Overcoming Performance Problems: Finally, men are facing up to impotence

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The National Ambulatory Medical Care Survey (NAMCS) shows that the rate of physician visits for impotence, or as it’s more clinically called erectile dysfunction (E.D.), is nearly triple what it was in 1985. Leading urologists Ivan Grunberger, M.D., associate chair of the Department of Urology at Long Island College Hospital, Brooklyn, N.Y., and Harris M. Nagler, M.D., chair, Department of Urology at Beth Israel Medical Center, New York City, spoke with The Network Journal about the incidence of E.D. among African-American males and other issues. The increase in visits doesn’t mean that it is more prevalent, says Grunberger. Like Nagler, he feels that it’s probably being discussed more as “new drugs and advertising make people feel more comfortable talking about it.”

Finding the Cause
Almost all men experience problems in sexual performance periodically, usually from temporary causes such as fatigue, stress and even alcohol consumption. When the inability to get or keep an erection firm enough for sexual intercourse becomes chronic, that’s erectile dysfunction. What brings on the condition, which experts estimate affects between 15 million and 30 million American men? Race doesn’t seem to be a factor, so African-American males aren’t genetically predisposed toward or against the condition. Instead what might cause this population to experience E.D., says Grunberger, is that its members are more prone to other medical problems that can precipitate it.

Diabetes is a good example. E.D. is found in up to 50 percent of men with diabetes, and statistics show that African-American males are twice as likely to have diabetes than Caucasians in the same age group. Nagler says that African-American patients’ E.D. may be the first symptom of either diabetes or hypertension (another condition more prevalent in Blacks than in whites). Other causes include: lowered testosterone levels; surgeries (especially for prostate and bladder cancer) that might harm the area around the penis; and certain medications, including appetite suppressants and blood pressure drugs. That’s why, Nagler says, “It’s critical to determine if there’s a correctable cause for E.D. itself. You want to make sure it’s not being caused by other
medical conditions that simply haven’t been diagnosed.”

Turning to Medication
Since Viagra was approved in 1998, two other drugs in the same category have become available: Levitra and Cialis. All three drugs need about 30 to 45 minutes to take effect. Then, says Grunberger, “Viagra and Levitra last four to six hours on average, Cialis up to 36.” He adds, “That doesn’t mean you’re walking around with an erection all that time.” It simply means the patient can be ready to respond to stimulation within that timeline. The degree of spontaneity a man and his partner require are thus important factors in determining what drug (if any) is to be used.The shorter-lived drugs could be fine, says Nagler, for “an elderly couple who know that they have sex every Friday night.” But they might not work for a scenario Grunberger remembers. “I had a divorced man in his sixties a few years ago who was dating. I put him on Viagra (which was the drug available) and two of his dates asked why he was looking at his watch all the time,” Grunberger says.

Both doctors remind patients that all of these drugs have side effects, most commonly facial flushing, headaches and heartburn. It is critical that you tell your doctor all the medications you’re already taking. None of the E.D. drugs should be taken with certain heart medicines, like nitroglycerin. Certain drugs for B.P.H., enlarged prostate, may also be inadvisable. Because about 25 percent of men with B.P.H. have E.D., that’s something to watch for.

Finding Other Solutions
Both doctors agree that drugs aren’t always the solution to E.D. There’s an insertable suppository called MUSE and injections directly into the penis, such as Caverject. The latter, says Grunberger, uses needles reminiscent of those used in diabetes treatment and thus some patients say it’s not as uncomfortable as it sounds. Nagler adds, “This bypasses the need for sexual stimulation, so if the patient has decreased sexual desire,” these might be the better method.

There’s also a vacuum pump and, ultimately, surgical implants. The bottom line, say both doctors, is that no one method works for every man.You need to work with your doctor to evaluate not only which treatment best meets your immediate physical needs, but your expectations for performance as well.