Sex is important to a healthy man. The Hardness Factor is, first and foremost, a health book. When you are physically and emotionally healthy, your penis is hard when you are aroused. This book is also about the essence of maleness and how masculinity is intimately bound up in the idea of hardness and its relation to the penis. And yes, it is politically correct to admit that you have a penis and that it does get hard.

Let's face it, men need to be hard. Not only is much of our self-image dependent on it, but so too is the creation of life. So much that is important in our life flows from this notion of hardness. Men's sexual identity is intimately linked to this fragile appendage that becomes engorged — how engorged is the reason behind this book.

The Hardness Factor is about a new definition of maleness. In the last forty years, the old chauvinistic notions of male superiority have been properly discarded as hurtful relics of the past. Eliminating this old baggage is well deserved. Nevertheless, in jettisoning those stereotypes, I believe, some important and positive aspects of being a man have been lost or marginalized.

The ideas of self-sufficiency, physical strength, and confidence — a man's mental hardness as well as his physical hardness — are vital parts of being a man. Moreover, a crucial aspect of male hardness is the strength of his erection. When the penis is hard, life is good. When hardness diminishes, so does a man's health and his innate sense of who he is.

For all of us, there comes a time when there is a change in penile hardness. The dependability of an erection wavers — this is a physical reality. There are important medical and psychological implications that often come with these changes — imperceptible changes. I am talking about subtle changes that occur in every man, more slowly in healthy, younger men, more precipitately in those who have ignored their health or are affected by certain illnesses.

We are all sexual beings and sex is an essential part of who we are. The fact that you are reading these words shows that you take erections, sex, and health very seriously. Unfortunately, most young men (and women) in this country fail to understand what links the three.

Men are an endangered species. We are dying from a variety of diseases that could easily have been prevented had they been addressed much earlier. We are dying from cardiovascular disease, our number one killer. We die of cancers (particularly of the prostate and colon) that have either metastasized or were detected too late. We die from the effects of depression and bipolar disorder, which often result in fatal heart attacks and suicide as we age. In essence, we are dying of a slew of disorders that can be prevented. Moreover, men are extremely slow to react when it comes to our own health and well-being.

What is it going to take to change this particular male trait of medical denial? It has always been very clear to me that men need some kind of motivating force to bring about positive health changes. And when you think of men and think of motivation, I think of only one thing: sex.

In just the past decade, researchers have made the all-important link between sexual activity and good health. When a man's blood vessels are healthy and "elastic," his heart and brain are functioning well — and his erections are rock hard.

When his neural connections are firing and nitric oxide is being released in great abundance throughout his body, his cognition is high — and his erections are rock hard. When testosterone levels are normal and weight is controlled, he has the ability to train most effectively — have a healthy, trim body — and his erections are rock hard. Once men start to connect the dots, once they fully understand that good health and a hard erection are synonymous, they will begin to take better care of themselves.

Men grow up appreciating that a part of their anatomy changes in a cyclical fashion throughout the day, starting with erections in the morning. They awaken from a deep sleep with an erection that holds the covers inches away from their body. Most don't have to work to have an erection; one may appear at the oddest moments. As they grow older, however, they're somewhat perturbed by the lack of these spontaneous erections. They no longer experience them when they're sitting around, nor do they become aroused at the slightest sexual thought, as they did when they were teenagers.

Many men are disturbed that even with extensive sexual stimulation, erections are often less hard and reliable. This confuses them. Some are ashamed that they can no longer get hard, or that they are not quite so hard as they used to be. A part of them has changed, for some reason they can't understand. The way many choose to deal with it is to ignore it. It's a guy thing — denial. It might get better, they think. Eventually. Unfortunately, for some, eventually can stretch out over a period of years until it turns into never.

Once a man realizes that smoking damages his hardness, he is given a powerful motivating force for change. The same goes for men with hypertension, the "silent killer." This ailment is not only about having a heart attack or stroke at some unforeseen point in the future. Rather, it's also about weak and progressively weaker erections: right now. As in today.

When I tell a man that obesity is not just about being thirty or more pounds more than an ideal weight for his age and height, but that it affects hardness and influences his ability to obtain and sustain an erection suitable for penetration — and will do so until he loses some weight — he listens carefully. He now has real motivation.

When a man hears that continually monitoring and regulating blood sugar to keep his diabetes under control means that his erections will be strong at night, I have his full attention.

Over the years, I have found that once men come to understand that their hardness depends on taking better care of themselves, they become much better patients. They take a more proactive stance when it comes to their health because they comprehend the far-reaching effects of the alternative.

The Hardness Factor is a book about the preservation and enhancement of a man's erections. If he chooses not to preserve and enhance, but instead ignore his health, he will have to restore sexual function at some point in the future — guaranteed. And that may entail anything from prescription drugs and injections to penile implant surgery. Believe me: preserving and enhancing are much easier than restoring.

This is a book that will tell you how your penis works and what it takes to attain a firm, hard erection — at any age. And no matter how hard your erection is presently, I can help you make it even harder. My message to all men is basic and direct: When you are able to have a hard erection every time, you are generally in the best possible health.

The ability to have truly satisfying sex depends, in great part, on your overall physical condition. When you are fit, you are also confident and happy with your body. Your hard erection — and muscular body that is equally hard — allows you to fully partake in vigorous and prolonged lovemaking with your partner. Moreover, when your partner is confident of your hardness, total focus during lovemaking can be placed on creating intimacy and experiencing and giving pleasure.

As you read The Hardness Factor, you will come to see the pivotal role a hard erection plays in physical and psychological health. The Hardness Factor is as much about learning what not to do as it is about learning what to do. Just as good lifestyle choices will keep you young and rejuvenate your physical and mental states to a degree you never dreamed possible, so too can poor lifestyle choices damage your health.

This knowledge can change your entire life, as it has for me and many of my patients. By following my suggestions, I assure you that a man can be healthy, active, and hard well into his 70s and beyond. At its very core, The Hardness Factor is a detailed health program. What you learn from this book will answer so many questions about erections, sexual frequency, masturbation, premature ejaculation, performance anxiety, and partner satisfaction. Sensuality is taken to a new level. Sex is more pleasurable. Intimacy is enhanced. You will enjoy life much more.

Your partner will, too. What condition do you know in which a positive change in a person's health enhances the health of his partner as well? If you lose weight, your partner doesn't lose weight. If you lower your cholesterol or reduce your blood pressure, you don't expect your partner's cholesterol or blood pressure to drop.

However, researchers have just reported that when a man is hard and healthy and enjoying regular sex, he also enhances the performance and sexual satisfaction of his partner. As a practicing internist and a researcher for the past decade, I have long examined the effects of sexual medicine. I am increasingly impressed by how much we now have at hand to maintain hardness and also by how little we have taken advantage of that knowledge. It is time we put these newly found discoveries to work for the sake of overall health.

When I was in medical school more than twenty-five years ago, we were taught that hardness problems were psychological, that they were "all in your head." We now know that that simply is not true — and we have ways to reverse many of those problems. The good news I will be offering in The Hardness Factor is based on the recent explosive growth in sexual medicine that started after the release of Viagra, the pharmaceutical blockbuster, in 1998. We now understand that increasing blood flow to the penis strengthens erections and enhances the function of that vital organ. I guarantee that this new medical knowledge will not only change a man's life, but it could save that life as well.

As a doctor who counsels and treats men and women with sexual concerns, I will guide you through my special program of enhancement and describe the lifestyle changes that I want you to make. I will offer delicious food selections to heighten your taste sensation and also aid in increasing your hardness. I will describe a variety of exercises

I want you to try that will bolster your mobility, strength, flexibility, and endurance — and make sex even more pleasurable. Using such nutritional powerhouses as Pycnogenol, L-arginine, omega-3 fatty acids, horny goat weed, and a host of antioxidant supplements, men can prevent and reverse most hardness problems. I will also detail what prescription medications you may need to take — or not need at all.

If you take advantage of this knowledge and put into action a few simple measures I recommend, you can almost certainly optimize your hardness, enhance your relationship with your significant other, and lengthen your active years.

Although this is a book for men who clearly need to understand the relationship between sexual health and overall health, perhaps you are a girlfriend, a wife, or a male partner in a relationship and you're concerned about what's really going on. Well, this book is written for you, too. It is packed with all the practical, research-based information you have been longing for and it will help you understand the central role of an erection in a man's being so you will understand the changes that may occur over time. You may discover that the erection you save may also save your companion's life.

Overall, my hope is that The Hardness Factor will help everyone understand more about themselves as sexual beings and healthy individuals who want a long and vital life. This book offers real lifestyle suggestions that will rejuvenate you, help you gain control over your health — and your erections — and pave the way to feeling confident and powerful into the upcoming years. That is the reason for my book. In the following chapters, read and make the right choices in caring for your body as you begin your journey toward maintaining your hardness and health for life. Now, let's get started. And remember, hard is good; harder is better.

Be well. Dr. Steven Lamm