Dr. Tony Sliwinski of Virginia Urology couldn’t believe what he was hearing as his patient explained why he had come to Sliwinski for help with erectile dysfunction (ED). The man, who was a six-year survivor of prostate cancer surgery, had contemplated suicide because of the humiliation of ED. Sliwinski noticed that his patient had been missing his doctor’s appointments. “Even under my watchful eye, he got so despairing,” he recalls.
The man grew more and more desperate, withdrawing from his family and friends. One night his wife walked into the room to find him sitting with a gun to his head. Her husband told her he couldn’t pull the trigger. “You have to do something about this,” she replied.
ED, defined as the consistent inability to attain and maintain an erection sufficient for sexual performance, affects half of men age 40 to 70. Experts believe that 80 to 90 percent of ED cases are related to a physical or medical condition, such as diabetes, cardiovascular diseases and prostate cancer treatment, while 10 to 20 percent are predominantly due to psychological causes. In many instances, however, both psychological and physical factors contribute to the condition.
Unfortunately, only 18 percent of men who have ED seek treatment. “Adequate treatment and diagnosis of ED helps you prevent other diseases associated with it,” Sliwinski says. “You can often catch the first stages of vascular disease, heart attack, stroke and diabetes. You can also detect prostate problems and depression. All doctors should ask their patients the question ‘Are you having problems with ED?’”
Being honest about ED could save your life, especially if you have an underlying condition. “ED is not a normal consequence of aging or other medical conditions,” Sliwinski says. “Just because you have diabetes, for example, you should still seek help if you are having problems with ED, because hypertension is an extra risk of the disease.”
According to the University of Michigan Health System, the most common cause of heart disease, a hardening of the arteries known as atherosclerosis, often causes ED. The risk factors for heart disease can also lead to the artery problems that cause ED.
To prevent both heart disease and ED, men are encouraged to practice a healthy lifestyle that includes regular exercise, adequate rest, good hygiene, a reduction of fat in the diet, good nutrition and regular health screenings.
Smoking can also contribute to ED because it impairs the function of the small blood vessels that are responsible for an erection. A study by researchers from the Harvard School of Public Health in 2006 found that obesity and smoking are strongly associated with a greater risk of ED and that regular physical activity appeared to have a significant impact on lowering the risk of ED.
There are psychological barriers that may prevent men from seeking treatment. “The sad truth is that once people are diagnosed with the disease, they are afraid of the stigma – you are less of a man – that surrounds the disease,” Sliwinski says. “Also, some physicians are hesitant to bring up the subject.”
Sliwinski believes that men worry that the diagnosis and treatment are not necessary. “They think that this is not a medical condition but rather a state of mind or a state of their well-being.”
In most cases, physicians can treat the disease with straightforward options such as Viagra, Levitra or Cialis. “These types of medicines average 80 percent effectiveness,” Sliwinski says. “Some of the other issues that might cause ED might not make them work perfectly.”
This January, the U.S. Food and Drug Administration approved Cialis for once-daily use to treat ED. When Cialis for once-daily use is taken each day, men can attempt sexual activity at any time between doses, according to Eli Lilly and Co., makers of the drug. Currently available in parts of Europe, this low-dose daily treatment option may be most appropriate for men with ED who anticipate more frequent sexual activity.
“We strive to provide patients with solutions that fit their needs, and Cialis for once-daily use delivers on this promise,” says Shawn Heffern, Cialis U.S. director of brand marketing at Lilly. “Now, patients have two options – some may prefer the up to 36 hours of efficacy provided by Cialis for use as needed, while others may want the unique benefit provided by this daily dosing option.”
Regardless of which medication you take for ED, you must give your system time to absorb the pill. “You need to wait 30 minutes to one hour before initiating sexual activities,” Sliwinski says. “Patients try to rush things because they feel as if they are on a time clock, but you have to let the medicine get absorbed.” Food delays absorption, so if it’s taken after a meal, it may not be absorbed for an hour or longer.
Physicians try to tailor medical therapy to the patient and his partner’s needs. “All three of the drugs mentioned have very tolerable side effects, such as facial flushing, nasal congestion and occasional heartburn,” Sliwinski says. “The medications are very safe for heart patients as long as you have the capacity to have sexual activity. You don’t want to mix the medications with nitroglycerin therapy. Together the pills and nitroglycerin therapy do too good a job of opening the blood vessels and you can have a precipitous drop in blood pressure, which could be dangerous.”
Patients often have the idea that all they have to do is take the pill and wait for results. Not true, says Sliwinski. “What people have to remember is that these medications need sexual stimulation to get the effect they want. Some of our patients will take the pill, sit down and read the paper and think they will get an erection, but it doesn’t work that way. It requires initiation.”
If the medications don’t work, there is a second line of therapy that is slightly more aggressive – penile prosthesis placement. Sliwinski’s patient who was suicidal opted for this procedure. “It carries a 97 percent patient and patient partner success rate,” Sliwinski says, noting that his patient is now an advocate for the procedure. “He talks to other patients about what this procedure meant to him and how his life has been restored.
“What people need to know is that there are options other than the pills that are highly successful but may be more invasive.”
Many of Sliwinski’s patients believe if they take the pill and fail, their life is over. “They are embarrassed and think that they might as well end their life,” he says. “That’s such a sad thing. We have options. No one should feel like it’s do or die.”
