One of the unintended side effects of the introduction of Viagra was that it caused talk. That is, the subject of impotence came out of the closet. Impotence, now termed erectile dysfunction, or ED, is defined as the inability to get or maintain an erection sufficient for satisfactory sexual intercourse.
Once tagged as a sure sign of emotional problems or a nonfunctioning libido, ED has come to be understood as something usually physical, involving nerves and blood vessels. Only 10 percent of cases are now regarded as primarily emotional in origin. ED is more likely to be the cause, rather than the result, of emotional problems and to arise, in the majority of cases, not from a lack of interest in sex or in a specific sexual partner, but from physical problems, many of them treatable.
Moreover, thanks to ongoing research and medical advances, ED is now regarded as a key indicator of male sexual health and of male health in general—not an isolated symptom. It is hardly an isolated problem, either. More than 10 million men in the United States have ED, and estimates run as high as half of the older male population, though there is some argument about how exactly to define and diagnose the condition. The incidence increases dramatically after age 70, but younger men get ED, too.
What every man should know
Briefly, what your and your sexual partner should know is that ED (if it is a recurring problem) is in many cases a sign of elevated risk of cardiovascular disease. “Oh, great,” you may be saying, “not only has my sex life vanished, but I may be in poor health as well.” But the good news is that if you seek diagnosis and treatment, and if you are willing to make some lifestyle changes, you may be able to solve both problems at once.
A man’s heart is connected to his penis in more than a figurative way—and not surprisingly, since from a physiological point of view, an erection is certainly an affair of the heart. In response to sexual stimulation, blood is pumped into the corpora cavernosa, a pair of tube-like structures in the penis, and muscle tissue relaxes, holding the blood in place and sustaining an erection. Both ED and impaired heart function can be caused by reduced blood flow. This can occur when blood vessels become less flexible because of, for example, smoking, high blood pressure or reduced production of nitric oxide. Nitric oxide causes vessels in the penis (and elsewhere) to dilate, allowing for increased blood flow and thus an erection. Drugs like Viagra boost nitric oxide.
ED shares many risk factors with cardiovascular disease, notably increasing age, smoking, diabetes, depression, obesity, physical inactivity and high blood pressure. A 2007 study in the American Journal of Medicine found that among a cross-section of 2,100 men, half of those with diabetes had ED. Men with high blood pressure and those who were sedentary also had a high incidence of ED. Often these conditions are intertwined. In men with diabetes, poor control of blood sugar can inhibit the release of nitric oxide, resulting in reduced blood flow, while neuropathy can damage nerves that trigger erections. Many people with diabetes—as many as 2 out of 3—also have high blood pressure, which further increases the risk of blood vessel damage.
Not surprisingly, ED is often a reliable predictor of heart disease and stroke. This was shown by a study of more than 9,000 men, published in the Journal of the American Medical Association in 2005, which found that men with ED had a substantially increased risk of cardiovascular disease.
Many experts believe that physical inactivity, in particular, is directly linked to ED and thus recommend exercise as a way to help prevent not only diabetes and hypertension but ED as well. Indeed, a large study of 22,000 male health professionals in the United States, published in the Journal of Urology in 2006, found that people who got regular physical activity of any type were less likely to develop ED. The authors of the study suggested that maintaining sexual health might serve as strong motivation for men to lead a healthier, more active life.
Keep in mind that many other factors can cause or contribute to ED besides circulatory problems—notably nerve disorders, excessive alcohol consumption, low testosterone, the after effects of prostate surgery and certain medications, particularly sedatives and some antidepressants.
What if you do nothing?
Sexual desire varies from one person to another and across a lifetime; desire tends to decline with age, at least for many people. Still, for most men ED is bad news. Losing the ability to have sexual intercourse is not a trivial matter for a man—or for his partner. ED can damage self-image for both partners, producing anxiety, conflict and depression.
Out of embarrassment and/or a lack of knowledge about medical solutions, many men choose to do nothing about their ED. But persistent, chronic ED is unlikely to improve without some form of intervention, particularly among men over 50. Fortunately, proven treatments for ED are available.
Take action against ED
If you have ED, consult your doctor. There’s no specific diagnostic test—your own impressions are key, and you should speak frankly to your doctor.
Don’t settle for just a prescription—find out what’s causing your problem. Viagra and similar drugs are okay if you want them, but they should not take the place of a careful diagnosis. Moreover, they are not appropriate for all men and may have serious side effects, especially when taken with certain other drugs. You may want to talk to a psychotherapist if ED has caused problems in your life (or the other way around). You should rule out diabetes and high blood pressure, and begin treating these conditions if you have them. You’ll want to find out if what is not happening in your penis is related to what is happening in your cardiovascular system. Whatever improves the health of your heart and blood vessels is likely to improve your erections, too.
A host of supplements are marketed as “natural alternatives” to prescription drugs like Viagra. The supplements contain a wide range of herbs and other ingredients—from ginkgo, arginine, ginseng and deer horn to damiana, maca, vitamins and Chinese herbs. But there is no good scientific evidence for any of them, and some are dangerous. In addition, none of the penis enlargement products touted on the Internet or via spam e-mail work, either, and they can have adverse effects. The only way to add length and girth to the penis is through surgery—and that can result in erectile dysfunction, infection and other problems.