Erectile Dysfunction

Erectile Dysfunction

Honest conversations with physicians can help men find treatment

Although you may see TV ads about erectile dysfunction (ED), the disorder is largely shrouded in silence. And yet, an estimated 30 million men in the United States live with the condition. 

Men who are unable to get an erection or can’t get an erection that is firm enough or long-lasting enough to have a satisfying relationship are reluctant to talk about it because they may see it as a sign of failure and feel embarrassed. 

But when men come forward to talk to their physician, they can often find help.

That was the case with Frank Carlson, who asked that his name be changed for privacy. When he was in his early 40s, his erections weren’t as hard as they were when he was younger. But he never mentioned his problem until his best friend started talking about a similar issue.

When Carlson went to see his urologist, Paul Merrick, MD, at DuPage Medical Group, he had no intention of bringing up the issue until the doctor asked him if he had any problems with erectile dysfunction. “I think there is definitely a stigma about talking about it,” says Carlson, who has been married for 14 years. 

Once men break through the silence, they often realize the disorder is more common than they had thought.

Many men think that their ED is caused by low testosterone, but it’s an uncommon cause for the disorder.

Merrick says that ED gets more prevalent with age. Approximately 40 percent of men experience some form of erectile dysfunction in their 40s, and 70 percent of men are affected in their 70s. “The rate of erectile dysfunction in- creases by about 10 percent with every decade of life,” he says. Out of every 100 patients that Merrick sees, between 40 to 60 of them have ED, he says. 

Causes of ED

There are many potential causes of ED. A man’s hormones, brain, nerves, blood vessels, muscles and emotions must all work together to create an erection. A problem in one of those responses can result in erectile dysfunction. Merrick compares the process to a car that breaks down when one part stops working. 

For younger men, ED may be caused by a psychogenic factor, such as anxiety or depression, that has an impact on their sexual activity, says Khalid Badwan, MD, a urologist at Elmhurst Memorial Elmhurst Clinic. In those cases, Badwan recommends a short course of an oral medication such as Cialis, Viagra or Levitra to relax the muscles and allow blood to flow to the penis. 

“It reverses the underlying anxiety and improves sexual competence,” Badwan says. “And then I taper them off the medication and that works reasonably well.”

Many men think that their ED is caused by low testosterone, but it’s an uncommon cause for the disorder, Merrick says.

In older patients, the underlying cause of the disorder may be untreated vascular disease, which slows the blood flow to the penis, Badwan says. Diabetes can also have a negative impact on blood flow, as well as cause nerve damage. Medications, such as some to treat high blood pressure or depression, can cause the disorder as well. In those cases, ED is treated by addressing the underlying health issues and adjusting the medications the patient is taking. 

Merrick points out two other causes: “Poor sleep habits, such as those caused by sleep apnea, are an unrecognized significant contributor to erectile dysfunction. And smoking in the short term, and surely in the long term, is anti-erection,” he says.

Badwan explains that trauma caused by surgery or an accident is a less common cause of ED. Avid cyclists may also experience trauma because aerodynamic bicycle seats can put pressure on the perineum and cause nerve damage and slow blood flow. He recommends switching to a wider seat or one with an opening in the middle. 

And then there’s the brain. The focus on sex in today’s culture can have a negative psychological impact on men’s perception of their sexual performance. 

“Men have unrealistic expectations because they compare themselves with what they see in the movies, on TV and on social media, and that can lead to performance anxiety,” Merrick explains. “I suggest they focus on their own circumstances and their own partners and not be distracted by those other visuals. Most of the time having a conver- sation with a professional physician is satisfactory for psychological challenges, but sometimes I refer patients to a sexual health counselor.” 

Seeking help

Carlson has been taking Cialis for four and a half years. “For me, it’s more of a confidence booster in my sex life,” he says. 

Merrick credits TV ads about ED medications with breaking down barriers that prevented men from seeking treatment. But men are not always making the decision to seek help.

“Often a man’s wife is the driving force for a man coming to see me because erectile dysfunction is a two-person problem that affects their relationship,” Badwan says. 

Side effects of oral ED medications include flushing, headache, dizziness and upset stomach. Merrick says that painful, unrelenting erections are rare. The medications may become less effective over time.

If the oral drugs are ineffective, there are other less commonly used procedures. Men can use a medication that is inserted into the penis using a very fine needle or inserted as a suppository, about the size of a grain of rice, into the tip of the penis. Men with ED can also use a vacuum pump that draws blood into the penis and a ring that keeps the blood there during sexual relations. Less commonly used is a surgically implanted device placed permanently inside the penis, which can allow a man with ED to get an erection.

Men themselves can also play an important role in their sexual well-being. Merrick says they should eat a healthy diet, exercise regularly, stop smoking and avoid alcohol and substance abuse.

“It’s irresponsible to offer therapy without coaching men with erectile dysfunction about lifestyle modifications that can reverse it,” Merrick says. 

It starts with honest conversations with your physician. With so many treatment options, Carlson, who found one that is successful, says, “Don’t be afraid to talk to your doctor.”

Originally published in the Spring/Summer 2019 issue