Medical History and Erectile Dysfunction
What are some of the main health conditions that contribute to ED?
Well, one of the biggest factors with one of the highest prevalence in our country, in the Western countries, is diabetes mellitus. This is a condition of abnormal sugar, blood sugar regulation, and what it leads to is, well, a lot of complications, but the one we’re talking about today, erectile function, by two main routes.
Diabetes and Erectile Dysfunction
The first is it causes microvascular calcifications or calcifications of the arteries. The smaller the artery, and the longer you have the diabetes and elevated blood sugar, the less blood flow that you have. The smallest arteries are the arteries of the penis, the helicine arteries, so that mechanism having diabetes leads to decreased inflow. Then you have, over time, having the elevated blood sugar. Impaired blood sugar regulation affects the nerves, the nervous system all over the body, and we hear of people having tingles or neuropathy in the feet.
There’s a neuropathy of the penis. What happens is the nerves, the autonomic nerves that control the venous valves that keep outflow from coming out of the penis, keep blood from coming out of the penis when it’s “go” time. They get damaged and so those valves don’t close. Not only are you dealing with decreased influx of blood into the penis, you have outflow that is not inhibited. So the blood that’s going in comes out, and when blood comes in, comes out, there’s no hydraulic pressure to raise the penis for intercourse.
Being diabetic, you have a four times increased risk of having ED over the general population.
It’s quite serious. One of the most common microvascular or early symptoms of those problems in diabetics, followed by the eyes. Two of the other biggest, or most common medical conditions that are associated with decreased erectile function are cardiovascular disease which can consist of hardening of the arteries, not from the diabetes itself, but just high cholesterol, high serum fatty acids or lipids in the bloods. These get deposited into the sidewalls of the great arteries of the abdomen and the pelvis, like the aorta and the iliac, and these impede blood flow going to the smaller arteries like the helicine arteries of the penis.
Hypertension and Erectile Dysfunction
On top of that, hypertension, or sustained elevated pressure inside the arterial blood system or the arterial system likewise does the same thing. The arteries tend to thicken and as they thicken from hypertension, the smallest arteries tend to get occluded, thus leading to decreased inflow to the penis. We can talk about this later but medications used to treat those conditions, unfortunately, are also associated with erectile dysfunction through a variety of ways.
Obesity and Erectile Dysfunction
Obesity in general can lead to a lot of the other conditions that are associated with erectile dysfunction like cardiovascular disease, hypertension, and diabetes. But on top of that, as well, in obesity in the metabolic syndrome, there is a decreased functional length to the penis. So because of the extra adipose tissue, the length of the penis that’s out to become engorged and usable becomes less and less.
Prostate Cancer and Erectile Dysfunction
Lastly, a major health condition that’s very common in American men as we age is prostate cancer. It’s not prostate cancer itself that affects erectile function, it’s the treatment for prostate cancer that often creates profound problems with not only erectile function but sometimes also hormonal factors, libido, and incontinence. So the bottom line is, if you have or are being treated for prostate cancer, your love life is not over. There are a lot of options, and I encourage you to discuss those options with your urologist.
Treating Medical Conditions Linked to ED
A lot of things like diabetes, hypertension, cardiovascular disease, obesity, or lifestyle/modifiable factors can be improved. For a majority of people with these conditions, they can see improvement with vigorous exercise, eating a healthy, proper, and nutritious diet.
Weight loss can lead to improvement of obesity’s factors’ effects on erectile dysfunction.
For things like medications for those conditions, that typically has to be discussed with your doctor. You can’t just stop a medication when you want, or you shouldn’t. But there are ways to influence and improve your erectile function even if you have all three or four of those conditions and prostate cancer. There are a lot of ways to treat erectile dysfunction, and the simplest thing you can do, right, is just maintain an active lifestyle, a healthy weight, and proper nutrition.
Doctors and Specialists for ED Treatment
So you say, “mention to your doctor about any symptoms you might have with ED,” but what if your doctor isn’t the person you see about ED?
A lot of primary care doctors don’t ask about ED. It’s not on their radar. They’ve got to get your blood pressure down, they’re going to get your A1C under control, you got to get your weight down. They’re not thinking about how some of the side effects of the medications that they’re giving you might affect part of your life that you might not feel comfortable discussing.
I’m a urologist. People come to me and that’s what they talk about. But if you’re someone who’s worried about their lipids, their blood sugar, you’ve got to start the conversation with a doctor. It may be a psychiatrist with your depression. You’ve got to have that conversation and say, “hey, this is killing my erections. I need help. I need to see if there’s other options out there.”
Talking to Your Doctor About ED
Just go in and be direct. The best thing I can tell you is just go up to your doctor and say “this is bothering me. I’m having a problem.” Be direct. Not all of you will need a referral to a urologist like me. Just talk to your doctor and be straight because, honestly, most primary care doctors, they’re not going to ask you. You’ve got to bring it up yourself.
Eddie by Giddy for ED Treatment
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