 male riders from a Boston cycling club with an age-matched control group of runners. A second study, presented to the association the following year comparing cyclists and swimmers, found that 4 percent of cyclists had ED compared with 2 percent of swimmers.

Older bicyclists and those riding long distances tend to have an increased risk. And yet another study, published in the International Journal of Impotence Research in 2001, found that men who rode for less than three hours a week decreased their risk of ED, compared with non-cyclists, possibly because of the benefits to the cardiovascular system. But the same research found that cycling more than three hours a week nearly doubled the risk of ED, compared with non-cyclists.

How to fix this? Seems a seat without a nose might be best:

Dr. Roger Minkow, a specialist in ergonomics, said that a properly designed and fitted bike seat with a nose can work as well as noseless saddles in avoiding erectile problems without sacrificing control and safety on the bike. Minkow, who has developed pilot seats for United Airlines and training equipment for the U.S. Olympic gymnastics team, was hired in 1997 by Specialized Bicycle Components to design a new line of bicycle seats.

Testing showed that the modified saddles allowed blood flow up to about 70 percent of normal in an upright position and 60 percent in a forward position. Some other saddles tested had flows less than 2 percent of normal. Minkow said that flows of more than 50 percent should be enough to prevent ED problems.

So guys, ride carefully out there, and have a great Summer!

-Wes