Written by Pete Stahl, M.D.
A recent Washington Post article, A Silent Crisis in Men’s Health Gets Worse, highlighted the fact that men are at a greater risk of dying from most causes than women. Our life expectancy is almost 6 years shorter—73.2 years vs 79.1.
While there are a multitude of physiological and behavioral reasons that drive these differences, there’s one obvious contributing factor. Most men do not attend to their health as well as women. The physician visit rate is, in fact, 40% higher for women than men.
Unlike women, who are accustomed to pregnancy visits in their childbearing years and a lifetime of regular breast cancer screenings and gynecologic visits, many men do everything they can to avoid seeing the doctor.
We don’t like to be probed and prodded and don’t want to “appear weak” or “complain” about physical or emotional problems. We may be afraid of uncovering a medical vulnerability that upsets our sense of control or puts a chink in our proverbial armor.
Pair that with the lack of symptoms associated with potentially serious illnesses like high blood pressure, heart disease, high cholesterol and diabetes, and it all adds up to a silent crisis affecting most men in the U.S.
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There is one condition, however, that gets our attention and is likely to lead us to a healthcare provider: erectile dysfunction or ED. Men with the courage to seek help tend to beeline straight for the first healthcare provider they can access when their penises aren’t working right.
And ED is common, with as many as 40% of men experiencing some degree of erectile dysfunction by the age of 40 and as many as 70% by age 70. This phenomenon, the ability of ED to break through many of the barriers that have been preventing men from engaging with the healthcare system, presents a tremendous opportunity for a urologist like me to help.
Getting a strong erection is a complicated physiological process that requires precise coordination of many body systems.
Dysfunction of any one of these body systems can cause ED. So, erections can go wrong in a lot of ways. But that also means that if a man has ED, it might be a warning sign that something undiagnosed is wrong with one of the body systems that is important for getting and maintaining strong erections. And that “something” could be critical to a man’s overall health.
Erectile dysfunction (ED) is not just a standalone condition. Men with ED are more likely to have chronic conditions like high blood pressure, high cholesterol, cardiovascular disease, diabetes and depression.
That’s because these conditions share pathophysiology with ED—the same things that go wrong inside the body that cause these diseases and conditions can also cause or worsen ED. In addition, claims data of close to a million men with documented ED found an association between ED and many other serious health problems. They include immune system, liver, lung, prostate, and myoneural (muscle-nerve) conditions.
I’ve seen thousands of men with ED in my practice. When a patient comes in, I focus on two objectives. First, I want to help each patient understand and solve their sexual problem so that they can feel great and confidently re-engage with their partner(s). Second, and it’s just as important, I want to identify any unknown health problems associated with or contributing to the patient’s ED.
The process is pretty simple. I start with detailed medical and sexual histories looking for symptoms or contributory factors (e.g. anxiety, smoking, low testosterone).
I check for high blood pressure, which is a “silent cause” of both cardiovascular disease and ED. I examine the patient, looking for signs of problems with the penis or hormonal imbalances. And, if a patient hasn’t had them checked recently, I will order blood tests to screen for diabetes, high cholesterol, and hormone deficiencies.
Treatment for ED is tailored to each patient. It generally involves medication to support erectile function, such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®) or avanafil (Stendra®).
Other treatments like testosterone replacement therapy or medication to reduce blood pressure or cholesterol may be appropriate, based on clinical signs and blood test results.
Sometimes I refer patients to other healthcare providers like a sex therapist (if there is a psychological component to the sexual dysfunction), dietitian, primary care doctor (if they don’t have one), or endocrinologist (if I discover that a patient has diabetes).
National polls are barometers of election results; the way you feel on a first date is a barometer of the way a relationship may develop; and the penis is absolutely a barometer of general health. So, take your penis seriously! If it is misbehaving, your body might be warning you of a serious but hidden medical problem.