Erectile dysfunction is a problem that men don’t like talking about because they feel like it’s not glamorous, and they’ll lose their character and masculinity. Still, the truth is, there are many men out there with erectile dysfunction issues.
Dr. Natalya Lopushnyan from Greater Boston Urology talked about some aspects of this problem and why the patient shouldn’t be afraid to talk with your doctor about it.
Erectile dysfunction occurs when your penis is not getting hard enough, and erection is not long-lasting long enough to have sex. There are a lot of men out there with ED, and you don’t have to be completely impotent to have this disorder.
In order to have a good erection, you need to have three things. You need to have a penis, you need to have good blood flow to the penis because that’s what erection is – it is increased blood flow to your penis. And you need to have good nerves that supply those blood vessels and your penile tissues.
Anything that can affect your penis, your blood vessels in the penis, or the nerves that go there can cause erectile dysfunction.
The most common causes are usually vascular disease, heart disease heart, high blood pressure, or diabetes.
Generally, we’ll want to start with the evaluation of the patient. Personally, I don’t particularly appreciate throwing medications such as Viagra or Cialis at the patient because you really want to know what the causes are. But in the garden-variety ED from mild to moderate, we will try the medications first.
What those medications do they improve blood flow to your penis, that is what really improves the erection.
It depends on the patient, their goals, what their lifestyle is, and what they want to get out of it. Once the medications don’t work, we can offer a couple of other different things, so, for example, we can always try injections.
That’s a treatment where a man would inject a tiny bit of medication into their penis. Anytime I say inject something into the penis, everyone cringes, says you’re crazy, “what are you talking about? I’m not stabbing myself, especially down there!”
But trust me, I teach men how to do that in my office, and probably out of a hundred men maybe one or two will say “wow, that was really uncomfortable, I’m not going to do that.” Because it sounds a lot worse than it actually is, and it works really well for most men.
Other options are things like vacuum devices to bring blood into the penis just by the vacuum suction and things like intraurethral suppository where you put a little pellet of the medication actually inside your penis.
Those are the non-invasive non-surgical treatments. If we go further to men with complete impotence or really poor blood flow to the penis, we can always talk about penile prosthesis, which is actually an excellent and very, very reliable option for treatment of the ED.
Talking about ED’s not glamorous, people don’t want to talk about erections unless they have amazing erections. So what I do in my office even when I’m seeing a patient who is not there to talk about erections – say, they are there because of their prostate issues, urination, kidney stones, etc. and they fall in that age range like the early 40s or older, I actually ask them myself. “Hey, how are your erections?” and if they say, “You know, I’m totally fine,” it is not a big deal, that’s great.
But probably about 70 to 80% of men who did not bring it up in niche initially we’ll share that “Yeah, you know like, it’s not working as well as it used to” or “not working at all” or “I’m so glad you asked because I did not know how to bring it up.”
The major improvement is in their self-esteem and their relationship with our significant others. Once you get them past that barrier, you show them you can have erections, and their personal life will improve so dramatically.