Improving Men's Sexual Health and Function

The Prevalence and Impact of Erectile Dysfunction

Over half of men over 40 suffer from some degree of erectile dysfunction (ED). As men age, the prevalence increases – 40% at 40 years old, 50% at 50 years old, 60% at 60 years old, and 70% at 70 years old. This extremely common issue can significantly reduce quality of life by impairing sexual function, harming relationships, and contributing to depression and anxiety.

However, many men suffer in silence due to embarrassment and reluctance to seek treatment. Better education and awareness around ED is critical so men feel empowered to discuss issues with their doctor and explore solutions.

Causes and Diagnosis of Erectile Dysfunction

The causes of ED can be vascular, endocrine, neurologic, medication-related, psychogenic, or often a combination. ED tends to be a progressive disease that worsens with age, likely due to accumulating health conditions. A validated 6-question IIEF questionnaire helps determine if ED is present and classify severity as mild, moderate or severe.

Typical Symptoms and Key Questions

• Inability to get an erection sufficient for penetration
• Inability to maintain an erection through completion of intercourse
• Do you get normal erections during masturbation or sleep?

Available Treatments for Erectile Dysfunction

Many effective options exist to improve erectile function:

• Oral medications – PDE5 inhibitors like Viagra, Cialis, Levitra, and Avanafil
• Injections into the penis – Alprostadil, Trimix
• Shockwave therapy
• Platelet rich plasma (PRP) injections
• Stem cell therapy
• Penile prosthesis (last resort)
• Psychotherapy for psychogenic ED
• Lifestyle interventions – diet, exercise, sleep, stress reduction

Mechanism of PDE5 Inhibitors

During arousal, nitric oxide is released, increasing cyclic GMP which relaxes smooth muscle for erection. PDE5 breaks down cyclic GMP, causing erection to cease. PDE5 inhibitors allow erection to be maintained for longer.

Erectile Dysfunction as Predictor of Cardiovascular Disease

Studies demonstrate a strong link between ED and future cardiovascular events. The theory is that endothelial dysfunction is the common factor, supported by overlap in risk factors like smoking, obesity, diabetes, and hypertension.

Men who develop ED have a 15% chance of a heart attack or stroke within 7 years. ED tends to manifest before overt cardiovascular disease, potentially serving as an early warning sign.

Lifestyle Changes Shown to Improve Erectile Function

A Mediterranean diet and exercise program in obese men with ED helped lose weight and gain a 3 point improvement in erectile function scores, without any medications. Lifestyle changes can reverse endothelial dysfunction and ED.

Other Sexual Health Concerns in Men

Beyond ED, other common sexual disorders include:

• Peyronie’s disease – penile curvature or deformity due to plaque buildup. Injections with Xiaflex can help break down scar tissue.
• Hypogonadism – testosterone deficiency leading to impaired sexual function, treated with testosterone replacement therapy
• Premature ejaculation – climaxing too early, treatments like SSRIs and therapy help delay
• Erectile refractory period – intervals between erections increase with age

Diagnostic Testing

Specialized testing by a urologist can help characterize the exact nature of erectile issues:

  
• Penile Doppler ultrasound – measures arterial blood flow and venous leak
• Inject medication to induce erection, assess erection quality, curvature, plaques

Data from testing guides appropriate treatment selection for optimal outcomes.

Conclusion

Sexual health has profound impacts on men’s well-being but often goes undiscussed. Fortunately many solutions exist, both medications and lifestyle changes, that can effectively treat common issues like ED and Peyronie’s disease. Men should adopt healthy lifestyles and feel empowered to speak openly with their doctor if they experience any sexual dysfunction.