Lets discuss erectile dysfunction.
Erectile Dysfunction are two words that seem to be kick to the balls to every man out there.
Many men believe that this disorder, yes it is a disorder is something than only affects older men. They think I have nothing to worry about.
What if I told you that ED affects 22% of men at age 40 and 49% of men 70 and older. Seems to touch a little closer to home doesn’t it.
First we must begin with what is exactly erectile dysfunction, some smart people define ED as the inability to obtain an erection or keep an erection firm enough to have sexual intercourse.
Analogy: Imagine a game of football, yes a game of football. In the game of football you have nitric oxide(running back) and phosphodiesterase 5 (PDE5) (linebacker). In a man with normal sexual function, when he gets an erection nitric oxide enters the penis, which causes blood to enter the penis and boom touchdown and erection.
In a man with ED, PDE5 tackles nitric oxide right before he can score a touchdown (erection). Some medications have the ability to block PDE5 to help nitric oxide enters the penis and score a touchdown (erection). Think of these meds as the offense line. We will discuss these medications in a few.
What causes ED???
So what causes ED, you have to know the cause to help fix the issue. In the above analogy I gave you a break down of one of the causes of ED.
- The major cause of ED is diabetes (high blood sugar), yes high blood sugar could be hampering your sex life. Men with diabetes are three times more likely to have ED.
- A low testosterone level also causes ED and obesity causes testosterone to convert to estrogen , which further decreases your testosterone level.
- Coronary artery disease which is the build up of plaque (fat) in blood vessels. The “fat” in blood vessels decrease blood flow to the penis. Hypertension (high blood pressure) can cause damage to the blood vessels again decreasing the amount of blood flow to the penis. Nerve damage can also result in ED. If the nerves are not firing in the penile area there will be no erection. Substance abuse (tobacco, alcohol, and drugs) can cause ED.
- One of the most significant issues involving erectile dysfunction can involve psychogenic causes. This can be stress, anxiety, and pain. Let your provider know if you are having any of these issues related to your sexual arousal.
If you are suffering from ED you can expect your provider to draw some bloodwork to help determine the cause. Your provider will most likely draw a serum glucose or A1C, which will let them know if your diabetics. Remember 50 % of diabetics have ED, so treating you diabetes may improve your sexual function.
Your provider may check you lipid levels (coronary artery disease). Lipids help determine some of the “fat” in your blood. Decreasing your lipid levels may help improve blood flow.
Checking your testosterone level will determine if hypogonadism (low levels of test) is the cause of ED. A level less than 300, is diagnostic for hypogonadism and may require supplementation by a provider.
Other labs that are helpful are a follicle stimulating hormone (FSH), lutenizing hormone (LH), PSA (prostate screening tool), CBC (compete blood count) and prolactin levels.
Some of the general things that can be done to help with ED is; psychological support,. Alternative sexual techniques (cuddling, foreplay, mutual masturbation), lifestyle changes (exercising daily, healthy diet, eliminating substance abuse, and managing chronic diseases (high blood pressure, diabetes, and coronary artery disease)
When we discussed our analogy we discussed viewing PDE5 as the line backer that stops nitric acid before it scores a touchdown. Medications that help ED are medications that block PDE5. These medications include Viagra the store name for sildenafil, Levitra (vardenafil), and Cialis (tadalafil). Think of these medications as the offense line against PDE5. A side effect of these medications are
Testosterone can be given if a patient has a low test below 300 after a morning check.
There are intraurethral medications (MUSE)that are placed up the “pee hole” which can help with an erection. The erection typically occurs in 5 to 10 minutes and can last 30-60 minutes. This technique requires patient education.
Another treatment option is intracorpeal injections which requires the injection of a medication into the corapeal muscle to obtain an erection. This treatment option can causing priapism (erection lasting way too long).
Be sure to discuss with your provider what options would be best for you to treat your ED.
New Hope: There are new drugs being developed that may help with ED. An Bremelanotide PT-141 shot that may be on the way that could help increase sexual desire in men and help obtain an erection. The medication was originally created as a tanning med but was found to give out erections. This medication acts on the nervous system unlike Viagra and the PDE5 blockers which work in the blood stream. Side effects include increase in blood pressure and of course darkening of pigment.
Erectile Dysfunction can be caused by vascular (Blood flow) issues (hypertension, coronary artery disease, and diabetes). Psychogenic (anxiety, pain, stress). ED can occur because of obesity and lack of exercise.
Labs: Your doctor may order testerone level, CBC, glucose, PSA, lipids, and other labs to see what is causing the issues.
Meds: Remember most first line agents work by blocking PDE5. If these medications do not work there are other options (injections and intraurethral suppositories). Always discuss with your healthcare provider what option would be best for you.