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Erectile Dysfunction
When the male body does not perform sexually as it once did, it’s not just a normal part of aging. Erectile dysfunction occasionally occurs in most men over 45 years of age, but there are ways to deal with it. The good news is that there are many causes to consider and a number of treatment options. It’s not something you just have to live with, and your partner will be happy to know there are answers, too.
Sexual Dysfunction, Erectile Dysfunction (ED)
Consider the circumstances of Steven, a 38-year-old man married for 16 years. Diagnosed with diabetes mellitus just two years ago, he is on insulin and oral medications to control his blood sugar. But his bouts with erectile dysfunction have stressed his marriage. Steven wonders about his erectile problem and worries how long his marriage can survive it.
Men like Steven are still interested in sex, but his body, and those of 30 million other American men, can’t seem to perform properly.
In Steven’s case, his sexual dysfunction is probably linked to diabetes. But there may be other contributing causes.
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Sources Of Erectile Problems
The more common promoters of erectile dysfunction include:
- Diabetes and metabolic syndrome (a prediabetic condition of high insulin, abdominal overweight, high triglycerides, hypertension).
- High blood pressure and vascular disease (heart disease or atherosclerosis).
- Metal sensitivity (mercury amalgam fillings).
- Certain prescription medications (see list below).
- Depressed mood and suppressed sexual desire.
- Tobacco use, alcoholism and other kinds of substance abuse (marijuana, narcotics, amphetamines, barbiturates, cocaine).
- Nerve diseases (Parkinson’s disease, multiple sclerosis).
- Treatments for prostate cancer or enlarged prostate (surgery, radiation) or surgery to pelvic area/spinal cord.
- Chronic kidney disease.
From this list of potential causes, the one category most often overlooked is prescription medications. There are more problematic medications than you might imagine. They include:
- Diuretics and blood pressure lowering medications.
- Antidepressants, antianxiety and seizure control medications.
- Antihistamines.
- The arthritis pain relievers naproxen sodium and Indomethacin.
- Parkinson’s disease medications.
- The muscle relaxants Flexeril® and Norflex®.
- Cancer medications.
- The heart rhythm stabilizer medication Norpace®.
From a psychological perspective, Steven’s thoughts play a key role in this problem. Although thoughts about sex can trigger the physiological events that lead to an erection, stress, fatigue, worry, arguments or even feelings of fear of sexual performance can lead to dysfunction.
Once Steven focuses his thoughts on becoming sexually stimulated, a healthy nervous system linking his spinal column and penis, healthy arteries and healthy smooth muscles are necessary to maintain an erection. In addition, smooth muscles must make enough nitric oxide to dilate the penile blood vessels.
Treatment For Erection Problems
Before using medications for an erectile problem, I first recommend an honest exploration of thoughts and feelings to see if these are the main causes of the difficulties. Exercise is one way to reduce stress and allow for the parasympathetic nerves to be reactivated. (These are the so-called feed-or-breed nerves.) Other stress-reduction therapies that can jump-start erectile function include massage or even stimulating sexual imagery. If none of this works, then maybe medications are needed.
The prescription medicines for ED are well known. The famous drugs Cialis®, Levitra® and Viagra® cause dilation of the penis blood vessels by increasing nitric oxide production. However, they can cause side effects like diarrhea, dizziness, flushing, headache, heartburn, stuffy nose and upset stomach. Fortunately nitric oxide can be improved by diet without side effects and additional health benefits.
Other serious side effects of these pharmaceuticals include allergic reactions (rash, hives, itching, difficulty breathing, chest tightness, swelling of the mouth, face, lips or tongue), chest pain, fainting, fast or irregular heartbeat, memory loss, numbness of an arm or leg, one-sided weakness, painful or prolonged erection, ringing in the ears, seizures, severe or persistent dizziness, severe or persistent vision changes, sudden decrease or loss of hearing, and sudden decrease or loss of vision in one or both eyes.
Mechanical Help
Suction devices are available that can be effective in causing an erection. Alternatively, a special device can be used to place a suppository into the urethra. This delivers the vasodilator medicine prostaglandin E1 that dissolves into the local bloodstream and causes veins to relax and engorge with blood to achieve an erection. This may be accompanied by some bleeding from the urethra and pain with insertion.
For the more daring, penis injections can also be employed. Since 1983, this option has shown to be effective in 90 percent of users. With a small diabetic needle, you inject prostaglandin E1 or a mixture of other vasodilator agents (phentolamine, papaverine, and atropine) directly into the shaft of the penis. This reliably produces an erection on command, at anywhere from $10 to $40 per injection. But you have to watch out for scar formation if you don’t apply compression after injections. And you may have priapism, an unwanted persistent rigid erection lasting for many hours if your dose is too high. (This necessitates a visit to the Emergency Room.)
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By Dr. Michael Cutler
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