Monday, December 12, 2005

Erectile Dysfunction: Solving a Common Problem

by Leonard DeRogatis, Ph.D.
Many men who suffer from erectile dysfunction (ED) experience a quiet catastrophe. They feel that their sex life, as they have known it, is over. They experience a sense of humiliation and loss of manhood. They also feel quite alone with their problem, as though each one of them is the only man on earth with ED.

It turns out that ED is common among men, particularly as they age. A large-scale study called the Massachusetts Male Aging Study showed that the prevalence of moderate to severe ED ranges from 8 percent at age 40 to nearly 50 percent at age 70. Factors such as diabetes, high blood pressure, heart disease, smoking, and high cholesterol all appear to undermine healthy erectile functioning. Even without these factors, erectile functioning can be a problem if testosterone levels are not high enough.

Fortunately, help is already here. Over the past decade, a class of drugs known as PDE5 inhibitors has given us three drugs to treat ED: Viagra, Levitra, and Cialis. All of these drugs have a good record of effectiveness and help 60 percent to 75 percent of men who take them. These drugs also are quite safe. Side effects experienced by most men include facial redness, stuffy nose, headaches, and some heartburn.

If for some reason a man cannot take one of the PDE5s, there are a number of second-line treatments available. Prostaglandin E1 (alprostadil or MUSE), available in a small suppository form, can be inserted in the penile urethra with a special device and has a good track record. A topical cream version of alprostadil is now in late-stage clinical trials. Alprostadil alone or in combination with several other drugs also is available in a form that is injectable directly into the side of the penis. The effectiveness of the injections is quite good; however, there are concerns about side effects such as penile scarring.

Although pharmacological treatments for ED have a very good track record, keep in mind that some causes of ED are psychological or interpersonal in nature. Drugs can help make the penis functional but they can’t fix a dysfunctional marriage or definitively treat a case of performance anxiety. In such cases, a good sex therapist or couples counselor (in many instances the same professional) can often be very helpful in treating the problem.

If you have ED, don’t let yourself feel isolated and alone with your problem. Ask your doctor for help and, if he or she doesn’t feel comfortable treating your problem, ask for a referral to an expert in sexual medicine. There’s a good chance that your problem is easily treatable, so don’t let potential embarrassment stand in the way of a rewarding sex life.

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