It’s safe to say, Erectile Dysfunction – or ‘ED’ as it’s commonly referred to in our field and beyond – is a complex condition. In most instances, this highly frustrating issue results from a much more concerning health problem.
As a leading Urologist practice in Sydney, we receive many questions about ED from patients and our fellow practitioners. As a subject matter expert, Dr Katelaris recently presented to a group of urologists about this very topic – you can watch the ED presentation here:
Today’s article summarises the presentation about ED, including causes, critical talking points, treatments and more.
Key Points to Understand About ED
Revealing the key points at the beginning of a story is often considered a spoiler. Yet ED is no Hollywood storyline but a real and sometimes dangerous problem for male patients, a fact that Dr Katelaris chooses to draw immediate attention to during the presentation.
His four takeaway points for fellow urologists are:
- Erectile Dysfunction can signal underlying cardiovascular disease.
- ED treatment is a motivator for better diabetic control.
- Current treatments for ED are highly effective.
- Addressing ED can prove beneficial for a couple’s relationship.
ED in the Spotlight: How Big a Problem IS It?
The layperson may not know it, but ED is a huge problem, and it worsens with age. 40% of 40-year-olds experience ED; this jumps to 70-80% for those in their seventies.
As professionals working in urology know, what makes ED even more complex is the silence around it. Most men, old or young, choose not to talk about it due to embarrassment – it seems they would rather suffer in silence. This puts the responsibility on urologists to ask questions about sexual health because their patients are unlikely to tell them voluntarily!
Dr Katelaris encourages his industry colleagues towards open and frank discussion with patients, particularly to uncover other serious health issues and also to ensure patients already living with a known condition that worsens their ED are educated.
Understanding ED in Practice: Psychology and Physiology
There are two sides to ED – the physical and the psychological.
Physiology: The complex process of erection involves nerves, hormones, emotions, and blood vessels. Nitric Oxide is also central to the erection process at a cellular level. A man’s optimal sexual function is physical, spontaneous and free from anxiety.
Psychology: ED causes this anxiety to emerge – the psychological side – which then impacts on a couple’s relationship. The pressure to ‘perform’ continues to build each time an opportunity for intimacy arises. And so, the spiral continues.
ED is a Predictor for Cardiovascular Disease
The penis, like the heart and brain, is a vascular organ. The inability to maintain an erection is a predictor of future cardiovascular disease (CVD). Dr Katelaris goes on to explain why this is the case.
The penile artery is the smallest in diameter (1-2mm) – 4 times more than the femoral artery. This means it has a higher chance of becoming obstructed than any other major artery. Moreover, if the penile artery is blocked, the likelihood of other arteries following suit increases.
Research shows that a man in his 40s to 50s with a softening erection is five times more at risk of a heart attack or stroke than someone the same age with no ED. If the patient is a smoker or diabetic, the risk increases again.
Motivating the Diabetic to Prevent ED
It’s fair to assume no man wants to suffer from ED. With diabetic men more at risk, ED can be used as a motivator to control and manage their diabetes and prevent this issue from occurring in the first place.
In the first instance, diabetic patients are well advised to improve their lifestyle by:
- Stopping smoking
- Increasing physical exercise
- Losing weight
- Reducing HbA1C to below 7%*
In an Italian study of men suffering from ED, half were supported to address these risk factors and the rest not. Of the men given support to lose weight and increase their exercise, over 30% showed a significant improvement to their erections. Therefore, encouraging lifestyle changes can prove crucial to the diabetic in preventing ED.
Effective ED treatments
Thankfully, in medicine, progressive treatments continue to emerge. Dr Katelaris highlights the latest treatments for ED in his presentation as follows:
PDE5 Inhibitors: Viagra, Cialis and Levitra.
These medications are taken orally, anywhere from one hour to one day before sex (depending on the medication). Stimulation is required for these types of treatment to take effect.
If oral medication is not successful, penile injection therapy is recommended. Here, a patient injects a vasoactive compound into the penis immediately prior to sexual activity, typically resulting in a 30-minute maintained erection.
The long-term solution for ED is a penile prosthetic device. This small device is placed permanently within the penile shaft and scrotum, with a pump to manually ‘inflate’ the genitalia and replicate an erection ahead of sexual activity.
Penile prosthesis is considered the most successful of these treatments due to its spontaneity. However, there are pros and cons to all treatments, and it’s crucial for urologists and GPs to discuss these with patients in full before commencing a treatment course.
Final Words: ED ‘Beyond the Physical’
Returning to the emotional side of sex, Dr Katelaris ends his presentation talking about relationship dynamics and their criticality to sexual activity – or, as he says, “Good sex requires a good relationship”.
This doesn’t mean all men in a good relationship will avoid ED. Of course, when ED hits those in an otherwise ‘good’ relationship, its impact on the partnership dynamic and man’s self-esteem is significant. Many will withdraw completely from any attempt at sexual activity, void of confidence and unwilling to communicate their feelings to their partner.
Communication is as critical as intimacy, with one reliant on the other to enable an effective, healthy relationship.
Furthermore, sexuality is deeply interconnected with physical health, emotional wellbeing, and relationship quality. This makes understanding and addressing ED critical to holistic male health.
If you are concerned about ED or any other male health issues, contact the team at Katelaris Urology and book a consultation.