Hello, my name is dr. Jonathan Lazar and the show is called health, medicine and sex. The show is about all aspects of men’s health and about male and female sexuality. The aim of the show is to educate you, the viewer, about your problem and to let what the treatment options are. Never be embarrassed or ashamed about your issue and never be afraid to seek help again. My name is dr. lazaar and I’m a urologist in New York City. Should you have any questions? Please email me your questions to J&L mv3 at aol.com, and I will either answer your questions on the show or I will email you. The response today, I want to focus upon the causes of erectile dysfunction. I want you all to know that if you have a problem, we can help you modern medicine has advanced and everyone, no matter how old they may be, can have an erection and have an excellent sex life and I mean everyone now I know. Many of you would like me to get to the bottom line the treatment of erectile dysfunction, but bear with me. The last show was on how the erection works, and this show is on the causes of erectile dysfunction. After you listen to both videos, you will have a good understanding of erectile dysfunction, and both videos are short, then you’ll be able to better appreciate my next show, which is on the treatment of erectile dysfunction. Let’s begin on, the last show I said that the erection is a vascular event, a blood flow of them, so the key to the erection is having healthy arteries. Erectile dysfunction results when anything blocks the flow of blood, so the number one enemy of the erection is atherosclerosis or hardening of the arteries. Atherosclerosis results in the deposition of plaque inside the arteries which blocks the flow of blood everywhere, including the penis, and what is the number one cause of atherosclerosis obesity and we happen to have an obesity epidemic in this country right now, so after our sclerosis is by far and away the number one cause of erectile dysfunction. So the question then becomes what happens if you’re obese and you go on a diet and you lose weight. Will your erections improve I’ll? Tell you on the next show, which is on the treatment of erectile dysfunction. Okay, I’ll tell you now. The answer is an emphatic yes, the next very important cause of erectile dysfunction is diabetes and we also happen to have a diabetes epidemic in this country. Right now, diabetes causes erectile dysfunction for a number of reasons. It affects the arteries, it affects the nerves and it affects the overall structure of the penis. Diabetes is also the most important cause of serious edie, the kind of edie that does not respond to medication. Many of these patients require surgery, but if this applies to you, don’t worry, the results of surgery are excellent and, finally, the third very important disease that causes erectile dysfunction is hypertension or high blood pressure. High blood pressure damages the inside of the artery, which then results in atherosclerosis. So there you have it. Those are three important diseases that cause edie diabetes, high blood pressure and atherosclerosis. Now the next important cause of edie results from your doctor trying to treat you medications are a very important cause of edie, particularly those medications that are used to treat high blood pressure and psychiatric disorders. Now I’m, not suggesting that any of you stop your medications, believe it or not. Controlling your blood pressure is more important than your sex life, but your doctor may be able to switch you to newer, more selective medications that have fewer side effects. Talk to your doctor now, the next important cause of erectile dysfunction is surgery. One very important operation that can lead to erectile dysfunction is the radical prostatectomy for prostate cancer, but it is important not to confuse this surgery for benign non cancerous enlargement of the prostate. That’s blocking the flow of urine rarely causes erectile dysfunction. Let’s take a look. This is a cross-section of the prostate, the arteries and veins to the penis that are responsible for erection run outside of the prostate at the 5 and the 7 o’clock position. The radical prostatectomy for prostate cancer involves removing the entire prostate. The arteries and veins can be injured because the dissection is adjacent to the arteries and to the veins. The surgery involved in treating an enlarged, non cancerous prostate is called the trans urethral resection of the prostate or the Terp. For short, it involves removing the inside of the prostate. Only this slide shows an enlarged, prostate compressing. The urethra. This final slide shows the part of the prostate that is removed during the tea. You are pee or Terp it. It is this red part. The arteries and veins to the penis are not injured because they are well away from the site of resection and they are protected by the outside of the prostate. The erection is preserved. The next important cause of erectile dysfunction is psychiatric disorders. This accounts for about 10% of erectile dysfunction. The most important culprits are anxiety, depression, bipolar disease and schizophrenia. If you are young and otherwise completely healthy, and you have erectile dysfunction, you probably have psychogenic. Now there are two rare causes of erectile dysfunction that I’d like to mention. One is called priapism or an erection that won’t go away. Priapism can result from medication used to treat erectile dysfunction and it can also result from recreational drug use, especially cocaine and the other very rare cause of erectile dysfunction is the penile fracture. The penile fracture can result from overly vigorous intercourse. It must be immediately repaired in order to prevent a reptile dysfunction. Finally, I’d like to talk about what does not cause erectile dysfunction. Testosterone. If you search the internet, you will find many many websites that claim, if you take testosterone, your erection will improve. This is a myth and it’s called the testosterone myth. Testosterone has virtually nothing to do with the erection. Testosterone is responsible for the man libido or the male sex drive. But again, testosterone has almost nothing to do with the erection unless the testosterone levels are extraordinarily low. So, to summarize, the erection is a vascular event, a blood flow of, and it requires the presence of healthy arteries. The six most important causes of erectile dysfunction are the three diseases: diabetes, high blood pressure and atherosclerosis medication, surgery and psychiatric disorders, so that wraps up the show. Thank you very much for listening. If you have questions email me at J&L, md3 at aol.com, please join me for my next show on the treatments of erectile dysfunction. Thank you. Goodbye.