Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual activity.
ED is highly prevalent, affecting about 40% of 40-year-old men and about 70% of 70-year-old men. So do not worry, you are not alone! But, just because it is common does not mean it needs to be a normal part of aging.
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Causes and Risk Factors
ED can have psychological, hormonal, neural and vascular causes. Common medications such as antidepressants and beta-blocking agents for elevated blood pressure can contribute to ED. ED shares multiple risk factors with cardiovascular disease such as obesity, high cholesterol, diabetes and smoking. It is important to recognize that ED may be an early marker of overall cardiovascular risk, and men with ED have a 50% higher risk of cardiovascular disease than other men.
When to Speak with a Urologist about Erectile Dysfunction
You should speak to a Urologist about erectile dysfunction if you are not happy with your erections, displeased with your sex life, or have a reduced interest in sex. Erectile dysfunction is an important part of Urology and we are the physicians most highly trained in treating it.
What to Expect when Seeking Treatment for Erectile Dysfunction
In addition to a history and physical examination, initial assessment includes bloodwork for morning total and free testosterone to check for possible hormonal contribution, hemoglobin A1c level to check for underlying diabetes, and cholesterol levels as a measure of cardiovascular health.
Patients should also discuss the condition with their primary care doctor or cardiologist for complete cardiovascular evaluation and. I you have difficulty climbing 2 flights of stairs in 10 seconds or walk 1 flat mile in 20 minutes, you may need to consider undergoing an exercise stress test. A formal cardiac clearance is required for history of chest pain with exertion, congestive heart failure, recent heart attack, stroke, or peripheral vascular disease.
Conservative measures can be effective in improving erectile function. Various forms of lifestyle modifications include weight loss, healthy diet, exercise, blood sugar control and avoidance of smoking. These changes can not only improve your erections, but also reduce your risk of death from cardiovascular disease by over 35%.
Many treatments are available to address ED symptoms without determination of a specific underlying cause. This approach is called goal-directed therapy. Initial treatments typically include oral medications called phosphodiesterase inhibitors (such as Cialis / tadalafil, Viagra / sildenafil, Levitra / vardenafil, Stendra / avanafil) if patients have no symptomatic cardiovascular disease or regularly use nitrates for chest pain. These medications have various formulations and durations of action to fit your needs. Daily formulations can improve bothersome urinary symptoms as well as erectile function. Studies have shown that these medications aid erections in about 67% of men with mild-moderate ED. Possible side effects may include flushing, congestion, headache and muscle aches in 5 to 15 % of patients.
If oral therapy does not produce a sufficient erection, several further options exist. These include vacuum erection devices (penis pumps), intraurethral suppositories (medicated pellets deposited into the urethra), penile injections and inflatable penile prosthesis surgery. Although more involved than pills, these approaches can be very effective and sometimes even less expensive than oral medications.
Consultation in the office will help identify which method is most appropriate for you based on your sexual goals. Although some of these treatment options may not be covered by insurance, we can help guide patients to achieve a successful outcome with lower cost.
Developing, but yet unproven, technology for the treatment of ED includes the use of platelet-rich plasma and shock wave therapy. These treatments are not FDA approved and are not covered by insurance. Current guidelines recommend only employing these techniques in an investigational setting within the context of a clinical trial. We are proud to offer the full array of proven treatments to our patients.