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Erectile Dysfunction (ED)
Talking about or addressing issues of erectile dysfunction (ED) can be challenging for many men. But it should not be. Because it is often hard for men to admit they are suffering from erection problems, I believe it is important to offer patients the time and comfort they need to broach this difficult topic. Furthermore, for the vast majority of patients, ED is an entirely treatable problem provided they seek the right help and advice.
My approach to Erectile Dysfunction
The Massachusetts Male Aging Study, suggesting a that up 52% of men will suffer erectile dysfunction at some point in their lives. However, ED is not something that is commonly talked about. We know that there are multiple causes of ED, most commonly diabetes, cardiovascular disease, and mental health. Yet many patients go on to be prescribed Viagra or a similar drug, or acquire it through some other route, with no further investigation of the underlying cause or causes of the dysfunction.
How can we do better?
I believe a useful starting point when managing patients with ED, is to think of the penis as a barometer of health. With the general acceptance of a 3-year period between the onset of erectile dysfunction and significant risk of a cardiovascular event, addressing the problem early in the course of the disease can offer the opportunity for risk mitigation and disease reversal. Accordingly, when treating erectile dysfunction, an holistic approach (looking at cardiovascular health, hormone levels, lifestyle and risk factors, and mental health), and not just symptom management, is the best way to achieve a long term reduction in symptoms and an overall improvement in health.
What causes erectile dysfunction?
We generally class ED into the psychological causes and physical causes, but due to the complexity of the erection mechanism, most are actually a mixture of both. The most common causes physical cases of ED include diabetes, high cholesterol, high blood pressure, low testosterone, obesity, smoking, alcohol, many medications, recreational drugs, and several neurological and endocrine disorders.
How we investigate erectile dysfunction?
- A clinical history of the condition
- A thorough physical examination
- Blood tests including testosterone levels, prostate, and general health
- Discussion of appropriate treatment options
Treatment of erectile dysfunction
Effective and long term treatment of ED has to look at the patient as a whole. Although viagra, (and other PDE5 inhibitors), play a crucial role in the management of ED, they are not a universal solution. Rather, I believe treatment should be based on three core considerations:
1. Treat the underlying cause
2. Provide appropriate medication to help improve function
3. Address any psychological issues.
Common misnomers around treatment of erectile dysfunction
- Viagra is for everyone. Currently, the most common form of therapy for ED still remains the use of prescription viagra (or similar). The success rate of these medications can be up initially up to 70%, but this is not long lasting without addressing the underlying cause.
- Failure of viagra means a urology referral. This is incorrect. We are now able to offer NON-pharmacological shock wave therapy for ED. This involves non-invasive remodeling of the vascular tissue and blood supply to the penis, and is proving to be highly successful.
- Seeing any counsellor will help. Although psychological contributors to ED are extremely common, the availability of specialist psycho-sexual therapy is poor. Therefore, often psychological therapy can be daunting and unproductive. We work closely with specialty trained counsellors and psychologists to make sure you get the appropriate treatment you need.
- You don’t need a blood test. Every patient with ED, whether it is suspected psychological or physical in its cause should have a blood test to rule organic causes. Conditions such as diabetes and low testosterone are becoming increasingly common and should be addressed as part of an overall treatment of ED.
Publications and further information.
For health professionals, or those who wish to find out more about erectile dysfunction, please refer to the accompanying image. For free access to the full article, please follow the attached link from the British Journal of Family Medicine.