About half of all men between the ages of 40 and 70 years find it difficult to have erection or maintain one long enough to have satisfactory sex. This condition, known as erectile dysfunction (ED), affect not only your sex life, but can predict or be an early sign of such life-threatening illnesses as diabetes or cardio vascular diseases (CVD).
In fact, a study of 9,500 men published last year in the Journal of the American Medical Association revealed that men with ED are at significantly greater risk for chest pain, heart attack, or stroke than men without ED. The men who had reported even one occurrence of ED were likely to experience such events as men who smoke, have family history of heart disease, or have high cholesterol levels.
Another study that compared nearly 300,000 men with ED to more than 1.5 million men without ED showed that men with ED were more than twice as likely as men without ED to have diabetes-and among younger men with ED, there was even greater association with diabetes than there was among older men. The good news is that as distressing as ED may be, if it prompts you to see doctor, the results could be very beneficial for your health. Discussing ED with your doctor can help you have more satisfying sexual experience, and it may unable you to prevent or slow the progression of these related, potentially deadly conditions.
An erection is a complex process involving you nerves and your blood vessels. With sexual stimulation, the chemical nitric oxide is released from the nerve endings and the cells lining the blood vessels of the penis. Nitric oxide is both a vasodilator, which means it helps blood vessels dilate to improve blood flow, and it is a neurotransmitter, which means it transmits the messages from nerves to cells throughout the body. Normally, in response to sexual stimulation, nitric oxide enters the penile erection chambers, known as corpora cavernosa, and triggers a cascade of events that relaxes the smooth muscle tissue of the small cavernosal arteries (arterioles), increases blood flow to the penis, and, ultimately, produces an erection.
Cardiovascular disease accounts for nearly 40% of all deaths in the United States. Although it commonly occurs as a complication of diabetes, it occurs in many nondiabetic people as well. Early counseling and appropriet treatment for CVD can dramatically reduce the disability and death associated with this condition. A man in the early stages of CVD may develop ED long before he has classic cardiovascular symptoms (such as chest pain) because the arteries supplying his pennies are much smaller than the ones in his heart. Any problem that disrupts blood flow, such as damage to the lining of the blood vessels or narrowing of the vessels due to the buildup of plague, usually affects the penis first.
Diabetes mellitus affects 18 million Americans and more than 221 million people worldwide. The most prevalent form of the disease is type 2 diabetes, which seldom produces symptoms before it damages blood vessels. Since symptoms develop later in the disease, about one third of diabetes type 2 cases are undiagnosed. In diabetes, as in CVD, early diagnosis and management are key to preventing serious injury and death.
Roughly 75% of all men who have diabetes have ED. There are at least four reasons men with diabetes are at great risk for ED. First, diabetes can damage nerves, including nerves that relay messages to and from the penis. Second, diabetes damages blood vessels, making it more difficult for blood to flow into the penis for erection. Third, when blood sugar is poorly controlled, the body produces too little nitric oxide for erection to occur. Finally, about 12% of all men with diabetes have low levels of the male hormone testosterone, which is required for normal erectile function.
If you have CVD or diabetes, you first priority is to get these conditions under control. Both are life-threatening and either may contribute to your ED-blood vessel damage by reducing the flow of blood to the penis and poor blood sugar control by reducing the production of nitric oxide. In addition to medical treatment, these conditions often signal a need to make such life-style changes as quitting smoking, losing weight, getting and keeping blood sugar under control, and increasing physical activity.
After addressing these underlying conditions your doctor may prescribe oral treatment with one of group of drugs known as phosphodiesterase type-5 (PDE-5) inhibitors. These drugs work by blocking the action of the PDE-5 enzyme and thereby improving the erectile response to nitric oxide. Three such drugs are available: Cialis, Levitra and Viagra. All three have been shown to be safe and beneficial in treating of ED in men with CVD or diabetes, but these drugs are not appropriate treatment for all men with ED.
For example, men who take nitrates for heart disease and those with some types of heart defects, certain eye disorders, poorly controlled blood pressure, sickle cell anemia, or leukemia should not take these drugs. Men who take alpha-blockers for an enlarged prostate or high blood pressure should discuss necessary precautions with their doctor. Depending on the specific alpha-blocker and PDE-5 inhibitor used, the dosages of both, length of time the patient has been taking the alpha-blocker, and the amount of time that has passed since the last dosage was taken, concurrent use may cause some patients to develop dangerously low blood pressure. Always discuss all of your medications with your doctor to avoid potential adverse interactions
If you unable to take a PDE-5 inhibitor or are dissatisfied with the results, these are other treatment options, including testosterone replacement therapy for men with low testosterone levels, intraurethral medication, penile injections, a vacuum erection device, or a penile implant. Discuss the possibilities with your doctor.
Remember, in getting the help you need for ED, you may uncover other serious health conditions, such as CVD, diabetes, or elevated cholesterol or lipid levels. Addressing these issues may improve not only your erection, but also your overall health.
Sexual Medicine Society of North America and Quadrant Medical Education grant permission to reprint this handout for patient education, not for sale or commercial reproduction.
1. Reprinted from: Erectile dysfunction, cardiovascular disease, and Diabetes
Men's Sexual Health Consult Collection. November 2006
Annenberg Center for Health Sciences at Eisenhower.
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