Opening the (bedroom) door to talk about ED

For a man with erectile dysfunction (ED), it can be difficult to admit there is a problem. Despite the popularity of effective medications, less than one in five men with ED will ask their medical professional for treatment.

For those who do inquire, it may take the average man more than two years to gain the courage to broach the subject.  Unfortunately, many physicians are hesitant to ask men who are clearly at high risk of ED.  The first step to successful treatment begins with talking to your doctor and your partner. 

Arnold Bullock, MD, Washington University urologist, Director of Men’s Health, explains, “Erectile dysfunction is the consistent inability to achieve an erection adequate for satisfactory intercourse. Many men have premature ejaculatory, loss of libido, inability to achieve a climax or infertility.

Most men with ED remain sexually active, but they are dissatisfied with the unreliability or overall poor performance.”

Erectile dysfunction is one of many several male sexual disorders, and while ED itself is not life threatening, the reason for the condition can be. Nine out of ten cases of ED are due to a physical reason – cardiovascular disease, elevated cholesterol levels, diabetes, neurological causes or even nerve damage from pelvic surgery. Lifestyle choices such as smoking, excessive alcohol use and being overweight can also contribute to ED.

Some men have psychogenic ED or performance anxiety, and they tend to respond well to the oral medications.

When a patient is frank with his physician, the correct diagnosis can be made and the treatment options are numerous. 

Once diagnosed, the treatment of ED might be the simplest step.  Many men benefit from changes in lifestyle.  This could include regular exercise, smoking cessation programs, reduction in alcohol and social drug use, improved diet and weight loss. 

Though changes in lifestyle choices are helpful for overall health, they rarely provide the degree of improvement desired for men with moderate to severe ED.  For these men, treatment options include the oral medications, vacuum devices, penile rings, urethral suppositories, penile injections and implants. Dr. Bullock explains, “We are now able to treat 100 percent of men with ED — each has to choose the quality of erections he desires.”

Prescription medicines taken by mouth are commonly used to treat ED. There are several medications (PDE-5 inhibitors) on the market and the cost has dropped significantly with generics.

Be sure to tell your healthcare provider about all the prescription medicines that you are taking, including over-the-counter medicines. The medicines used to treat ED can have dangerous interactions with some common medicines. Men should not take these medicines if they have a history of heart attack or stroke, or if they have a bleeding disorder or stomach ulcers.

MUSE (Medicated Urethral System for Erections) is a medication (pellet) that can be placed as an urethral suppository. MUSE does not have the effectiveness of the oral medications, however the one advantage of MUSE is that it is safe for men on heart medications.

Testosterone therapy may improve energy, mood and increase sexual interest in older men who have low testosterone.  Measuring testosterone is a routine part of the evaluation of ED.

A penile vacuum (Vacuum Erection Device) is used to draw blood into the penis to create an erection. An elastic ring is put on the base of the penis to maintain the erection  during sex.

Prescription medications injected with a small needle into the side of the penis increase blood flow to the penis. They are safe to use regularly and very effective at providing a rigid erection even in men who fail the oral agents.  Dr. Bullock routinely encourages a trial of the injection even on the first visit for men who have tried the oral agents without success.

Penile implants are recommended after other treatments for ED fail — they provide the most reliable and satisfactory means to fix ED. An implant is placed through a small (1.5 inch) incision in an outpatient procedure that takes less than an hour. There are two types of implants – semi-rigid and inflatable. Each type of implant works differently and has various pros and cons — before choosing penile implants, you should be fully informed.

 The implant is not obvious to others — a man can quickly create a rigid erection without leaving the bed, and this erection can be maintained for as long as the couple desires.  It is a safe procedure that is covered by most insurers.

Dr. Bullock’s approach to evaluating patients is comprehensive. He combines his expertise along with Washington University primary care physicians, endocrinologists and sometimes psychologists to make a diagnosis and develop a treatment plan.

Dr. Bullock adds, “I want my patients to know that the focus is not solely on the symptom of erectile dysfunction. My goal is to find the underlying disease causing ED. When this is determined, the health needs of my patients can be addressed while providing the ED therapy best suited for them.”

For more information on treatment options for ED or to make an appointment with Dr. Bullock, please call 314-996-8060.

Barnes-Jewish West County Hospital
Medical Building One, Suite 122
1040 N. Mason Road
St. Louis, MO 63141

Christian Hospital
Professional Building One, Suite 202N
St. Louis, MO 63136