A Man's Guide to Sexual Health

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A Man's Guide
to Sexual Health

An owner’s manual for men 2
Everyone is different 4
There are no secrets about size 7
How an erection happens 8
And the result is... 11
Problem...what problem? 14
If you are having a problem 23
What should I say to my doctor? 25
Facts and fiction 27
Guarantee 31
Contents
1

Think about all the tools, equipment and appliances
you’ve bought in your life. Almost all of these
came complete with an owner’s manual containing
instructions that explained how
to put the item together, how
it worked and what could
go wrong.
Many of these
manuals even ex-
plained how to
troubleshoot or fix
things if they stop-
ped working correctly.
So why is it that you don’t get an owner’s manual for
your body — especially your sex organs?
Surveys show that in most healthy relationships, the penis
issomethingthatisusedalot.Unfortunately,it’snotalways
user friendly. You assume your penis will always work
perfectly and mostly it does. But sometimes it fails and
that’s scary. The situation can be bewildering, frustrating
and at times terrifying for both you and your partner.
An owner's manual for men
2
TV INSTRUCTION MANUAL
G
uide
How To Guide
ReferenceManual
Encyclopedia
InstructionGuide

It seems there is a real need for an owner’s manual for
the penis — to help you when something goes wrong
and tell you how to fix it. That is the purpose of this
manual — to tell you, in plain language, some of the
things you need to know. To answer some of your
questions and lessen some of your fears, and mostly to
let you know that you’re not alone: every man with a
penis is in much the same boat.
This owner’s manual includes information on:
q how your sex organs work
q reasons why you might suddenly
find it difficult to have sex
q what your doctor can do to
help when there’s a problem
q how to help your partner understand
the problem and share in solving it
q ways to get back to a good sex life.
Although this manual may answer some questions
about problems with sex, if you think you have a
problem, you should always talk with your doctor for
personal advice.
AN OWNER'S MANUAL FOR MEN
3

Much as your nose or ears are unique, so is your penis.
No two penises are exactly alike, each has its own
personality, some are lean and sensitive, some are thick
and bulky. The head of one may resemble a fireman’s
helmet, another may be round, blunt or cone shaped.
Your penis is actually quite hollow — it is made of three
tubes which run from the base to the tip.
Everyone is different
4
Structure of the penis
Tube connecting to the
bladder — allowing
urine to be passed
Urethra (tube allowing urine
to pass from the bladder)
Testis
Spongy tissue
(most of the penis is
made of this tissue)
Blood vessel
Tubes of erectile tissue
— these fill with blood
during an erection
Blood vessel
Cross-section
of the penis
Direction of
cross-section

q One tube connects to your bladder and allows
you to pass urine.
q The other two tubes are used to make your
penis hard enough to have sex (an erection).
They are filled with a special sponge-like tissue
that swells and becomes firm when blood flows
into it. This happens when you become aroused
or feel like having sex.
q There is about seven to eight times more blood
in your penis when it is hard than when it is soft.
In a hard penis, the blood normally can’t flow
back out. This is because the pressure of the
blood in the tissues closes the blood vessels that
would carry it out to the rest of the body. All this
is controlled by the brain. Once sex is over, the
muscle tissue contracts and allows the blood to
flow away, back into the rest of the body.
You can see that your penis has to be able to change
function as needed. When at rest it is used to empty the
bladder of urine, when aroused and erect (hard) it
provides the way to have sex and is a channel for semen.
q Between half and one teaspoonful of
semen comes out of your penis each time
you ejaculate (discharge semen).
q The semen contains millions of sperm —
yet only one is needed to make a baby.
EVERYONE IS DIFFERENT
5

q A smaller amount of semen will be released if
you have a few ejaculations during one sex
session. If you have many hours or days between
the times you have sex, then the amount of
semen should be about the same each time.
q Regular sexual activity can keep the body’s
sexual systems in good shape. Lack of use can
create its own problems with sex after a time.
q As you may have noticed, it is difficult to urinate
when the penis is erect. It is also difficult to
ejaculate semen when the penis is limp.
All men are born with uncircumcised penises. If your
penis remains unchanged, it takes a little more time to
keep the nooks and crannies clean.
q Draw the foreskin (hood) back fully.
q If it gets stuck on the rim of the penis,
or if it is painful and seems to stick in places
a small repair job may be necessary.
This simple procedure loosens the foreskin
and doesn’t require circumcision.
q Remember to replace the hood
in a comfortable position.
EVERYONE IS DIFFERENT
6

Nearly every man is concerned about the size of his
penis. In many cultures, potency, maleness and general
strength are thought to be set by the size of the penis.
This is a fantasy because the penis will constantly
change its size depending on the outside temperature,
your inside feelings and the circumstances of the
moment. Your penis shrinks with fear and cold and
appears larger in a warm, comfortable atmosphere. Yet,
it is frequently when at rest that men try to compare
themselves. There may be no worse place to try to
compare yourself with others than in a urinal line or a
group shower room.
It is almost impossible to judge what the erect size of
your penis is when it is at rest and limp. In spite of the
fact that all penises are physically different, their size
when erect and hard is more or less the same.
q When erect, the average length of the penis
is twelve centimeters (about five inches).
q A penis that seems small can swell a great deal
to become erect. A seemingly large penis may
swell less. Both types end up more or less the
same size when fully erect.
q Size can be an illusion in men of differing
build. A small, slightly built man may have
what appears to be a large penis. A large,
heavily built man’s penis may look smaller.
There are no secrets about size
7

An erection — a hard penis — is simply a sign of comfort
and arousal (sexual excitement). It doesn’t take a lot of
arousal to cause an erection, especially for younger men.
Usually, men do have erections while they sleep. They
accompany dreams which happen three or four times
each night — whether you remember them or not. This
happens to women too. When a woman dreams, her
sexual organ (the clitoris) swells, similar to what
happens to the penis during an erection.
q If your dreams are in any way anxiety
provoking or scary, there will be no erection.
q When you wake up with an erection, you are
still in part of the dream cycle. Your erection
has nothing to do with having a full bladder.
It is also not always a sign of arousal.
Young men can get an erection very quickly — through
erotic stories, pictures or fantasy — or just thinking
about sex. As you get much older, it takes longer for your
penis to harden. More time, stimulation or manual help
may be needed.
How it works
There are both physical and mental ingredients involved
in having an erection. These are parts of your
relationship that can also affect your sexual health.
How an erection happens
8

This is what a man needs to have an erection:
q Healthy blood vessels throughout his body,
so the blood flows in the right ways.
q No nerve damage in the area of the hips,
stomach or the actual sex organs.
q The right amount of special body chemicals (the
ones that travel in the blood and affect the sex
organs. For example, those that help the
blood stay in the penis during intercourse).
q A relaxed and happy outlook,
without too much stress.
HOW AN ERECTION HAPPENS
9
What a man needs for an erection
Good nerve supply to
the penis from the
main nerves of the hip
and backbone areas
Healthy blood vessels to carry special
body chemicals and to control the blood
flow for an erection to be possible

Being sexually aroused is the most important trigger to
an erection. It is a step-by-step process that is set in
motion by substances that are always present in the
body, just waiting to be called into action.
The process is like this:
HOW AN ERECTION HAPPENS
10
You have
a sexual or
erotic feeling
A special body
chemical is released causing
the muscles in the walls of
your penis to relax
Blood flows into the
spongy tissue of your penis
causing it to harden and become erect.
As the inside of your penis fills with blood,
the spongy tissue squeezes against veins in the
walls of your penis stopping the blood from
flowing back out. All this blood held
in your penis keeps it hard.

...the ejaculation. This is a sudden spurt of semen lasting
a few seconds. It can feel differently depending on how
intense the arousal was.
q If you have frequent sex ending each time with
an ejaculation, the strength of your feelings and
the amount of semen may lessen for a while.
Once your body has had a rest for a few hours or
days, the amount of semen should return to
normal. Usually a certain amount of semen is
produced by the body each day. The making of
sperm inside the body continues at the same rate
as long as a man is in good health. The number
of times a man has sex over his lifetime does not
affect the amount of semen the body produces.
Sometimes the intensity of the sexual feeling may
be so great that the muscle twitch may spread to the
back passage (anus) causing a short, sharp pain there —
this is normal.
Some men have difficulty with ejaculation. The semen
may be passing into the bladder and not out of the tip of
the penis. If this happens, it may need a visit to a doctor
for repairs.
Many men ejaculate too quickly. They finish before their
partnerscanenterthegeneralflowandrhythmofthesexual
experience to enable them to also achieve an orgasm.
Lastinglongerisalearnedexperienceandcancontributeto
a mutually satisfying relationship with the partner.
And the result is...
11

‘Wet dreams’, or ejaculating during an erotic dream
while you are asleep, is normal for all men. There is a
normal build up of the semen that the body releases on
its own while you sleep.
AND THE RESULT IS...
12
After an
ejaculation the system
goes into reverse
A different
special body chemical
is released
Your penis returns
to its limp state
This causes the muscles
of your penis to contract or pull
inwards. Blood now flows back out
of your penis and into the
rest of your body

All erections are angled sharply upwards. As you grow
older your penis gradually sags to become more at right
angles with your body.
Your erection will last as long as the sexual stimulation
lasts. A sudden distraction may cause you to lose your
erection. If the stimulation is still there your penis
might become hard again. Fear or worry may cause an
erection to fail.
In younger men, both getting and losing an erection can
happen quickly. In older men this is more gradual.
As you age, it may become more difficult to reach an
erection — and you may lose it before you are ready to.
But this doesn’t always happen. There are many senior
citizens who function very well sexually. Paying attention
to your general health, taking care of your penis, having a
good relationship with your partner and a healthy
attitude towards sex will all help you as you age.
AND THE RESULT IS...
13

Did you know that more than half of all men over 40 have
had a problem with getting and keeping an erection? In
America alone, it is thought that over 30 million men
may suffer from this problem.
It is a very common experience and is now understood
to be a real medical condition that can be treated.
There are many problems — both physical and emotional
— that can affect the smooth functioning of your penis.
Problem...what problem?
14
Only 2 million
have ever had
treatment (that’s
only one man
in every 15).
Over100 million
men (1 in every 10)
in the world worry
about not being able
to have an erection
at some point in
their lives.

Physical problems
Among the physical problems that may cause you to
have trouble with an erection are:
q Aging
q Illness
q Accidents
q Smoking
q Operations
q Alcohol, and
q Drugs (both prescriptions from the doctor and illegal drugs)
Aging
Sometimes, the aging process causes
a change in the sexual habits and
abilities of men. This doesn’t happen
to everyone, but changes can occur
in the time it takes to get and keep
an erection and in the hardness of
your penis.
It’s all perfectly natural, and the solution may be an easy
one. If an older man finds it difficult to have sex, extra
foreplay and attention may solve the problem. This
could be enough to help get your sex life back to normal.
PROBLEM...WHAT PROBLEM?
15

The chart below shows some of the differences among
men as they age.
16
Younger men can usually
have an erection at almost any time,
just by thinking about sex. They also usually
have a higher sex drive than older men
and may recover after ejaculation and be
ready to have sex again in just
a few minutes.
Teen to 40
A man's response to sexual
thoughts becomes slower, and more
foreplay tends to be needed. Manual help
might be needed to make the penis
firm enough to be able
to have sex.
40 – 70
An older man's erections
may be less firm, and he might find
it difficult to have sex again for quite
a few hours after a first ejaculation.
For men in their 70s, this can
be as long as 12 to 24 hours.
Over 70

Illness
As men age, there are lots of common diseases that can
all cause problems in getting and keeping your penis
hard enough to have sex. Illnesses such as hardening of
the arteries, high blood pressure, stroke,
heart disease, heart attacks,
diabetes (where the body is unable
to control the blood sugar level)
and injury to your sex organs
can all cause problems. If a
man has cancer and is
treated with chemotherapy,
radiotherapy or surgery, this can also cause
problems with sex. Other illnesses such as kidney and
liver diseases can affect your sex life, particularly if those
special organs begin to fail.
Often, when many illnesses start, a man can find it
difficult to have or keep an erection because the body
makes changes to try to get well again. This can mean
taking energy away from sex to help make a man well
again. For long-term illness, this can be a slow process
and the loss of ability in having an erection might not
even be noticed for quite a while.
A man can also have problems with the balance of the
special body chemicals that help sex happen or control
how a man feels in general. For example, there is a
17

thyroid gland in the body that can be overactive or
underactive, and this can make a man feel restless or
very tired all the time. A thyroid gland problem can
cause a man to lose interest in sex because he is not
relaxed enough or doesn’t have the energy.
There can be problems with the levels of body chemicals
that can control how a man feels about sex. The body
chemical that controls sex in men is called testosterone
and this is also what makes a man grow more hair than a
woman, have a deeper voice and develop male sex
organs (the penis and testicles). As a man ages, the
amount of testosterone in the body nearly always begins
to drop quite naturally. This is one reason why sex drive
and ability can decline with age.
Accidents and operations
Some men have problems with sex after they
have had an accident or operation.
This is usually because there
has been some damage to
nerves or blood vessels.
Anything that causes the
blood flow into your penis
to be reduced can stop
your penis becoming hard
enough for sex.
18

Accidents or operations affecting your lower body
might cause nerve damage that could
affect your penis and whether you can
have an erection. Breaking bones, such
as your hips or lower back (the
pelvic area), or accidents to the
spine can also affect the
nerves or blood flow and
cause erection problems.
Operations on organs in the lower body, such as the
prostate, the bladder or large bowel, can also have an
effect on your sexual function.
Drugs
Over 200 drugs used for other illnesses can affect your
sex life. They include drugs to help depression, worry or
high blood pressure. This kind of side effect may be
only short term, or sometimes other drugs can be
found that won’t cause this kind of problem. In either
case, it’s important that
the prescribed drugs
are taken, because
the illnesses they
treat can be very
serious. Also, the
illnesses themselves can
cause sexual problems.
19

Smoking
and alcohol
Drinking too
much alcohol or
smoking a lot of cigarettes can damage the blood vessels
and nerves that affect your ability to have an erection.
Giving up any of these can have a positive effect on your
sex life — if the habit is stopped in time. It may take a
whileforyourbodytorecoverfrom
the use of alcohol, drugs or
cigarettes. Your doctor can give
you good advice about what you
might expect.
Emotional problems
Emotional problems can play a major role in being
able to get and keep an erection, and they are often
poorly understood.
20

One of the reasons most often mentioned as causing
sexual problems is stress. Few people today are totally
free of stress or worry. The stresses in our world, both at
home and at work, have become part of our lifestyle.
Because stress lowers the levels of important male body
chemicals, a man might not want to have sex as often,
and there might be a drop in the ability to perform when
he does try.
Some of the other emotional issues that may cause
sexual problems are:
q thinking too much
about other issues
and forgetting
about your
sex life
q shyness
q concern about
performance or
about the size of
your penis
q being in
a new
relationship
q worry about a
long-term relationship.
21

Another big issue is fear of failure – it’s hard to believe
that fear of failure causes failure, especially when you are
so determined to succeed.
Other emotions such as depression, worry or anger can
also affect your sex life. Sometimes these feelings are so
deep that you are not even aware of them and the effect
they are having. This is when a doctor might suggest
going to a counselor (a person who works with
emotional problems). These experts can give advice on
why you have a problem and then help to solve it.
Remember!
At all ages, your desire to have sex and your ability to get
and keep an erection is affected by:
q your overall health
q what happens in your social life
q how happy or positive you
are about life in general
q what sort of attitude you have
to problems not related to sex
q your lifestyle — how busy you are,
what else is on your mind at the time.
Also, remember that for most men who cannot get or
keep an erection the problems can be treated. A visit to
the doctor can usually sort out a treatment that works.
22

Having a problem getting or keeping an erection is a big
deal for a man. You might still feel like you want to have
sex but you can’t because your erection is not hard
enough, or it goes away too quickly or might not last long
enough to satisfy your sexual partner.
Men don’t often know why their sex lives have started to
be a problem and they can feel sad, frustrated or maybe
even angry. In a relationship, sexual problems like this
can lead to problems like arguments, blame, loneliness
or sadness.
Some men hide their difficulties from their partners.
Unfortunately, this doesn’t solve the problem or make it
go away. Sometimes it creates more problems. Your
partner may feel unloved or unwanted — or might think
you are having an affair or want to end the relationship.
Not being able to have sex can greatly affect both your
life and your partner’s.
If you are experiencing a problem having sex — getting
an erection or keeping one — there is help available
and there are medical treatments. The first step is to see
your doctor.
If you are having a problem
23

Here’s what some men with sexual problems have said to
their doctors:
IF YOU ARE HAVING A PROBLEM
24
“I kept my
thoughts to myself
and became
very bitter”
“I'm afraid
of losing my
partner...”
“I feel less
of a man”
“It can't be
good for my
partner...”
“I began to
feel like it was
all my fault and
that there was no
solution...”
“A huge sense
of loss and an
increasing feeling of
uselessness”
“I'm afraid
to get
married...”

Among the many things that
have kept men from
talking about their sexual
problems is the fear that
“the problem is in the mind”. Hopefully, you now
understand that if you are having a
problem getting or keep-
ing an erection, it may
be because of a physical
reason that can
be treated.
Talk to your
partner. And
talk to your doctor.
These are some
examples of the questions doctors get
asked most often on this page. You
might like to use them, so you
can find out all you need to
know about your problem
and about treatment.
What should I say to my doctor ?
25
Why is my
erection not like
it used to be ?
Why do I have an
erection in the morning
but not at other times ?
Why am I having
difficulty getting
an erection ?Are there any
side effects ?
What is normal
for my age ?
How much
do treatments
cost ?

WHAT SHOULD I SAY TO MY DOCTOR ?
26
If you go to your
doctor, it might be a
good idea to take a pen along, so you can make notes of
what your doctor says. You may also
want to write down some
questions of your own before
you go.
Do treatments
really work ?
Why am I not
feeling as interested
in sex as usual ?

There are lots of myths about sex and sexual ability.
These are a few of the ones heard most often — and the
real answers to the statements...
Facts and fiction
27
Your sex life can
carry on well into old
age. Younger men may be
more healthy and energetic so
they feel like having sex much
more often — but this has no
effect on what they will be able to
do when they are much older.
Many older men (in their
70s, 80s and more) have
become fathers.
“Too much sex when you’re
young will mean you can’t do it
as much when you are older”
WRONG
Some
penises
have a slight
curve. This is
completely
normal.
WRONG
“An erect
penis must be
absolutely
straight”
Germs can
enter the body
through the skin of
penis and this can happen
in a few seconds. Trying to
wash out any germs after sex
can be too late. Wearing a
condom is the best way to
reduce risk to you or
your partner.
“Urinating after sex will
wash out the possibility
of an infection”
WRONG

FACTS AND FICTION
28
“Men who can have more than
one erection during sex are more
masculine than men who can
only have one erection”
WRONG
All men need a
rest after ejaculation
while the body replaces
semen. The time for resting
usually gets longer with age as your
body’s overall function slows down.
Also, some men might have only one
erection during sex and then they
continue the intimacy of sex in
other ways. Sex is based on
shared experience, not a
single performance.
Lasting
longer is an
internal sense,
an awareness and a
feeling of control
and it can be
learnt.
WRONG
“Men with
circumcised penises
last longer during
sexual intercourse,
because the head
of the penis is
less sensitive”
“It’s all in the mind,
there is no real problem”
WRONG
An erection
problem has a
physical cause. Usually
it can be a sign of another
illness or can occur because
some medicines have
side effects that
cause this type
of problem.

FACTS AND FICTION
29
“If a man can’t keep an erection it means
that he doesn’t love his partner any more”
WRONG
You may
be so involved with
your partner that you try too
hard to have an erection. Because
emotions can be so intense, you can
feel under stress and the stress itself can
stop an erection. These feelings can
become a downward spiral of failing to
have an erection and then feeling
inadequate. No matter how hard you may
try to relax or whatever other approach is
used, the spiral of trying and failing
may continue. This is when outside
help should be looked for and a
visit to the doctor could
really help.
It can
almost always be
treated. Millions of
men are enjoying
sex again after
treatment.
“Once you have a
problem with
erection you just
have to learn to
live with it”
WRONG“Only old men
are affected by
this condition”
WRONG
Men of all
ages are affected.
By the age of 50
almost all men will have
experienced some
problems in having
and keeping an
erection.

FACTS AND FICTION
30
Erection
problems usually
involve other health
problems which can include:
q problems with blood flow in the
body (such as high blood pressure)
q diabetes (changes in blood
sugar levels) or its treatment
q shock or wounds
from accidents or
operations.
“Not being able to have an
erection is a sign of a loss of
manhood or lack of sex drive”
WRONG
“Only a few men suffer
from problems like this”
WRONG
Over 100
million men (1 in
every 10) in the world
are not able to have an
erection at some time in
their lives — it is a
very common
condition.
“Women prefer men with
large penises so that they
will have an orgasm”
WRONG
The nerves that
trigger a woman’s
orgasm are near the
entrance to the vagina so
penis size does not really
matter. Often it is really
other factors in the
relationship that
encourage sexual
response.

31
There is no general guarantee for sexual
health. There is no service contract or easy
replacement of worn out parts.
With reasonable care, an understanding of the
facts, and a willingness to seek help, most
sexual problems can be overcome. A loving,
sexual relationship can once again be part of
your overall good health and well-being.
There's no better guarantee
than that.
Guarantee

A Man's Guide to Sexual Health

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