The Time is Right…But are you Ready?
Sunday, December 19, 2010
By Robert C. Robinson III, MD
Sexual performance is a topic of increasing popularity these days.  From ads of “natural male enhancement” to prescription medications, everyone seems to have an opinion or claims to be an expert on the topic. What makes this even more confusing is the number of terms tossed around when addressing this issue.  From impotence to erectile dysfunction to low libido, the terms vary widely with no guidance as to what distinguishes one from the other. While there have certainly been several advancements in the treatment of sexual dysfunction, it is important that you are well informed before you make a decision as it relates to the treatment options that might be best for you. Here we will provide some insight on this topic to help you navigate through the sea of information on the topic of erectile dysfunction.
What is erectile dysfunction (ED)?
Erectile dysfunction is defined as the repeated inability to achieve or maintain an erection firm enough to engage in sexual intercourse.  This can range from a complete inability to achieve an erection to an inconsistent ability to do so, or the ability to maintain only brief erections.  This differs from impotence which describes other problems that interfere with sexual intercourse and reproduction including lack of sexual desire (low libido) and problems with orgasm or ejaculation. The spectrum of this disorder makes defining ED difficult.
Who suffers from it?
It is estimated that between15 to 30 million American men suffer from some form of ED.  It’s important to recognize that men of any age may be afflicted by this highly treatable condition.  While it is often assumed that this is a problem only for older men, it has been shown that approximately 5 percent of 40 year old men suffer from erectile dysfunction.  This percentage increases dramatically for men age 65 or older to 15 to 25 percent.
What are the causes?
While most cases of ED are related to a physical factor, there may be other issues at play when it comes to a man’s inability to perform sexually.  Some of the more common causes of sexual dysfunction are due to chronical medical problems, medication, psychological stressors, or lifestyle habits.
•    Physical/ Medical
The leading cause of erectile dysfunction is physical abnormalities.  These include damage to the nerves, arteries, or muscles of the penis which are responsible for achieving an erection.  The nerve, blood vessel, or muscle damage may actually be the consequence of other medical conditions that have been mismanaged, ignored, or undiagnosed.  Conditions such as diabetes, vascular disease, alcoholism, and neurologic disease are responsible for approximately 70 percent of cases of ED. These ailments can all have a negative impact on blood flow and nerve function-both critical factors in a man’s ability to achieve an erection.
Studies indicate that between 35 and 50 percent of men with diabetes experience erectile dysfunction.
•    Psychological
Stress and anxiety can certainly lead to issues with sexual performance.  Recognize the stressors in your life that may be impacting your sexual health.
•    Lifestyle
Smoking, being overweight and lack of regular exercise all increase a man’s risk of suffering from ED (makes that membership to the local gym seem worth it, huh?)
•    Medications
Just as certain medical conditions may contribute to the development of ED, the medications used to treat some of these conditions may also adversely affect your ability to achieve an erection.  Some common culprits are:
Beta blockers- Most often used to treat blood pressure
Antidepressants- Used to treat depression
Appetite Suppressants-Often used to assist in weight loss
Antihistamines- Often used to treat allergy symptoms
If you feel that your medications could be contributing to your ED issues please talk to your healthcare provider.  There may be alternative therapies available to treat your condition without causing ED.  You should NEVER stop taking any prescribed medications without first speaking with your physician.
How is erectile dysfunction diagnosed?
Your physician will use a combination of medical history, physical exam, laboratory tests and in some cases a specialized sleep test to determine the cause of your ED.  If you believe that you are suffering from any of the signs or symptoms of ED speak with your healthcare provider.
How is erectile dysfunction treated?
The treatment of ED has evolved over the years.  Let’s review some of the common treatments used today:
•    Psychotherapy
If it is determined that your ED is the result of stress or anxiety, your healthcare provider may recommend counseling or provide techniques that reduce the anxiety and stress associated with intercourse.  These techniques are also often helpful in relieving the anxiety of ED from physical causes.
•    Oral Medications
By now most of us are familiar with the number of FDA approved medications used for the treatment of ED.  These popular medications often with ads televised during major sporting events, include pills that can be taken either an hour before planned sexual activity or in small dosages daily.  They work by relaxing the smooth muscles in the penis which allows for the increased blood flow necessary to achieve an erection.  These medicines improve the response to sexual stimulation but do NOT cause an automatic erection.  It is also important to know that none of these medications should be used more than once a day.
•    Injectable Medications
Injections can also be used.  Medicine can be injected directly into the muscles of the penis causing an automatic erection.  They also have been known to cause unwanted side effects including scarring and persistent erection (an erection lasting for greater than 4 hours).
•    Hormone Replacement
Those men who have low testosterone levels as the cause of their ED may benefit from oral testosterone replacement or testosterone gel.
•    Mechanical Devices
Vacuum devices have been useful in some cases.  These cause an erection by creating a partial vacuum drawing blood into the penis and engorging it.
•    Surgery
In severe cases of ED, surgery may be recommended by an urologist.  This is obviously the most invasive therapy and is reserved for men who may not benefit from the other forms of therapy mentioned above.
Which treatment options are best for me?
It is important to consult with your healthcare provider to determine which form of treatment is safe and appropriate for the treatment of your ED.  Be sure to inform your healthcare provider of all the medications that you are taking (including over-the-counter medicines) and provide them with your complete medical history as this may influence the treatment options that are appropriate for you.
ED is treatable at any age.  Speak to your doctor and don’t delay.  With increasing awareness and improvements in the treatments for ED, more men have been seeking help and returning to normal sexual activity.  Make sure when the time is right, your'e ready!
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This article was printed in the December 19, 2010 - January 1, 2011 Edition.

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