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Erectile Dysfunction: A Complex Problem with Many Solutions

Don't Suffer in Silence. Learn Why ED Affects So Many Men and How to Overcome It

Erectile Dysfunction (ED) affects more than half of American men over age 50, and none of them are happy about it. With each passing decade beyond 50 the incidence of ED increases by another 10%. Aging, diseases like diabetes and high-blood pressure, low levels of testosterone, smoking, and certain medications all contribute (see table 1). The good news is that even in these settings the problem is virtually always treatable. There is no reason whatsoever to suffer in silence. An understanding of what's involved in the evaluation and the full-spectrum of treatment options opens the door to renewed vitality.

  • How the Penis Works: The penis contains two spongy cylinders called corporal bodies. When a man is sexually stimulated blood rushes in and is trapped within these cylinders resulting in an erection. When the stimulation ends (or typically after orgasm) the blood is released and the penis softens.
  • Evaluation of ED: When a man presents to my office with a complaint of ED I take a thorough medical history and I ask a few questions like "How long have you had the problem? Was the onset of ED related to any recent medication changes, trauma, or stress? Do you get any erections ever? How's your libido (sex-drive)?" A physical exam will include a penile and testicular exam, and if he's over 40 a prostate exam. I'll look for sugar in the urine (which could indicate undiagnosed diabetes) and order at least a testosterone level (adding a PSA blood test if he's over 40). I'll often schedule a penile Doppler (ultrasound blood flow test) exam, which documents the blood flow into the penis and the ability of the erect penis to store blood. You might wonder: Why not just prescribe a pill? I greatly prefer to sort out all of the conditions and fully document the nature of the problem. It's just good medicine. Why not just buy the pills over the internet? Because you cannot afford to overlook the potentially serious causes of ED. Diabetes and hypertension (high blood pressure) can kill you. Hypogonadism (low testosterone level) can affect your entire body, not just your penis. Take this seriously, and see a qualified physician. Not only will you get help, you'll get all your bases covered.
  • Treatment Options: Since the late 1990s millions of men have found a solution in a pill form: Viagra, Levitra, and Cialis have been used safely and effectively for millions of men. These drugs block an enzyme called PDE-5 (see sidebar next page) potentiating the erection. But for every man they help there is one who doesn't find this to be the magic bullet: 30-50% of men fail to respond to these pills. These drugs need something to work on: a man who gets NO erection will not respond to a pill. Also the cost of these drugs (approximately $15/pill) and the side effects (facial flushing, headache, visual disturbances, nausea, backache, etc) limit the satisfaction delivered by this apparently simple remedy. Here's where knowing a good urologist can help.

Vacuum cylinders (fondly referred to as "penis pumps") are mechanical devices that help some men. Like anything, quality matters: we offer free demonstrations of high quality vacuum devices in our office. Although simple to use, a constricting band is applied to the base of the penis to hold the blood in and it can be both uncomfortable and creates a poorly-supported, floppy erection that may not be satisfying to the patient or his partner. Consequently, 80% of men who try a pump decide its not for them.

We can also teach penile self injection with a drug like prostaglandin that enhances blood flow; this idea takes a little getting used to but works well, often even in the man who has no ability on his own. Drawbacks include pain and scarring; 70% of men who start this therapy stop it within a few years.

So many men work their way through these options, often incompletely satisfied and unable to enjoy a sexual relationship. And here's a depressing thought: the longer you go without consistent erectile function, the shorter and smaller your penis gets! We call this "atrophy" and its similar to what happens to your leg in a cast for a long period of time. The adage "use it or lose it" comes to mind..

For those who don't find pleasure in a pill, pump, or shot, and want a permanent and very satisfying solution some urologists offer inflatable penile prosthesis surgery. These "internal pumps" have been available since the 1970s and boast an unheard of 98% satisfaction rate. There have been many advancements over the years (including infection reduction techniques, less invasive surgical procedures, and development of devices that provide penile girth and length enhancement) which have made this option more appealing to doctors and patients alike. Prostheses represent the solution that offer the most spontaneity and the best erectile quality. The device is implanted in under an hour through a tiny 1 ½ " incision, often as an outpatient, and occasionally even under local anesthesia; it is completely concealable and easy to operate. It gives satisfying tumescence and partner satisfaction is exceptionally high. Medicare and some commercial insurance carriers cover the costs. I do lots of surgery for lots of urological conditions; this is THE procedure I get thanked for on a regular basis.

Bottom line: there is no reason to suffer in silence. Don't let feelings of embarrassment get in the way of sexual intimacy and enjoyment. Life is just too short.

Article Reviewed: August 8, 2012
Copyright © 2015 Healthy Magazine
Steven N. Gange, MD

After completing his education at the UCLA School of Medicine and the University of Kentucky, Dr. Gange entered the US Army as a urologist, where he was twice awarded the military medal of meritorious service. Now at the Western Urological Clinic, Dr. Gange works to advance the field of urology and serve the community. He researches prostate cancer, BPH, prostatitis and more and is widely published. Locally, Dr. Gange is president of the Utah Healthy Living Foundation, which works to improve Utah's health through education and screenings. He is the former chair of the Prostate Cancer Task Force in Salt Lake, and former chief of surgery at St. Mark's. Dr. Gange lectures to physicians and lay audiences nationally.
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