Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Up and Coming

Erectile dysfunction (ED) is a common, “embarrassing”, and treatable problem in men. ED is defined as persistent inability (at least three months) to achieve or maintain an erection sufficient for satisfactory sexual performance. Through surveys, it is estimated that over 30 million American men have some degree of erectile dysfunction, and estimates also project that close to a million new cases of ED will develop each year as reporting becomes more consistent and our population ages. Clearly, the problem is on the rise.

More than 50% of the patients with ED are males at least 50 years old who are in stable monogamous relationships. The history of erectile dysfunction is one of gradual progression over a number of years. Commonly, the men are otherwise in good physical and psychological health. What these statistics point out is that ED is a common problem in typical middle-aged American males. When patients do not fit this profile, additional testing can identify specific causes such as testosterone deficiency (or other hormone imbalance), depression, blocked or leaking blood vessels to the penis (possibly related to diseases such as diabetes, high blood pressure, or high cholesterol),surgery or injury to the pelvic area, and medication side effects. Obviously, treatment can be tailored to meet individual needs.

Erectile dysfunction is a distinct sexual problem. Once again, it is a problem achieving and maintaining an erection. Other sexual problems such as decreased libido (lack of desire), and difficulty ejaculating (either too soon or too prolonged) are often separate medical problems. If you believe that you or your sexual partner have any of these problems, please discuss them with your doctor. Treatments are effective and available for each of these conditions. Hopefully, knowing that these problems are both common and treatable will get a rise out of you!

While on the subject of truth, I want to dispel two other common myths or misconceptions about erectile dysfunction. 1) “It’s All in Your Mind” is a commonly perpetuated myth about ED. In fact, most erection problems are linked to various medical problems. True, psychological factors often play some role. . .especially if a man is conditioned to expect “failure.” However, illnesses, medications, and injury or surgery are the root of most erectile problems. 2) “It’s Just a Part of Getting Older” is another common myth. Generally, getting erections may take longer and require more stimulation as men age, but aging itself is not the cause of erectile dysfunction.

Don’t let Bob Dole get one up on you! If you feel you have ED, please talk to your doctor about specifics and possible therapies. Standard medical tests, routine physical exams, and “Sexual Health Inventory” questionnaires are all helpful in defining the problem and deciding on appropriate treatment. Currently, specific surgeries (including penile prostheses), vacuum pumps, hormone replacement, medication either inserted or injected into penis, oral medication, and counseling are all available as possible treatments. In the near future, a medication which dissolves under the tongue may also be available. Remember to tell your doctor about all medications you are currently taking. Possibly, one or more of them can be changed to a drug less likely to affect erections. And, absolutely, stop smoking, limit alcohol intake, and exercise with regularity. All of these lifestyle changes will improve health and may reverse early problems getting erections.

In summary, erectile dysfunction is a common medical problem which affects millions of American men and their sexual partners. If you think you have ED, please discuss this with your doctor. There are multiple treatments available for this up and coming problem.

Stephen L. Hines, M.D.
June 2000

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