Why erectile dysfunction• This topic is often laughed at, but can be symptom of current/future problems• This topic is often uncomfortable for both the practioner and the patient due to stigma• This topic is often ignored by students
What is erectile dysfunction • According to Stacy Elliot, MD, erectile dysfunction is defined as “the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance” • Sexual performance: • Intercourse • Masturbation • Same gender sexual activity • or other stimulatory methodsElliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
What is an erection and what causes erectile dysfunction? • When a male is sexually stimulated/aroused, blood will engorge the penis allowing sexual activities to commence. • Erectile difficulties are often the result of inadequate blood inflow due to: • cardiovascular disease • obesity related, smoking, hypercholesterolemia • Diabetes • metabolic syndrome • disrupted neurological signals • SSRIs used to treat depression • venous leaksElliott, S. L. (2011). Hot topics in erectile dysfunction. BC Medical Journal, 480-486.
Pathway to an erection • an erection is dependent on the nitric oxide-cyclic guanosine monophosphate pathway • at penile nerve endings and healthy endothelial lining • these areas can be damaged by hypertension, hyperlipidemia, and smoking http://www.nature.com/ijir/journal/v20/n4/fig_tab/ijir20084f1.htmlElliott, S. L. (2011). Hot topics in erectile dysfunction. BC MedicalJournal, 480-486.
Cardiovascular disease • Cardiovascular disease can affect the ability to maintain an erection • Erectile dysfunction can be used as a marker for physicians to discuss cardiovascular disease and prevent fatal heart attacks • Potentially the most efficient predictor of silent coronary artery disease in diabetic population** ** Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi,Elliott, S. L. (2011). Hot topics in erectile M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectiledysfunction. BC Medical Journal, 480-486. Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
Cardiovascular (cont.)• Cohort study on patients with erectile dysfunction• 13 item structured interview of 1,697 patients followed for an average of 4 years• 159 patients suffered a major cardiovascular event • 15 were fatal • 85 were ischemic heart disease • 41 of these were acute myocardial infarction • 40 cerebral (stroke or transient ischemic attack) • 14 peripheral artery disease Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
Cardiovascular (cont.)• That erectile dysfunction shows early coronary artery disease due to smaller arteries when compared to coronary arteries.• Individuals with severe erectile dysfunction has an 80% increased risk for cardiovascular disease• Erectile dysfunction can be used as indicator of future cardiovascular disease Corona, G., Monami, M., Boddi, V., Cameron-Smith, M., Lotti, F., De Vita, G., & …Maggi, M. (2010). Male Sexuality and Cardiovascualr Risk. A Cohort Study in Patients with Erectile Dysfunction. Journal of Sexual Medicine, 7(5), 1918-1927. Doi. 10.1111/j.17436109.2010.01744.x
Diabetes and Erectile dysfunction • Erectile dysfunction is a common side effect of diabetes and 36% of men with diabetes will experience some for of erectile dysfunction • Erectile function is dependent on the patients age, need for insulin, glucose control, and how long the patient has been diagnosed with diabetes • Men who are diabetic should be routinely asked about erectile dysfunction and that blood glucose monitoring is not enough to determine if a patient is likely to experience erectile dysfunctionTyagi, S., & Roy, R. K. (2010). Effective therapy for the managment of erectiledysfunction in men with diabetes mellitus: a review. International Journal of Pharma and Bio Sciences, 1(2), 1-12.
Other causes of erectile dysfunction • Erectile dysfunction can be linked to metabolic disease and lowered testosterone • Caused by the natural decline in testosterone in the aging male, which in turn, also plays a part in the build up of central fat deposits leading to metabolic syndrome • Visceral adipose tissue is an endocrine organ and is directly related to cardiac risk.** **Traish, A. M., Feeley, R., & Guay, A. (2009). Mechanisms of obesity and related pathologies: Androgen deficiency andYassin, A. A., Akhras, F., El-Sakka, A. I., & Saad, F. (2010). Cardiovascular diseases endothelial dysfunction may be the link betweenand erectile dysfunction: the two faces of the coin of androgen deficiency. Andrologia, 1-8. obesity and erectile dysfunction. FEBS Journal, (276), 5755-5767.
Other causes of erectile dysfunction• Obesity also leads to increased insulin, glucose, C- peptide levels, and reduced plasma testosterone• Erectile dysfunction is much more common in men with a BMI greater than or equal to 25 (59.3% in a study of 158 men) **Traish, A. M., Feeley, R., & Guay, A. (2009). Mechanisms of obesity and related pathologies: Androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction. FEBS Journal, (276), 5755-5767.
Psychology and Erectile Dysfunction • Sexual dysfunction can lead to: • incompetence schema • erection concern thoughts • lack of erotic thoughts • sadness • continued erectile dysfunction all due to the fact that many men believe they must have continual successful sexual performance that pleases sex partners 100% of the timeNobre, P. (2010). Psychological determinants of erectile dysfunction: testing a cognitive-emotional model.International Society for Sexual Medicine, (7), 1429-1437.
So in other words My erection is a I’m older, not deadgood indicator of my health!