It affects millions of men, but it’s a difficult subject to discuss
"There can be changes in their relationship with their spouse that can have a serious effect on their marriages. It can be a delicate issue."
But Nehra is working to change a culture in which, he says, many men visit the urologist only after being urged by their partners.
He stresses that men should never put off seeking medical attention for erectile dysfunction, not only because treatment can significantly improve quality of life but also because the condition often signals other health problems.
A first sign of cardiovascular disease
Erectile dysfunction results from a variety of causes, including uncontrolled diabetes, weight problems, excessive drug and alcohol use, some prostate cancer treatments, and the decreasing testosterone levels that come with aging. Among the most common and most worrisome of these causes are artery blockages that reduce blood flow to the penis.
"The body is united by a common blood system," Nehra says. "So what happens in the penile blood vessels frequently is an early manifestation of problems elsewhere."
He recently co-authored a major report, the Princeton III Consensus Conference recommendations, showing that men who experience erectile dysfunction, especially before age 50, are more likely than others to develop cardiovascular disease — which in turn increases a man's risk for stroke and heart attack.
The importance of comprehensive care
Because of the condition's link to other problems, physicians at Rush University Urology offer comprehensive health evaluations to men seeking treatment for erectile dysfunction.
"Often when men come in with this problem, we identify other issues such as high blood pressure, heart disease, pulmonary disease, or gastrointestinal or memory problems that also must be addressed," Nehra says.
"Rather than merely treating symptoms, we take a broader approach to men's health by looking comprehensively at the symptoms' implications in order to prevent illnesses in the future."
A range of effective treatments
At Rush, care for erectile dysfunction may incorporate dietary modification, exercise and evaluation of testosterone levels in addition to medical or surgical treatments for the condition's primary symptoms.
These treatments include medication, which improves sexual symptoms in many men, as well as penile prostheses — inflatable cylinders surgeons implant within the penis.
Implants may be a good option for men who don't respond well to medication, including those who have undergone prostate cancer treatment (which can damage penile arteries or the nerves responsible for erections) or who have diabetes (which can significantly affect blood flow).
"We have the ability to use devices that can come as close to a natural response as possible," Nehra says. "Spontaneity is there, togetherness is there; the implant really allows men to pursue their physical and emotional endeavors. When we address the problem successfully, it can have a phenomenal benefit."