At what age does erectile dysfunction start affecting men?
Erectile dysfunction can occur and affect men of any age. In younger age groups, it is likely to be of psychological origin. In older age groups it is more likely to be of organic or physical origin. One study has shown a prevalence of ED of approximately 40 percent in 40-year-old men and approximately 70 percent in 70-year-old men.
I am a 50 year old male with erectile dysfunction. During my last visit with my doctor, I complained of reoccurring abdominal pain, and I wasn't sure if it was connected with my dysfunction.
It is unlikely that recurring abdominal pain is associated in any way with your ED. I would advise following the advice of your physician.
What factors are likely to cause erectile dysfunction?
Disease conditions that are associated with ED are diabetes, atherosclerosis, high blood pressure, neurological diseases and a variety of operations. Operations that are associated include prostate cancer surgery, some rectal surgery, and some neuro surgery or lower spine operations. Radiation treatment for prostate cancer is also a factor. Medications may cause erectile dysfunctions. Frequent problems occur with medications used for high blood pressure, also with antidepressant medications and other psychoactive medications. Trauma may also cause erectile dysfunction. Fractured pelvis or other injuries in the vicinity of the genitalia may be associated. Smoking is a major associated cause of erectile dysfunction. It certainly can make worse the vascular disease caused by diabetes, atherosclerosis or high blood pressure. Large alcohol intake can be associated with sexual problems. This is due to hormonal changes that may be brought about by liver disease. Mild alcohol intake is not associated with any sexual difficulties.
I'm a diabetic with ED. My diabetes doctor ignored my complaint of sexual dysfunction. How can I get him to take this problem seriously?
Frequently, endocrinologists are not willing to undertake the treatment of ED. If your doctor is unwilling to take care of this problem, it would be advisable for you to see a urologist. Any urologist in your area would be happy to undertake this aspect of your treatment.
What is involved in the selection of treatments for ED?
There are several effective treatments. The most common treatment used nowadays is oral medication (a pill), such as Viagra, Levitra or Cialis. Alternative treatments include self-injection in the penis with medications that produce an erection. Another treatment is a vacuum device. Another possible treatment is penile prosthesis operation. The least common treatment is vascular surgery. This surgery is to increase the blood supply to the penis. In patients under 50 years old, where psychological difficulties may be a significant cause, evaluation by a psychologist may be sought. If pills do not work, the next most common treatment would be injection of medications into the penis. This produces an erection within 10 to 15 minutes in most men, even without sexual activity. The vacuum devices work by applying suction to draw blood into the penis and produce an artificial erection. These devices are successful in about 70 - 80 percent of the men who try them even when pills have failed. Surgery to implant a penile prosthesis is an extremely successful operation. Satisfaction rates are 90 percent or greater. Infection rates are approximately 2 - 3 percent and infection requires removal of the prosthesis. If an infection occurs and a prosthesis has to be removed, it is extremely difficult to perform the operation again because of scar tissue. The operation is quite expensive and may cost anywhere from $12,000 to $15,000 depending on your location. Pills are about $10 per pill. Injections are about $20 per treatment. The vacuum device is about $400.
Should one's partner be involved in the choices of alternative treatments?
I think this is a very good idea. It would be useful to bring your partner along when initially seeing a physician regarding your erection problem. It is easier for two people to remember what was said and to come up with relevant questions when talking to your physician. It is also better if your partner understands the treatment you may end up using.
Are there any new treatments on the horizon?
There are no radically new treatments on the horizon. There are several drugs that have undergone some testing and have not yet achieved FDA approval. Quite likely there will be other drugs developed in the future, alternatives to Viagra as oral therapies.
Does diet have an affect on erectile dysfunction?
Diet probably has little overall effect on ED. High fat diets, which can lead to high cholesterol levels, might eventually cause vascular disease and lead to erectile problems. Common non-alcoholic drinks such as sodas, teas, coffee, etc have no known effect on erectile dysfunction.
Is Viagra effective for severe erectile dysfunction?
You don't know until you try it. It is more effective in low or moderate dysfunction, but works in some people who have severe difficulties. It is well worth a trial and you could probably get some free samples by visiting a urologist. The success rate in severe erectile dysfunction is 30 to 40 percent. The success rate of mild ED is 80 to 90 percent. The pill should be taken about 1 hour before sexual activity. Keep in mind that it has some side effects. Viagra is absolutely contraindicated (not advised) in patients who have heart disease and take nitroglycerin tablets. The combination of nitrate medication and Viagra may cause a severe drop in blood pressure and possibly fatal consequences. Viagra appears to be safe when taken by patients who are on blood pressure medication. Most cardiologists recommend that if you have to take more than 2 medications to control your blood pressure, you should not take Viagra.
How do you decide what is mild vs. severe?
The mild erectile dysfunction typically is a situation where a patient can obtain an erection and maintain it for a matter of time but it may not be of satisfactory firmness. Severe dysfunction is where a patient cannot get an erection at all. To some extent, the severity of the problem is a subjective matter. Some men may be quite satisfied with an erection quality that would make others very unhappy.
Do you routinely check testosterone levels?
I do not routinely do this test. Many physicians do perform serum testosterone tests on all patients with ED. Other hormonal tests may also be performed. Deficient testosterone may be suspected if the patient has small testicles on a physical exam. Testosterone tests may also be conducted in younger men to assure them that they are hormonally normal. Older men who have low serum testosterone levels may be helped by supplement testosterone therapy. The success rate with testosterone therapy is relatively low, and it is therefore not a commonly recommended treatment.
What are IIEF criteria?
IIEF stands for International Index of Erectile Function. There are 15 questions on a questionnaire that a patient can answer. The patient can grade the answers on a scale of 1 to 5. The answers to these questions give the physician a quantifiable estimate of the severity of the patient's dysfunction. This can be used for follow up examination to test the effectiveness of different forms of treatments. The IIEF questionnaire is frequently used for research on new treatments for erectile dysfunction.
Do you use a rigiscan and for what reasons?
We use a rigiscan to determine if patients are able to get an erection during sleep. In older patients with erection problems, I use it rarely. In younger patients, it is very useful to determine psychological versus organic problems. Frequently it can be reassuring for those with psychological difficulties to know they get erections during sleep. The rigiscan is also useful as a medical legal instrument. In general, however, it is not routinely used on most patients.
Medical legal cases?
Occasionally a man may be accused of a sexual offense; either the defense or prosecution may use it to test whether he can or cannot get an erection.