Summary

INTERVIEW RESUMES: David Susskind Alright Dr Kaplan, you wanted to talk about prevention? Helen Singer Kaplan Well, I want to say one word about prevention of impotence. Because I mean, organic impotence of middle age and beyond. Two of the most prevalent causes are diabetes, the complications of diabetes and vascular problems, poor circulation of the penis, that's probably the two most common causes, especially poor circulation. And that can be prevented or at least retarded by the same measures we use to prevent heart disease, cardiovascular disease, there's been a decrease of 60% in the last six or seven years in heart attacks, because of people keeping their diet and their blood pressure down. So that a patient of mine who has vascular beginning problems, I make them all go on a diet to take their lipids, I treat them like a coronary patient, and patients with diabetes, and use Maj-Britt Rosenbaum and to quit smoking. Absolutely. I think I mean, which is one of the really major, quite striking slowly, many men that Clifford Sager And some men would rather continue smoking and have good sex. Helen Singer Kaplan But it's easier to get a man to give up cigarettes, if you say he's going to have a heart attack, a certain percentage give it up. But if you tell him he's, he's making his impotence worse, he's more likely to give it up also, the tight control of diabetes where people take their blood sugar couple of times a day and really keep it tight, not just the you know, in a gross way, watching the urine a very tight control, probably, you get less complications, and you can prevent a lot of that. So those are the two things I insist on regulation of hypertension diet, David Susskind By regulating hypertension, you are bringing into play chemotherapy drugs, Helen Singer Kaplan not necessarily you have a guy lose weight exercise, change around the drugs by working with his internist, often they need much less medication. David Susskind But isn't it true that all hypertension drugs in one way or another cause a loss of sexual appetite? Helen Singer Kaplan Yes, they all can Maj-Britt Rosenbaum at one time, in one way or another individually became a switch around drugs that may in one man cause erectile problems, another not Harold Lief one day, we have to see a level of changing drugs is that even though you switch drugs, the there may be a psychogenic reaction to the old pharmacological effect. And so the man doesn't always get better. Once the drug is switched, hasn't been taken into account, Helen Singer Kaplan you're completely right. And what I've been doing is when patients and working with the internist, with a cardiologist, we don't know if a certain drug is making them impotent, or if it's a placebo, what I now do is test all my give my patients that sleep test with the drugs and without the drugs. And unless there's a definite improvement, it wasn't the drug. You don't have to guess because people get so obsessed about their drugs. That's been one of the nicest use, I suppose we Maj-Britt Rosenbaum say the sleep test, I think maybe we should mention that it's a rather cumbersome test, and it's not at home David Susskind Explain that. What do you do? Helen Singer Kaplan Patient comes to the office and a male technician or a male doctor in my group I had a group of people do this work shows him how to put on little strain gauges. And then he gets something that looks like a bowling bag. And it's got a machine in it and he takes it home and attaches it for two nights or three nights, depending if I'm testing with it with that drug. And he comes back and I read that record like an EKG. Harold Lief Are you satisfied with that? Because I have great doubts about that. Because first of all, there are so many artifacts associated with it. Then there are medical legal questions, I don't think to get get in. Because I'm this panel, but they are important. Clifford Sager Well it becomes important to for the attendant to observe the read through Helen Singer Kaplan No, it isn't really not the way it's used. Because most people are positive. They say they don't think they have a reaction. Then you sit with them, but said look, that is so therapeutic. I don't use it as a fine David Susskind Wait a minute, I'm lost. You sit with the patient and put the thing on Helen Singer Kaplan after the record comes back. David Susskind Yes, after he comes back. Helen Singer Kaplan you and your wife come to me and he says I can't possibly haveerections anymore. And like I said, Look, you had this big erection at four o'clock this morning. You had enough that has such a good psychological effect, that that's how it is used or he comes in obsessing about his medicines is finished. And you show him that the medicine didn't stop the erection that faces them with reality. It's it's not the same as an absolute experimental use. Harold Lief Well, I'm not sure, but that we may have some disagreement. I'm inclined to agree with Cliff that direct observation is necessary to make sure that the record is correct. Maj-Britt Rosenbaum I often find myself recommending a very simple and cheap way of doing it. I mean, asking the why for a partner to observe them instead of going through the cumbersome Yeah. This is a real concern to them, they can spend it doesn't take that long. I mean, if you had few hours, or especially early morning observation, Clifford Sager actually, Fisher efficient way of Charles Fisher Sinai, who was a pioneer in these, this type of study, also devised a very simple method of folding over a few postage stamps. As a gross test Helen Singer Kaplan Too gross because you turn around and bed Clifford Sager that's another simplification process, David Susskind How do you test women? Helen Singer Kaplan well, that's a different issue. You were starting to mention it if if you start if you have the patient, do a masturbation with the device on and then compare. If it's better than masturbation, that is good, we'll get Harold Lief There are, there's the woman lubricates during sleep. The trouble is that our technology hasn't caught up with this yet. I mean, there are a plethora demographic devices, and thermocouples things that will measure the increase in temperature, the increase in blood flow during sleep, but they are not only special laboratories have that it's not in wide use. And I think maybe one day it will be so we can have the same kind of measure of the female that we have of a male Clifford Sager Or if sufficient studies were done on this at Sinai again, to indicate that the same thing precisely happened with women's happens with men with REM sleep is an increase in blood flow. It's lubrication, which is similar to the erection and a male, which takes place same number of times during the night. Maj-Britt Rosenbaum But I think it's also important to keep in mind that male and female sexual problems are very different. Yeah, erection is a much more specialized the physiological function then the lubrication, swelling in women, and we much more rarely will see that face interfered with and women women's problems are different David Susskind what would be the female equivalent of failure to have an erection? Maj-Britt Rosenbaum there is no clear cut equivalent clinically, I mean, it would be a woman who has good sexual desire, but then does not have the swelling and the lubrication. You may have sort of the organic equivalency after menopause in some women when the hormones drop and there is less lubrication because of organic causes, but it's not quite the same and more easily corrected with hormone therapy or creams or vaginal lubrication Harold Lief Isn't it true that a woman will come in complaining of lack of orgasm rather than a train. Rather than saying I don't get turned on during sexual stimulation. So the chief complaint may be different. Although her physiologically she may be going through a similar process to the male. Helen Singer Kaplan for women, the most important medical test other hormones, because many women come in after hysterectomy after menopause, and they say I've lost my sex drive. And we've always assumed this was completely psychological. But we've been doing some hormone studies and we now find that some women don't have enough testosterone, which is a hormone they need in very tiny amounts to feel sexy. And we've been giving some of that hormone and little amounts so it doesn't masculinized woman with excellent results. David Susskind And when a woman comes in and complains of lack of satisfaction, orgasm. How do you deal with that? Why isn't she having orgasm? Maj-Britt Rosenbaum For many reasons, if there was one David Susskind premature withdrawal. Maj-Britt Rosenbaum Women can usually be divided roughly into groups women who have never had the experience of orgasm, which has a lot to do with biological experiential learning she may never David Susskind How large of a group is that? Maj-Britt Rosenbaum It depends on the age group. I mean, most young men will have the experience of orgasm during their adolescent years, many young women will not Helen Singer Kaplan About 10% Maj-Britt Rosenbaum women but even higher in the 20s 18 years 20 or 20, before they've had enough experience with their own bodies, again, it takes longer for women to have their bodies respond sexually, at this sort of label all the sensations because it's vaguer and just takes a longer time for her body to start forming the experience Clifford Sager with cultural their culture cultural variations are very important. When I first started practice, and having read Kinsey Kinsey 1938 39, in their published the fact that women are most orgastic at the age of 38, after having had two children and young women at the time were relatively non orgastic compared to where they are today. Evidently, a sex education change and cultural social mores, has made a big difference women had been liberated, so that now a much higher percentage of women are able to enjoy orgasm then did their counterparts a generation or two ago, David Susskind enjoy it and at an earlier age Clifford Sager and at an erlier age Harold Lief they expect to their expectations are important Clifford Sager Expect it and they want it David Susskind Oh, that's the murder spot. We'll go back the moment we come back