How To Treat Erectile Dysfunction? Interview With Dr. Jonathan Blazer

Erectile Dysfunction or Impotence: Definition, Types, Causes, Risk Factors, Treatment Options, Natural Remedies, ED Drugs Overview

Table of Contents

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  1. Types of sexual disorders in men
  2. Erectile dysfunction defined by a sexologist
  3. Why sporadic erectile failures do not equal ED
  4. ED in figures
  5. Possible ED causes
  6. ED risk groups
  7. Dangers of protraction in ED treatment
  8. ED treatments that are currently available
  9. Viagra, Cialis and Levitra principles of action
  10. Viagra efficacy assessed by doctor
  11. The safety profile of Viagra and other oral ED agents
  12. Expert advice on how to drive up the efficacy of ED treatment

» How could we categorize sexual disorders?

There are a variety of sexual disorders men can face when it comes to their sexual health. The best way to categorize these disorders is to put them in groups as far as natural sexual responses are concerned.

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Males go through four distinct phases in a normal sexual response cycle.

The first phase is connected to actual sexual desire. Man has to have this ignition, this spark that is eventually followed by the excitement phase, which is constituted by the gradual hardening of the penis. The excitement is followed by the orgasmic phase, which, in its turn is followed by sexual resolution.

Sexual dysfunction can happen at each of these phases. Even though the phases are discreet, there is a significant overlap in all these processes. You can have abnormalities anywhere along these phases.

Abnormalities connected with desire include low libido and hyper-sexuality, and sexual aversion.

Erectile dysfunction is part of the second part of the natural cycle which is the excitement phase. For urologists, it is the most common problem we deal with in the field of sexual health.

» What is the general definition of erectile dysfunction?

Erectile dysfunction can generally be defined as consistent inability to either obtain or to maintain an erection so that the latter is sufficient to have a sexual intercourse. Complete erectile dysfunction, also known as complete impotence is characterized by the inability to have penetrative relations at any stage. So both inability to obtain an erection and inability to maintain erection can be counted as erectile dysfunction, that is why it is necessary to identify to which particular scenario one’s case belongs to.

» Would it be normal for men to occasionally experience difficulties in having an erection sufficient for a healthy sexual practice and not to worry about having erectile dysfunction?

There are certain times in life of almost any man, when he has to face problems with either obtaining or maintaining an erection.  But what defines erectile dysfunction is the constancy of the inability to keep an erection.

» What is the percentage of male population dealing with erectile dysfunction?

There have been a lot of scientific studies targeting precisely these statistics. What they have shown, is a wide discrepancy as far as the precise percentage of males with erectile dysfunction is concerned.  A lot of medical specialists consider the study known as the Massachusetts Male Aging Study, to be the ultimate guide. What the specialists that conducted this study did, they took men of various ages, and found out that men who passed 50 years old threshold have 30 to 50 percent among them who are experiencing problems associated with erectile dysfunction. While above 75 percent of men above age 60 were found to have problems with erection.  As a matter of fact, there is a slight decline in testosterone levels, which drops for around 1 percent per year between ages 40 and 70. So by the age of 70 men have 30 percent lower circulating testosterone level.

What can cause erectile dysfunction?

Causes of erectile dysfunction are commonly divided into organic and psychogenic. These can be further broken down into various groups, depending on the approach.

Organic causes can be connected to:

  1. Vascular problem
  2. Arterial and venous problems, clogging of arteries, etc. Essentially in this case the blood flow to the genital area is decreased. It is crucial to keep one’s cholesterol levels under 150 mg/ dl in order to have a proper blood supply.
  3. Neurogenic dysfunctions
  4. Hormonal problems
  5. Drugs and/or medications induced problems
  6. Enlarged prostate problems. During the aging process, the nerve receptors which are responsible for transmitting sensations via pathways to the central nervous system. These receptors are situated in the glands of the penis, start dying off, so you have a fewer number of nerve receptors. In the end, it becomes more difficult to get the arousal response even with physical stimulation. We call this cause “decreased vibrotactile sensitivity” of the penis.

Psychogenic causes can be broken down into a variety psychiatric conditions, such as, for example, borderline personality disorder caused, clinical depression, anxiety disorders. As a matter of fact, almost any psychiatric condition can have erectile dysfunction as one of its consequences.

Another subgroup of these is psycho-social and relationship problems. Lack of attraction to your mate can cause erectile dysfunction. Also simple stress of life pressures sometimes can bring your sexual libido down, which, in its turn, will surely affect your sexual performance.

» If we do not consider the age factor, what other groups of the male population can be considered as being at higher risk to have erectile dysfunction? What are the risk factors for erectile dysfunction in general?

Medical specialists know that there are certain risk factors for erectile dysfunction. If you think of all the risk factors for cardiac abnormalities, those are mostly also the factors that can be applied for erectile dysfunction. Doctors should include these in their medical history when seeing a man with these conditions in order to understand and to inquire the reasons for erectile dysfunction fully.

These risk factors include:

  • Diabetics have a greater inclination for clogging blood vessels, which include those that lead to the genitalia. So for diabetics and predioabetics it is important to get your cholesterol down and manage your blood sugar level in order to maintain a proper blood flow through all of your body, which will also prevent heart attacks and possible gangrene problems.
  • Hypertension
  • Elevated cholesterol levels
  • Obesity

Alcohol. Alcohol also increases risk of erectile dysfunction. It wouldn’t affect your ability if you drink a glass of wine once in a while, but if you drink regularly, on a daily basis, you would certainly belong to the risk group.

» What happens if men do not do anything after being diagnosed with erectile dysfunction?

The penis, like many other organs of the human body, needs constant exercise to maintain a healthy condition.  Think of the regular muscles; they tend to decrease in size and to lose their ability to perform a certain task, if they are not maintained in the proper shape via either exercise or labor that involves them. The same thing happens to the penis. For example, men who had prostate cancer and had their prostate removed as a result, and have serious erectile dysfunction, are found to lose around 2 centimeters in size of their penis. The longer they live without an erection, the more they lose in size. Urologists do not recommend keeping on living with erectile dysfunction without treating it in one way or the other. Fortunately, there are many ways men can apply to treat erectile dysfunction.

What are the known treatment options to deal with erectile dysfunction?

What can cause erectile dysfunctionNowadays, there is a variety of different medications specifically engineered to treat erectile dysfunction. The most known include Viagra, Cialis, Levitra, Stendra, and some others. These medications were not available for men 25 years ago. There were very few things doctors could offer their patients suffering from erectile dysfunction. This was the reason why many men sort of stayed in the closet, and did not tell about their decease anybody, even doctors. What you can say if everybody knows there are no effective treatments? They breakthrough happened when Viagra was first introduced in 1998, followed by Cialis and Levitra in 2003. Men could take them orally to enhance their erection.

Other methods to treat erectile dysfunction include:

Intra-cavernous injections

It is best to describe how these injections work compared to how pills work. Pills like Viagra and such affect the blood flow in the entire body of a man, while an injection works specifically on the blood flow in the penis. Usually a very tiny needle is used. They put it on a side of the erection body where it is not painful and inject. The drug works on the whole penis and gives a very natural erection which lasts for about five minutes. The downside of applying this method is in the psychology of men who take it. When they feel desire, they have to take the needle and perform this operation, which is not overall very convenient. So the dropout is about 50 percent.

Vacuum Erection Devices

This device is essentially a plastic cylinder and a pump. The penis is being put into the cylinder and pumping causes the increase of blood flow. There is also a rubber band that is being put around the basement of the penis to hold the blood in. The positive thing about this device is that it doesn’t give any side effects, because it is not a drug. They are usually relatively inexpensive and often are covered by insurance. The downside of using this device is that an erection obtained as a result is unnatural. Patients often complain that an erection feels sort of cold and uncomfortable. The success rate is also not too high, estimated at around 20 percent.

A Urethral Suppository

These can go straight to the urinary channel in the penis. The medication is being put in this channel right after the urination, and it stays and diffuses there. The upside of this method is that you can avoid needles. The downside is that it is very expensive, certainly the most expensive method of all we are talking about. Another downside is that is accompanied by some pain, while the drug dissolves inside the penis. About 30 percent men experience this pain.

Surgical Methods, including Penile Prosthesis Insertion

These have been around since the early seventies, and there are several types of these devices. Each prosthesis is a device that stays within a body, and is totally concealed; looks very natural. The positive side of using it, is that we have a lot of clinical data on them because they have been around long enough. They are natural, there are no spontaneity issues with them. Patients have been positive about these devices. The downsides are, prostheses are mechanical objects and as such, they can wear off with time. Another thing, they can carry foreign bacteria to the body. Infection rates, though, are extremely low, estimated at about 1 percent. Another downside, is the expectation of a patient. It can’t substitute your former natural size of the penis; it can just restore your function.

Taking Testosterone

If a patient has already some prostate cancer cells in his body, taking testosterone is like putting fertilizer on these cells, they will feed by testosterone and will start growing and developing further. So eventually risk of prostate cancer increases significantly.

Natural remedies

Unlike the pills like Viagra, Cialis or Levitra, natural remedies help not only men, but also women, if the latter have troubles with low libido, increasing sensitivity around the genitalia, reaching orgasm, or improving quality of orgasm.

Natural herbal remedies that can reverse erectile dysfunction issue include:

Tibulus Terrestris

Studies have shown that this remedy increases the release of nitric oxide in the genitalia which gives a greater blood flow, and, eventually gives firmer and longer lasting erection.

Muira Puama

This remedy is taken from the plant found in Brazil, and it has shown qualities of aphrodisiac and nerve stimulant for years. As a matter of fact, it is listed as a treatment for impotence in British pharmacopoeia, the world’s largest catalogue of available approved medications. Studies conducted by the Institute of Sexology in France, have shown that this remedy proved to be useful in improving libido, frequency of intercourse, and overall sexual health, including proper erection.

Avena Sativa

This is another herb, which belongs to the group of “wild oats.” It has proved to be a great remedy if you want to increase your tactile sensations in the genitalia. Eventually this would give an easier erection. The studies have shown that around 22 percent of men have their erection issues improved. What is also significant about this herb, it increases sensitivity not only in men, but also in women. The latter reported to have increased frequency of orgasm in 22 percent cases.

Maca Root

This is probably the most famous aphrodisiac in the list of natural remedies. This herb is also known as horny goat weed. It was first found in China and since ages has been used to treat low libido and erectile dysfunction. What is gives is the increased dopamine levels in your brain, which affects the overall sexual activity.

Daniana Root

This herb has similar qualities to those of Maca Root.

Among these methods, the easiest way to treat erectile dysfunction is still taking Viagra type medications orally.

How do Viagra, Cialis, and Levitra work?

Essentially, these medications make the breakdown of cGMP slow down. CGMP, or Cyclic guanosine monophosphate, is a chemical that is largely responsible for sustaining an erection by way of making blood vessels dilate. This way, overall blood flow to the genitalia is improved and erectile dysfunction is successfully dealt with.

» How successful can be the treatment with the help of Viagra and similar medications?

viagra cialis levitra mcpWe can say that these medications proved to be very effective. About 80 percent men who took the pills to treat their erectile dysfunction reported success pretty soon after they started the treatment versus those who took just a sugar pill or a placebo.

If you would ask me how many could have a successful intercourse after taking Viagra, we’d say that this statistic is not that impressive as in the case of obtaining an erection. For a sufficiently long sexual intercourse, an erection has to be sustained long enough and penis has to be firm enough. Still, in most cases it works pretty well.

» What are the other known side effects of Viagra and similar medications? Are these serious?

First and foremost, men who are going to take Viagra-type medications are advised to examine if they are taking any nitrates. Nitrates are known to cause a significant drop in blood pressure, which can be extremely dangerous when combined with Viagra. Nitrates are counter indicated with all oral pills for erectile dysfunction treatment.

As far as other side effects, most common include following:

  • Headaches
  • Upset stomach
  • Feeling flush
  • Blurry vision
  • Muscle aches

Generally, Viagra, Cialis, Levitra, and other oral pills are considered very well tolerated by male organisms regardless of age. Despite nearly 30 percent of patients having mild side effects, very few are known to have discontinued taking these medications due only to side effects.

» What men have to understand to use the medications for treating erectile dysfunction successfully?

There are several things one has to keep in mind before and while taking these pills. Viagra and Cialis are amplifiers; they can’t produce an erection out of nowhere. A man has to have the desire to have a sexual intercourse in his mind, before taking these pills, otherwise chances are they won’t work.

Also, it is strongly recommended to take these pills on an empty stomach. It’s better to take it before dinner, or after taking a snack. Do not take Viagra, Cialis or Levitra after a big fat meal. Avoid eating food rich in fats.

And the last thing we want to mention, if the pill doesn’t work for you the first time you have taken it, do not get discouraged. In lots of cases these pills, if they are genuine, work after the third or the fourth subsequent pill.

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» Author info

Johnathan Blazer, MD has recently enrolled in My Canadian Pharmacy Pro team of contributing authors. Urologist consultant, Dr. Blazer is a board-certified practitioner with passion to improve the quality of life for patients of various health backgrounds. Dr. Blazer has been practicing for over a quarter of a century now, helping men win back their lower urinary tract health in a way that is not too restrictive or time-intensive. At My Canadian Pharmacy, Dr. Blazer reviews articles in his field of expertise and gives professional advice with care and commitment.