Sex, viagra, cell phones, and sperm cells

There are few topics one can discuss in a health column that can attract more attention than sex, Viagra, cell phones, and sperm cells. By coincidence, I received three letters within three weeks about these interesting subject matters. Here are the three questions these letters asked and here are my answers:

Q. I had a heart attack recently, and I’m worried about resuming my sex life. Is it safe? Will I want to have sex again? — E.B., Quezon City

A. Your concerns are normal. A common fear is that sexual arousal after a heart attack will trigger another cardiac event. In truth, the risk is very low – sexual activity rarely causes repeat heart attacks or sudden death.

After an uncomplicated heart attack, it is generally agreed that if you’re able to be physically active and you’ve passed a stress test, it’s OK to resume sexual activity. The demands sex places on your heart approximate those of other mild or moderate physical activities, such as brisk walking, walking up a couple of flights of stairs or playing golf. Most people can return to their usual sexual activity within three to four weeks. But if you’re experiencing complications, such as heart failure or low blood pressure, you may need to begin sexual activity more gradually.

Still, you may face some other challenges to your sexuality after recovery from a heart attack. Feelings of stress, anxiety, and depression are common and may make you lose interest in sex. In most cases, the depression lifts within three months. Your feelings about your body may change and you may be intensely aware of your heartbeat and breathing. Finally, the medications you take to treat heart disease can cause sexual difficulties.

Here are some guidelines on how to prepare physically and emotionally to restart your sex life:

• Participate in a cardiac rehabilitation program.  Your regimen will include regular exercise, which helps you prepare for the physical “work” of sexual activity. Exercise has also been shown to improve the depression that often follows a heart attack.

• Start slowly. Focus on communication and emotional intimacy with your partner first. Spend some time being romantic — go on a date.

• Wait one to two hours after eating a heavy meal. Food and alcohol place extra demands on your heart, so give yourself time to digest.

• Choose a relaxing time and place.  Select a familiar, peaceful setting and a time when you’re rested and free of stress. Plan a rest after a sexual activity, as you would after other physical activities.

• Enjoy intimacy without sexual intercourse. If you don’t feel ready for intercourse, explore other ways of experiencing intimacy and sexual pleasure, such as kissing and caressing.

• Find the most comfortable positions. Experiment with different approaches that help both you and your partner feel comfortable with sexual activity.

• Lubricate. Use an over-the-counter lubricant during intercourse. Options include glycerin-based or silicon-based products.

• Know the warning signs to stop.  If you develop severe chest pain, shortness of breath, palpitations or irregular heartbeats, stop sexual activity and seek medical guidance.

Q. I was diagnosed to have erectile dysfunction recently. My doctor said my first option is to use oral medications, such as Viagra. Can you give me guidelines on how to use these different drugs for my condition? — F.J., Cebu City

A. Drugs known as phosphodiesterase-5 (PDE-5) inhibitors – sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) – have revolutionized the treatment of erectile dysfunction (ED), helping many men to reclaim their sex lives with a simple pill.

Your doctor was correct. The new guidelines from the American College of Physicians now recommend that most men with ED try a PDE-5 first. However, the drugs don’t work in all men and may pose problems for those using certain medications. As such, if you have ED, review the dosage, effects, precautions, and side effects before using them.

Studies have yet to demonstrate that one PDE-5 is superior to the others, so the choice of drug depends largely on the individual. But the drugs differ in dosage, duration, and speed of action, and thus may have different advantages.

For example, sildenafil and vardenafil are effective for about eight hours, while tadalafil’s benefits last about 36 hours. However, sildenafil and vardenafil take effect in about an hour (a half hour on an empty stomach), while tadalafil requires two hours to reach efficacy. The drugs are generally safe and have similar side effects (see chart).

Men who take nitrates to treat heart-related chest pain (angina) should not use PDE-5, as doing so may cause a dangerous drop in blood pressure. Medications known as alpha-blockers (used to treat high blood pressure and enlarged prostate) may also lower blood pressure, so use a PDE-5 with caution if you take an alpha-blocker.

The PDE-5s augment a sexually induced erection, so they may not work as well if you’re tired, anxious, have had too much to drink or you’re having difficulties with your partner. And since cardiovascular disease is to blame for most cases of ED, the drugs’ effects may wane if vascular disease progresses. Similarly, the drugs may be ineffective if the nerves that control erections are damaged.

Many doctors recommend a trial of four doses taken on four separate occasions, to determine if a particular PDE-5 will work. However, one of these three oral medications, or other treatment options, in a motivated man, is almost always going to be successful!

Q. I use my cell phone the whole day as my preferred way of communicating around Metro Manila. Recently, a friend told me to limit my cell phone use and warned me that I could end up being sexually infertile. Is there really scientific proof to this?   — B. T., Pasay City

A.  Cell phones have revolutionized communication. Like many innovations, however, these devices have been greeted with celebration as well as concern. Because cell phones emit radiofrequency electromagnetic waves, they can interfere with some implanted cardiac pacemakers – but only if the user holds the phone directly over the pacemaker. Similarly, cell phones have the potential to disrupt sensitive electronic monitoring devices in hospital intensive care units – but only a minority of monitors is vulnerable, and even then, only at very close proximity between the phone and monitor poses a risk.

Because electromagnetic waves can also have biological effects, some people worry that cell phones may even cause diseases, including cancer. Fortunately, many studies have failed to link cell phones to malignancies of the brain, eye, salivary gland, and the acoustic nerve in the ear, though a 2008 study reported an association between cell phone use and benign tumors of the parotid gland, which is located beneath the lower jaw.

It’s easy to see why scientists have wondered if cell phones might have ill effects on tissues in the head and neck. But researchers in Cleveland have asked quite a different question. Based on animal studies that indicate electromagnetic waves may damage testicular function, they wondered if cell phones might affect human sperm cells.

The subjects were 361 men with an average age of 32 who were attending an infertility clinic. All the men had been carefully evaluated for medical problems known to affect sperm function; men with such conditions were excluded from the study. Each man recorded their average daily cell phone use, and each submitted a semen specimen that was evaluated by technicians who did not have any knowledge of the subjects’ cell phone use.

Forty men reported no cell phone use; 107 used cell phones for less than two hours; 100 men used cell phones two to four hours; and 114 reported more than four hours of daily use. When scientists analyzed the results, they found a steady decline in sperm count with increasing cell phone use. In addition, sperm structure, motility, and viability all declined with increasing cell phone use.

However, it’s only one study, and it did not account for possible electromagnetic wave exposure at work, or for Bluetooth devices, computers, or time carrying a cell phone that is turned on but not in use. In addition, all the men were undergoing infertility evaluation. Still, it raises the interesting – and worrisome – possibility that new communication techniques may interfere with the outcome of old-style communications between men and women. Further studies are underway. And while you’re waiting for additional results, remember that cell phones do have one proven health risk: car crashes!