DEFINING ERECTILE DYSFUNCTION
Erectile dysfunction (ED) is defined as the inability to have an erection satisfactory for penetration. It is a very common complaint in men and fortunately, one that can be restored in most situations.
The causes are often psychogenic (anxiety, fear of not satisfying one’s partner, depression, etc.) or physical (trauma to the external genitalia , radiation injury, pelvic surgery, etc.). Rarely, the cause may be hormonal, i.e., secondary to a low serum testosterone (male sex hormone) level. Regardless of the cause, treatment is often effective in a single office session.
Erectile dysfunction can occur transiently as a result of the above causes which can be treated by reducing the psychogenic cause or if physical, have the ED treated by medical, injectable or surgical therapy. For example, erectile dysfunction (ED) in men who are anxious or who are afraid of “under-performing” can often be discerned on history and treated by reassurance and by reducing one’s fear of failure. If this approach is not successful, a small dose of medication used to increase blood flow to the penis is often enough to convince the patient that he does not have an ailment which can’t be corrected.
Medical therapy to improve penile blood flow has been the major advance in men’s health over the past several decades. There are a host of Food and Drug Administration approved medications around which can be utilized but the dosage and timing of these medications must be coordinated by a physician so that the incidence of negative side effects is kept to a minimum.
Hormonal therapy (testosterone supplementation) can often restore potency in men who have “low” serum testosterone levels. Testosterone is not absorbed orally so there is no testosterone medication a man can take by mouth. Testosterone therapy is provided in the form of a gel, drug patches or by deep tissue (muscle) injection. For those patients that do not respond to oral medical therapy, a vacuum pump device will often be satisfactory. The pump is a bit cumbersome but many couples find it to be acceptable.
Direct injection into the penile tissue of medications used to increase penile flow is another approach particularly in men who find the oral medications ineffective and/or who do not wish to use a vacuum pump. Men have to be taught by a physician how and where to inject the medication which one does prior to each sexual encounter. The erection provide by this technique is often very firm and can last for several hours. The downside to injection therapy is that it does cause a small amount of pain (particularly following the first few injections) and may stimulate the formation of some penile scar tissue. For those patients who do not respond to any of the above treatments, implantation of a surgical prosthesis (silicone rods) is the remaining option. This is a surgical procedure which is performed under an anesthetic in a hospital or ambulatory surgical care setting. The advantages are that no medication is involved and “one is always ready”. The downside is that this is a surgical procedure and there is a slight risk of infection since the rods are foreign bodies. If this does occur, the prosthesis may have to be removed.
Most cases of ED can be treated successfully. Usually one or a few physician visits can remedy the situation to everyone’s satisfaction.
Prostate cancer is the most common non-skin-related cancer in men in the United States. It is also the second leading cause of cancer death in men. One in seven men will be diagnosed with prostate cancer. African-American men face a one-in-three chance of being diagnosed. Over 29,000 men die each year from prostate cancer, but early detection may save lives.
Recent reports about PSA (prostate-specific antigen) testing may confuse patients about the value of prostate cancer screening. The PSA test is not perfect. However, when used correctly, this blood test gives important information. The PSA test can help diagnose, assess the risk of, and monitor prostate disease such as cancer. Men should talk to their urologist about whether to get screened or not. Talk with your urologist about the benefits and risks of testing. You should also talk about factors that can increase your risk for prostate cancer, including:
– your family history of prostate cancer (Did your
father, brother or other relative have prostate
– if you are African-American;
– a high BMI (a measure of your body fat)
– your age; and
– your previous health history
A number of things can change PSA levels and should be kept in mind when reading the results. High PSA levels can be caused by more than just prostate cancer. Other causes of higher PSA levels include:
– prostatitis (inflammation of the prostate) and other
types of urinary tract infections (UTIs);
– benign prostatic hyperplasia (BPH – enlargement of
– injury; or
– treatments such as prostate biopsies (tissue samples)
or cystoscopy (a test to look inside the urethra and
Men choosing the PSA test should know their results could be influenced by some important factors, such as:
– Blood PSA levels tend to rise with age.
– Larger prostates make more PSA.
– Change in PSA levels over time (known as PSA
velocity) can be markers of both cancer risk and how
quickly a cancer may be growing.
A prostate biopsy (tissue sample) is the only way to know for sure if you have prostate cancer. The decision to go ahead with a prostate biopsy should be based mostly on PSA and findings on a digital rectal exam (physical exam of your prostate). Other factors to take into account include your family history of prostate cancer, your race, results of any prior biopsies and other major health issues you may have.
The choice to use PSA for early detection of prostate cancer is a personal choice. While PSA screening has been shown to have benefits, it also carries risks.
Possible benefits of having a PSA test:
– A normal PSA test may put your mind at ease.
– A PSA test may find prostate cancer early before it
– Early treatment of prostate cancer may help some
men slow the spread of the disease.
– Early treatment of prostate cancer may help some
men live longer.
Possible risks of having a PSA test:
– The PSA test is not perfect. A normal PSA result
may miss some prostate cancers (a “false negative”).
– Sometimes the test results suggest something is
wrong when it isn’t (a “false positive”). This can
cause unneeded stress and worry.
– A “false positive” PSA result may lead to an
unneeded prostate biopsy (tissue sample).
– A positive PSA test may find a prostate cancer that
is slow-growing and never would have caused you
– Treatment of prostate cancer can cause side effects.
Short- or long-term problems that can occur are
issues with getting erections (“ED”), leaking urine,
or bowel function.
Before you decide to have a PSA test, talk with your urologist about the benefits and risks of testing. Also talk about your individual risk of prostate cancer, including your personal and family health history.