Connection Between Sexual Health and Overall Health Health Radio Network March 7, 2007 Ridwan Shabsigh, M.D. Introduction

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1 Connection Between Sexual Health and Overall Health Health Radio Network March 7, 2007 Ridwan Shabsigh, M.D. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. Introduction All right. If you ever wanted to call the Health Radio show this is the time because we're going to talk about sex. I'm Andrew Schorr. Hello. Thank you for being with us on Health Radio. I am an almost 11-year leukemia survivor, but before any of that happened to me, before I was diagnosed with leukemia, and thank goodness I'm doing well thanks to modern medical science, years ago started doing videos for patients. I was one of the first people to do it. And I was a television news reporter and then became a documentary producer. And when I was doing documentaries I was actually doing one for, guess who, the Playboy Channel, and they wanted to do something on what we used to call impotence. Nobody says that now. They call it erectile dysfunction, and you know what that means for men. And very frustrating and certainly a medical problem and an emotional problem too. So I found myself in 1984 at the medical meeting of all of urologists from around the country and many from the around the world, the American Urological Association's meeting. And one of the manufacturers said, Well, you're doing this documentary about impotence or erectile dysfunction. Could you do a patient education video for us. And I said, What's that. And they said, Well, it's a video to help patients understand one of the treatments now, which in 1984 was pretty much solely surgery where they started doing implants in the penis to help a man have an erection, and there were two or three companies with those products. So, sure enough, I did the video, and it was very successful. And I interviewed men, you know, older than myself. One man was a diabetic, one man had other blood flow problems, one man had some other issues, but all medical reasons why they could not successfully have an erection. And these devices helped them, and they considered it, and there were other approaches that they tried as well. And I interviewed a lot of urologists. So that was my first foray into all this medical sexual stuff. Well, we've come a long way. Viagra and all these other pills and potions and clinics and videos and Dr. Ruth. Well, now I want to introduce not Dr. Ruth but Dr. Shabsigh, Ridwan Shabsigh. He is a urologist and fairly highly trained and very well respected nationwide. 1

2 He's director of the division of urology at Maimonides Medical Center in New York City. He's also an associate professor of urology at Columbia University, where I went to graduate school, so I'm a big Columbia fan. And he's written a book called Sensational Sex in Seven Easy Steps: The Proven Plan For Enhancing Your Sexual Function and Achieving Optimal Health. I can't wait. Dr. Shabsigh, thanks for being with us. Thank you very much, Andrew, for hosting me today. Okay. So this sounds just irresistible because sex is a part of life for just really should be for any adult, right? Well, as you mentioned in your introduction, which was wonderful, sex is a wonderful part of life, and it's a body function that biologically research has shown is connected to multiple important organ systems. That's why sexual health is so intimately related to overall health, and that's the main theme of the book, that sexual health is related to overall health. And I tell my patients, If you are healthy you are sexy, and if you are sexy you are healthy. Sexual Health Requires More than Medicine Okay. So it's interrelated. So let's talk about that now. I mentioned these devices, and certainly urologists still use them, and there are other approaches. We have the sexual counselors. We have these pills. There are all these products around there, but at the core it's a natural human desire and hopefully a healthy function. So help me see this in the bigger picture as I'm sure you do because while you are a urologist by training you look at the whole person. Of course. When we treat a patient with a sexual dysfunction such as example erectile dysfunction or what we call ED, to get a pill, for example, just to get, as you mentioned, Viagra Levitra or Cialis, is fairly easy, and I tell my medical students and residents and fellows who we have in training, I tell them if all you do is write pills the patients don't really need you. If all you do is write a pill the patients could get the pill over the internet, and that's why we frown at internet prescriptions. The reason for that seeing, the doctor should be a review of overall health and intervention in lifestyle management. Research, that's why my book really capitalizes on recent research and science. Research has shown, for example, that quitting smoking has improved sexual function and it improves even response to medication such as Viagra, Levitra and Cialis. It has 2

3 shown that improving--your sugar control if you are diabetic improves your sexual function. More stunning, there is research coming from Italy and Germany, which is included in my book also, that has shown that if you are overweight, especially if you have a lot of fat in your belly which we call abdominal obesity or central obesity, and you go on diet and exercise and you lose weight, your sexual function improves without medications. Obesity and Sexual Health Wait a minute. I want to go back to that one for a minute. So we have 60, 65 percent of American adults are overweight and certainly what you described as many American men with that sort of what do you want to call it, beer gut or just round middle, and you're saying that's relate to do our sexual, what, desirability, how would you describe it? Well, absolutely. There is a significant relationship between what we call abdominal obesity or central obesity and sexual dysfunctions, a number of sexual dysfunction, including erectile dysfunction, including testosterone deficiency. Here's one piece of information which is important to every man. If you have a lot of fat in the belly, abdominal fat, and fat cells have an enzyme called aromatase. This enzyme is a nasty enzyme. It converts testosterone, which is a masculine hormone produced by the testicles, into estrogen, which is a feminine hormone in women. That's why, for example, many men who have a big belly and a lot of fat in the belly they have weak muscles, they have small muscle mass because their testosterone is low. They also have low sexual desire. A see a lot of men who come to the doctor, Not only can I not get an erection, I really don't have a desire. Furthermore, you get these men, for example, if you've ever been to the beach and you saw men with a lot of abdominal obesity fat in the abdomen, what else do they have? They have enlarged breasts. True. And it's a very commonly observed observation, and the reason for that again because abdominal converts testosterone to estrogen and estrogen causes the breast to enlarge. It's one visible aspect of this. All right. Just let me go over this for a minute because really this is news to me. So okay. Let's go to that guy on the beach. Yes, he is overweight, and that's not attractive to anyone and maybe not even to himself. He has developed almost breasts. And I always thought that would just be a function of the fat. So this fat, and I've heard this in other illnesses, of course, other conditions, the fat cells are not benign, if you will. 3

4 They're not sitting there, and you're saying that there's chemistry that happening, hormonal chemistry that is decreasing sexual desire. Well, we in medicine and research, and that's what we have to share with the public, we call abdominal fat an active endocrine organ. That's the medical jargon of it. An active endocrine organ means the abdominal fat is not just fat sitting there. It's not just a storage of fat. This is an active organ that has enzymes, that interferes with your metabolism, interferes with your hormones, changes your metabolism. Let me make a list for you what abdominal fat does. We're going to take a break, though, in just a second, Doctor. I want you to save that until after we come back. And we are just having a fascinating visit with Dr. Ridwan Shabsigh, who is a urologist, and he's written is wonderful book, Sensational Sex in Seven Easy Steps: The Proven Plan For Enhancing Your Sexual Function and Achieving Optimum Health, and it's printed by Rodale Press, right, Doctor? Yes. Okay. So that's more about the book. We invite your questions as we continue on Patient Power on Health Radio. We'll be right back with much more about sex. Andrew Schorr.... for being with us today live on Health Radio. Andrew Schorr here with Patient Power day after day, and all the replays are on healthradio.net. And take a look at my website sometime too, patientpower.info, and I have a blog there as well. Last night I hosted an event for the Arthritis Foundation and a really good friend of mine, Dr. Jack Klippel, who is a rheumatologist but he's head of the Arthritis Foundation nationwide. There are 46 million people now with some sort of arthritis condition. It's the number one cause of disability. So we'll have Dr. Klippel on soon. He's a very inspiring guy, and rheumatoid arthritis, there's a lot of progress being made. So we'll talk about that in a future program. 4

5 Today we're talking about something that applies to millions of a larger audience, and that is sex. And with us is Dr. Ridwan Shabsigh, who is a very world renowned researcher in urology and, he's in the division of urology at the Maimonides Medical Center in New York City. I used to be from New York, so happy to have you with us, Sir. And he's an associate professor of urology at Columbia. And he's written a really fascinating book that I am making my way through, but it is sort of a page turner for me because the title is Sensational Sex in Seven Easy Steps, and it's published by Rodale. So, Dr. Shabsigh, so we talked about the connection between obesity and you also mentioned along the way smoking. So I imagine you're telling men lose weight from that middle, stop smoking. Those are some steps toward overall health, important in any way, but it makes a difference in sex as well. Yes, absolutely. Healthy lifestyle not only improves overall health, not only improves cardiac or heart health but it also improves sexual health. And I said a number of examples. Obesity, for example, is associated with reduced testosterone which is a masculine hormone. It is associated, especially abdominal obesity, with increased estrogen, which is a feminine hormone. And it is associated with erectile dysfunction. And smoking. Now, smoking has been shown to affect the blood flow in the penis. In fact in the late 80s I was a resident in the department of urology at Baylor College of Medicine in Houston, Texas, and I won a resident essay contest on my research in looking at the blood flow in smokers and showing that smoking is associated with reduced blood circulation in the penis. Age and Sexual Function Okay. So let me go over some of this just to bring everybody up to date here. So you started by saying, as you say to your residents, if all you do is write a prescription for a pill like those advertised on TV that may really not be helping the patient with all they need. That could be part of the plan, but stopping smoking, losing weight, their overall health is key to sexual health. Now, one of the things that we all wonder about whether it's a villain in our sexual health or performance is age. So I'm 56, and I'll say right now things are okay, but you know Hollywood has it in movies all the time. Guys get older, they can't perform. Can sexual functioning, sexual enjoyment be a part of your life till your dying day? Well, we are biologically sexual beings. Sex is part of what we desire, part of what we enjoy, part of what makes us happy, and it is with us for a very long time. In fact, at our center here, at Maimonides Medical Center and also at Columbia University, we do see a lot of patients who come to me with a desire to be sexually active and with a variety of 5

6 sexual dysfunctions even into their 90s. Just to share with you, my oldest patient is 94, and he came to me, he said, Doctor, I know you're a professor. I know you teach and I want you to share my story with all your students. I am 94 and I work--and that was true, Andrew, he worked part-time. He said, I work, I make money, I pay taxes, and I swim once a week. You know, Doctor, if I work, make money, pay taxes, I deserve to have sex. Yeah, I saw that in the book. I love that guy. That positive attitude, that joy of life, that uplifted mood is definitely a part of what we are. And we treat patients of all ages from the 20s to the 90s with a variety of sexual dysfunction. That's what I mentioned in my book, Sensational Sex in Seven Easy Steps, that the age is not really only the number, it's also what kind of health you are. If you stay healthy--i see men in their 80s who are in better shape than men in their 40s or 50s, and I see men in their 40s and 50s who have diabetes and high blood pressure and obesity and are heavy smokers and heavy on alcohol who are much less healthier than older men. So it is what you do with your life more than how much life and how long life you've lived. Right. And I see here in something that was sent to me that one of the drug companies did a study that said 45 percent of men with erectile dysfunction had high blood pressure. 20 percent had diabetes. Another statistic here is a whopping 150 million men suffer from some degree of erectile dysfunction as they approach their 50s and beyond. That is quite a number, Doctor. Yes, it is. And it is a reflection not necessarily of the age. It is a reflection more than aging of aging-associated conditions such as high blood pressure, diabetes. You just mentioned it. 45 percent have hypertension. Yeah. And our obesity problem in our country. Well, I want to get to the specifics. I think now we understand that we're not just going to be able to take a pill or do one thing and that's going to lead to sexual wellness and satisfaction. It's more than that. It's part of our whole health and optimal health for everything to control these conditions, so I think that's a very good message. What I want to get to are some of the steps that we can take. First we need to know where you are, and I understand you have sort of a sexual thermometer for people. What's that? 6

7 Sexual Health Requires All Systems of the Body Well, as I mentioned earlier in order to have sexual function biologically you need multiple important organ systems to work. The nervous system, the vascular system, the hormonal system, the mental health, the physical health. So that makes the sexual function, and in men we call the penis the thermometer of overall health. And in my book the first step is really to do a test to test where you stand in terms of sexual and overall health and then go into the seven steps of improving the different factors that are associated with sexual function and enjoyment. One of them is obviously the medication, the medications and the devices, but that's not the only thing. There are a lot of other things that one could do. On my website with no spaces, on the website you will see actually a men's health calculator. If you have the website in front of you open-- I do. I'm going to spell it for people too, s-h-a-b-s-i-g-h, sevensteps.info. Dr. Shabsigh, we're going to explore all this, your website, talk more about your book and those seven steps in a little more about the sexual thermometer when we continue our discussion. And again I want to mention the book, Sensational Sex in Seven Easy Steps: The Proven Plan For Enhancing Your Sexual Function and Achieving Optimum Health. And there's a lot of stuff out there that's baloney, but this is not it. It's written by a leading urologist in New York City, Dr. Ridwan Shabsigh, who is with us for the rest of the hour. We'll have more Patient Power, Dr. Shabsigh right after this. And back to the show means back to Patient Power, really the only show of its kind in the country. Hosted by a patient who has had a serious illness for years leukemia, and really devoting my life, my mission to help you be a smarter patient. Well, you would be lucky if you were concerned about sexual health if you went to New York City and visited with Dr. Ridwan Shabsigh, who is a leading urologist and expert in sexual health at his clinic. He's at Maimonides Medical Center in New York City, and he's also an associate professor at Columbia. But he's written a book, so you can learn a lot, and that's what we're talking about now. Sensational sex in seven steps. So, Dr. Shabsigh, let's get into the seven steps. Take us through them, please. Seven Steps to Sensational Sex Yes. In my book, Sensational Sex in Seven Easy Steps, the first step really after doing the self evaluation is to overcome the barriers. Andrew, what we found in research in multiple countries, even in international studies, that men have a lot of barriers to seeking 7

8 help for sexual dysfunction. There's shame, there's embarrassment, there's trivialization, fatalism, a lot of barriers that stand in the way. And in that step one my book offers a number of strategies to deal with your barriers if you're having a barrier in talking to your doctor about a sexual problem. In step two then, which is the very, very important step after you go to the doctor, you speak about your problem, is to address what we call Lifestyle Issues. The lifestyle issues include very, very important issues as obesity, exercise, smoking, excessive alcohol, nutrition, time management, stress management, very, very important issues that can interfere with sexual health, sexual joy and also with overall health. There are very detailed programs in my book Sensational Sex in Seven Easy Steps in step two about losing weight. So this book is not only about information. It's not only for your information. There's a lot of information but there are also practical programs and practical steps and also practical tools. How you can calculate your BMI, the body mass index, which is a very important calculation for your obesity. How much should be your pulse, for example, when you exercise. How far up should you bring it according to different ages. So there are a lot of different tables and tools in my book Sensational Sex in Seven Easy Steps. In step three then we go into what we call Everybody Participates, which looks into different organ systems for those who have medical problems. For example, if you have a low testosterone what to do. What are the choices in terms of testosterone replacement therapy. If you have diabetes what is the effect of that on your sexual health and your overall health and what you can do to improve on that. Hypertension, high blood pressure, cardiovascular disease, metabolic syndrome, this is are very important medical conditions that many people have. As you mentioned earlier on the program, Andrew, 45 percent of men with erectile dysfunction have high blood pressure, 35 percent have high cholesterol and lipids, and 20 percent have diabetes. Another 25 percent may have depression. These are very important medical conditions and here in step three in my book does deal with that. Then we go into step four in my book Sensational Sex in Seven Easy Steps, which is under the title Mind Matters. This is really the acknowledgment of a lot of science that shows that we are not to be separated into mind and body or sexology and physiology. It's all one. It's all a seamless one being. The mind affects the body, the body affects the mind, and to have a successful and enjoyable sexual life you need to have a healthy body and a healthy mind. So this step deals with such important issues as depression. Depression is very common among men with erectile dysfunction especially those who have mind depression. The other thing is it is sometimes a sexual side effect of antidepressants. Anxiety, especially performance anxiety is very important. Stress, life stresses, job stress, family stress, can affect-- 8

9 Right. For my wife, you know, for my wife and I our best sex is when we're on vacation and relaxed and away from the kids, and certainly stress has played a role the other way at other times. So I know that pretty well. And then I see step five is Two to Tango. So you want to have a sex life with someone else so of course you need a partner. Yes. The step five, Two to Tango is probably the largest part of my book, the largest chapter of my book, because it deals with the couple, their relationship, and also with the female partner, with women and women's sexual health and sexual function. So the chapter is extremely rich in information and also practical tips and advice about issues of women's sexuality, issues of couples, relationships, and it really offers a lot of information to both men and women. And I notice as we go on, step six, Sexual Medicine, that probably has a lot of the stuff that we normally think of all the stuff advertised on TV or the products. I give you a lot of credit for spending basically steps one through five in helping us get there but recognizing that those are very important steps before you start making these different interventions. Absolutely, Andrew. And that's why this book is not only from my brain it's also from my heart. Because I really believe that for us to provide good medicine and good healthcare to our patients and to the public at large it's not only about writing a prescription and doing surgery and giving the implants. This is about a comprehensive approach to sexual health and overall health. And the advantages are huge. If you can--i tell my patients if you lose 10 percent of your weight you not only improve your sexual function you improve your overall health risk for yourself and your family. Right. We're going to take a break. We're visiting with Dr. Ridwan Shabsigh. He's a urologist, but he's an expert in giving us advice, in, as his book says, how we can take seven easy steps to sensational sex. And we're going to more of the good stuff now, step six, Sexual Medicine and then Time to Play in step seven. So stay with us. It's all coming up as we continue our sexy discussion on Patient Power on Health Radio. Okay. Now we're getting to the good stuff on Patient Power with Dr. Shabsigh, urologist who has written a book, Sensational Sex in Seven Easy Steps, Rodale Press. And I'm up to page 184, which is step five. And that is Sexual Medicine. So okay. These are all these health problems that urologists have seen for so many years, erectile dysfunction or 9

10 ejaculating too soon, and a lot of other things, but there are a lot of products that come into play here, surgery and pills to help men with erections. Put this into perspective for us. There are good products, aren't there? Well, science over the past several years has really produced wonderful products and wonderful treatments when used appropriately and in appropriate candidates after professional evaluation. And, for example, the oral pills--viagra, Levitra and Cialis--for the treatment of erectile dysfunction are highly effective and safe when used properly. Testosterone replacement therapy is very successful in those that are chosen and monitored medically. Penile implants, we do a lot of that, and they are successful in the treatment of erectile dysfunction when medical therapy fails, and they are highly satisfactory. In addition to penile implant surgery we do surgery for correction of penile abnormalities such as what we call Peyronie's disease, curvature of the penis or other abnormalities. So, yes, medicine, and as I mentioned in my book Sensational Sex in Seven Easy Steps, in step six, which is Sexual Medicine, there are a lot of very successful and very satisfactory treatments with high effectiveness and low side effects, but all this has to be done by a professional in a healthcare facility and with experience in dealing with sexual medicine and that can be very successful. Medication Only One Piece of the Puzzle Right. And I want to emphasize that because that's what my show Patient Power is all about. So there are hundreds of thousands of doctors, and any licensed doctor can hang out a shingle, and if they want to say that they deal with sexual issues they can say that or promote that for whatever reason. Whether or not they have the expertise in that is another thing. And as you mentioned there are many more tools and much more research--and you've been part of a lot of it, Dr. Shabsigh--in helping us understand the big picture of sexual health and, as you said, combining it with overall health. So it's not just about somebody prescribing a pill or saying, Yes, I can put in that implant or we can straighten this out or change this blood flow and boom you're fixed. It's a lot more than that, and that's why I would recommend that people go to a center such as you have in New York City where this is what they do and they can look at the full range, and it can be personalized for what your situation is. Now, help me understand, though, Doctor, a lot of what we know, millions of men now, about the offerings, you know, the ads on TV and in the newspaper. You mentioned that many of these medications can help. Typically, it doesn't--you never see a guy smoking, of course, in the ad, and they always seem to be physically fit so we know that fits in there, but do the pills work pretty well? 10

11 The pills do work pretty well. The large studies and multi centers in the United States and elsewhere and also in our hands the pills work well. Again, the most important thing--two points I would like to make here. One is that the pill comes within a program. In other words, as you mentioned, if I get a smoker who has erectile dysfunction, yes, I do prescribe a pill with erectile dysfunction, but in addition to that I really help the patient in quitting smoking. In fact, just taking this example, if you're a smoker and you come to our center what we do to help you quit smoking we give a program to quit smoking, which is also mentioned in my book, Sensational Sex in Seven Easy Steps. I have a collection in my office of cigarette lighters, cigarette packs and ash trays that patients left in my office as a ceremony for quitting smoking. Oh, neat. So, yes, these pills do work. Other things do work when, again, given by a professional after a professional evaluation in the package of overall health. Okay. Let's just get the last step, real quick, Plan to Play. What would you like to say about that, step seven? Well, Plan to Play, after all the prior six steps that I mentioned in my book Sensational Sex in Seven Easy Steps, if you do overcome the barriers, improve your life style, improve your medical conditions, improve your mind matters, address the relationship and your significant others, and you go get the sexual medicine treatment, then you need to put all that together. And the step that's mentioned in my book, step seven, Plan to Play, is how you put all this together in a program that will work for you as an individual. In other words help you set health targets and sexual function targets in a timeline fashion that will help you achieve satisfaction. There you go. And then I want to be that 94-year-old guy who is physically fit. He's still thinking a lot about sex. That's going to be me. As we wrap up our program after the break we'll get some final comments from Dr. Ridwan Shabsigh, urologist at Columbia and Maimonides Medical Center also in New York and put you on your way. So remember that book, Sensational Sex in Seven Easy Steps. We'll be right back with some final comments on Patient Power. Dr. Shabsigh mentioned earlier in the show that he had done work down at Baylor College of Medicine, which is also one of the top medical schools in the country. So, Dr. Shabsigh, we're going to have a Dr. Subramanian from Baylor on on Friday talking about sleep 11

12 problems and sleep apnea, and that affects a lot of people too. But that's from your alma mater down there. We've been visiting with Dr. Ridwan Shabsigh, who is a urologist. He's also director of the New York Center For Human Sexuality. If you happen to be in New York City, Brooklyn, here's a number for their center because I'd go if I was near, not in Seattle. So far away Or and/or you can take a look at his book, Sensational Sex in Seven Easy Steps: A Proven Plan For Enhancing Your Sexual Function and Achieving Optimum Health. And as Dr. Shabsigh has said, it's really about the whole person. So, Dr. Shabsigh, a couple of take-home messages for us, what you want to leave people with? Us men, you know, we want to be sexual powerhouses till the very end, and it sounds like it's all about better health in general. Yes, Andrew. And I think the most important thing to remember from my book Sensational Sex in Seven Easy Steps is that it is never too late, whether you are young, whether you are middle aged or you are senior. Actually, one of the themes of my book is that every man can improve his sex life, and the majority can do so without significant medical intervention. There are a number of things you can do to improve that, and it's explained in a number of steps that are mentioned in my book Sensational Sex in Seven Easy Steps. Well, I'm getting it. Thank you so much for being with us. I just want to mention tomorrow we're going to talk about vitamins with a man who has been in the vitamin industry, Howard Schiffer, for 25 years and find out where do they fit in in our health, who needs them, which are helpful, which maybe aren't, just how often do you need it. But it's all coming up on Patient Power. We're here with you every day. Today it was sex, tomorrow it's vitamins, next it's sleep. Thanks for joining us and remember knowledge can be the best medicine of all. Bye-bye everyone. Have a great day. Please remember the opinions expressed on Patient Power are not necessarily the views Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. 12