| Foreword | ix |
| Preface | xi |
| Acknowledgments | xiii |
| List of Contributors | xv |
| Introduction | xvii |
1 | Impotence: An Opportunity to Revive Intimacy | 1 |
| Key Points | 1 |
| Reality Hits | 2 |
| From Relationship RUT to CREST | 5 |
| Breaking the Erectile Dysfunction Mindset | 6 |
| Back to the Subject of Sex: Happiness Is an Erection--or Is It? | 7 |
| Mindset | 10 |
2 | Facts about Impotence | 11 |
| Key Points | 11 |
| Causes of Erectile Dysfunction | 12 |
| Sexuality, Impotence, and Age | 13 |
| What Is a "Normal" Sex Life? | 13 |
| It's Over--or Is It? | 14 |
| Trollope Works for Me | 15 |
| The Effects of Prostate Cancer Treatment: What's the Truth? | 17 |
| Am I the only one with a problem? | 17 |
| Is nerve sparing or nerve grafting surgery a miracle treatment? | 18 |
| Is potency known immediately after surgery? | 19 |
| Will my penis be shorter after radical prostatectomy surgery? If it is, can I still have intercourse? | 19 |
| Do I need testosterone injections to increase my desire or treat my erection problems? | 20 |
| Does hormone treatment destroy desire and potency? | 20 |
| Can sex stimulate cancer? Can I transmit cancer to my partner through sex? | 20 |
| Will my partner have any effects from my radiation treatment for prostate cancer during intercourse? | 21 |
| What are the effects of treatment for benign prostatic hyperplasia (BPH)? | 21 |
| General Questions and Answers about Impotence | 21 |
| Do I need an erection to have an orgasm? | 21 |
| Can my partner have an orgasm if I don't have an erection? | 22 |
| Does satisfaction require having an orgasm? | 22 |
| If one medication, such as Viagra, does not work for me, will another one work? | 22 |
3 | Talking with Your Partner | 23 |
| Key Points | 23 |
| Elephants Bite | 25 |
| Planning for Talking | 29 |
| Improving the Quality of the Relationship | 29 |
Step 1 | Are you in a RUT? | 30 |
Step 2 | What would you like? | 30 |
Step 3 | Make arrangements | 30 |
Step 4 | Have a heart-to-heart talk | 31 |
Step 5 | Do it! | 32 |
Step 6 | Review | 33 |
| Two Effective Approaches to Handling Differences | 34 |
| Sex and the Single Man | 35 |
4 | Reviving Loving | 37 |
| Key Points | 37 |
| Relearning Loving | 39 |
| Creating a Loving Environment | 41 |
| Increasing Desire | 43 |
| Pleasing a Woman | 45 |
| Loving Is a Partnering Activity, Not a Solo Sport | 46 |
| Learning about Your Own--and Your Partner's--Anatomy | 47 |
| Be Creative in Your Love Life | 48 |
| Making Things Romantic | 50 |
| Early Bird Special Sex | 51 |
| The Partner's Role | 52 |
| Take Time | 54 |
| Just Do It: Make Love | 54 |
5 | Sensual Sex | 57 |
| Key Points | 57 |
| A Sensual Encounter | 58 |
| What Sensual Sex Is All About | 61 |
| Getting in the Mood | 61 |
| Getting Prepared | 63 |
| Sensual Arousal | 65 |
| Kissing | 65 |
| Touching | 66 |
| Touchpoints | 67 |
| Giving and Receiving | 71 |
| Penile Massage | 71 |
| Oral Sex | 71 |
| Massage | 72 |
| Visualization and Sexual Fantasy | 73 |
| Special Techniques to Assist in Sex with Impotence | 75 |
| Using gravity | 75 |
| Massaging the penis | 75 |
| Partial penetration | 76 |
| Female orgasms with a limp penis | 76 |
| The Self-Renewing Relationship | 77 |
6 | Getting into Shape for Sex | 79 |
| Key Points | 79 |
| Eating Right | 81 |
| Exercising | 82 |
| Physical activity and routines | 84 |
| Pelvic floor exercises | 86 |
7 | Talking with Your Doctor | 89 |
| Key Points | 89 |
| Understanding the Doctor's Situation | 90 |
| Preparing for a Visit to Discuss Sexual Dysfunction Issues | 91 |
| Writing down your questions | 91 |
| Making the appointment | 93 |
| Getting the Most from the Meeting | 94 |
| How to Be Sure the Doctor or Other Professional Is Truly Listening | 96 |
8 | Commercial Therapies and Medications | 97 |
| Key Points | 97 |
| Is There a One-Size-Fits-All Treatment? | 98 |
| Treatments: What Works for You? | 99 |
| Understand the psychological side effects of treatment | 100 |
| Understand what anxiety can do | 101 |
| The importance of a conservative approach | 102 |
| Why so much information? | 103 |
| Pill Splitting | 106 |
| Interpreting Clinical Trial Results | 106 |
| The List of Treatments | 108 |
| Penile rehabilitation | 109 |
| Oral medications | 113 |
| Topical medications: penile creams and gels | 127 |
| Intraurethral medication | 131 |
| Penile injection (intracavernosal injection) | 135 |
| New medications in development | 144 |
| Devices | 147 |
| Penile splints and supports | 147 |
| Vacuum therapy systems | 147 |
| Penile implants | 158 |
| Surgery | 162 |
| Neural therapies | 162 |
| Nerve sparing surgery | 162 |
| Nerve grafting surgery | 165 |
| Neural regeneration | 167 |
| Penile vascular surgery | 167 |
| New target areas for erectile dysfunction research | 169 |
9 | Nonapproved and Off Label Treatments | 173 |
| Key Points | 173 |
| Combination Therapies | 175 |
| Combination therapies using sildenafil (Viagra) | 175 |
| Sildenafil (Viagra) and doxazosin (Cardura) | 175 |
| Sildenafil (Viagra) and apomorphine (Ixense and Uprima, in Europe, Latin America, and Asia only) | 175 |
| Sildenafil (Viagra) and a tension ring | 176 |
| Sildenafil (Viagra) and a vacuum erection device | 176 |
| Sildenafil (Viagra) and intraurethral prostaglandin E-1 (MUSE) | 176 |
| Sildenafil (Viagra) and intracavernosal injection (Caverject) | 176 |
| Combination therapies using yohimbine hydrochloride | 177 |
| Yohimbine and L-arginine glutamate | 177 |
| Yohimbine and Naltrexone | 177 |
| Off Label Drug Usage | 178 |
| Dopamine receptor agonists | 178 |
| Herbal Products and Dietary Supplements | 178 |
| Ginkgo | 180 |
| L-arginine | 181 |
| Kava | 181 |
| Korean Red Ginseng | 182 |
10 | Putting It All Together | 183 |
| Romeo and Juliet | 183 |
| Napoleon and Josephine | 184 |
| Bill and Jill | 186 |
Appendix A | Treatments for Erectile Dysfunction | 189 |
Table A-1. | Medications | 190 |
Table A-2. | Devices | 191 |
Table A-3. | Combination Therapies | 192 |
Table A-4. | Non-FDA-Approved Therapies | 193 |
Table A-5. | New Medications in Development | 194 |
Appendix B | Manufacturers of Erectile Dysfunction Products | 195 |
Appendix C | Resources | 201 |
Appendix D | References and Further Reading | 205 |
| Books | 205 |
| Scientific and technical papers | 208 |
| Index | 213 |