Erectile Dysfunction Podcast
Dr. Stormont, everyone sees those ED commercials on TV, but can you tell us what is ED… and is it just a fact of life for men?
ED stands for “Erectile Dysfunction” and it’s a condition that affects some 15 to 30 million men in the United States. It’s defined as the inability to achieve or maintain an erection sufficient for sexual relations on an ongoing basis.
ED affects men to varying degrees and many men will suffer an occasional episode for a variety of reasons -- like stress, being very tired or drinking too much alcohol. But having ongoing ED is NOT necessarily a normal part of aging. Suffering from ED can sometimes indicate a serious underlying problem that may require treatment.
You can imagine how untreated ED can damage relationships and lead to psychological problems for both partners. The good news is that many treatment options are available.
What causes ED?
ED can result when any of the internal systems that help create an erection fail to function properly.
Normally, an erection starts with physical or mental stimulation, which causes the brain to send chemicals to the nerves in the penis, and those chemicals cause the blood vessels to relax. Blood then flows into the penis, and becomes trapped within the spongy tissue, causing expansion and erection. The process requires normal amounts of the male hormone, Testosterone. Problems with testosterone levels or any of these systems can lead to ED.
Well, what kinds of conditions interrupt those systems?
It can be many things. Usually there is an underlying vascular cause, due to atherosclerosis, high blood pressure, high cholesterol or diabetes. In fact, ED has been called “the canary in the coal mine” because it can be the first sign of one of those underlying problems, which can be serious.
Also, neurological diseases, like Alzheimers, Parkinsons, Multiple Sclerosis, Stroke, and spinal cord injury can also cause ED. Pelvic or prostate cancer surgery or radiation is also known to result in ED. Hormonal imbalances, mainly from low testosterone can contribute. Some chronic diseases, such as liver, lung or kidney disease, emotional problems or certain medications (especially blood pressure pills) can lead to ED.
And as if that isn’t enough, poor lifestyle habits, including illicit drug use, smoking, alcohol abuse and lack of exercise may bring on ED.
Wow, that’s a lot of possibilities. How do you determine which it is?
To determine the cause of ED, a history and physical exam that focus on the above conditions can usually find the culprit. It’s sometimes necessary to order a couple of tests, like those for hormones, glucose and lipid levels. Or, a duplex ultrasound using high-frequency sound waves to measure blood flow in the penis may be used. This test is painless and may be the most effective to identify the cause of ED, by evaluating blood flow and looking for evidence of tissue scarring.
Once the cause is determined, how is it treated?
After the cause of ED is determined, couples can choose a treatment that suits their lifestyle.
First of all, men should begin to take measures to prevent the ED from progressing. This includes adopting a “heart healthy diet”, exercise, weight control and avoiding smoking to reduce the risk of heart disease, diabetes or depression, and the need for medications for these. Alternatives are available. If there are low levels of testosterone, supplements can be given, usually as a gel, patch or injection. If emotional problems seem to be the major cause, then a visit with a sexual therapist may be necessary.
Otherwise there are prescription pills called PDE-5 inhibitors, such as Viagra , Levitra and Cialis. These drugs vary slightly in the way they work, but they’re all safe as long as the man is not also prescribed nitrates. That’s something he needs to bring to the attention of his doctors.
I’ve heard about these external devices – do they really work?
Yes, they work, but they are often a little cumbersome. Vacuum devices fit around the penis and pull blood into it, and then use a rubber band to maintain the erection.
There’s also a urethral suppository that is occasionally effective – it involves placing a medicated pellet about the size of a grain of rice in the tip of the urethra.
Injections, which use a fine needle to inject a medication into the side of the penis to increase blood flow, may work, however they can rarely lead to priapism, which is a painful, prolonged erection.
All of these methods can work, but do have a high drop-out rate because they may not be effective in all cases, and they definitely diminish spontaneity for a couple.
It sounds like there’s no “silver bullet,” so to speak. What if NONE of these methods work?
If none of the methods we’ve discussed are working, the most successful and satisfying treatment for the couple is a penile implant, which requires a surgeon to place inflatable cylinders within the penile shaft. Implants are discreet, more spontaneous than any other treatment and allow a man to have an erection for as often and as long as he wishes.
