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Prostate and Urological Health

What Men Should Know About Erectile Dysfunction

Dr. Salvatore J. Giorgianni

Pharm.D., Science Advisor, Men’s Health Network

There was a general view that men and their partners in their 60s, 70s, and beyond did not need to — or, in some views, shouldn’t — engage in an active sex life.

Then sildenafil — or Viagra, “The Little Blue Pill  came along, soon to be followed by tadalafil and vardenafil in the 1990s. These landmark medicines ushered in a new era for older men in the treatment of ED. It’s estimated more than 2 million prescriptions for Viagra, or its generic, will be filled in the United States this year.

While there has been progress in treating erectile dysfunction, the stigma around the condition has yet to completely disappear, despite the condition impacting as many as 25 percent of U.S. men 65 years and older.

The facts about ED and treatment

Traditionally, ED was thought to be an inevitable part of aging, only occurring in older men. But in reality, about 5 percent of men develop ED in their 40s.

While the physiology is complex, at its core, ED is caused by a lack of increased blood flow to the penis in response to sexual stimuli. This increased blood flow is what creates an erection.

The actions of Viagra and related medications depend on a small, three-molecule compound naturally found in humans, nitric oxide (NO2). When scientists at Pfizer made the link between the observed action of Viagra to facilitate erections, and its physiologic effect on NO2, the treatment model, and the way we think about sexual intimacy in older persons, underwent a seachange.  

A complex network of causes

ED is caused by myriad complex, interlaced psychological and physiological conditions, and a substantial percentage of ED is related to medical conditions that harm blood vessels, including those in the penis. Treatment of ED is often linked with treatment of underlying health conditions like diabetes, hypertension, arteriosclerosis, depression, and low testosterone.

Healthcare providers work with patients to bring these conditions under better control to manage ED.  When ED is found to be mainly psychological, medications like Viagra may need to be paired with behavioral health treatment.

Men should first start talking to their medical providers if they think they are experiencing some form of ED. After an adequate exam and history evaluation, health care providers may prescribe oral medications, like Viagra as first-line treatments.

It is important for men to discuss all the medications they are taking with their provider — they may be contributing to the condition or be adversely interacting with ED medications. If these oral medications fail, there are other options, including surgical interventions that may be helpful.

If sexual intimacy has been absent for awhile, men, and their partners, may need to reinvigorate intimate relations slowly over time.

Why sexual intimacy matters

Many experts believe having intimate moments with their partner is crucial to overall healthy living for men and women. Lack of ability to engage in sexual intimacy has been linked to poor social interactions and may contribute to feelings of inadequacy or social isolation for both partners that may lead to depression and lack of self-worth.

It’s important that men don’t think of erectile dysfunction as the end of the road for their sex lives — treatments exist.

Dr. Salvatore J. Giorgianni, Pharm.D., Science Advisor, Men’s Health Network, [email protected]

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