Understand Erectile Dysfunction

What is erectile dysfunction, and how common is it? Steven Brooks: Erectile dysfunction is the consistent or recurrent inability to either achieve or maintain an erection sufficient for pleasurable sexual relations. Jeff Brady: There are probably about 20 to 30 million men in United States who suffer from that. Longitudinal study suggest that probably there are 600,000 new cases per year. Steven Brooks: Erectile dysfunction affects all age groups and in fact the Massachusetts Male Aging Study suggested that some degree of erectile dysfunction is present in 50% of men between the ages of 40 and 70. I've seen men as young as in their 20s. I've never really seen anybody below the age of 20. Certainly it's more common in older patients, but you will see patients in their 20s and in their 30s. So it's not just in the older patient population. Jeff Brady: For those who have erectile dysfunction, about 85% probably have physiological erectile dysfunction where 15% will have more of a psychological issue. Steven Brooks: But I think it's fair to say that the overwhelming majority of patients have a combination of both psychological and physical factors and one into place on the other. If you are having some mild physical dysfunction, it will cause anxiety and stress, which will have psychological affects and impact on sexual function as well. So there is a very specific or consistent interplay between the two. Jeff Brady: There are lot of causes. The main causes are those processes that will affect the heart. So think about what are the risk factors for coronary artery diseases, the risk factors erectile dysfunction. Diabetes, hypertension, smoking, those are probably the biggest risk factors. Smoking is one that people can control and that's why we are going to really try to work with them if they can discontinue smoking, they will probably lower the risk of having erectile dysfunction. Steven Brooks: Depression itself is considered a risk factor for erectile dysfunction. So you not only have the depression, but you have the antidepressants affecting function. Jeff Brady: There are also pshycogenic causes which are probably in a long run easier to treat and not a permanent problem, but there are more likely be reversible. Steven Brooks: Generalized stress and anxiety is definitely a contributing factor. In fact when we speak to patients about what they can do, I suggest stress relieving protocols and procedures and not trying to have sex at those times when they are under a great deal of stress because they may be setting himself up for a disappointment. Jeff Brady: Well what happens is it's an interesting response that men will have. When they get into a situation where they may fail to have an anxiety response and anxiety will stimulate the sympathetic nervous system and that's the fight or flight response. What that does is that response tells the body to not have an erection, it's getting ready to fight to flee a scene. So it works against the body having an erection. So when a man gets in a situation where he's worried about failing, that part of a nervous system stimulated and the body tells itself do not have an erection and so men when they get anxious, when a person gets anxious, it's very difficult to have an erection. So that's probably what happens. The majority of men who have a psychologic or a that type of erectile dysfunction. Steven Brooks: It's a couples disease. Communication between the two is very important. It's not uncommon that a husband will come in and say hey my wife is mad at me, she doesn't think I love her anymore. She thinks that my erectile dysfunction is because a lack of interest and desire and libido. So communication between both partners is very, very important. In fact, I always encourage my patients to bring their partner. Jeff Brady: What usually happens and it's always interesting when you have a husband and wife together. If you talk to them about it, what happens they start out having some mild problems, or the men doesn't get as good of erection they used to. Now any person does not like to be in a position where they are going to fail. So he starts to shy away from being having an intimacy. The wife does not want to see him fail so she starts to push herself away, and before you know it they are not having any intimacy anymore. What ends up happening is after a few years there now not even affection at all, and they have lost that part of spark in their relationship. If they can get that confidence to go back and be sexually active oftentimes they are very, very happy and very satisfied. So I think it's important to have the female involved with any therapy that you decide. Steven Brooks: Here we get back to psychological issues. If the wife is flippant or expresses dissatisfaction or makes fun of the spouse's or the partner's dysfunction, it's only going to increase his level of anxiety and stress which will only increase his erectile dysfunction. So an understanding wife is very important.