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What Men Should Know About Erectile Dysfunction

04 May 2019

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More than ten years ago, in March of 1998, a little blue pill called Viagra was given the green light by the FDA. It was the moment that revived millions of marriages and launched even more punchlines.

Fact is, the effect of Viagra on penile erections was discovered accidentally. Scientists at Pfizer were testing sildenafil, a new drug for lowering blood pressure. At the drug trial’s conclusion, test subjects did not want to return the remaining pills to the scientists because they’d begun noticing harder, firmer and longer-lasting erections. Erectile dysfunction (ED), it seemed, had become a very treatable medical condition.

In many instances, this has been the case. Viagra, Cialis and similar drugs may be the best-known treatments for erectile dysfunction, but they certainly are not the only treatments. There are also multiple causes and degrees of ED. We asked INTEGRIS Health urologist Dr. Mike Holzer to tell us more.

What does the term ‘erectile dysfunction’ or ‘ED’ actually mean? 

ED is the recurrent or consistent inability to attain and/or maintain an erection sufficient enough for sexual satisfaction. So essentially, it is a spectrum. Some men have no erections at all, some are frustrated they sometimes can't maintain an erection and so on. The main point is that if a man is not satisfied with his ability to get or maintain an erection, then he meets the definition of ED.

What are the causes of erectile dysfunction?

There are several different causes of ED. Most commonly, ED is due to aging and medical conditions such as diabetes, hypertension or vascular disease. ED can also be a side effect of prostate cancer treatment. Sometimes, psychological causes can impact ED as well. Regardless of the cause, however, the treatment options are generally the same. 

How can erectile dysfunction be treated? Can every case be treated?

There are a number of treatments available. The most common treatment is with a type of medication called PDE5 inhibitors. You've probably heard of these types of medications, which include Viagra and Cialis.

To put it simply, these medications help improve blood flow to the penis and can be very effective at improving erectile dysfunction. These medications do have downsides: they have be taken at least 45 minutes ahead of time, food and alcohol can decrease their effectiveness, and they don't work for everyone.

Some men complain of a headache or congestion when taking these medications. They can also be expensive, as most insurance companies don't pay for ED treatment.

Most importantly, they can interact with certain heart medications. Men who take certain heart medicines can't take Viagra, Cialis or other PDE5 inhibitors.

If medication is not effective, other options include using a Vacuum Erection Device (VED) or penile injections. A VED is a cylinder placed over the penis that uses vacuum suction to pull blood into the penis.

Penile injections involve injecting a medication similar to Viagra or Cialis directly into the penis with a small needle or via the urethra with something called an “intraurethral pellet.” Since it is most often given directly into the penis, it can be a more concentrated dose of medication and is typically very effective, even in men who did not have an adequate response to pills.

All of these treatments require a prescription from a physician, as not every patient is a candidate and there can be side effects. Like the commercials say, "If you have an erection longer than four hours, please consult your physician."

If the above options fail to improve a man's ED, surgery can be performed to insert a penile prosthesis. This is typically a device placed in the penis that inflates and deflates by the patient "pumping" a small bulb that is placed in the scrotum. Like all surgeries, there are risks of complications. So, while it is very effective and satisfaction rates are high with the operation, physicians typically reserve that option for men who have failed the other options listed above.

Is erectile dysfunction an isolated condition or can it be an indicator of something else?

Great question. While we do see the incidence of ED increase as a man gets older, it is often partly caused by other medical conditions such as diabetes or high blood pressure. A man with ED should be evaluated for such diseases.

There is an association between ED and heart disease, and this conceptually makes some sense: if a man has issues with poor blood flow to his penis due to narrowing of those arteries, he could certainly have narrowing of the arteries that supply his heart as well.

What would you say to a man who is embarrassed to bring it up to his doctor?

ED is an extremely common health condition. It affects up to 30 million men in the U.S., so a man shouldn't be embarrassed to bring it up. Many doctors (especially urologists) discuss these issues with men and their partners on a daily basis. I try to make the discussion as comfortable as possible. Since there are lots of options that can help, it's definitely a conversation worth having.

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