Steven Lamm, MD
Biography

	How do you measure the quality of an erection? What is The Hardness Factor program? I have tried both Viagra and Cialis with poor results. What else can I try? What can a woman do to help her partner? Can certain foods really help your sex life?

"The harder the erection, the healthier the man." Is the penis a barometer of a man's health? Steven Lamm, MD, says that great sex can only come with great health and that once men understand the connection between health and virility, they will take better care of themselves. For men who want to achieve peak sexual health -- and the partners who love them -- Lamm shared his advice for health and hardness on July 13, 2005.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD live, Dr. Lamm. Thank you for joining us today.

LAMM:
Thanks for the opportunity.

MODERATOR:
Doctor, the link between overall health and a man's sexual health seems obvious but it's so often overlooked by men. Why?

LAMM:
I think that most men have actually not connected those dots. They actually have the misconception or misperception that somehow they can abuse their body but somehow the one organ that they value the most, their genitals, will somehow not be affected by the abuse. I think in general men abuse their bodies and they are not very proactive.

We are trying to capture a gender, trying to capture the male species because from all the recent data and all the recent research, it appears as though we are an endangered species. We are dying of diseases that we need not be dying from, such as diabetes, excessive obesity and the metabolic syndrome as it's called, hypertension, sleep apnea syndrome, depression and suicide. We know about the longevity of males vs. females and we know that men are dying at a younger age for a variety of reasons. There is one thing for certain -- men are not proactive.

The whole reason and purpose of writing the book was, and is primarily, to make it very clear to men that there is a very, very important relationship between their overall health, their overall lifestyle, and their sexual performance. I think it's ultimately going to be the best and strongest hook we can possibly have to change a man's perspective about his health.

I think that the data with reference to the overall health issue and sexual performance has not really been known for as long as you might think. It actually started with the introduction of the revolution in male sexuality with the introduction of Viagra, when the data started becoming clear that the majority of men who suffer erectile problems actually have a biologic basis for it. Prior to the introduction of Viagra and then Levitra and Cialis, the pervasive thought was that 80% of erectile problems or issues were psychological and only 20% were organic or structural or vascular. That has completely been flipped around to the fact that we really do appreciate that it's the comorbidity -- the diabetes, smoking, obesity -- that is actually the basis for the changes in erection function.

That's another point that I'm trying to make in our book, which is that we have to move away a little bit from the idea of erectile dysfunction just as we moved away from the term impotency because it's not politically correct and it implies things about the person that we don't need to imply. We're raising the new issue of erection quality, called EQ. That's an easier concept for the average young man and the average woman to understand.

Erections change over time, they change with every decade of a man's life, as every other organ changes. That organ has to age and be affected by illness and vascular disease and stress as any other organ. So we're actually trying to educate the public in understanding that erection quality changes and the knowledge and awareness of what these changes are can be very helpful for a man and certainly very helpful for a woman.

MEMBER QUESTION:
How do you measure the quality of an erection?

LAMM:
That's an extremely good question! In the past, we basically had a questionnaire. This is a questionnaire that is standardized and it's a whole host of questions. There's a long form and a short form to the questionnaire. Men would basically be put in a room and we ask them: How confident are you in your erection? How confident are you that you can complete a sexual encounter? It contained a whole host of different questions -- questions about their libido and about their interest in sex, and that was basically it. There were no objective or very few objective ways of measuring the erection.

For a while physicians were using a device where they would place the device around the penis at night and see whether the penis actually expanded during certain forms of sleep known as REM sleep, where it is normal and appropriate for a man to have an erection even though it's not really a sexual erection since the man is paralyzed at the time during the sleep. So he is obviously not doing anything with the erection, but it's a biologic, physiologic marker of the capacity to have an erection.

A few years ago I encountered a very well-known physician in Spain. His name is Dr. Rosselló. He has been a well-known urologist in Europe for many years with a very, very strong interest in what we call andrology and sexual medicine. Dr. Rosselló has done more penile implants than probably any other doctor in Europe. He came up with a device, which is an FDA-approved device, called a Digital Inflection Rigidometer (DIR). It's a handheld device that you program for each patient with a head which is disposable. You give it to the gentleman and ask him to go home and to induce an erection the old-fashioned way. Then you press the device up against the penis for five seconds -- it's painless. It records what we call the axial rigidity of the penis.

We now know that you need 500 grams of axial rigidity to penetrate during intercourse. For comparison, a 15-year-old man might have a rigidity of 2,000. With every decade those numbers start to decline and they will decline precipitously in smokers and in diabetics and people with underlying medical problems. What will happen is, you might on your best day be 700, which should be good enough for penetration. You have a bad day -- the stock market goes down, you're worried about your child, something happens at work -- and now the biologic forces drive the rigidity down to 400 and you're just not able to perform. So we now can actually measure the rigidity and for me as a physician, what it basically did was it gave me some insight into the changing performance of men with disease process. It also gives me an opportunity to study the effect of medications, whether it is testosterone or Cialis or Levitra on the rigidity of the penis.

"I think that my whole goal now is to ensure that every man have an erection every day of his life."

MODERATOR:
Is this loss of axial rigidity through the years inevitable? Is there anything a man can do to improve his odds?

LAMM:
Yes, and once again a terrific question. It is not inevitable and it is not necessarily associated with aging. It is simply very common because we basically subject our bodies to a lot of injury as a result of life -- whether it's excessive eating and smoking and sleep problems, maybe even some medications that we might be taking for other causes. But there is no doubt that a man who preserves his body -- and hopefully he can preserve his body as well as he preserves his car with rotating the tires and changing the filters and doing whatever else you need to do to keep your car going -- if you do the same for the body, you can preserve yourself and you can function at extremely high levels into your 80s.

I think that my whole goal now is to ensure that every man have an erection every day of his life. I say that kind of in a joking way and it's not intended to mean that he needs to be having sex every day in his life, it means that he should be biologically healthy enough to have an erection every day of his life because that would imply the integrity of his blood vessels, his nerves, his hormones and his brain. That's what the goal really is, and I think that it's a good goal because I think it's one that is achievable, believe it or not. I think it's also one that can be a very powerful motivating and driving force for the average man. I cannot imagine a more powerful force as a man than to be able to say, if I stop smoking, if I start exercising, if I reduce my caloric intake and try to reduce body fat, that the collateral benefit will be an enhanced erection. It's a pretty powerful message to young people.

MODERATOR:
It should be a powerful message to all men.

LAMM:
I agree with you. When we wrote the book we wanted to be certain that men didn't misinterpret this as being for men who were already severely affected by erectile problems, but rather we wanted to get the attention of 16-year-olds and 30-year-olds. I'm happy to say that two of my boys, one in San Diego who is 28 and the other 21, have stopped smoking as a result of this book and maybe the realization that it's just not a good thing, but it certainly it precipitated their stopping.

MODERATOR:
I have to tell you that sharing the book with some of the men in my life of a variety of ages and letting them take a look at it, and all of the funny jokes in there, has gotten them thinking about the connection between their overall health and what they may be able to do in bed.

LAMM:
That's exactly what I love hearing about. We did create humor because I do know how to deal with men. I understand that men do find that this can be an intimidating subject and to address it with humor is something that makes it easier for men.

We have this world-class cartoonist from the New Yorker -- Jonny Cohen. And a world-class chef from the Beacon Restaurant in New York -- Waldy Malouf. Together we did the best we could in really creating a book that would hopefully be enduring and would really just not be a sex book, but rather be a health manual that can change a generation of men and get them to take better care of themselves. That's what our real goal is.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.