Sexual health

Erectile dysfunction: A problem with a solution


Special to The Miami Herald

If you’re a man, and you’re reading this article, chances are you’ve experienced erectile dysfunction.

One out of two men over age 40 have had difficulty attaining and maintaining an erection sufficient for sexual intercourse, doctors say. And while the numbers are smaller, even some younger men may have difficulty developing an erection.

However, more than at any other time in history, erectile dysfunction is a problem with a solution, doctors note. Medications and external and internal treatments have improved dramatically, allowing thousands of men to return to healthy sexual functioning. Likewise the stigma has decreased with public awareness.

Over the past 20 years, increased media attention, scores of television ads for medications like Viagra and Cialis and starring roles in movies and television shows have moved erectile dysfunction out of the shadows and onto the list of common health concerns.

“If men have become aware of their treatment options, they’re aware it’s not just them,” said Dr. Lawrence Hakim, chairman of the department of urology and head of the Section of Sexual Dysfunction at Cleveland Clinic Florida.

Hakim cautions men to see a doctor. Erectile dysfunction is caused by a lack of adequate blood flow, he said, which can be an indicator of a potentially life-threatening health problem.

“Erectile dysfunction is a marker. It can be the first sign of other underlying disease,’’ Hakim said. “A guy starts having erection problems not realizing why… two years later he has a heart attack.”

The problem can result from a number of health issues, said Dr. Bruce Kava, chief of urology service at the Miami Veterans Affairs Medical Center and associate professor of clinical urology at the University of Miami Miller School of Medicine.

“The primary causes we see for people with erectile dysfunction are related to the vascular system … underlying heart disease, medications, surgeries, diabetes, high blood pressure,” Kava said.

Surgeries for prostate cancer, bladder and certain colorectal cancers may result in erectile dysfunction, he added.

While the problem primarily affects older men, Hakim said, he sees men from their teens into their 90s. In younger men, the problem is often a sports injury.

“Any contact sport you can think of whether it’s basketball, hockey, baseball, football, any type of trauma to the penis or scrotum … can have a significant and often permanent effect on their ability to attain and maintain an erection,” he said. Cycling as a sport can also cause erectile dysfunction, he said.

Regardless of age or cause, treatment options are the same, depending on the individual.

Pills like Viagra, now known as simply “the little blue pill,” Cialis and Levitra remain popular and effective treatments for some men. They vary in how long they work for, how quickly they metabolize in the body and the side effects they produce.

Viagra was the first to hit the market in 1997, followed by Cialis and Levitra.

“Cialis is the longest acting one. If you take a Cialis tablet, it will still be in your system up to 36 hours later,” Hakim said, increasing spontaneity.

Though the drugs are similar, because they are different chemical compounds, the response will be slightly different. Men who have not had success with one drug, may be helped by another. For example, men who have not found Viagra to be effective are having success with Levitra, Kava said.

The drug a couple chooses may depend on age, he said. Studies of couples and their sexual behaviors have revealed that “most couples, as they get older, actually have more regimented sexual behaviors. They usually have sex once, maybe twice during a full weekend.”

For them, spontaneity may not be as important. For younger couples, who have sex more often, “Cialis may be the best option for them.”

Side affects of all the drugs include headaches, flushing and a drop in blood pressure. Cialis may also cause back pain.

Men with heart problems and some other health conditions cannot take the pills, Kava said. The drugs can be fatal for men taking nitroglycerine or any nitrates, he said.

And for some men the pills don’t work, Hakim said.

“They are not magic pills,” he said. “Depending on the severity of the erection problems those pills will be less successful as it becomes more severe.”

The next level of treatment includes injections and vacuum pumps, both of which can be effective. While the thought of injections is less than appealing to most men, the results are excellent, Kava said. Patients are taught to perform the injections.

“I will tell you from thousands of patients, once they get the hang of it, the erection is of such high quality that many people continue to use the injectables. It’s a very natural feeling erection. It doesn’t hurt, and very rarely do we have anybody have any side effects.”

Though rare, one risk of injections and some drugs is prolonged erection or priapism, an erection lasting more than four hours, he said. “It can cause severe and irreversible damage to the inside of the penis,’’ Kava said.

If pill and external treatments are not effective, doctors say an internal prosthetic device is an option.

“It gives them the spontaneity and quality of erection that they can’t get with many of the other treatments,” Hakim said, including pills, injections or vacuum pump. “Internal devices or a penile prosthesis are effective continuously on demand, which means a man and his partner can achieve a full erection on demand and within seconds that contains itself as long as they want to have sex.”

While these surgeries have been performed since the 1950s, he said, improvements in surgical technique and devices are dramatic.

The 30-minute procedure is minimally invasive, and requires only a 24-hour hospital stay. Men may experience some discomfort for days or a couple of weeks, doctors say.

“Once they get beyond that period of time, and they start working with the device, they forget about the pain,” Kava said. “It’s a really satisfactory device as far as patients and their partners go.”

Hakim agrees.

“They have by far the best satisfaction rate for any treatment for erection problems, up into the 99 percent range,” Hakim said. “We see men every day with problems with prostate surgery or have had other significant medical problems who just can’t function … and you’re basically fixing that, giving them their life back.”

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