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Health Information An Expert Opinion: The Truth About Erectile Dysfunction

Talking to your doctor is the first step toward restoring sexual function.

Knowing that upwards of 50 percent of men older than 40 have some degree of erectile dysfunction probably isn't comforting if you're one of them. Many men equate sexual function with manliness, says Laurence Levine, MD, a urologist and specialist in men’s health at Rush University Medical Center. "Erectile dysfunction can reduce self-esteem, make a man more irritable and less productive at work, and affect his interactions at home," he says. "That's true even though the main cause of erectile dysfunction is almost always physical, not psychological." Discover Rush Online asked Levine to shed some light on this common — and often treatable — condition.

Why do men experience erectile dysfunction?

Most of the time, erectile dysfunction (ED) is caused by poor circulation, often brought on by diabetes, hypertension, cholesterol imbalances or smoking. It's important to keep in mind that poor circulation and its causes don't just lead to erectile dysfunction. They can also lead to other serious problems, such as atherosclerosis, the buildup of plaque inside blood vessels that can cause a heart attack or stroke. Erectile dysfunction may be present as early as three to four years before any vascular problems are recognized; it actually may be the earliest indication of vascular disease. For that reason alone, it's vital to see your doctor if you are experiencing erectile dysfunction. It might also be associated with medication side effects, a hormone imbalance,depression, obesity, and even an uncommon scarring condition of the penis called Peyronie's disease. But regardless of the cause, erectile dysfunction should not be ignored. No matter what your age, if you're having problems with your erections, you should talk to your primary care doctor or a urologist and get to the root of the problem.

Isn't ED also a common side effect of many prostate cancer treatments?

If you've had prostate cancer treatment, it's common to experience changes in your ability to get an erection. The prostate gland, which produces nearly half of the fluid the body produces to deliver sperm during sexual intercourse, is in a precarious location. It's nestled right between the penis and the bladder, which is why removing or treating the prostate gland has the potential to affect both penile and bladder function.

There are, however, newer prostate cancer treatments that carry a lower risk of causing erectile problems. For example, at Rush we offer prostate cancer patients a high-tech, nerve-sparing surgical technique using the da Vinci Surgical System that allows us to see high-definition images of the prostate, so we're better able to protect the nerves and other structures that affect erections. Also, posttreatment rehabilitation programs, including a comprehensive medication therapy that we offer here, can encourage nerve regeneration and restore erectile function.

But isn't it true that potency can be restored most of the time?

ED may not be reversible, especially after treatment for prostate cancer. But regardless of the cause of erectile dysfunction, men of any age can become sexually active again with medication, as well as other more aggressive forms of therapy, such as penile injection therapy or penile implants. In choosing a prostate cancer treatment, each patient brings his own concerns and values into the decision-making process. Along with considering your age, the stage of the cancer and the likely progression of the disease, you must weigh the potential risks of each treatment option against your personal priorities. Preserving potency may be of the utmost importance to you, or it may not be important at all — you may just want the cancer gone as quickly as possible regardless of any potential side effects.

The key is to communicate your feelings to your doctor, and make sure you’re on the same page. I realize that erectile dysfunction can be an embarrassing topic, but it's important to be open and honest to ensure that you get the best possible outcome.


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  • Want to learn about the latest in prostate cancer treatments, such as the da Vinci robotic surgery system and TomoTherapy? Join us for "Advances in Treatment for Prostate Cancer," a free event at Rush on Tuesday, Sept. 11, 6 to 8 p.m. To register or for more information, call (888) 352-RUSH (7874).
  • Laurence Levine, MD, has published extensively on erectile dysfunction and Peyronie's disease. Watch a video in which he discusses his approach to men's health issues.
  • Looking for a doctor? Call toll free: (888) 352-RUSH (7874).
  • Stay in touch with Rush with Rush News Blog, Rush InPerson, Facebook, Twitter and YouTube.

Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

If you enjoyed this article and are not already a subscriber, subscribe today to Discover Rush Online. You'll receive health information, breaking medical news and helpful tips for maintaining your health via e-mail. To subscribe, send an e-mail to DiscoverRushOnline@rush.edu

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