Real Men Ask for Help

Erectile dysfunction can damage self-esteem and hurt relationships.
But if dealt with appropriately, it just might save your life.

OK, maybe we wouldn’t normally put that last one on the list of manly attributes. But lacking good vascular health can mean that everything else on the list is compromised.

There are few things that fall more squarely into the manly category than an erection. An erection is distinctly male, and, historically and culturally, it symbolizes much of the other attributes. So it’s easy to understand the depression that befalls most men who experience dysfunction. But while the first concern might be about ideas of manhood, it needs to be about vascular health. Your manhood may be in significantly less danger than your life.

“The field of sexual dysfunction, going back to [Alfred] Kinsey (founder of the Institute for Sex Research at Indiana University) in the 1950s and 60s, was really thought to be psychological, but it turns out that it’s predominantly a physiologic or a vascular issue,” says Dr. Ajay Nehra, vice chairperson, professor and director of Men’s Health, Department of Urology at Rush University Medical Center. “It may be the early harbinger of future cardiac disease.”

While heart disease is a leading cause of death for both men and women, men seem to be particularly disadvantaged when it comes to overall vascular health, Nehra says. They’re three times more likely to have a heart attack and have twice the occurrence of liver disease when compared with women. On top of that, men tend to die six years earlier than their female counterparts, when compared with women their own age.

This understanding of the interconnected nature of sexual health and overall vascular health means that grabbing a prescription for Viagra and considering the problem solved is potentially an unwise approach, especially if you’re not very old.

“The younger you have manifestations of erectile dysfunction, the higher the chance of future cardiac mortality and morbidity,” says Nehra. In other words, if you’re young and you can’t get it up, you need to be talking to your doctor.

“When you ask patients whether they are comfortable bringing up sexual issues, research shows that over and over again they say, ‘I’m waiting for the provider to say something,’” says Dr. Jeffrey Albaugh, an advanced-practice urology clinical nurse specialist with a PhD in sexual health studies and director of the Nort­hShore University Health-System William D. and Pamela Hutul Ross Clinic for Sexual Health.

“[Patients] feel that it’s important, but they’re embarrassed and don’t feel completely comfortable bringing [sexual issues] up,” says Albaugh.

Talking openly about our private, intimate lives doesn’t come naturally to most of us. But doctors are people, too, after all. And often, it doesn’t come that naturally to them either. Albaugh cites the results found in a study reported in the article, “Views of Health Professionals on Discussing Sexual Issues with Patients,” first published in Disability and Rehabilitation in 2003, which found that greater than 90 percent of healthcare providers felt that it was important to address and treat sexual dysfunction. Yet the same study showed that more than 90 percent of those same providers were not likely to discuss the issue.

“These issues are often a big white elephant that gets ignored,” says Albaugh. “Healthcare professionals are not really looking at this essential aspect of the human experience.”

However, inroads exist at NorthShore, where Albaugh heads up an interdisciplinary sexual health clinic, and at Rush, where Nehra oversees a similar enterprise. They really are looking at this fundamental issue of human health from all sides. Poor or compromised vascular health, which can lead to sexual dysfunction, is a big indicator of high cholesterol and heart disease, but it’s also present in people with diabetes and in many cancer patients and survivors. Erectile dysfunction is rarely an independent problem. That’s why clinics like these have assembled interdisciplinary teams of specialists. “Our mission is to treat patients, not the disease,” Albaugh says of the clinic at NorthShore.

Prostate cancer can also have an effect on the tumescence of manhood. Dr. Tracey Thomas, is a naturopathic oncology provider at Cancer Treatment Centers of America (CTCA) in Zion. “We work directly with the medical oncologists,” she says, “to offer safe, evidence-based natural medicines and nutritional therapy to help improve the patients’ quality of life.”

Thomas is part of an interdisciplinary team of physicians and therapists who work to treat the whole patient. Strictly focusing on fighting the disease of cancer would leave the patient facing many of the challenges of recovery, including sexual dysfunction, on their own. But at CTCA, each patient has a team of specialists devoted to their care. And each team is led by a medical oncologist like Dr. Kaoutar Tlemcani.

“In our initial consult [with prostate cancer patients], we always prefer to have the patient’s partner present because the discussion always ends up being about the side effects and sexual dysfunction. Every single patient with prostate cancer is concerned about that. That always comes up, and if it doesn’t, we bring it up,” says Tlemcani.

“The cancer issues may be controlled, but guess what? If you have incontinence; if you have erectile dysfunction, there’s a tremendous amount of depression, discordance with your wife or your partner, [which can] even [lead] to suicidal [thoughts],” says Nehra. Facing sexual dysfunction is troubling for anyone, particularly if you’re already confronting a disease like prostate cancer. But an interdisciplinary approach can yield results, and we have the benefit of an ever-increasing understanding of the interconnectedness of our health issues.

Armed with this knowledge, we know that erectile dysfunction is nothing to be embarrassed about, but it is not to be taken lightly either. A lower libido could be an early sign that there are urgent steps needed to protect your health.

And what could be more manly than escaping death?

Published in Chicago Health Winter/Spring 2013