Peripheral artery disease, peripheral artery disease support
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Let's Talk About Sex...and P.A.D.

"Once P.A.D. reaches advanced stages, there is no sex drive. But there's hope."

· Patient Stories


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By Douglas.

In the early stages of P.A.D., you may not connect the dots that obstacles during sex might be related. It’s not your manhood that is first noticeably impacted. Cramping in the calves during sex was the most obvious related issue during my earlystages of P.A.D.. Drinking extra water prior to intimacy seemed to help somewhat. I also tried some ancient magnesium oil as I was told thattransdermal absorption of that mineral would help with cramping. What was mosteffective to reduce calf cramping was either standing up or hanging my legs partially off the side of the bed so gravity could maintain blood flow to my calves and feet. P.A.D. is defined by lack of blood flow, mainly in the legs. When you lay down blood has to work harder to get through narrowing in thevessels. Gravity helps. In terms of erectile dysfunction, that didn’t seem tobe a frequent problem at first. It wasn’t until I was on multiple pharmaceuticals, such as blood thinners and statins, that I started recognizing I was taking longer than normal to be aroused. My physician said it could be a side effect of some of the drugs. He thought it was more likely that it was related to P.A.D. impacting small vessels beyond my legs. He said plaque can build-up and restrict flow to the groin. I asked if stimulants such as Viagra could help. Unfortunately, high blood pressure is a contraindication for stimulants. So, that wasn’t an option. The key at that point was to just slow things down for both of us and focus on foreplay. More quality time never sparks complaints. As my disease progressed, however, there wasn’t enough time in the day for me to not only satisfy myself in that manner, but also my partner. So, fingers and toys became more of the norm and although it didn’t help me reachfull satisfaction, I was still satisfied satisfying my partner with an orgasm. 

Once P.A.D. reaches advanced stages,there is no sex drive. Plain and simple. That’s my experience. For me, on topof the restricted flow already in the small vessels to my groin due to plaquebuild-up, I also have what they consider a "Hail Mary" bypass called an Axillobifemoral Bypass, which is only used when all other efforts to restore flow to my legs have failed. An Axillobifemoral Bypass entails a graftprotruding from my chest visibly, connecting from basically my shoulder togroin and then splitting off into both legs to get blood flow to my legsand feet. With this bypass, my legs are saved, but there's less flow going to someof my other organs including my groin. As if I didn’t have enough anyway tohave an erection at that point, this graft makes my prognosis worse when itcomes to sex not just in anatomically, but also mentally. The graft visibly protrudingfrom my chest has made me self-conscious and insecure because I don't feelattractive.  

So, how do you attract when you're not feeling attractive yourself?  

Maybe that’s a good thing because Icouldn’t do anything about it even if I did attract the right woman.  

I had given up on the idea of everbeing able to perform again until I connected with the wellness team at The WayTo My Heart, a nonprofit organization that supports P.A.D. patients. My primaryconcern at that point was to address other symptoms related to lack of flowcaused by a new blockage in my graft. They found me a second opinion with anInterventional Cardiologist who, during our consult, initiated the conversationwith me about my sex drive, taking the pressure off me by bringing it uphimself. He said he had looked at my test images and I also have narrowed flowin vessels to my groin. My insurance doesn’t cover a procedure just to fix thatas it’s not considered life-threatening. But my Interventional Cardiologistsaid that while he’s performing an angiogram to restore limb-threatening flowto my feet, he would take a moment and restore my sex drive as well. My otherphysicians had never even broached the subject. I didn’t know it was even the issue causing my erectile dysfunction. I’d heard that statins, pain killers, and beta blockers impact the sex drive. But when eliminating those at first and even trying drugs designed to induce an erection didn’t work, I had lost hope until restored it. The physician they connected me with really understands how important the sex drive is to mental and physical health, especially for patients with PAD  He has found that when PAD patients are satisfied, they're also more likely to walk since it is the best medicine for people with P.A.D.  

I don’t know what I’d do if I didn’thave hope that this highly skilled physician could restore blood flow to my groin and improve my sex drive. I’m 60 years old and still desire to be marriedand spend my life with someone versus alone. It’s been a real struggle as a manto cope with this issue. Just the other day I saw a woman I used to date. I went home afterwards thinking of how life used to be with her and all ofour romantic, highly exciting, experiences. It was thrilling tothink about. So, I tried masturbating. That failed. That failure to evensatisfy myself not only impacts me physically, but mentally. It really messesme up.  

I used to get excited just touching a woman in a romantic encounter. I liked that feeling. But it doesn't happen anymore. When I did have a girlfriend during the first year or so of mydiagnosis, we used to stay out late and if she drank enough, we may kiss, butnot much more because she would be too exhausted and so we basically roll overand go to sleep. It would get me through for a time without having to have thatuncomfortable discussion which really is demasculating. But there’s only somany times I could get away with that. So, the next step was forgoing anyin-person contact. When she would call, I would change the subject if she wastrying to get me to schedule a date. We would enjoy the conversation, have afew laughs, and I could quickly find a reason to have to end the call withouthaving to address performance. You could imagine I didn’t get away withthis tactic many times. So, we're not together anymore. She did hold my feet to the fire as we parted ways and I openly admitted my fears about performance. She was more accepting than I was about it. But for me, if I’m in arelationship, I want to be able to give more than I receive. Yes, many couples in the same situation have told me that using fingers and sex toys are satisfying for women, even if an orgasm isn’t achieved. But I haven’t come to terms with accepting that as truth for me.  

To me, sex is a big part of being human. It's a big part of life. Not being able to perform to satisfy others,even not being able satisfy myself, brings on depression. It's real. Many don'ttalk about it. We try to hide the depression. But the more I've ignored it, theworse it's gotten. I'm thankful I’ve found real-time support from clinicians at, but I still can’t get over what I know in what it means tobe a man or how society defines what it means to be a man in a sexualrelationship. I know a man can be satisfied without having an erection. Women have told me they can be satisfied without having an orgasm. I know there’s somuch satisfaction in the kissing, the petting, even just hold hands. When I think about that, I think about one woman I dated long ago and how much shewould always tell me how much fun we would have together. The sex was great, but she truly appreciated the fact that our relationship was so much deeper. We were the best of friends and would do every activity together. We loved all of the same things. But just the thought of laying in bed with her and having a moment where I would have to confront my lack of ability to perform adequately, scares me. I would have to say, “Here are my fingers, or a toy, but Uncle Buck has checked out.” That fear keeps me home and anti-social these days until I can get this issue fixed. I call it “aversion therapy” so I don't encounter anyone that would drum up those feelings of inadequacy.  

I miss being social. I miss dating.But it’s easier to avoid temptation. It still bothers me to think about it,even when alone. But it’s better than feeling as though I’m disappointingsomeone else with my feeling of inadequacy. The way I get through the mental anguish is to distract myself. Sitting at home on the couch and watchingtelevision is not enough. I have to do something I’m passionate about thattakes all of my focus and brings me satisfaction in many other ways. For me, my greatest distraction is woodworking. I love woodworking. I can immerse myself into it and it requires my full attention to create wonderful designsperfectly. Don’t get me wrong, I know I need to confront this head-on at somepoint. I’m just counting the days until my Interventional Cardiologist can restore my manhood. But I do have to consider the possibility of it beingimpossible. And at that point, I will have to do one of the toughest things I could ever imagine, which is being totally honest with myself, owning who I am, and learning how to move forward accordingly and finding true love and happiness anyway.