In June, I had the pleasure of interviewing the renowned urologist, Dr. Dudley Danoff. Dr. Danoff is the author of The Ultimate Guide to Male Sexual Health. You can read my review of his bookHere.
Dr. Danoof works at Cedars Sinai Medical Center in Los Angeles and has great knowledge on all things male sexual health.
Ashley: What encouraged you to write the book, The Ultimate Guide to Male Sexual Health?
Dr. Danoff: I am a mainstream urologic surgeon who spends most of my professional day treating prostate, kidney and bladder cancer. About 15 or more years ago, a patient came in and said, “You should write a book. You’re a good communicator. You’re a funny guy. You’re a shmoozer. There’s a lot of ignorance and misinformation out there." I didn’t have the time. He pulled out a three by five card out of his pocket and on it, it said, “Penis Power”. This is probably 15 or more years ago. And I said, “Wow. What a great title for a book.” This was before Howard Stern and the very, very early days of the Internet. So on weekends and nights, I started to write a book for lay people about male sexuality and everything you wanted to know about your penis but were afraid to ask.
I actually sold the book to Warner Books and they gave me a very – I thought was a very generous advance. The book was completed and when it came out and went to the editorial board, they said, “You can’t write a legitimate main health book by a legitimate urologist and have the word penis on the cover.” I argued, “Penis is not a pejorative word. It’s a body part. The penis to the urologist is what the stomach is to the gastroenterologist. Get over it.” I eventually prevailed and the book came out at the title 'Super Potency'. After a number of years, I said, “The time is right,” so I rewrote the book with the same theme, bringing a lot of new elements, PSA, robotic surgery, and this time I called it ‘Penis Power: The Ultimate Guide to Male Sexual Health’, and that came out maybe five or six years ago.
It was a very successful book but it got a huge amount of pushback from the mainstream press again. It had the word penis and a funny little logo on it. Again, every time I was on a television or radio interview, I would always have to stop, “Here is Dr. Dudley Danoff, our favorite Beverly Hills urologist and author of Penis Power (giggle, giggle, giggle).” And I would go into my spill about the word penis not being a pejorative word, but there was a lot of mainstream pushback.
So I rewrote the book and shortened it a little bit to 'The Ultimate Guide to Male Sexual Health', which is the book that you have now. That’s how the book came to be, but mostly because there’s a lot of misinformation out there. There are half truths about male sexual health and with specific reference to your area of interest, sexual health in older people. So there’s a lot of stuff in my book about older people. You’re never too old to have sex. If you can get out of bed in the morning and brush your teeth, you can have sex.
Ashley: Absolutely. I find it really interesting how people giggle at the word penis, but slang words are used all the time.
Dr. Danoff: I thought about this quite a lot and I’ve been asked about it. I think a lot has to do with our puritanical values. You could go into a strip club (mostly) anywhere in America and you see women completely nude jumping up and down and rolling around on the pole. You go to a male strip club and you never, or almost never see a man’s genitalia. It’s all very suggestive. It’s really kind of weird.
Ashley: It is. It’s very strange. That’s why I really enjoyed the term 'Penis Power'. You even mentioned in the book how there is so much shame from a very young age about the penis and that you call your genitals euphuisms. It’s really important to use the real words from little on.
Dr. Danoff: I think there’s a point in the book or a section in the book, Ashley, in which I make the point that there’s no other body part or probably no other object in the world that has more nicknames than a penis and I listed about 50 of them; slug, toy, tool, hammer. It’s okay to do the vagina monologue but puppetry of the penis, was not really so popular. Part of my job, as silly as it sounds, is to get the penis out of the closet and let’s stop giggling every time we talk about the penis. If a father needs to tell his son about his penis, he should use the word penis and not be embarrassed by it. Again, it’s not a pejorative word.
Ashley: Do you think the embarrassment affects male sexual health?
Dr. Danoff: Yes, the more we’re not embarrassed to talk about it, then the more we’re open about it. The more men will come and get their prostate cancer screenings. I mean, what woman would ever let the year go by that she didn’t have a mammogram or a pap smear? Yet, you got to push a man over 40 to come to the urologist to get a digital rectal exam, a prostate check or a PSA. There will be 240,000 new cases of prostate cancer diagnosed in the United States alone this year and the only way we can save those people is by early diagnosis. There’s extraordinary treatment in the early diagnosis of prostate cancer. Again, it’s all about this male machismo, “I’m going to be the guy that catches the touchdown pass in the last minute of the last quarter of the Super bowl and I’m invincible.”
Ashley: Right. So how does aging affect the penis? I know you mentioned prostate cancer, but what are some other things?
Dr. Danoff: Well, let me talk about the aging penis. So, it can be summed up by a little joke an older patient told me. He said, “You know Doc, it takes me all night to do what I used to do all night long.” So the penis functions well into old age. The erections may be a little less firm. The ejaculations may be (less powerful) and there may be an increased refractory period (time between erections). In the young there might be an hour or even 30 minutes, but in an older man, the refractory period may be two weeks. I think it’s very important for older adults to look at sexuality and view it through an age appropriate lens. You may have to modify certain positions in sex. You have to have realistic expectations, so sexuality in older healthy adults is no less satisfying and maybe even more satisfying than in younger people. I mean, you have more time, you have less pressures of job, children, maybe even less economic pressures. It is definitely different and you have to have age appropriate expectations, but it’s no less satisfying or can be no less satisfying.
Ashley: Your book mentions “penis power” a lot, so what is it exactly?
Dr. Danoff: Penis power is the positive -- the attitude of the power of positive thinking that is applied to your penis. Meaning for men, it’s as big as you think it is. It’s as reliable as you think it is. It will perform in the best way you think it can. We all fail sometimes; can’t get it up, premature ejaculation, get over it and go, it’s par for the course, it’s yours, love it.
Ashley: Yes, absolutely. Should men have any concerns about their sexual health?
Dr. Danoff: Yes. So sometimes failure to get an adequate erection can be a harbinger, a red flag that there may be some underlying medical disease. It is not infrequent that an older patient comes to me with a primary complaint of ED (erectile dysfunction), and in the process of working that patient up, we might find that he has uncontrollable hypertension or he might have diabetes, which is unrecognized or he might have high cholesterol, which is unrecognized or he might have some underlying neurologic problem or he might have vascular insufficiency unrecognized. So ED taken in a vacuum is not medically realistic. If a man has ED, he should seek medical attention. He should have it evaluated and he may find that he has some underlying significant medical disease, so that’s a very important message for older adults.
Ashley: That’s very important. In my doctoral studies, I interviewed older men and women about their sexual experiences as they age. With the men, a lot of them went to their primary care doctors because of erectile dysfunction. The doctors didn’t ask anything about lifestyle or about other health problems, they just gave them a prescription for Cialis or Viagra with no explanation of what could be the potential cause. I find it really sad.
Dr. Danoff: I think that’s bad medicine. Those drugs are drugs of performance and they are all based on increased blood supply. They’re not drugs of passion. They’re not drugs of emotion. They do increase blood flow and with a lot of them who have some underlying disease, it will be the band-aid. It will be the panacea but it’s much more important to evaluate ED in a detailed manner with hopes that you might be able to find some underlying medical condition, which is imminently treatable. For example, there are a lot of older men who have hypertension, so one of the treatments for hypertension is to give drugs obviously that lower the blood pressure by dilating the vessels. Sometimes those drugs actually decrease blood flow to the penis. I have had older men say, “I’ve taken this for my blood pressure and now I don’t get such good erections. I’m going to stop taking the medicine for hypertension.” And of course my answer is, “My God. Don’t trade a stiff penis for a stroke. Speak with a medical professional and see your other choices, but don’t stop taking your hypertension medicine."
Ashley: What other things can help sexual health?
Dr. Danoff: Visible fitness in young adults is about looking good in the gym and flexing your buns on the dance floor, but physical fitness in older adults has a lot to do with healthy sexuality. You’ve got to be in good cardiovascular shape to have sex. You have to have good upper body strength. You have to have lower body strength. You have to have some degree of flexibility. So exercise in the older adults, in terms of preserving sexuality, is very important. It should be emphasized.
Ashley: I like how you put in the book that sexual dysfunction, especially erectile dysfunction or premature ejaculation is 98% in your head and two percent is biological.
Dr. Danoff: You’re a therapist and I’m a mainstream urologist, I’m not a psychiatrist or a sex therapist, but there’s this direct pipeline from a man’s brain to his loins and we’re very visually stimulated and sometimes it goes up and sometimes it doesn’t. In a healthy man who is neurologically intact, who’s endocrinely intact, who’s vascular intact, it is 99% between the ears and one percent between the legs. Now, the exceptions of course are people that do have underlying medical problems but the majority of patients with ED do not have underlying medical problems.
Ashley: Right. Have you seen a change in male sexual health since you have been practicing? Has there been an improvement or has it stayed the same? Has it gotten worse?
Dr. Danoff: My experience, it has definitely has improved. For example, when I started in practice, more than 30 years ago, it was really quite unusual for me to see a 100 year old patient. Maybe I would see one a month. Fast-forward 30 years, it’s not uncommon for me to see one or more 100 year old men in a week. About two weeks ago, I had two gentlemen back to back who needed a cystoscopy, which is a camera we put into the penis for bladder tumors and their combined age was 205. A lot of those patients who are a 100 years old, don’t know they’re a 100 years old, I mean they’re out of it. But there is a surprisingly large number, I would say, more than half of these people are perfectly alert and rational. Ninety (years old) in 2016 is like 70 in the 1960s. We are living healthier lives. We may be extending life expectancy, but a lot of people are dying in perfect health. I mean, they may die of something like a malignant melanoma or they’re killed in a car crash or they have overwhelming pneumonia. They don’t spent the last 20 years of their life withering away on a vine. And, if you are healthy, as I say, if you can get out of bed in the morning and make it to the bathroom and brush your teeth, then you can have sex. I mean, it’s certainly not going to be what it was when you were 30, but it could be more than fine. So yes, I think there’s a real advance in aging sexuality certainly in my practice life term.
Ashley: That’s really good to hear. I see a lot of diabetes, hypertension and high cholesterol, so it’s really good to know that with the medical technology we have, people can still have a healthy sex life.
Dr. Danoff: Without a doubt. And a lot of those conditions are treatable. So if you have uncontrollable hypertension and it is properly and appropriately treated, I mean that promotes good sexuality, same goes for diabetes and cholesterol. As you add to that, the use of the PDE5 inhibitors, the Viagra, the Cialis, you’re talking about some real advances in sexuality in older patients.
Ashley: I found in some of my patients that they don’t understand what the normal signs of aging look like. They have maybe one erectile dysfunction episode and they completely freak out and then that anxiety leads to performance anxiety, then the erectile dysfunction becomes a psychological thing rather than them realizing that it’s just a normal part of aging.
Dr. Danoff: Yes, and that’s why we talked about appropriate age expectations and that’s very, very important for the patient to understand. So yes, maybe you can’t do it as often or as long, but you certainly can have satisfactory sex. I think that triad of good physical health, a proper mental attitude, the power of positive thinking and a willing partner, that triad is unbeatable.
Ashley: I also wanted to mention, I think it was at the end of the book, about the different penis personalities?
Dr. Danoff: Well, that’s a little tongue and cheek. I mean, if you recalled the sort of the theory behind that; a man is the same in the bedroom as he is in the boardroom. So if he’s a jerk in the boardroom, he’s going to be a jerk in the bedroom. If he’s loud mouthing in the boardroom, he’s going to be a braggadocio in the bedroom, which springs to mind, our good friend Donald Trump. I wonder what he’s like in the bedroom.
Ashley: Oh God. That’s something I never want to found out.
Dr. Danoff: I’m sure. I’m sure. We have positive penis personalities and negative ones, like Pompous Penis Personality, promiscuity, and then we have some good ones, like pleasurable. So we had some with the P words and then we make little cartoons for them.
Ashley: I really liked it. Do you think a lot of the medical professionals back away from aging and aging and sexuality in particular?
Dr. Danoff: I think a lot of people are uncomfortable with aging patients. I mean, a lot of the medical professions deal with diseases that basically have no cure. It’s really hard to cure hypertension. It’s hard to cure heart disease. It’s hard to cure stroke. I mean, you can certainly help the patient. So a lot of the younger doctors shy away from treating older people because it’s tough to cure a patient. An orthopedic (doctor) can cure a patient, you break your leg, they put you in a cast. Somebody with prostate cancer will use the robot and remove the cancer. It’s much more difficult to treat the aging patient. We’re all living longer. We age in population. I’m not a statistician, but it’s no question that the aging population is exploding.
Ashley: Yes, absolutely. What advice do you have for older men in regards to sex?
Dr. Danoff: Don’t give up. Get all the help you can. By seeing your doctor and correcting any underlying co-morbidities that you may have, hypertension, obesity, too much alcohol, smoking; if there’s any great killer of both people and sexuality, it’s cigarette smoking. Get the magic drugs; the Cialis, Viagra, Levitra of the world and find a willing partner. Don’t give up the ship.