Straight Talk About Erectile Dysfunction

When the body won't respond

Jeanne L. Alexander, MD

February, 2004

There is a myth that men don't feel and that their erections are on "automatic pilot." This can't be further from the truth. Stress, anxiety, changes in a man's job or finances, as well as issues in his relationship will all increase the risk of sexual dysfunction and can produce a decline in his level of desire or in his ability to have and maintain an erection.

There is a second myth that erectile dysfunction is reserved for older men. Frankly, we don't know how soon it starts, or how many younger men are also experiencing a loss of their sexual powers. In 1993, The National Institute of Health Consensus Development Panel on Impotence concluded that only10 percent of all patients with erectile dysfunction had been diagnosed and another 90 percent were simply suffering through this on their own, with no medical help or attention.

In the June 1999 Journal of the American Medical Association, Dr. Charles Marwick reported that 85 percent of adults would like to discuss their sexual function with their physician, but don't feel comfortable raising the issue. They felt that the clinician wouldn't have time, they feared embarrassment, or they worried that the clinician would not know how to treat the problem.

When can a man no longer depend on his ability to get or maintain erection?

The problem is most common over the age of 40. The biggest risk factors are smoking, excessive alcohol consumption, excessive weight or obesity, and substance abuse. Men can often improve their situation by making simple lifestyle changes. Medical conditions, however, are not always that easy to address. These include hypertension, heart disease, depression, diabetes, endocrine disorders, and cancer (particularly prostate).

If lifestyle and illness don't get a man's erection, medications can. Drugs that can interfere with sexual performance or erection include medications for depression, hypertension, cancer, chronic pain and seizures.

It's important to note that only a small percentage of men who take these medications go on to develop problems with erection. Patients should be warned beforehand that this may be a side effect of treatment.

Once they figure out that drugs are dampening their sexual performance, they may fail to take them as prescribed. They may also react emotionally, with depression or low self-esteem, because they feel that they have lost something very special in their lives. If men are open with their doctors, it may be possible to find an alternative treatment that does not have this side-effect.

If the man in your life is experiencing difficulty with erection, encourage him to talk with his physician. To make it easier for him to broach the subject with his doctor, ask him to consider the following:

• Are you satisfied with your current sexual function?
• Do you or your partner wish to have sex more often, or want your intimacy to change in any way?
• If you have a problem, does it happen every time you try to have sex or just in particular situations?
• What is the source of the problem? Getting or maintaining the erection, having an orgasm, ejaculating?

A physician may have more specific follow-up questions, but these will provide a starting point and help a man to focus on his sexual concerns.

This information was excerpted from Sexual Health School for Primary Care Physicians sponsored by the National Foundation for Sexual Health Medicine (NFSHM). The authors are Irwin Goldstein, MD, Director, the Institute for Sexual Medicine and Professor of Urology and Gynecology, Boston University, Laurence A. Levine, MD, Director, Male Sexual Health and Fertility Program, at Rush- Presbyterian-St. Luke's Medical Center in Chicago, Ill. and Richard Sadovsky, MD, Associate Professor at SUNY Health Science Center in Brooklyn, N.Y.

This is the first in a series of articles on men's health. In future issues we will consider the many ways a woman's life is affected by the well-being of her partner.

General References

Basson R. Med Aspects Hum Sex. 2001;1(4):39-42

Benet AE, Melman A. The epidemiology of erectile dysfunction. Urol Clin North AM 1995; 22:699-709. Abstract

Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study . J Urol 1994;151:54-61 Abstract

Greiner KA, Weigel JW. Erectile dysfunction. Am Fam Physician. 1996;54:1675-1682 Abstract

Marwick C. Survey says patients expect little physician help on sex. JAMA. 1999;281:2173-2174 Abstract

Maurice WL. Sexual Medicine in Primary Care. St Louis, Mo Mosby, 1999:1-17

NIH Consensus Development Panel on Impotence JAMA. 1993; 270:83-90 Abstract

Nusbaum MRH. Sexual Health. Leawood, Kan: American Academy of Family Physicians, August 2001,Home Study Monograph Self Assessment Program, Monograph 267