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Happy, Healthy, and Hard

Experts explain the connection between a man's overall health and his sexual health.

The Erectile Continuum

ED becomes more common as men age, but aging itself is not the cause. "We never expect a healthy man to develop ED as a result of aging alone," Montague says.

A very healthy octogenarian can have erections. But Montague says even in the fittest men, some changes occur with age. An erection is still possible, but it may take some coaxing.

"As men get older they require direct genital stimulation from their partner or from themselves. A young man can just daydream and get an erection," he says. "Those changes by themselves, though, don't prevent performance."

By definition, having ED means a man cannot get an erection hard enough for penetration or one that lasts long enough for him to reach orgasm. But in Lamm's opinion, there are shades of gray between normal sexual performance and dysfunction.

"You don't go from being 'normal' to having ED. What you end up having is a transition," he says.

Usually doctors assess erectile function by the International Index of Erectile Function, a set of five questions such as, "How do you rate your confidence that you could get and keep an erection?" A patient's answers are scored, and that score determines whether or not he has ED.

Lamm says he thinks a better way to measure erectile function is with a new tool called a rigidometer. A man presses the head of his erect penis against a sensor attached to the digital device, which measures the precise hardness of his penis in grams of pressure. According to the manufacturer, 400 grams is limp; 400-500 is "borderline," and 500-1,000 is sufficient for sexual activity. A number over 1,000 is considered optimum.

Living a Hard Life

Lamm thinks men want harder erections, even if they don't have ED. The rigidometer can show a patient objectively how hard his penis is -- hard enough for penetration, maybe, but not as hard as it could be. The number might be an incentive for him to improve his overall health in order to make his penis harder.

Having a very hard erection, Lamm says, can enhance a man's sexual pleasure, or at least boost his self-esteem. Many men are definitely interested in their penis size, and a more fully engorged erection is the only thing shy of surgery that can actually make it bigger.

Sharlip's experience, however, leads him to doubt that degrees of hardness beyond hard enough matter to most men. "I don't think it's important at all," he says. "As long as it's hard enough to get it in ... I don't hear patients complaining about rigidity."

The Hardness Factor details a wellness program that Lamm says will show positive results on a rigidometer in six weeks. It involves exercise, eating healthy meals, sleeping well, and taking vitamins and supplements. The book describes the cases of some patients of Lamm's New York City practice who followed the six-week program and had good results.

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