How do you attach? And are you compatible?

Finally, there is a new, serious, not pop psychology advance in the understanding of how we connect with one another.

I’m not taken with fads. This really is big stuff.

It’s based on attachment theory, that psychoanalytically inspired work of John Bowlby. A couple of folks have broken it down, applied it, and put it into layman’s language in a new book, Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love, by Amir Levine, MD (a sometime-collaborator with Nobel Prize-winning neuroscientist Eric Kandel) and Rachel S.F. Heller.

You’ll want to read the short excerpt in Scientific American online: http://www.scientificamerican.com/article.cfm?id=quiz-relationship-science-attachment-quiz

And to decipher your attachment style — and if you’re not flying solo that of your partner(s), and also to get a pretty decent attachment theory-based read on your likely compatibility — take the attachment quiz:  http://www.attachedthebook.com/compatibility-quiz/

You can read the stellar reviews, and order the book on Amazonhttp://www.amazon.com/Attached-Science-Attachment-Find%C2%97-Keep%C2%97Love/dp/1585428485/ref=sr_1_1?ie=UTF8&s=books&qid=1294345363&sr=8-1

As an aside, a few of us in sex and relationship therapy have been working with people along these lines for a number of years. It’s exciting to see attachment and intimacy moving into the limelight and coming of age.

The organic obsession

It used to be that “the inability to perform” drove many men to withdraw from — or rendered them unable to enter and successfully sustain — a sexual relationship.

When getting a good erection became less and less likely and over time proved increasingly impossible, that fundamental, pleasurable part of life known as sex was usually gone for good, many times replaced by self-doubt, sadness and even shame.

For many men, and for their partners if they had them, there was a persistent sense of personal failure.  Rarely was the subject ever mentioned let alone discussed.

That was until Viagra and TV ads of smiling couples and men proud of their revived manhood.

Today, the only obstacle for most men to overcome is getting an appointment with someone who can write a prescription.

Well, that’s not entirely true.

Erectile dysfunction (ED) meds are pricey.  They’re patented.  There are no generics. Few medical insurance plans cover them and those that do typically pay for only a few tablets a month for “occasional use.”  For many, this means that getting an erection that will prove itself  may be a luxury. It doesn’t quite come naturally, takes planning and at very least it’s an added expense.

Planning and scheduling sex is a problem for most people.  In fact, it’s one reason so many men who can be helped by ED meds try them but quit using them.  Thirty-six hour Cialis was a big step in the right direction.  Then came Cialis for daily use.  It’s the only prescription medication on the market that makes it possible for most men who suffer from ED to have successful, stress-free, spontaneous sex.  In my opinion it is the best option by far to date.  I have been encouraging the use of Cialis this way since before there was an FDA-approved daily dosage (by breaking the occasional-use tabs into smaller pieces) back when Eil Lilly, the drug’s maker, had just started the daily protocol in trials.

Since the patent on Viagra doesn’t run out until March 27, 2012, cheap sildenafil — Viagra without its stage name — won’t be on the market for another 15 months.  The Levitra patent is good until 2018 and Cialis patents will remain in effect until 2017 and 2020. So will next year’s generic sildenafil drive down prices on vardenafil (Viagra) and tadalifil (Cialis)?  Only time will tell.

This much is clear: men do want erections and their partners (or those they may aspire to have as partners) generally want erections too.

But at what price? It’s not simply a matter of the dollar amount.

Many health conscious people wonder: Are these medications safe in the long run?  Do I or my partner really need to be taking pills every day? Is this the trade-off I have to make for the sake of sex going to have long-term adverse effects on my life and longevity?

I don’t know how to answer those questions. People ask me my opinion and tell them that I am very comfortable with the ED meds.  But I’m also one who always tries find a natural, healthy “diet and exercise” answer before turning to a pharmaceutical one.

But is there such an option?  When it comes to ED, there is.

It’s commonly referred to as Horny Goat Weed. Okay, let’s roll our eyes and shake our heads at the name. (I do every time I say the words.) Also referred to as Rowdy Lamb Herb, Barren Wort, Bishop’s Hat and Fairy Wings, Horny Goat Weed, or Yin Yang Huo as it is called in Chinese medicine, works on the same basic principle as the three ED medications. It acts as a vasodilator.  Its primary active ingredient, icariin, works by increasing levels of nitric oxide to relax smooth muscle cells lining the blood vessels supplying the spongy tissue of the penis. That’s what takes a flaccid penis and firms it up.

Horny Goat Weed is often referred to as an aphrodisiac, but in my view that’s a misnomer. It doesn’t stimulate desire. What it does is foster genital engorgement. That’s a very important distinction because with ED you can have all the desire and no or very little “sign of arousal” in the form of a hard-on.   (However, in a classic feedback loop, desire can increase when one is feels the physical effects of stimulation.)

So where does one get Horny Goat Weed? How much is needed? And how does one take it? These are the questions I’m asked. Unfortunately, they’re not as easy to answer as “Doc, can you give me a prescription?” followed by a trip to CVS or Walgreen’s.

Where do you get it? If you Google Horny Goat Weed you’ll find lots and lots of folks who sell it. The problem, of course, is that marketing trumps quality. I’m betting there is a lot of junk Horny Goat Weed out there. Like any herb (I nearly typed “weed”) the best place to get it is from a source you respect and trust. My most trusted online herbalist doesn’t carry it at all.  You’re not likely to find it in the local Whole Foods or herbal section of the drugstore. Wherever you get it — online or locally — look for the words wild-crafted and/or organic. The last thing you want is bad Horny Goat Weed.

What form is best? It comes in capsules, tinctures and in bulk to make a tea. My recommendation is to make the tea. Swallowed capsules don’t seem to metabolize well. I don’t have much experience with tinctures. Besides, there is something wonderful about the ritual of making and savoring tea.

How much and how often? I have heard different things from different Chinese herbalists regarding dosing.  I recommend a pot a day, consistently, 2-4 hours before the time when you might be likely to have sex. If you buy whole leaves, chop them first before brewing in a tea ball.  Steep the tea, make it stronger or weaker as you like, and see how it goes.  After a couple of weeks, adjust the amount of Horny Goat Weed in the mix, stronger or weaker, to increase or reduce the dosing.  Aim for consistency over time. Horny Goat Weed seems to be most effective in the way that daily use Cialis is, as a regular part of your life. And it’s helpful if you can get it from a consistent, reliable source.

An added bonus: very good quality Horny Goat Weed costs only a small fraction of what the medications do, at least until the day of generics comes.

But just as the prescription meds don’t work for everybody — because most but not all ED is tied to vascular issues — not everyone will be helped by Horny Goat Weed.  Still, for those who stick to it, it’s very good and my first intervention of choice.

One more thing. For those who are going to go the prescription meds route, the Cialis folks have a smart way of getting people to believe in their product and I think it’s fair. They offer a free 30-day trial of their daily-use medication (with a doctor’s prescription, of course).  When asked, I usually recommend that doctors write for the higher dosage (5 mg) and start patients off with half-tablets (2.5 mg), breaking them in half. If the dose works well, the patient gets two months free and establishes a solid habit and a regular sex life.  Assuming the 2.5 mg dose works, by continuing that way you get daily Cialis for a cut-rate price.  Here’s the link: http://voucher.cialis.com/index.cfm

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