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Erectile Dysfunction: Difficult to Talk About but Often Easy to Fix

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Talking about sexuality isn’t easy for many people. Embarrassment, shame, or anxiety can prevent partners from having meaningful conversations about sex or talking to their doctor about problems in the bedroom.

This is often seen in men who suffer from erectile dysfunction (ED), which is defined as having trouble getting an erection – sometimes or at all – or being unable to keep an erection long enough for sex. Many men associate erections with masculinity and believe that a good sex life is the essence of being male.

However you feel about it, ED is relatively common and quite treatable, according to Adam Baumgarten, MD, assistant professor of Genitourinary Reconstruction and Prosthetic Urology at UAB Medicine. “Thirty million men suffer from ED at any one time, and about one in four men will experience some form of erectile dysfunction in their lifetime,” he says.

Causes of ED

Most often, ED can be traced to issues associated with circulation, the nervous system that controls the body’s functions, or the system of glands and organs that produces chemicals called hormones. Sometimes, ED is directly related to certain chronic medical conditions like diabetes, high blood pressure, high cholesterol, and heart or kidney disease.

“The blood vessels in the penis often are the first ones impacted by cardiac issues,” Dr. Baumgarten says. The good news? “If we can correct the underlying reasons for ED, the patient may see in improvement in erectile function.”

Other times, ED occurs as a result of treatment for another condition or as a side effect of medication. For example, prostate cancer treatment can lead to ED, as can surgery for bladder cancer. Medications linked to ED include antidepressants, blood pressure pills, and opioid painkillers.

When medications are the culprit, a prescription change may resolve ED. “Occasionally we get referrals and speak to the patient’s psychiatrist, cardiologist, or primary care provider to see if his medication can be changed,” Dr. Baumgarten says. “We often see improvement once the switch is made.”

Behavioral Factors

Certain behaviors also can cause ED or make it worse. These include smoking, heavy drinking, recreational drug use, and physical inactivity. According to Dr. Baumgarten, “Smoking doubles your risk of erectile dysfunction, because it can impair the smooth muscle relaxation of the blood vessels in the penis.”

Psychological issues such as anxiety and depression can contribute to or worsen ED, too. The same holds true for stress, low self-esteem, sexual guilt, and fear of sexual failure.

“ED can definitely be a standalone issue,” Dr. Baumgarten says. “Erections are complicated, involving nerves, blood vessels, and the brain.” When the brain triggers anxiety or doesn’t trigger sexual desire, it can impact erectile function. “For example, patients may have performance anxiety, and sometimes they can benefit from sex therapy.”

Many people assume that ED is inevitable in older men, but Dr. Baumgarten says this is a misconception. “As men age, they tend to have more medical problems, such as cardiac issues or issues with blood pressure,” he says. “Those medical problems can lead to ED.”

Although sexual interest and testosterone levels can decline with age, ED isn’t an inevitable result, Dr. Baumgarten adds.

Treating ED

Most men have their first conversations about ED with their primary care doctors. “It’s a sensitive subject to talk about, and many patients don’t want to talk about ED or their sex lives,” Dr. Baumgarten says. “A man might have a consistent inability to sustain an erection sufficient for intercourse, brief erections, or erections that aren’t rigid enough for intercourse. We’re here for all of those patients and want to help.”

Patients of the UAB Urology Clinic usually are referred by their primary care doctor, but some men start their ED treatment journey at the clinic. Almost always, treatment begins with pills designed to increase blood flow to the penis. These include:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra and Staxyn)
  • Avanafil (Stendra)

 

Typically, the medication is taken 1-4 hours prior to sexual activity and no more than once per day. Sildenafil and tadalafil are available in generic form, making the pills significantly less expensive than the brand-name versions.

While ED medications are safe for most men, some people should not take them. Men who are taking nitrite medications – usually for chest pain, congestive heart failure, or pulmonary hypertension – should avoid ED pills, as they can cause a severe drop in blood pressure.

According to Dr. Baumgarten, 70% of men with ED are successfully treated with pills. “The good news is that we also have treatment options for the other 30%,” he says. “Virtually any man can get an erection.”

Patients must ask themselves how important erections are – and which treatments they’re willing to consider. One option is penile injection therapy, where the man injects a medication into his penis for an immediate erection. Alternately, a device known as a penile prothesis that permanently corrects ED can be surgically implanted. Two less popular treatments are a vacuum device that pulls blood into the penis and a suppository that’s inserted into the urethra prior to intercourse.

Dr. Baumgarten says a growing number of men are asking about shockwave therapy, a procedure that uses low-intensity soundwaves similar to those used to break up kidney stones. In theory, shockwave therapy applied to the penis increases blood flow and promotes the growth of new blood vessels.

“Currently, the two main urologic and sexual medicine societies (the American Urological Association and the Sexual Medicine Society of North America ) view shockwave as an experimental treatment for ED,” Dr. Baumgarten says. “The jury is still out on whether or not it works and who it might benefit.” UAB Medicine does not offer shockwave therapy for ED.

The Importance of Seeking Help

Despite our society’s reluctance to talk about sex, there’s little doubt that having a fulfilling sexual relationship contributes to a man’s physical health and emotional well-being. While it can be difficult to have a conversation about ED with one’s partner, doctors are available to help. Evaluation and treatment are straightforward, often enabling men to improve their quality of life while also addressing underlying health issues that may play a role in ED.

“The healthier you are, the better your erections are going to be,” Dr. Baumgarten says.

Click here to learn more about erectile dysfunction, the treatments UAB Medicine offers, and to make an appointment at the UAB Urology Clinic.