Erectile and Sexual Dysfunction

Erectile dysfunction (ED) is a pervasive disorder that afflicts as many as 30 million men in the United States (NIH, 1993).  Yet only 6 million men seek medical attention and even fewer receive therapy.  Only 4.2 million men receive a medication for ED (Gallop Marketing Survey Information, 2001).  Premature ejaculation (PE) is another sexual disorder whose true prevalence is unknown but probably exceeds that of ED. Disorders of orgasm in men are rare, poorly understood and other than due to low testosterone, no known therapy exists. Another common disorder effecting 6-8% of men over fifty years of age is penile curvature (Peyronie’s disease). This debilitating condition often disappears within a year or two but if persists may require surgical correction.

The incidence of ED increases with the presence of concomitant conditions, such as vascular disease, neurologic injury or disease, diabetes mellitus, endocrine disorders, and heart disease. Vascular disease, in particular, is thought to be the most common cause of organic ED. Lifestyle causes include lack of physical activity, smoking and obesity.

Evaluation of men with sexual dysfunction is simple and quick. Often a physical examination and blood tests are all that are needed. It is important to work closely with a man’s family physician to exclude high blood pressure, diabetes, and hidden cardiovascular disease since ED is often a predictor of future stroke or heart attack. These events can be often prevented with early intervention.

Fortunately there are effective treatments for ED and PE. Oral drug therapy is the primary mode of treatment for ED. Failures of Viagra or similar drugs can be rescued by intraurethral or intrapenile drugs or vacuum constriction devices. Rarely penile implants are utilized. At the University of Virginia we utilized the latest therapies and even experimental trials to offer patients the widest range of treatments geared to their needs.

The cause of PE is unknown. PE is most often treated with drugs that tone down nerves. These drugs are often used to treat depression but doctors take advantage of side effects including inhibition of ejaculation.

Peyronie’s disease is caused by scar tissue formation possibly due to trauma or bleeding that bends the penis during erection. It’s effect is similar to a bowstring. A portion of men with Peyronie’s disease also develop ED. If spontaneous remission does not occur after 1-2 years and the deformity prevents intercourse surgery may be warranted. Fortunately outpatient surgery can be performed to straighten the penis.