Author: Dr. Elna McIntosh

Sexual health gets a boost!

Pink Viagra approved

2015 was a significant year for Sexologists worldwide. After a long and controversial process, the US Food and Drug Administration (FDA) approved the first-ever drug aimed at boosting female libido. The medication, called flibanserin, will be sold under the brand name Addyi, also known as “pink Viagra.”

Pink versus Blue

Just to clarify: the pill is not pink and has nothing in common with the blue pill, Viagra. Viagra works “below the belt”, so to speak, and Addyi works in the brain. So let’s rather not call it Pink Viagra, but rather just call her by her real name Addyi.


Q: What is this new drug, flibanserin?

Flibanserin is an antidepressant that failed to help depression in clinical trials, but was noted to have improved sexual health outcomes. It’s not uncommon for a drug to be developed for one purpose, then approved for another. Sildenafil (Viagra) was originally developed to lower blood pressure, but failed those trials. The benefit of both of these drugs was discovered by accident. However, flibanserin has now been studied for its effects on sexual health for nearly a decade.

Q: How filbanserin work to boost a woman’s libido?

Researchers think that flibanserin restores some of the chemical imbalances that affect sexual desire disorders. Most people have heard of antidepressants known as selective serotonin reuptake inhibitors, like fluoxetine (Prozac). SSRIs can have negative sexual side effects: reduced libido or erectile dysfunction, suggesting that serotonin plays an important role in sexual desire and excitation. Flibanserin affects serotonin but in a different way than SSRIs. It stimulates one type of receptor while blocking another. It also increases dopamine in the body. Dopamine is known to have positive effects on sexual health.

Q: What are flibanserin’s benefits and drawbacks?

This is the first medication approved to treat sexual desire disorders. While many people think desire is more psychosocial than biological, there are clear biological processes that affect sexual desire and function. Flibanserin was shown to have a modest improvement over placebo in increasing desire. Women taking the drug had up to two more satisfying sexual events (SSEs) each month, compared to the placebo’s increase of one more SSE a month.

It is important to note it is very hard to overcome the placebo effect when studying drugs; people often improve on placebo alone. The controversy over flibanserin focuses on the degree of benefit. Is one more sexually satisfying event each month enough of a benefit? For many women, this is a significant increase and should not be discounted, given how important sex can be in a relationship. Overall desire, very important to many women, scores also increased in the most recent trials.

Drawbacks: there are adverse effects, as there are with all medications. The major adverse effects are dizziness and drowsiness, which can affect about 10-15% of women taking the medication. This is not significantly different from the widely prescribed SSRI antidepressants. We don’t yet have long-term data on other potential risks, including cancer. It should be pointed out, however, that Viagra was approved with six months of safety data. Most studies on flibanserin have one to two years of safety data.

Another drawback is the concern that this drug will simplify the complex factors that affect women’s sexual health. Many people feel that this is just a ploy by pharmaceutical companies to cash in on a problem that is widespread, and cannot be treated pharmacologically.

Q: Why is flibanserin such big news?

Up to 40% of women report having sexual problems, and about 12% find the problems very bothersome. This equates to millions of women who suffer from female sexual dysfunction, the most common being hypoactive sexual desire disorder (HSDD) or loss of libido.

Women are still in the shadows when it comes to talking about sexual dysfunction. They’ve been told for years that their only options are expensive therapies, including psychotherapy, hormones, and supplements. The FDA’s standard of approval for drugs to treat sexual dysfunction in women is significantly higher than for those to treat men’s sexual health concerns.

Just as Viagra opened the door for men to talk about sexual health, the hope is that flibanserin will allow women to discuss this often highly distressing problem and have an option for treatment. This is an important development for women and for those who treat them.

Addyi is available in the USA, but it might be a few years before the MCC* will make it available in South Africa.

*The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances. All medicines for human use are subject to this law, including complementary and complementary biological medicines.

Dr Elna McIntosh, sexologist and Retire Successfully Retirementor

A man’s sexual health affects him and the woman in his life

Sex and sexuality play a large part in the discussion about men and masculinity. Men are goal-oriented in sex, and it is therefore the orgasm that counts. As such, men bring to the sex act numerous concerns about their technical performance, asking questions like: ‘Did I do well?’, ‘Did I satisfy my partner?’ Men, irrespective of their position to hegemonic masculinity, believe they must be in charge, and feel responsible for orchestrating the lovemaking and subsequently its success. Thus images of normal male sexual functioning are synonymous with the thought of being a ‘real man’.

Consequently, men believe that all intimate physical contact should lead to genital sex and that they should always be ready for it. Genitalisation of sex means that sexual organs are highly important to male self-images. Sexual ill-health therefore acts as an enormous threat to a man’s sense of wellbeing.

A man’s sexual activities are profoundly infused by gender. Masculine gender socialisation defines and sets the standard for sexual performance, and the quality of this performance in turn, bears the authority to confirm (or shatter) one’s identification as a man (Zilbergeld, 1992).

Therefore a man experiencing sexual difficulties often feels that his masculinity, and not merely his sexuality has been threatened (Person, 1980).

When the culturally prescribed standard for sexual performance is not met, this loss ‘extends to the entire male-body, disabling him, de-sexing him, and submitting him to powerlessness—to “impotency” ’ (Potts, 2000, p. 94).

Repercussions for relationships

The consequences of this mindset are often disturbing, particularly in context of relationships.

On the one hand when men encounter sexual health problems, their manliness is questioned; and, on the other hand, the consequences on their intimate relationships go unparalleled. The women in the relationship start to question themselves whether it’s their fault that their men encounter difficulties. They begin to internalise what could be a medical condition into their personal fault or shortcoming. Consequently, their actions and responses may encourage risky behavior among men to try and fix themselves.

Communication within the relationship and trust are key issues to consider. The more open the communication within the relationship, the easier it is to negotiate appropriate action to consider. Where fluid communication exists, exploring treatment options, where the ill-health can be
treated, becomes easier and prepares the couple also to readily accept the situation.

This becomes quite significant for stability within the relationship and cures insecurity issues.

Good counselling and educating oneself can go a long way to dealing with challenges that emerge with ill health that threatens a man’s sense of his masculinity.

Elvis T Munatswa, author of this article, works in collaboration with Dr Elna McIntosh. He is a Researcher and Counsello in Men’s Health, President of the Rotaract Club of Wits University, Cancer Advocacy Master Trainer, African Cancer Advocacy Consortium (ACAC) Chairperson, Livestrong Foundation Johannesburg Leader, Founder of regional Men’s Health Prostate Cancer Survivor Support Group.

Let’s talk about sex

9 health benefits of an orgasm

Orgasms… How can something so enjoyable be good for us? There is a mindset that we all experience that dictates that all things nice must be bad. But unlike that extra glass of wine, or a fatty steak, orgasms are no longer perceived to be guilty pleasures. Researchers and physicians have finally come to the conclusion that sex and orgasms are good for body, mind and soul.

Here are 9 reasons to heat things up this winter…

1. Relieves stress

The relaxation that typically follows orgasm is often one of the few times people actually allow themselves to completely relax and to let go of the day’s stresses. In the afterglow of an orgasm it’s usually impossible to focus on distracting thoughts. Oxytocin, the bonding, sleepy hormone, floods your body one minute after orgasm making you awash in calm.

Masturbation Suggestion

Use a “massager” for clitoral stimulation. A long handle is best for comfort and a better reach. Try the Hitachi Magic Wand, labelled as “the most reliable way to orgasm”.

2. Helps you sleep better

Why do men fall asleep almost immediately following an orgasm? They usually experience a quick drop in blood pressure and then fall into sudden relaxation. For women the effect is more progressive but just as powerful. Consider orgasm as your own personal tranquilizer – throw the sleeping tablets away and overcome insomnia by letting the joyful release of endorphins take over and calm your body and mind.

3. Boosts your immune system

An orgasm a day keeps the doctor away! When you orgasm DHEA is released and Dr. Theresa Crenshaw author of The Alchemy of Love and Lust says, “DHEA may be the most powerful chemical in our personal world. It helps balance the immune system, improves cognition, promotes bone growth, and maintains and repairs tissues, keeping your skin healthy and supple. It can mean less frequent colds and flu.” In fact, Wilkes University in Pennsylvania says those who have sex once or twice a week show 30% higher levels of an antibody called immunoglobulin A, which is known to boost the immune system.

Product Suggestion

“The Rabbit” is an all-in-one vibrator designed to vibrate on the clitoris, while small beads gently turn inside the shaft to give the labia and vagina some action as well.

4. Reduces depression and improves your mood

Many hormones are positively affected by the act of sex and orgasm, which can lead to a lighter mood. Another theory is proposed by psychologist Gordon Gallup who states that Prostaglandin, a hormone found only in semen (which upon being absorbed in the female genital tract) may have led to 30% more of his female study participants to report feeling happier than the participants who didn’t have men ejaculate inside of them. So, he can apparently make you feel happy inside and out.

6. Strengthens your body

Muscle contraction as a form of exercise is generally good for any muscle. The muscle contraction associated with orgasm can also address issues such as erection problems and incontinence. When 178 Belgian men with minor erection problems participated in a four month daily rehabilitation program which primarily focused on Kegel exercises, 74% showed improvement and 43% reported they were cured. For women, Kegels strengthen the entire uro-genital tract which prevents the onset of incontinence.

Product Suggestion

The Kegel Exerciser – Weighted Kegel Exerciser is the perfect PC training companion.

7. Alleviates pain

Orgasm has been linked with decreased pain with menstrual cramps, migraine and a general increase of pain threshold. Because of natural opiates, sex and specifically orgasm become a powerful analgesic, elevating the pain threshold. Now that’s a prescription everyone can follow.

7. Reduces your risk of heart disease

It’s simple — by having and orgasm three or more times a week, individuals reduce their risk of heart attack or stroke by half. Heart attack rates were found to be much higher with women who didn’t have orgasms.

Product Suggestion

Indulge in some visual sensuality to get that heart pumping gradually to get you in the mood. I suggest watching an erotic movie. Orgasm comes easier after visual stimulation. Try the popular, woman-made, Bad Wives.

8. Helps you lose weight

There are 3500 calories in a pound of fat. For every 3500 calories you burn you will lose one pound of fat. Sexual intercourse burns approximately 150 calories per half hour. In comparison, yoga uses 114 calories per half hour, dancing 129, walking at 6km/ ph 153, weight training 153, volleyball 174. The pulse rate, in an aroused person, rises from about 70 beats per minute to 150, the same as that of an athlete putting forth maximum effort.

9. Decreased risk of cancer

Higher oxytocin and DHEA hormone levels released with orgasm were linked with decreased rates of breast cancer. And men who had an orgasm (ejaculation) more often were found to have lower levels of prostate cancer.

Live long and prosper with lots of orgasms!

How Erectile Dysfunction (ED) is diagnosed

Erectile dysfunction or ED, also called impotence, isn’t something to be embarrassed about, but you do need an accurate diagnosis before you can be treated.

ED isn’t an uncommon occurrence.  At some point, most men will experience difficulty getting or maintaining an erection long enough to enjoy intercourse.  But if you experience ED on more than 25 percent of the occasions when you try to have intercourse, there may be a medical reason.

Possible causes of ED…

ED can be caused by a number of serious health conditions, including:

  • Heart problems
  • High blood pressure
  • Atherosclerosis
  • Depression
  • Nerve damage or injury
  • Thyroid problems
  • Neurological condition or injury
  • Stroke
  • Poor circulation
  • Low testosterone levels (Hypogonadism)
  • Problems with the kidneys or liver
  • Diabetes

There are many other reasons why erectile dysfunction can occur, including fears or anxieties about sex, substance abuse, and relationship problems.  But if a physical condition or abnormality is the cause, it’s important to get a medical diagnosis and treatment before even more serious symptoms occur.

How a medical diagnosis is made…

Your doctor will start by out taking a medical history and asking a number of questions to determine if your ED is caused by a serious medical problem or by lifestyle issues.

Questions will likely be about:

  • Alcohol and drug use
  • Prescription medications you’ve recently taken
  • Recent surgeries
  • Your history of erections and impotence
  • Difficulty urinating

Other steps leading to the right diagnosis may include:

A discussion about your emotional health.  Your emotional health can play a big role when it comes to sexual function, so your doctor will evaluate whether psychological or emotional issues may be interfering with your ability to have or maintain erections.  Be honest with your doctor about any problems with your partner, fears, anxieties, or personal stressors that you’re experiencing.  They could be the reason for your ED, and can be dealt with through therapy and counselling.

The physical exam.  The next step will usually involve a careful look at the penis and a rectal exam.  A physical also includes a check of your circulation to see if problems with blood flow are affecting your erections.  There will also be a neurological exam to see if you have any issues with your nerves or spinal cord, or conditions like Parkinson’s disease.

Diagnostic tests.  Your doctor will need to run a number of different tests to diagnose or rule out health conditions that may be causing your ED.  Your blood pressure will be checked, and a urine sample will be tested to look for any problems with your urinary tract.  An ultrasound of the penis may also be performed to check for circulatory problems.  A blood sample could be drawn for a complete blood count and metabolic panel, which can help to identify problems with the kidneys and the liver.  Your hormone levels — thyroid, for example — may be tested, as well as the levels of a prostate-specific antigen, or PSA, to diagnose problems of the prostate.

If you notice more than just the occasional instance of erectile dysfunction, schedule an appointment with your doctor.  Not only can your ED be treated, so can any health problem that’s causing it, and do it now before the problem gets more serious.

The FAQ sheet

Q: Who should I talk with about my sexual dysfunction – it bothers me but I don’t know who can help me – is there a particular kind of doctor for me to see?

A: You should speak with your primary care physician or gynaecologist (for women) regarding your sexual health.  If he or she does not have a broad enough knowledge base in this field, there are physicians who specialize in sexual medicine, some of whom see only men, some only women, and some who treat both.  Remember that your dysfunction may affect your partner, so you may want to go to your appointment as a couple.

Q. How do I know if my problem is caused by physical or psychological difficulties?

A. Today in the vast majority of cases there are physical reasons causing a sexual dysfunction. Often, the psychological problems associated with these problems tend to be a result of the sexual dysfunction rather than causing it.  It is difficult to have a sexual problem without experiencing some feelings of stress and other emotional reactions.  These emotions can intensify an already existing problem.  New treatments for sexual dysfunctions are effective in treating sexual difficulties regardless of whether they are caused by physical or psychological issues.  Because most problems tend to have both physical and psychological components, it is generally a good idea to see a physician with training in sexual medicine in conjunction with a psychologist or sex therapist.  A good sex therapist should refer you to a medical doctor for a comprehensive evaluation and a good medical doctor should also suggest that you see a sex therapist or psychologist for the emotional components.

How to feel sexy for life

Don’t let your age keep you from experiencing the pleasures of intimacy.  Although libido may lessen as you age, here’s how to feel sexy for a lifetime.

As you grow older, it’s easy to lose that spark in the bedroom.  Boredom, loss of adventurousness, physical ailments, and other problems can overcome even the healthiest of relationships over time, causing a loss of libido and creating emotional distance.  But keeping intimacy alive can have profound effects on your life.

Research has shown that healthy people have better sex lives.  Fit people enjoy sex more and have a lower chance of dealing with a sexual dysfunction that can impair their love life.  If you’re experiencing a loss of intimacy, there are steps you can take to reclaim it.  Here’s how to feel sexy again.

Intimacy tip no 1:  Stay healthy

To keep your libido revved for lovemaking you should:

  • Exercise regularly.  Your arousal depends in large part on how well blood flows through your body.  Regular aerobic exercise can help keep the heart pumping and the blood flowing.
  • Eat right.  Maintain your health by eating a diet low in fats and sugars and high in fibre and good nutrition.  Eat lots of fruits and vegetables, plenty of whole grains, and a good daily amount of low-fat dairy products.  Protein should come in the form of fish, poultry, and lean meats.
  • Sleep well.  Good, healthy sleep gives your body the chance to refresh and recuperate.
  • Stop bad habits.  Alcohol and tobacco can harm sexual function and can negatively affect your overall health.

Intimacy tip no 2:  Communicate

Partners with a satisfying sex life talk to one another; those with an unsatisfying one need to talk to one another.

  • Voice your concerns.  Tell your partner about changes in your body that worry you along with any other issues that bother you about your sex life.
  • Describe what makes you feel good.  Your partner can’t satisfy you if he / she doesn’t know what you desire.
  • Don’t criticize.  Focus on what your partner is doing right, rather than pointing out the things they’re doing wrong.
  • Talk at the right time.  During lovemaking is the right time for discussing what you like and enjoy.  Save your concerns, worries, and more negative issues for outside the bedroom.

Intimacy tip no 3:  Improve your own game

Try these ways to be a better lover:

  • Think about sex.  The brain is an important — some say the most important — sexual organ.  Get your head in the game by thinking about your fantasies and desires more often.  Write down your sexual fantasies and share them with your partner.
  • Touch.  Maintaining physical affection is critical to keeping a love life happy and frisky. Cuddle, hug, kiss, and hold hands often, even if you’re tired or not in the mood for sex. During lovemaking, experiment with touching your partner in ways that please and arouse him / her.
  • Educate yourself.  There are plenty of self-help books available that will give you tips on improving your sexual technique.

Intimacy tip no 4:  Have fun

Don’t forget that sex is supposed to be an enjoyable experience.  Be sure to have fun in the bedroom (and elsewhere) by:

  • Trying out different sexual positions.  The tried-and-true missionary position can become stale.  Experiment!
  • Taking a break from intercourse.  Try pleasing each other with oral sex, manual sex, massage, and caressing.
  • Being inventive.  Leave love notes.  Plan an erotic getaway.  Try making love at different times of the day.  Read a love poem.  Craft a scene that appeals to all five senses.  Try having sex in different locations.

Most importantly, have sex and enjoy intimacy on a regular basis with your partner.


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