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ED: The "Invisible" Male Health Concern

Viagra® has cracked open the closet door on erectile dysfunction (ED), or impotence, but there's still a ways to go. ED refers to a man's inability to achieve or sustain an erection, either on a constant or inconsistent basis. An estimated 30 million American men have ED, yet only about 10 percent of them receive treatment.

In some cases, ED has psychogenic(emotional or psychological) causes. "That doesn't mean it's not real," says Dr. Hossein Sadeghi-Nejad, assistant professor of surgery-division of urology at New Jersey Medical School and a urologist at University Hospital. "Too much stress, concern about performance, or difficulties in a relationship can affect a man's potency."

However, for most men, there are organic, or physical reasons. "They fall into four general categories: failure to initiate, or nerve-related problems; failure to fill, where there's not enough blood supply to the penis; failure to store, where instead of extra blood remaining in the penis to maintain an erection, it is released; and failure to maintain, where there may be a vascular problem," says Dr. Sadeghi-Nejad.

Many drugs (prescription and over-the-counter) can interfere with a man's ability to achieve erection. Uncontrolled diabetes can damage nerves and small blood vessels, and heavy smoking can narrow the vessels. And while nerve-sparing techniques often are used in prostate or bladder surgeries, it's possible for nerves to be damaged during these procedures. Trauma to the pelvic area, a martial arts injury, or even lengthy bicycle riding can cause problems. Although rare, Peyronie's disease (an inflammatory condition that causes scarring of erectile tissue and a curvature of the penis) can lead to ED.

When men decide to seek medical help for impotence, they often turn to a urologist. Urologists are specialists in the male genital tract, just as gynecologists are specialists in the female genital tract. Some urologists, like Dr. Sadeghi-Nejad, are fellowship-trained in the sub-specialty fields of male impotence and male infertility.

A man who seeks treatment for ED will be given a physical examination and have his medical history taken. Blood tests can reveal conditions that can contribute to ED, such as diabetes, a sluggish thyroid, or low levels of testosterone. There are other tests that can help the urologist determine the cause or severity of ED. An ultrasound, for example, can evaluate blood flow or indicate vascular damage. Penile nerve function tests can gauge nerve sensation in the organ. Once the testing is complete, the doctor can help the patient determine what his best treatment options are.

"Much of the time, erectile dysfunction is a very treatable condition," says Dr. Sadeghi-Nejad. "The biggest obstacle for many men is making that first appointment."