House Calls / Dr. Michael Schwartz
A very common complaint of male aging is erectile dysfunction [ED]. This disorder is characterized by the inability to achieve or maintain an erection. Men are bombarded daily by advertisements from pharmaceutical companies on the television, radio and even in magazines. Whether watching a sporting event, surfing the Internet, listening to the radio or even riding the bus to work, the public is subjected to countless ads for medications to treat the disorder.
It is estimated that more than 30 million Americans suffer from erectile dysfunction. ED is never an easy topic for a patient to discuss at an office visit. Usually, it is brought up at the end of a visit for an unrelated complaint. Men are often embarrassed and although they will seek guidance for this condition, they are not comfortable discussing the specifics of the disease. Nevertheless, a comprehensive history and physical may help diagnose and treat the problem.
"Patients with ED need to understand that there is nothing wrong with their masculinity," said Dr. Stephen Batter, a Norwalk urologist. "Everyone is at risk for ED at some point in their lives and it doesn't only happen to `the other guy.'"
ED may have medical, neurologic or psychological causes. For example, patients with high blood pressure, elevated cholesterol and diabetes may have vascular (blood flow) reasons for the disease. Psychological issues such as stress, depression and excessive alcohol intake will frequently worsen the symptoms of ED. Other causes include hormones (low testosterone), surgical procedures (prostate) and treatments for certain diseases (e.g. high blood pressure). All will affect the intricate process of achieving an erection.
Initially developed as a class of blood pressure medications, the phosphodiesterase (PDE) inhibitors (e.g. Viagra, Cialis and Levitra) are used to treat ED. These medications work by increasing blood flow to the penis. Although very ineffective for treating high blood pressure they were proven very effective in treating ED, and have been marketed accordingly. Unfortunately, they do have some potential side effects. These include headaches, lowering of blood pressure, changes in vision and hearing loss. All of these medications are dispensed by prescription only and must be ordered by a physician. Too often, these drugs are "shared" among friends. This is a dangerous practice given the fact that certain medications are contraindicated, (i.e. interact negatively) with the PDE medicines and may result in a potentially life- threatening event. Additionally, these medicines are frequently ordered by patients online, often from foreign countries. This too is risky since you never know if you are truly getting the real drug.
Testosterone replacement therapy is used for patients with documented low testosterone levels. This male hormone is essential for libido and low levels may contribute to ED. A blood test can be performed to assess your level and whether replacement therapy is warranted.
Penile injections and suppositories work by dilating the blood flow into the penis. Effective over 80 percent of the time, these medications are absorbed directly into the penis. They usually work within 10 to 15 minutes.
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Penile implants (prostheses) include both semi-rigid and inflatable devices. They require a surgical procedure performed by a urologist. In general, these implants are used as a last resort when the cause of the ED is unlikely to resolve with more conservative approaches.
ED pumps work by creating suction over the penile shaft, causing an increase in blood flow resulting in an erection. In addition, a penile ring may be used to prevent blood from prematurely flowing out of the penis during an erection. These devices may be prescribed by a urologist or primary care physician.
Natural herbal supplements such as yohimbe, saw palmetto and Ginkgo biloba have been used for ED, but their efficacy has never been proven.
Dr. Batter also recommends behavior modification including weight loss, blood pressure control, smoking cessation and seeing your primary care physician regularly.
Erectile dysfunction has many causes. Its effect on personal relationships is well documented. Some studies suggest that more than 60 percent of men over 40 suffer from ED. The first step is to visit your doctor for a comprehensive exam. Treatment options are available and are effective. Don't treat ED as an after-thought. It may indicate a more significant underlying disease.