Erectile dysfunction is very common with up to 40% of men over the age of 40 being affected. It is when a man can’t get or keep an erection firm enough for sexual intercourse. It is associated with increased risk of peripheral vascular disease, stroke and all-cause mortality. Men with erectile dysfunction often have vascular diseases like diabetes and coronary artery disease.
It is good practice to discuss this with your provider honestly and open up when the provider screens you for erectile dysfunction. Most times erectile dysfunction is diagnosed by history and physical exam alone. Often medications account for up to 25% of the cause and additionally, any history of diabetes, hypertension, circulation clotting or bleeding disorders, as well as seizure and stroke history, should be examined.
Lifestyle modification, such as weight loss through healthy eating habits and exercises, to control any of the above illnesses and starting a PDE-5 inhibitor (sildenafil, vardenafil, tadalafil, avanafil) can be both safe and effective in treating erectile dysfunction. Sometimes a visit with the urologist may be needed, and if those treatments fail, mechanical or surgical intervention is needed.
Normal penile erection requires two things: arterial inflow in the cavernosa so that oxygenation of these tissues can be guaranteed and nitrogen oxide synthase present in order to generate the nitric oxide to allow for penile engorgement through vasodilation. Therefore any process that interferes with arterial blood flow or nitric oxide synthesis will lead to erectile dysfunction.
There are many risk factors for developing erectile dysfunction. Risk factors include age, diabetes, hypertension, dyslipidemia, obesity, cardiovascular disease, smoking, obstructive sleep apnea, scleroderma, Peyronie’s disease, prostate cancer treatments and a lot of different medications. Some causes of erectile dysfunction are correctible and include changing medications, treating stress and depression, treating hormonal imbalances relating to the androgen, thyroid and the pituitary gland.
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Erectile dysfunction has a positive predictive value for the development of coronary artery disease equal to or greater than smoking, dyslipidemia or a family history of myocardial infarction. It often starts 2-5 years before the onset of coronary artery disease. Patients who have diabetes are three times more likely to develop erectile dysfunction.
Keisha Ellis is a certified family nurse practitioner for Eastern New Mexico Medical Group’s Quick Care. The advice offered in this column is that of the author.