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Erectile Dysfunction: Why Does it Happen?

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. Today's topic is erectile dysfunction or male impotence or in everyday language, when you have trouble "getting it up." I think you know exactly what I'm talking about now. Fifteen million men in the United States suffer from erectile dysfunction. Of those, only 1 in 20 seek treatment. That makes this one of the most common untreated medical conditions in the world. We're going to try to shed some light on it for you and everybody out there.

Joining me are a couple of experts to discuss this today. On my left is Dr. Michael Perelman. He is a Cornell psychologist, specializing in sex and marital therapy in Manhattan. Next to Dr. Perelman is Dr. François Eid. He is the Director of the Center for Male Sexual Function at New York Hospital in Manhattan. Dr. Eid has also brought along a couple of patients with him. Off-camera we will be speaking with later Jim and John. Thanks for both of you to join us today.

DAVID FOLK THOMAS: Dr. Perelman, let's start with you. Just very simply -- I said erectile dysfunction, male impotence. What exactly is that condition?

MICHAEL PERELMAN, PhD: Inability to obtain or maintain erection so that you are able to perform adequately in order to both please yourself and usually pleasing your partner as well. Can you have intercourse is the most typical way of looking at it?

DAVID FOLK THOMAS: Dr. Eid, I had mentioned we have Jim and John off-camera with us. Maybe you can ask them how they first came to know that they had this problem.

J. FRANÇOIS EID, MD: Both these gentlemen, both Jim and John, had prostate surgery for prostate cancer and they both did very well. As sometimes happens, one of the consequences of the surgery was loss of erections. They dealt with it. They are going to share a little bit about their experience with us today.

John, do you want to say anything?

DAVID FOLK THOMAS: John, you knew I guess from what Dr. Eid said that one of the byproducts of prostate cancer surgery is impotence. Were you prepared going into this?

JOHN: I think more than a byproduct, it was a fear. Probably why it took me three months to get the operation after the diagnosis was that I was looking for different options -- that being C, that being a radical, that being ignoring it.

When I realized that my age and the situation that I was in mandated the radical only because of the logic of the future of my lifespan, I went through the decision with the fear of incontinence and impotence. What I was told, however, that I was starting to go through an era of new medications, hence the pill that would enable someone who was having slight difficulty possibly to have the erections and there were other types of procedures down the road.

After the operation, I was healing very well. But I was having difficulty maintaining an erection or getting an erection as I knew it. There was an insignificant amount of time where I was given Viagra. Viagra was helping me but my erection was there, but it was very distorted.

Again, age consequently made me make the decision for the penile implant to rectify that aspect of it.

J. FRANÇOIS EID, MD: I think one of the key points is that since we have so many great treatments for the problem of erection that one should be free to choose the best treatment for the prostate cancer. I find that it's important to be cured of the cancer. Once you are cured of the cancer, then the treatment options, as we will see later, talking to both Jim and John are really fabulous. They've done so well with it. I think that's the key point.

DAVID FOLK THOMAS: We're talking about medical causes. Dr. Perelman, what about psychological causes for erectile dysfunction.

MICHAEL PERELMAN, PhD: They can run the whole gamut. I think part of what we're seeing here is really the intelligence of the patients in recognizing that if you have a prostate cancer surgery and subsequently find yourself unable to get an erection, it's a good idea to go back to that surgeon and also speak to a urologist and have full medical consultation. However, so many men as they age presume erroneously that they're supposed to have automatic erections. They're supposed to be looking at their partner with the same degree of excitement and interest that they used to have and spontaneously have an erection as if it's some kind of peter meter. So the most common cause of erectile dysfunction is essentially insufficient stimulation. We don't get the direct friction, if you will, to our penis that we need in order to obtain and maintain the erection.

Fatigue is another common cause of erectile dysfunction. When people say, "Hey, I'm just too tired. It's not just some lame excuse. It's a reality because that effects your physical capacity.

The same thing with negative thinking. So relationship issues can somehow impede a couple's ability to be able to function completely and correctly.

There are some other more deeper, if you will, psychological causes, but the most common ones are really insufficient stimulation, negative thinking and fatigue.

DAVID FOLK THOMAS: Do we know what percentage of patients with erectile dysfunction -- is it caused by psychological or physiological?

MICHAEL PERELMAN, PhD: Most of us at this point in time have adopted a much more sophisticated view, a new paradigm, if you will, where you can see both the psychological and organic causes. Because even in cases of organic disease, like these gentlemen have, the concern that develops about that will cause a complete dysfunction even if there was partial functioning, as John described. So we all have to work together which is part of why Dr. Eid and I are here together.

DAVID FOLK THOMAS: Jim, let me ask you a question. You and John both had prostate cancer surgery, now do you feel that there was any sort of emotional attachment, as we've just discussed, psychological component to your erectile dysfunction? Or was it strictly the medical procedure?

JIM: When I was first diagnosed with cancer, I was worried about living. That was my main thing. At my age, I'm fairly young, I went to two different specialists and they both recommended the surgery. I really wasn't too worried about the incontinence or the sexual dysfunction until I wanted to get the cancer out of my body.

After I had the operation and the doctor told me basically, worry about your PSA level which is -- again I was going back every month. Luckily it stayed almost at zero.

Then the incontinence -- I was incontinent for about three or four months. I conquered that. The next thing was the sexual part of the operation. I was very fortunate to go hear Dr. Eid at a man-to-man meeting. I was very impressed with him and that's the doctor I wanted to go see. I made an appointment with him. Whatever he suggested, which was the penile implant -- after I tried Viagra. I tried Viagra. It's been over a year since the operation. Went from 50 mg to 100 to 150 and it didn't work. I got the penile implant and everything seems to be fine.

DAVID FOLK THOMAS: Jim, thanks for sharing that. We're going to wrap up very quickly. Dr. Eid, let's very quickly talk about other physiological processes.

J. FRANÇOIS EID, MD: Yes. When we talk about the fifteen million men with erectile dysfunction, a lot of these patients have a physical cause. The physical causes have to do with the vascular system, with blood flow -- insufficient blood flow going to the penis. It has to do with high blood cholesterol levels, diabetes, high blood pressure --

DAVID FOLK THOMAS: Smoking --

J. FRANÇOIS EID, MD: Tobacco smoking. Sixty-eight percent of all our patients who don't have surgery and have problem with erections are tobacco smokers.

Now there are also patients who have multiple sclerosis, patients who have had any sort of radiation, chemotherapy, colon surgery, bladder surgery have problems with erections. Then we also have patients with spinal cord injury. Males have neurological inability to have an erection.

MICHAEL PERELMAN, PhD: In addition to these direct medical causes, sometimes unfortunately if the necessary treatments for medical conditions such as high blood pressure, depression even. Approximately 70 percent of people suffering from depression will also manifest some kind of sexual dysfunction. So we have to take a look at the medications the person is taking in order to help other kinds of problems because frequently they can cause a sexual problem as well. This is how we work together.

DAVID FOLK THOMAS: All right. Unfortunately, that's all the time we have for this webcast. I want to thank my two experts here. Dr. Michael Pereleman and Dr. François Eid and also to Jim and John, off-camera. We hope you've learned a little bit about erectile dysfunction, impotence and will look into it more if you need more information. Thanks for joining us. I'm David Folk Thomas. We'll see you next time.

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