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Don’t Ignore Erectile Dysfunction

Men: Think of your penis as the canary in the coal mine. It can signal health problems beyond your genitals.

Men who have trouble getting and maintaining erections should see a doctor, says

Culley C. Carson III, MD, distinguished professor emeritus of urology at the UNC School of Medicine. Erectile dysfunction, or ED, is sometimes caused by serious cardiovascular issues, among other conditions. It’s very important to get to the bottom of what’s causing it.

That’s a good reason to get over the embarrassment and talk to your doctor. Not only has he or she heard it all before, but expressing your concern could save your life.

In the meantime, here’s what you should know about erectile dysfunction.

What is erectile dysfunction and how many men have it?

According to Dr. Carson, ED is defined as the inability to have and maintain an erection firm enough for sexual intercourse at least 50 percent of the time.

And men who deal with it should know they’re not alone; ED is very prevalent. Dr. Carson says that 50 percent of men over the age of 40 experience some amount of erectile dysfunction and that the prevalence increases with age, roughly by decade. For example, roughly 80 percent of people in their 80s have some ED.

The majority of these patients have moderate to severe erectile dysfunction. About 10 percent of people with ED have severe erectile dysfunction, meaning that they are not able to attain and maintain an erection firm enough for penetration. In other words, they cannot have sexual intercourse.

This correlates to about 120 million men in the United States having ED, according to Dr. Carson—a pretty high number for something people don’t really talk about much.

But patients talk about it much more than they used to, Dr. Carson says.

“In the days before Viagra, when ED was just called impotence, patients virtually never talked about it,” he says. Today, people feel a bit more comfortable, but still, “many of the patients I see for erectile dysfunction are pushed to see me by their partner.”

Why a doctor’s visit is necessary in the presence of ED.

People should “tell their doctors, absolutely” if they are suffering from erectile dysfunction, because ED can be a sign of something worse, including cardiovascular disease, Dr. Carson says.

If Dr. Carson sees a patient in his 30s or 40s that has erectile dysfunction as a new diagnosis, he typically sends him straight to a cardiologist.

According to Dr. Carson, a man with a new diagnosis of erectile dysfunction is at very high risk for a stroke, a heart attack, or other kind of a cardiac event within three to five years of the time that diagnosis occurs.

“If you think about it, it makes total sense,” Dr. Carson says. That’s because to have an erection, you’ve got to have high blood flow through the very small blood vessels of the penis. So if cholesterol or hypertension is adversely affecting blood flow, it can produce a noticeable effect in the small blood vessels of your penis first.

That’s why “it’s what we consider the canary in the coal mine,” Dr. Carson says.

Lifestyle risk factors that can contribute to erectile dysfunction.

There may be lifestyle changes you can make to lower your risk of erectile dysfunction.

  • Smoking. “Smoking is the biggest enemy of erectile function that there is,” Dr. Carson says. A number of studies show that quitting smoking can bring back some erectile function.
  • Diet and exercise. Studies have shown that when patients lose weight and exercise, not only do the rest of their vascular systems benefit, but their erections usually improve as well.

What to do if you’re embarrassed to talk about it with your doctor.

Many of the patients who visit Dr. Carson for erectile dysfunction give a decoy reason to the front desk staff. They say, “I’m coming for my prostate” or “I’m interested in getting a vasectomy.”

The truth comes out in the exam room, and usually right at the end when the appointment is over. Physicians call it the “doorknob complaint” because it’s the issue patients blurt out when the doctor is almost out the door.

“That’s when they say, ‘Actually, I’m having erection problems: can I get some little blue pills?’” Dr. Carson says. He’s sympathetic to patients who feel embarrassed, but it’s always best to state your concerns up front, he says.

Know you have options for erectile dysfunction.

In the 1970s and ’80s, there were very few options for treating erectile dysfunction.

“You could send somebody to a psychological counselor. There were also some surgical options, but they were not very tolerable to the average patient,” Dr. Carson says.

Today, there are several effective cures for erectile dysfunction. If one treatment doesn’t work, another might; but you have to be willing to talk to your doctor about your options.

  • Pills. Often called the “little blue pills” (they aren’t all blue), these work very well for the for most patients.
  • Hormonal treatment. Low testosterone levels can hinder the pills from working. Sometimes increasing testosterone makes the pills work.
  • Injection therapy. It’s not as easy as a pill, it but works very well for many patients.
  • Penile implants. For patients who haven’t found success with other treatments, there is the option of penile implants. These devices require a surgical procedure that takes about an hour. The satisfaction rate is well over 90 percent, according to Dr. Carson, and it restores patients’ ability to have erections.

 What to know about penile implants.

Penile implants had been the goal of surgeons for many years when the first trial took place in the 1930s, during a procedure in which they actually took a piece of human rib cartilage and put it in a patient’s penis.

It didn’t work. Find out more about the history of penile implants here.

The modern era of penile implants really began in the 1960s, when the space program developed silicone rubber that could be implanted in the human body. These materials are still used in penile implants today.

Inflatable implants are put in the erectile bodies of the penis and are connected to a small fluid-filled reservoir in the abdomen. Using a small pump placed in the scrotum, the man can move fluid into his penis and create an erection.

A penis with an implant has normal sensation and can still ejaculate; the implant doesn’t affect fertility, either. The erection should seem typical to both the patient as well as his partner.

“It’s a very good way to go,” Dr. Carson says. “These devices are reliable, safe, and they last 12 to 15 years.”

Of course, most men with ED don’t need a penile implant. But any man having trouble getting an erection should talk to his doctor.


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