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Get back in the game: treatments for erectile dysfunction

Listen to the Mayo Clinic Q&A podcast to learn about treating erectile dysfunction.

Mayo Clinic Q&A podcast: Men’s health – Treating erectile dysfunction

Erectile dysfunction is a common problem, affecting up to one in five men. While there are many potential causes, it is often a result of a physical or psychological issue.

In this Mayo Clinic Q&A podcast, urologist Dr. Bradley Anawalt discusses the causes, diagnosis and treatment of erectile dysfunction.

Causes of erectile dysfunction

Erectile dysfunction can be caused by a variety of physical and psychological factors. Physical causes can include:

  • Atherosclerosis – hardening of the arteries
  • Cardiovascular disease
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Injury to the nerves or arteries supplying the penis
  • Kidney disease
  • Multiple sclerosis
  • Parkinson’s disease
  • Pelvic surgery
  • Prostate cancer treatment
  • Prostate enlargement
  • Sleep disorders

Psychological causes can include:

  • Anxiety
  • Depression
  • Guilt
  • Low self-esteem
  • Relationship problems

Diagnosing erectile dysfunction

If you’re experiencing erectile dysfunction, make an appointment to see your doctor. While it may be uncomfortable to talk about, erectile dysfunction is a common problem that can often be treated successfully.

Your doctor will likely ask about your medical history and perform a physical exam. They may also order tests to check for underlying health conditions. These can include:

  • Blood tests
  • Urine tests
  • Imaging tests
  • Psychological evaluations

Treating erectile dysfunction

The treatment for erectile dysfunction depends on the underlying cause. In some cases, making lifestyle changes may be all that’s needed to improve your erectile function. These can include:

  • Exercising regularly
  • Losing weight
  • Quitting smoking
  • Reducing stress
  • Treating underlying health conditions

In other cases, medication or other forms of treatment may be needed. These can include:

  • Oral medications. These are often the first line of treatment for erectile dysfunction. Medications that can be used to treat erectile dysfunction include:
  • Sildenafil (Viagra)
  • Tadalafil (Adcirca, Cialis)
  • Vardenafil (Levitra, Staxyn)
  • Avanafil (Stendra)
  • Injections. Alprostadil (Caverject
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For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

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Video transcription:

Welcome everyone to mayo clinic q, a I’m dr helena gazelka. We know that men are less likely to seek routine medical care than women are, but while men have a bad habit of avoiding the doctor, there are some problems that will prompt them to take action. A common complaint erectile dysfunction here to discuss men’s sexual health and fertility with us today is dr savann hilo mayo clinic urologist, thanks for being here today, dr hilo, can you explain for our listeners? What is the definition of erectile dysfunction? The simplest way to define it is really the inability to get or keep an erection. That’s firm enough for sex? Is the loss of erectile function, a normal process of aging? I always tell patients that it doesn’t have to be. It certainly is more common as men get older, but it doesn’t necessarily have to be something that happens to every man. How common is it? It’s estimated that 40 of men by the age of 40 will have some degree of erectile dysfunction and by the time they get to age 70? That number goes up to 70, so it’s certainly more common than you would think. Is there anything that can be done to prevent sexual dysfunction? Fortunately, many of the things that men can do to lower their risk of erectile dysfunction will also lower their risk of diabetes, high blood pressure, heart disease, the three most common things that I tell men that they can do to prevent erectile dysfunction are to exercise regularly maintain a healthy diet and to refrain from smoking. I imagine there are treatments for erectile dysfunction. We know of some of them because we see them advertised on television, but what are the common treatments and how successful are they? Fortunately, we have many treatment options for men, the options range from pills to a vacu erection device injections and even a surgery, a penile implant. I always tell my patients that I guarantee there’s something I can do to help them, but it’s a matter of how invasive that treatment is going to be. I know you’ve mentioned that there are different ways that sexual dysfunction can occur or erectile dysfunction. Is there a difference between when it occurs just from a disease state versus surgically, such as after a prostatectomy and are the treatments? Different certainly are special situations and men who have undergone previous surgery in the pelvis like prostatectomy for prostate cancer or various kind of surgeries for the colon, can certainly affect the nerve function for erections. The vast majority of cases that we see really is a blood flow problem or a vascular problem, and so generally most of the treatments are aimed at correcting that, although the penile implant will solve the problem, regardless of what the cause is, is there a connection between erectile dysfunction and heart disease? Absolutely the way I explain it to my patients is that the vessels that carry blood flow to the penis are about an eighth, the diameter as the vessels that carry blood flow to your heart. So you can imagine that these vessels are very sensitive to changes in blood flow and that can be caused by buildup of cholesterol and plaque inside the vessels just like causes for heart disease. So sometimes erectile dysfunction is actually the first sign of a heart problem and it can develop even 10 years earlier than a man may ultimately have heart issues like a heart attack. That’s a great perspective to put it in and what should the first step be that a man takes if he notices this is starting to occur. First thing is talk to your doctor, certainly about treatment options like we talked about when we see patients in our clinic generally they’ve already tried the pills and the pills either work for a period of time, or maybe it didn’t work from the get-go and in those cases, if they don’t have a strong history of something such as high blood pressure, heart heart disease or previous history of heart attack or surgery on their heart, then sometimes there’s some additional testing that we’ll do in the office to make sure that there’s no major issues with blood flow and if we find that the blood flow they’re getting to the penis is a lot lower than we would expect for their health and or age, then sometimes we’ll refer them to a cardiologist to make sure they’ve had a thorough workup so that we’re not missing the bigger picture. So it sounds to me like when a man presents with concerns for erectile dysfunction that that’s a great time for him to get some of his routine screening for other potential disease states done as well. For me, that’s the most gratifying kind of visit is when a guy comes in saying I just want to make sure that we’re not missing something else, because that’s the guy, who is willing to make some lifestyle changes. If there are things we can do to improve his overall health, so that’s really a great opportunity for intervening early, so we’re going to switch tracks just a little bit now, because dr hilo, I know that another area of expertise, for you is male infertility. Percentage of couples are infertile, and can you tell us what that means exactly 10 to 15 of all couples who are trying to conceive will ultimately struggle to conceive and will struggle with infertility and it’s defined as an ability to conceive after a year of trying with unprotected intercourse and unfortunately, it’s again more common than you would imagine. I feel like we hear so much about female infertility and the measures that are taken to help correct that. How common is it that the male may have fertility issues in the relationship? First off, I would say the way I approach it is. I tell couples that it’s really a couple’s issue, so that no one feels like they’re at fault and and honestly, that being said, ultimately, a third of the time, a male factor is identified along with a female factor. So it’s very common that it’s a little bit of both both partners are having an issue conceiving and 15 of the time. It’s a male only factor what are the most common reasons that couples may experience infertility. The most common reasons would be a hormone imbalance on the male’s part, with his testosterone that male hormone, that’s important for building muscles, but also for making sperm varicocele is also a common cause of infertility, and that’s essentially like dilated veins that go to the testicles that warm up the environment of the testicle and make it hard harder to produce sperm. You can also have a blockage of the vas deferens that tube that carries sperm from the testicle out through the ejaculate and that can be caused either by genetic factors or certainly by previous surgery that you may have had, and then. Lastly, there are some more rare genetic causes that typically will run in families, but also can appear over time. So it sounds to me like. There are multiple causes for male infertility, just as there can be for erectile dysfunction. Are these causes fixable? What can be done to aid male infertility? The answer is yes, and no. Some of the causes like hormone imbalances, potentially infections or surgeries that may have caused a blockage of that tube carrying the sperm. Some of those can be corrected either with medication or surgery. That being said, average sperm counts in the last 40 years have dropped by about 60 percent, and we don’t completely understand why that is some of the reasons that may account for that may be environmental exposures, such as increased radiation around us higher rates of obesity and increased use of prescription medications. So again, some of those things may be treatable or reversible, but a lot of the time, even after we’ve taken a very thorough history that we may not find so to speak, that smoking gun that may be fixable and it’s likely a number of factors that we can potentially modify. I know that many couples are waiting until later in life, when they’re more established to attempt to have children now, and certainly that can affect female infertility. I believe, do sperm counts, drop with aging. Could that affect it in any way? We get that all the time certainly does affect female fertility. Age is a major factor there, but t hat being said, if you look around, you, celebrities seem like they’re having children a lot later in life and at first I think for some people. It normalizes that men in their like 60s having children but realistically sperm counts, do drop over time and the quality of the sperm tends to diminish. You can also have increased, what’s called dna fragmentation, which is essentially like the quality of the dna inside of the sperm itself, also diminishes with time and so there. While I certainly understand people putting that off later in life, you don’t want to put it off too late in life, because there is, there is a point where it can certainly be more difficult. I’ve had multiple couples that I know who struggled with infertility. I think everybody has it’s so common. Inevitably, it seems to reach a point where people are anxious to start investigating women understand their biological clock is ticking, etc. When a couple begins to engage in investigation for infertility. What should the man expect when he comes to see you in the office most important tests that we’ll do for men is, is a semen analysis and that will give you a total idea of the number of sperm that are in your ejaculate. It will give you an idea of the volume of the ejaculate and how well the sperm move and using those three numbers we calculate what’s called a total modal sperm count, which is really the number that’s most predictive of being able to conceive. Naturally, so that’s probably the most important test that we’ll do and then, aside from that, we’ll also typically look at the hormones, including the testosterone level, which, again more more often than not even with men who aren’t having symptoms, will find that their testosterone is low and that’s something that’s potentially treatable and will not just help their sperm counts, but potentially also improve other aspects of their life that maybe they didn’t realize, had changed kind of subtly over time when there are concerns for male fertility, how successful are the treatments and management options that really depends on what the cause is for men, who have some sort of blockage surgery to bypass that blockage is generally very effective. We talked about a varicocele those dilated veins to the testicle surgery, for that also is typically effective in improving their sperm counts and oftentimes. Men also have pain related to the varicocele, which is also very effective at treating that, and then men with low testosterone who we can treat with medication generally, will improve their testosterone levels pretty dramatically and will have some modest improvements in their sperm count. We focused on two pretty narrow topics today, which I’m sure are a big part of your practice, but I in broader terms, could you tell us how urologists help assist with men’s health and and what what some of your other rules are, the most common men’s health conditions that I treat are also so intimately associated with a man’s overall health and well-being. So it’s really a great opportunity for us, as providers to discuss with our patients, ways that they can improve their life on multiple levels, their relationship with their partner. That’s probably one of the most gratifying things is hearing couples talk about how this treatment or intervention has improved their relationship with their partner, but also just to be overall aware of their health, because your erectile function and your fertility, those are really manifestations of your overall well-being. So for us again, it’s a great opportunity just to highlight some things that men may not be thinking about, or sometimes may be scared to talk about, and so I think approaching that in a really careful way. That feels like it’s a safe space and really know that we are here to help- and I think one of the most important things today that you’ve shared with us is just empowering men to seek answers to concerns that they might be having. I guess we do often think of women as more likely to pursue that type of care from a physician or another provider, but I think men understanding that there can be improvements made if, if they’re desired and they can get their questions answered, is really important. I can’t tell you how many guys will say I wish I’d come in sooner or I’ve been so anxious to talk to someone about this or scared to bring it up, but know that this is really what we talk about all day long. There is nothing to be embarrassed about there’s almost nothing we haven’t heard so come in with your questions. We’re really excited when patients come in with questions, because that means that they’re really engaged in in their overall health, and I know, there’s something that we can do to help. That’s wonderful thanks for being with us today. Great thank you for having me. We’ve been discussing men’s sexual health and fertility with mayo clinic urologist, dr savann hilo, mayo clinic q. A is a production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts to see a list of all mayo clinic podcasts visit newsnetwork.mayoclinic.org, then click on podcasts thanks for listening and be well.

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