Erectile Dysfunction (ED)
What is ED?
Erectile dysfunction is defined as the inability to attain and or maintain an erection adequate for sexual intercourse.
What causes erectile dysfunction?
The main categories of erectile dysfunction are vasculogenic (due to poor blood flow), neurogenic (when the nerve pathways that trigger an erection are affected as in diabetes) and psychogenic (when physical changes triggered by worry or anxiety interfere with normal erection). Most men suffer from a combination of factors, and a careful history of the problem often leads to a diagnosis.
Who is affected by erectile dysfunction? How are men affected by erectile dysfunction? Is the problem getting better or worse?
Nearly 50 percent of men ranging in age from 40 to 70 years of age are affected by ED and nearly 40 percent of men will experience some problem with erections, libido or ejaculation by the age of 40. Men report guilt, shame and frustrations related to inability to perform. Due to repeated failed attempts, performance anxiety may present with subsequent attempts.
What is a little known fact about erectile dysfunction that the public should be aware of?
The presence of the condition is a precursor to the nation’s leading cause of death in men, cardiovascular disease. Since ED usually presents 3 to 5 years prior to cardiovascular disease, recognizing risk factors is crucial in addressing potential heart disease in men with ED.
What are the different types of treatments for erectile dysfunction? What can be expected during a physician’s visit to discuss ED and treatments of ED?
Treatment for erectile dysfunction always starts with an assessment of the root causes of the problem and making healthy lifestyle changes to address those risks. Addressing psychological factors is always part of the treatment plan and is sometime the most important aspect of care. Non-invasive testing like an ultrasound and Doppler can help guide decisions about using oral medications, gels inserted into the urethra or intracavernosal (penile) injections. For men who have difficult to treat erectile dysfunction, or who prefer a more permanent solution, implant surgery is an option with a high rate of patient satisfaction.
Are there any new treatments available for erectile dysfunction?
Several newer therapies are in development and show promise. Low-intensity shockwave therapy (LISWT) has been used successfully to help with wound healing and healing of bone fractures. Research in animals shows that this type of treatment stimulates the growth of new blood vessels and recruitment of stem cells to the penis. Clinical studies in men with ED responsive to medications like Viagra show promise, but this treatment has not been standardized and is not yet FDA approved for the treatment of erectile dysfunction. The American Urologic Association guidelines do not currently recommend this treatment outside of clinical trials.
How effective are the treatments for erectile dysfunction?
Response to treatment depends on the cause of the problem and the type of treatment. Response to oral therapies can be as high as 70%, and the rate of satisfaction in men who have surgical treatment for ED is more than 90 percent. Men who are committed to addressing the root cause of the problem (diabetes, sleep disorder, smoking) have a better response to treatment. Having a supportive partner is also an important factor.
Is the Men’s Health Center at The Miriam Hospital unique in the treatment and services it offers for erectile dysfunction?
The Men’s Health Center employs a multidisciplinary model of care that takes into account all factors that may contribute to sexual dysfunction. Patients undergo a thorough “cardiometabolic” workup to address the root cause of the problem and determine if additional cardiovascular testing is necessary. Surgical treatment options are available, and the incorporation of psychology and physical therapy provides a level of care not available at other centers.
Are support groups available for erectile dysfunction?
Support groups are available for prostate cancer survivors who are affected by ED. Forums include questions about oral and injectable meds, urinary incontinence and coping after a diagnosis. Some groups meet face to face while others are entirely online. Online forums may be more appropriate for some individuals given the nature of the conversations.