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Determining the causes of erectile dysfunction

Dr. Sharkey

Dr. Sharkey

With Valentine's Day nearly upon us, men are under a lot of pressure to perform. Gifts, flowers, cards, dinners and champagne are all in a category of their own.

Bedroom performance, however, is a different thing entirely. When a man goes to his doctor complaining of erectile dysfunction, many factors need to be considered.

Age, diet and lifestyle habits, health conditions and emotional issues all must be considered in erectile dysfunction treatment. In fact, performance issues frequently are a sign of underlying health concerns that require more than one of those little pills constantly advertised on TV.

Here are some questions I have frequently heard over the course of my 40 years practicing urology:

What is erectile dysfunction?

The inability to obtain and maintain a penile erection of good quality for a sufficient length of time to result in satisfactory sexual intercourse.

Is it all in the man's head?

For many years, it was thought that "fear of failure" would lead to ED. We now know that applies to fewer than 10 percent of patients. The vast majority of men have a physical cause of their ED.

How have doctors come to this conclusion?

We now know what needs to happen for a man to have a normal erection. The blood supply to and from the penis must be normal, the nerves to the penis must be intact, the smooth muscle of the penis must be responsive to certain chemicals that result from stimulation so that the muscle can relax, allowing blood to fill the penis, resulting in an erection.

If a man doesn't have regular erections, can damage occur?

Yes. Like any muscle that isn't used, the smooth muscle of the penis can deteriorate.

Does every man with ED need medication?

If you get your health information from TV ads, you'd think every man in America needs ED drugs. But this is simply not true. It all depends on what is causing the ED.

What are some of the most common causes of ED?

• Normal aging results in decrease in blood flow and strength of erection — but this doesn't necessarily lead to ED.

• Emotional stress, like the kind you experience at work — or from trying to find a job — can result in depression, which often means a loss of energy and desire.

Smoking, which damages the circulatory system, is a leading cause of ED. And drinking to excess is infamous for creating performance problems.

• Uncontrolled high blood pressure can cause vascular damage that leads to ED.

• Blood pressure medications can cause a decrease in blood flow, but of course you should never go off these medications without your doctor's agreement. Same goes for some antidepressants, which can affect ejaculation and the entire sexual experience.

• Diabetes affects the entire circulatory system, so it too can affect the small blood vessels to the penis.

• Surgical or radiation damage to the nerves, peripheral neuropathy — even long-distance biking on a hard seat can affect the nerves of the penis.

• Hormone disorders, such as low thyroid or testosterone, and Parkinson's disease can lead to ED.

How do you evaluate and treat patients with ED?

In my practice, I've seen that ED can be the first sign of heart problems, namely coronary artery disease (a decrease in blood flow to heart). This means even young men should have a medical evaluation, and even a stress test, when they complain about ED.

Drugs such as Viagra, Cialis and Levitra can be dangerous if a patient taking them suffers chest pains and doesn't tell the doctor. That's because if nitroglycerin is given on top of those ED drugs, it can cause a very serious drop in blood pressure.

Bottom line: These popular drugs should only be taken exactly as prescribed by your doctor. Never use these pills in an effort to "improve'' normal sexual function.

What can be safely done to treat ED?

First, you should eliminate the risk factors you can control. Stop smoking, limit alcohol, get your diabetes and blood pressure under control. Eat wisely, exercise regularly. Enlist the help of your sexual partner.

If lifestyle modification doesn't solve the problem, the next stop is medication. Sometimes switching to another antidepressant or blood pressure medication resolves ED.

If Viagra and the like aren't appropriate, some drugs can be injected directly into the penis.

More invasive procedures, such as vacuum devices and penile implants, are usually reserved for more difficult cases. Your family doctor should direct you to a specialist in this area.

Dr. Sharkey is a prostate cancer educational consultant in Palm Harbor and was in full-time urological practice for 40 years. Contact him at (727) 786-4531 or at

Determining the causes of erectile dysfunction 02/12/10 [Last modified: Thursday, February 18, 2010 10:39am]
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