Erectile dysfunction (ED) is common and is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Erectile dysfunction is strongly age related and affects as many as 30 million American men. While there is an estimated prevalence across all ages of about 10%, the prevalence rises to over 50% in men between 50 and 70 years of age. While ED is common, only a small percentage of men ever discuss this problem with a physician.
It is important to listen to men with ED and make them feel comfortable with what can be a troubling symptom for them. ED may also occur with cardiovascular disease, neurological disorders, after pelvic surgery or trauma, with diabetes and as a consequence of certain medications used commonly. Dr. Nudell works hard with patients to deliver a comprehensive approach to both diagnosis and treatment of ED. This can includes hormone testing, non-invasive ultrasound measurement of blood flow, and trials of medicine and non-medicine treatments. He believes that ED is NOT “in the patients’ head” but rather that it is a real medical issue.
Currently, there are a number of lifestyle changes and treatment options available for men with erectile dysfunction. Among the treatment options are:
Changing habits and medications
Quitting smoking can be an important step in reducing the impact of impotence or eliminating it altogether. Small changes in prescription medications may also help improve erectile quality.
Some cases of ED are caused by irregular levels of sex hormones (such as low levels of testosterone, excess prolactin and excess estrogen), these conditions are usually treatable with excellent results.
Because ED can result from a combination of psychological and physical factors, counseling can lessen anxiety, which in turn may reduce the impact and duration of the condition. This therapy is often used in combination with other treatments directed by a physician.
This treatment involves the use of an external vacuum device and one or more tension rings (basically rubber bands). The device works by inserting the penis into a plastic cylinder, which is then pumped to create a controlled vacuum. Once an adequate erection is produced, a tension band is slipped around the base of the penis to maintain the erection; the vacuum device is then removed. The erection-like state generally lasts long enough for a couple to have intercourse.
One of the newest forms of treatment involves the self-injection of medication into the side of the penis. The relatively painless injection produces erections of good quality for about 70-80 percent of patients. There are several injectable medications that, when used alone, help increase blood flow to the penis which promotes an erection. Originally, these medications had been registered and marketed to treat other conditions. Researchers, however, also found them to be effective in treating erectile dysfunction, so doctors began prescribing these medications for their patients.
This treatment involves the surgical placement of a stationary or movable device into the two sides of the penis, allowing erections as often as desired. These implants come in two forms: an inflatable device and semi-rigid rods. This treatment is not recommended until other methods have been considered or tried first.
The mainstay of therapy for erectile dysfunction has consisted of very safe medications called PDE5 inhibitors. These medications include Viagra, Levitra, and Cialis. They are all similar bit there are some important differences between them. They are typically quite effective and can be given at the initial visit as samples.
This treatment is usually reserved for those patients whose blood flow has been blocked by an injury to the penis or pelvic area. Surgery is also used to correct ED caused by vascular blockages. The goal of this treatment is to correct a blockage of blood flow to the penis so that erections will occur naturally.
Hormonal Changes With Aging (Andrology)
We now know that many men have a decline in important hormone levels as they age. This can occur in some men in their 30’s and 40’s, but is more common in their 50’s, 60’s and 70’s. Many physicians have called this condition “andropause,” which may be analogous to the female menopause. However, unlike in the female, male hormone problems do not occur in every man and occur at variable ages. The condition includes changes in many hormones including testosterone, DHEA, growth factor/insulin-like growth factor, and melatonin.
Decreased testosterone levels (hypogonadism) are estimated to occur in 4 to 5 million men. Unfortunately, male hypogonadism appears to be under diagnosed and undertreated. Only about 5% of hypogonadal men ever receive testosterone replacement. Clinically, the symptoms of hypogonadism are
- Often attributed to other medical problems
- Not reported by patients, and
- Not recognized or understood by many physicians.
In men, testosterone and its metabolites are responsible for virilization, normal pubertal development. In adult males, testosterone is not only responsible for maintenance of secondary sex characteristics (facial hair, deep voice, erectile function), but also for cognition, muscle strength, libido and bone strength.
Hypogonadism is associated with a number of signs and symptoms. These include:
- Loss of libido
- Erectile dysfunction
- Mood and behavioral symptoms (depression, irritability)
- Loss of motivation
- Lethargy or loss of energy
A deficiency of endogenous testosterone also has a deleterious effect on bone mass and is a risk factor for osteoporosis. Furthermore, reduced muscle mass is also associated with low testosterone levels. Because hypogonadism is characterized by testicular dysfunction, production of sperm and semen volume is often impaired.
The diagnosis of these hormone problems is not difficult if the physician is looking for the signs and symptoms and understands what blood tests to obtain. Treatment is easy and well-tolerated. Treatment depends on whether the man is attempting pregnancy. If no pregnancy is being attempted, treatment with one of several easy to use forms of testosterone is safe and effective. Testosterone replacement can be accomplished through injections, patches or absorbable gels. If pregnancy is desired, testosterone itself cannot be used as this causes a sharp decline in sperm production. In this case, either Clomid or another pituitary hormone called hCG must be used. In men with a low testosterone level and low sperm counts, this type of treatment is highly effective in improving sperm quality.