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Men cross their legs when you mention injections but the sensation is said to be no

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Men cross their legs when you mention injections, but the sensation is said to be no more than a "small prick", according to Dr Geoff Hackett of Keele University, who ran tests for five years.To those critics who say doctors are yet again "interfering with nature", he replied: "Spontaneous intercourse isn't very common in most 20-year- old marriages. Injectable prostaglandins, (blood-stream messengers) such as Caverject are a special boon for diabetes and stroke patients. He claims that hard cycle-saddles on sports bikes are responsible for reducing penile blood flow by up to 66 per cent, and even the softer versions reduce blood supply to the region by a third.So it is just as well that we live in a period replete with remedies. The latest significant cause of impotence among younger men turns out to be "bicycle-riding", at least according to Dr Irwin Goldstein of Dallas, Texas (his website: http:// www.nd.edu/ktrembat/ www-bike/BCY/men.bikes. html), who sees six such patients a week. And the Independent on Sunday's campaign to promote cannabis has to answer concerns that up to 20 per cent of long-term cannabis users may become impotent.Even if you are trying to lead a drug-free, well-exercised lifestyle, there is little prospect of escape. Men who consume more than 40 units of booze a week are likely to deliver little or no sexual thrill.

It has been shown that smoking two high-tar cigarettes, one after the other, reduces blood-flow in the penis by about a third. These may cause impotence directly, or as a result of taking medication for the conditions. The same is true of depression - a common enough feature of mid-life crisis. Both the illness, and remedies such as Prozac, can reduce libido and affect sexual performance.

New drugs to counteract baldness, such as Propecia, also carry some risk of impotence.Nor do "old" drugs such as alcohol and nicotine help. Up to a third of men over the age of 45 experience some symptoms of impotence, and up to two-thirds of those aged 75 and over. Longer life span usually means more heart and hypertension problems. But to pass up a National Health aphrodisiac when it is lawful and licensed seems more than perverse.As men live longer, compete with women harder and consume more health and grooming products, impotence is, in any case, set to spread rather than diminish. Poor educational attainments and falling sperm counts are one thing. And as the survey suggests, patients are equally slow to face up to their difficulties, often suffering in silence as only "real" men can.In fact, if the male sex were quoted on the stock exchange, today's price would be in trouble again. I thought you should be informed I shall be seeing a sexual consultant in London ...' "When you consider that good sex adds years to the life of middle-aged men such as Allan, cutting the risk of premature death by as much as 36 per cent ("The truth about sex; more of it makes you live longer", The Independent, 19 December 1997), this does amount to a legitimate health concern.Yet time and again, for reasons of embarrassment or lack of empathy, GPs seem reluctant to be proactive or to prescribe.

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