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    Happy, Healthy, and Hard

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

    Heart Health and Sexual Health continued...

    "There are pretty strong suggestions that those things are true," he tells WebMD.

    One persuasive piece of evidence appeared in the April 2004 issue of the Journal of the American College of Cardiology. Between 1972 and 1974, researchers in California surveyed 1,810 men about their risks for heart disease. In 1998, researchers contacted 844 of them who were still alive and asked them about their erectile function. The men who had risk factors for heart disease in the '70s were much more likely to have ED 25 years later.

    If men with heart disease are more likely to develop ED, it stands to reason that having ED could be a warning sign for heart disease, too.

    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.

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