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It is crucial for men to pay attention when things feel different. A change in sexual function can be a marker for more significant changes in overall health. Erectile dysfunction (ED), the inability to get and keep an erection firm enough for sex, was once considered a routine part of getting older, and something to just accept.
As it turns out, ED can be an important marker for cardiovascular risk, particularly in younger men. Suffering from ED is on par with smoking, having high cholesterol levels or having a family history of heart disease when it comes to predicting cardiovascular risk. ED also shares risks with heart disease including hypertension, diabetes, smoking, high cholesterol, and obesity.
A doctor’s evaluation of ED should include screening for all the traditional risks for heart disease and an estimation of cardiovascular risk for the next 10 years. Men with elevated baseline risk for heart disease or a high risk of heart attack or stroke who also have ED should have additional testing.
Here’s an example: A 48-year-old man has a history of high cholesterol, high blood pressure and a family history of heart disease. He gets a yearly physical and knows he should change his diet and exercise more to improve his blood pressure and cholesterol levels. Yet he feels well, so he puts off making the necessary lifestyle changes. Over time he develops a problem with ED that keeps him from having sexual relations. He avoids situations that might lead to this intimacy. Over-the-counter treatments do not work, and he schedules an evaluation with a men’s health specialist.
Review of his blood work shows that his risk for heart disease is high despite his young age. The steady decline in sexual function suggests a vascular cause for his ED, and that increases his risk for heart disease even more. A coronary artery calcium score is arranged, and his test shows that he has significant coronary artery disease even though he is not symptomatic. Fortunately, he did not yet have a heart attack. He passes a stress test and starts working with a cardiologist on better management of his risk factors. Now he is eating more nutritious foods and exercising and has added years to his life.
After skin cancer, prostate cancer is second most common cancer in men, and the second leading cause of cancer death among men in the United States. Prostate cancer can be present without causing any symptoms, which is why screening is so important.
Screening for prostate cancer can be done with a blood test to check your prostate-specific antigen (PSA) levels, and a digital rectal exam (DRE) may be included. PSA is a protein produced by the prostate, and elevated blood levels of PSA may indicate a high risk for prostate cancer. A nodule detected on physical exam may also indicate risk.
Six major medical societies have published recommendations for prostate cancer screening. This has created confusion about how to screen, how often to screen and at what age to start and stop screening. What all the guidelines agree on is that screening should be a shared decision-making process between patients and providers. Characteristics such as age, health status and life expectancy factor in, and the risks and benefits of screening tests should be considered. African American men and men who have a first degree relative with prostate cancer are at higher risk and should consider screening as young as 40 years old.
We all experience stress at home and at work, and we tend to accept stress as an everyday part of life. When our ability to adapt to stress becomes overwhelmed, we begin to experience its negative effects.
Stress can cause;
Men are less inclined than women to recognize, talk about, and seek treatment when they experience a problem like depression. They are also more likely to appear angry or aggressive instead of sad, and the diagnosis can sometimes be missed.
If you are experiencing any of these symptoms, you should first talk with your primary care provider for an evaluation and to discuss treatment options.
For men dealing with depression, maintaining social connections, and staying close to family and friends can be helpful. Also:
Dr. Mark Paulos is an internist and co-director of the Men’s Health Center at The Miriam Hospital. He practices in both the department of urology and department of medicine and has faculty appointments in both at The Warren Alpert Medical School of Brown University. In his practice, he focuses on the link between sexual health disorders and metabolic and cardiovascular health.