By Barbara Pierce
The most common sex problem that men talk to their health care professional about is erectile dysfunction or ED, according to urologyhealth.org.
Physician assistant Christopher Emerson of Upstate Urology at Mohawk Valley Health System shares some things we should know about this condition:
1 — How prevalent is ED?
Erectile dysfunction is a very common condition, particularly in older men, said Emerson. Fifty percent to 70% of men older than 60 may have ED; 30% to 40% of men aged 30 through 59; only 3% of men younger than 30.
2 — What exactly is ED?
ED is a complex condition with various psychological and physical features that cause it. Also known as impotence, it’s the inability to get and keep an erection firm enough for sex.
Most men have some problems with erections from time to time, but if ED happens much of the time, it should be treated. Finding the cause will help treat the problem and help with your overall well-being.
3 — What are the causes?
Emerson shared the top causes:
• Limited blood flow to the penis: Anything that limits blood flow to the penis can cause ED; many health issues can cause limited blood flow, such as arteriosclerosis (clogged arteries), high blood pressure or pelvic trauma. Men who have clogged arteries in their heart often have the same problem with the arteries that supply the penis — ED could be the first sign of developing a heart attack in the future.
• Neurologic disorders such as multiple sclerosis, Parkinson’s disease, spinal injuries, diabetic neuropathy, radiation side effects or consequences of surgery may be a cause.
• Hormonal problems: Low levels of testosterone or excessive levels of estrogen which can cause a low sex drive. Testosterone is the main sex hormone in men. If testosterone levels drop below the normal range, the result can be an inability to get and keep an erection. Men who have unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, radiation therapy to the testes, HIV or a history of chronic drug use are at risk for low testosterone. Some try testosterone replacement therapy as a treatment.
• Psychological factors like anxiety, depression, stress and a variety of other emotional issues can be a cause.
Difficulty achieving and maintaining a suitable erection can be a side effect from many medications, both prescription and over-the-counter.
• Lifestyle choices can contribute to all of the above causes, including cigarette smoking, physical inactivity, a poor diet, excessive use of alcohol or substance abuse.
In the past, many men were told by their health care professional: “It’s all in your mind” and sent home. Now, for most men, health care professionals are able to pinpoint the cause of erection problems and successfully treat 90% to 95% of them.
4 — How is ED treated?
Treatment must be tailored to the individual, as it depends on a detailed history and physical examination, said Emerson. Blood tests and hormone analysis may be required. Sexual partners are often invited to the discussions so both partners can share the same information and understand the recommendations and goals of treatment. Sometimes an ultrasound vascular flow study of the penis is helpful in designing the best solution.
Treatment possibilities include: Medication classified as PDE-5 inhibitors, such as Viagra, Levitra, Cialis, and a more recently approved drug, Stendra, helps dilate the blood vessels and improve blood flow to the penis.
Other options include a venous constriction ring that fit firmly around the base of the penis to inhibit premature loss of an erection. Or a vacuum erection device that creates an erection in a plastic cylinder which can then be maintained by a very snug ring around the base of the penis. Intra-corporeal injection therapy uses self-injection of the penis with very small amounts of vaso-active medications each time an erection is desired. Penile implant–prostheses are surgically implanted and come in a variety of types, rigid, semi-rigid and inflatable.
The majority of men with ED can be sufficiently helped using the PDE-5 inhibitors, said Emerson. Occasionally the side effects of the medication — most often headaches — are severe enough to require alternate treatment. Also, these medications cannot be used by anyone that requires nitroglycerin or similar cardiac medications as the combination might result in a dangerous drop in blood pressure.
Low testosterone levels can cause a man’s sexual desire to decrease enough to contribute to ED. Replacing his testosterone to normal levels can sometimes be all that is needed to solve the ED problem.
5 — What if treatment doesn’t work?
More than one treatment modality may often be required, said Emerson. If the first doesn’t work, your health care professional will try another.
Don’t be embarrassed to talk about this. Find out if there could be an underlying health issue that might be causing erectile dysfunction. The longer you ignore the symptoms, the more embedded the problem might become.