E-Mail This Article to a Friend Sex machinery (continued)
	Related links The Institute for Sexual Medicine at Boston University’s School of Medicine One of the only centers of its kind, the institute focuses exclusively on the diagnosis and treatment of the sexual-health problems of men, women, and couples. Ibis Reproductive HealthA Cambridge-based organization that researches reproductive and sexual-health issues in the United States and internationally, provides policy analysis, and advocates for women’s health choices and autonomy. Massachusetts General Hospital Vincent Center for Reproductive Biology Scientists at this Mass General center study women’s health issues such as infertility, the transition into menopause, gynecological cancers, and pregnancy care. Harvard Health Publications Harvard Medical School’s newsletters provide current, easy-to-understand health information for both men and women.

Since the early 1980s, when Goldstein began studying the sexual perils of bike riding, he has performed more than 1000 penis-bypass surgeries on male bike riders. While most people think of erectile dysfunction as affecting older patients, such as those commonly seen in ads for Viagra or Cialis, bike-related erectile dysfunction often happens to younger men — Goldstein operated on an 18-year-old just this week. He and Dr. Ricardo Munarriz, the institute’s assistant professor of urology, recommend using physician-approved, properly fitted, wider seats, as opposed to saddles that must be straddled.

Beacon Street Bicycle, near Kenmore Square, sells some of the wider seats that Goldstein and Munarriz recommend. But Finn Harrigan-Anderson, a former bike messenger and an employee at the shop, says such seats can compromise the handling of the bike for aggressive riders.

Still, concern about bike-induced erectile dysfunction runs deep in the cycling community, he says, quickly pointing out that although he’s occasionally felt some pain or numbness down below, "I’m unaffected, so I’m not too worried about it." But while he downplays the likelihood of erectile disaster, he adds that some friends are "totally freaked out by it."

Men’s Health Boston, Mass General, Harvard Medical School, and others: The joy of testosterone

Both men and women can be troubled by sexual problems such as low sex drive or unsatisfactory orgasms. (Dr. Abraham Morgentaler, a Harvard Medical School associate clinical professor of surgery and the director of Men’s Health Boston, describes a typical complaint: "Doc, when I used to come, it was like, oh my God, and now it’s like, oh, did I finish?")

Treatments for these patients are a hot research topic, and will likely attract even more attention now that the Boston-based Journal of Sexual Medicine has reported that a male’s sexual dysfunction can have negative effects on his partner’s sexual satisfaction — a fact that seems remarkably intuitive but had never been supported by hard evidence.

New research projects, such as those led by Morgentaler and Massachusetts General Hospital gynecologist Jan Shifren, indicate that testosterone gels and patches are becoming increasingly prevalent in treating sexual dysfunction, especially in older people. Testosterone, a hormone that affects the coordination of sexual thoughts and impulses, is present in both men and women (though women have about one-10th the amount that men do).

For both sexes, low testosterone levels can translate into a low libido — and, conversely, testosterone treatments can rev up a lagging sex drive. For decades, doctors feared those treatments could increase the risk of prostate cancer. But Morgentaler’s research shows that concern to be unfounded, evidence he hopes will boost the use of testosterone therapies to treat an "underdiagnosed and undertreated" problem.

In women, the low-testosterone problem is even less likely to be identified. As women age, their testosterone levels naturally decline — 20-year-old women have twice as much of the hormone as 40-year-olds do. Shifren, director of the menopause program at Mass General’s Vincent Ob-Gyn Service, studies the effect of testosterone patches on both surgically and naturally menopausal women who need a little help getting in the mood. She’s found that the patches "significantly improve sexual activity and sexual desire."

Ibis Reproductive Health: Down EC Street

It’s not all test tubes and trials. One Cambridge-based organization is working on less-technical sexual-health projects that could have political implications, such as a recent study of the availability of emergency contraception (EC) in emergency rooms across the nation. The three-year-old Ibis Reproductive Health organization, which does research and policy analysis in Harvard Square, San Francisco, and Johannesburg, South Africa, is part of an "emergency-contraception network" conducting research into how much Boston-area women actually know about what’s commonly called the "morning-after pill." (See "Not So EC After All," News and Features, July 16, 2004.)

Researchers distributed a questionnaire to Jamaica Plain women between the ages of 18 and 44, and found that while 99 percent of white women had heard of EC, only 75 percent of black women and only 51 percent of Latino women were familiar with the pill. On top of that, of the whole group, a mere 39 percent knew that EC works by preventing pregnancy; 48 percent knew that it should be taken within 72 to 120 hours of unprotected intercourse; and 44 percent knew that it is available only by prescription in Massachusetts. Only 25 percent of women had ever discussed EC with a health-care provider, and just 12 percent had ever received an advance ("just in case") prescription.

Judging from these results, perhaps it is fair to say that Massachusetts could use even more sex talk.

Deirdre Fulton can be reached at dfulton[a]phx.com