New treatment effective in dysfunction

One of the most troublesome problems in our sexually nervous society is impotence. But the 30 million American men who suffer from impotence and its associated "performance anxiety" need not use the dreaded "I word" anymore.

Instead, a National Institutes of Health (NIH) panel would have patients and their physicians substitute the less threatening, more empowering term "erectile dysfunction," a condition that can be treated with many effective therapies, allaying unnecessary fears.

Does aging cause erectile dysfunction? Many men worry unnecessarily that they may be romantically "over the hill." Patients are apt to say, "it's not like it was when I was twenty." But while there is likely to be some decrease in sexual activity as a man ages, that is not the same as impotence.

Because impotence may affect 15 to 25 percent of men at age 65, compared with 5 percent at age 40, many men incorrectly assume that erectile dysfunction is a inevitable consequence of aging. However, this misconception may be starting to change. In summing up the panel's findings, NIH Healthline declared:

"While the frequency of impotence does increase with age, it is not a consequence of aging, per se."

In other words, it is not the years that make for impotence -- but recognizable, often treatable, conditions that set in along the way. In this framework, a correct diagnosis is essential.

The NIH Panel emphasized that males with "erectile dysfunction should first obtain a thorough medical examination, including a detailed sexual history, physical examination and basic laboratory studies. Psychological therapy may be useful even if a physical cause has been identified, according to the panel.

"Psychological therapy may be useful in relieving depression and anxiety as well as improving sexual function," the panel said. And treatment is more effective when sexual partners are included, panel researchers emphasized.

Erectile dysfunction is usually caused by a combination of physical and psychological factors. Some of the most common physical factors cited by the panel include diabetes, vascular disease, hypertension, neurologic disorders, prescription medications, and illicit drugs.

Psychological factors that may cause erectile dysfunction include depression, anxiety, loss of self-esteem, and relationship problems. In addition, cigarette smoking can adversely affect erectile function by accentuating the effects of other risk factors, such as vascular disease and hypertension.

Nocturnal tumescence testing can be helpful when the physician suspects a primarily psychogenic cause or when the patient reports having no erections at all.

If a physical cause is identified, the panel recommended that doctors first try the least invasive procedure available, such as medications (available through injection) that increase blood flow or vacuum devices that achieve the same result.

"Vacuum constriction devices are effective in most patients with erectile dysfunction and have relatively few side effects," according to a consensus report issued by NIH's Office of Medical Applications of Research.

As for vascular surgery, a more complicated procedure, it should be conducted only in a research setting for carefully selected patients, according to the panel.

Yet despite those many effective treatments, for unknown reasons there is a substantial dropout rate for all forms of therapy. Many subjects drop out, perhaps because of unrealistic expectations, commented Panelist Philip Lanzisera of Henry Ford Hospital in Detroit.

"Increasingly, more and more men are seeking treatments that will allow them to return to a satisfactory level and range of sexual activities," said Panel Chairman Dr. Michael Droller, who chairs the urology department at Mount Sinai Medical Center in New York.

PHOTO (BLACK & WHITE): Edith Kermit Roosevelt


By Edith Kermit Roosevelt

Share this with your friends