Press Release

Stanford Expert Explains What Erectile Dysfunction Really Means


Support Men's Health WeekJune 11-17

To support National Men's Health Week, Michael Eisenberg, MD, director of the Male Reproductive Medicine and Surgery program at Stanford's Department of Urology, is providing important advice on the issues that are sometimes difficult to talk about for either gender.

Dr. Eisenberg's research has brought new understanding to the complexity of men's health. He initiated the largest-ever study in the U.S. to examine the relationship between fatherhood and cardiovascular disease. The study, of 135,000 men tracked for 10 years, showed a 17 percent increase in the likelihood of a childless man's dying of a condition related to cardiovascular disease. Since fertility issues can surface well before any obvious outward symptoms of cardiovascular disease, such a link could help flag cardiovascular risk sooner, leading to earlier and more effective intervention, he said. Understanding more about sexual dysfunction can be an important first step.

Here he answers common questions about erectile dysfunction:

Is some loss of erectile function a normal part of the aging process?                               
Many men think that things change as they age. And, to a large extent, that's probably true; but things can happen a little earlier than they need to, and it can be a warning sign for other problems that can be averted. More than that, there are interventions that we can institute to help maintain function. You certainly can't expect erections to be the same when you're 70 as when you were 20, but there are normal expectations that men can have for good and adequate sexual function.

How common are problems not related to age? 
Large epidemiologic studies estimate that dysfunction affects probably about 50 percent of all men in this country between age 40 and 70. Other estimates predict that in the next 10 years, another 300 million men worldwide will develop erectile dysfunction.

What explains that high percentage? 
In the past, it was thought that most of this dysfunctionwas psychological. We now know that probably 85 to 90 percent is due to an organic cause that we can identify. The predominant causes are cardiovascular disease, high blood pressure, diabetes, smoking and obesity—and those conditions have increased in recent years.

Are there any other reasons for dysfunction?
Certain medications for blood pressure and psychiatric illnesses can also have a negative impact on function. We talk with a patient's primary doctor or cardiologist to see if medication might be adjusted. There also are some psychological causes of erectile dysfunction. Typically, it can become a self-fulfilling prophecy so that performance anxiety does become an issue. But anytime somebody comes in, we first try to rule out an organic cause.  We look at the whole patient. 

Michael Eisenberg, MD

Are there hidden health conditions that dysfunction can signal? 
All men should know is that it is often a precursor to other medical problems. It can actually precede cardiovascular disease by three to four years. So even if they do consider themselves otherwise healthy, this may be a warning sign to take their health a little bit more seriously, to make sure they see their primary doctor on a regular basis.

Prostate and other pelvic cancer surgery has been associated with a risk of post-operative erectile dysfunction. Are there any new approaches to that circumstance?   
At Stanford, we've found that there are things we can do before surgery or radiation to preserve function and expedite recovery. What we've learned also is that in the immediate post-operative period, an aggressive rehabilitation program is very important for maintaining penile health. If a normal oxygenated erection does not occur every day, natural erections either will not recover as fully as they were before, or the recovery can be delayed.

What kind of physical treatments are available? 
The first thing we do is try and identify any modifiable causes. We also usually look at a hormone profile. For instance, low testosterone has been linked to problems with sexual function. That's something that could also be corrected. Then we move on to some of the different medications that we have, familiar ones like Viagra and Levitra, and Cialis, which work very well. If those don't work, we move on to some other options that are more invasive, like injection therapy or urethral suppositories. There's also something called a vacuum erection device. And, if none of these approaches work, there is surgery we can do to put an inflatable prosthesis in the penis, which also has very high patient and partner satisfaction rates.

Are there non-medical options, too?
Some men find that their erectile dysfunction very situational and want to learn different techniques or get psychological help.

Can treatment do more than just improve physical health?
Erectile dysfunction has a large impact on emotional life, on overall quality of life. I've seen relationships end. Once we initiate treatment, new relationships can begin.

What do you recommend to preserve and protect function? 
I always tell men, in order to prevent erectile dysfunction, you should live a healthy life.  Anything that's good for your heart is going to be good for your penis. So, a good diet and exercise will all benefit. If they have other risk factors that are modifiable, such as smoking, they should definitely cut that out. Weight control also is very, very important. If you do have a problem, I always do encourage a patient's partner to be involved in treatment as well, because it's a team sport, and I think having a very interested and active partner that's willing to help goes a long, long way.

By Sara Wykes

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