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You Are Not Alone

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Dr. Michael Zaragoza is a Dover urologist and president of the Delaware Urological Society. Photograph by Jared CastaldiOver the past five to 10 years, Dr. Bruce Benge has noticed an increase in the number patients with a similar complaint: erectile dysfunction. The condition is nothing new, but advertising for the prescription medications Viagra, Cialis and Levitra has taken the stigma out of seeking help from specialists like Benge, section chief of urology for Christiana Care Health System.

Erectile dysfunction, however, is only one of several sexual matters that men may face in their lifetime. Premature ejaculation or difficulty reaching orgasm can also create tension in relationships and chip away at a man’s confidence. And sustained erections lasting for more than three hours are often excruciating.

Getting help may not just solve the problem. It could also save your life. Erectile dysfunction is often a symptom of another medical condition, which, if left untreated, could prove life-threatening. Consider diabetes and high blood pressure. “With the majority of erectile dysfunction—85 to 90 percent—there is a physical cause,” Benge says. “Only a few cases have a psychological cause.”

That is not necessarily the case with premature ejaculation, a common form of sexual dysfunction. Premature ejaculation generally occurs two minutes—usually less—after penetration. Experience it once and it may become a self-fulfilling prophecy. “It becomes a learned response,” says Dr. Delbert Kwan, a board-certified urologist with offices in Lewes and Milford. “They fall into a pattern of ejaculating quickly.” Anxiety can also be a cause.

Treatment might involve anti-depressants, which delay ejaculation, and therapy with a counselor. “Usually problems with orgasms are psychogenic,” Kwan says. “They’re related to problems with expectations.”

That can also be true of delayed ejaculation, which can go on for more than 30 minutes or longer, causing both partners discomfort. Some men are worried about their performance, or they’re experiencing guilt or shame due to a cultural or religious upbringing. They might also have developed a certain pattern of achieving orgasm by themselves that’s not being replicated with their partner. The condition might stem from excessive alcohol use or anti-depressants. Since an erection requires arousal, nerve impulses and blood flow, the condition could indicate a neurological condition. Diabetes, for instance, can affect the nerves, causing decreased sensation—there is no signal to have an orgasm.

Diabetes is also linked with erectile dysfunction, which affects as many as 20 million men in the United States. Erectile dysfunction refers to the inability to get or sustain an erection firm enough for sex. Stress and anxiety can cause the problem from time to time. But an ongoing issue warrants a trip to the doctor.

Erectile dysfunction is not necessarily related to aging alone. “I still have 80-year-olds and 90-year-olds with a healthy sex life,” says Dr. Michael Zaragoza, a Dover urologist and president of the Delaware Urological Society. Yet, as men age, the risk increases of developing a condition that could cause erectile dysfunction.

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Doctors treating the condition run a battery of tests to look for signs of disease. “We don’t look at treating the organ but at treating the patient,” Kwan says. Diabetes, spinal cord injuries, Parkinson’s disease, strokes, brain tumors and multiple sclerosis can affect the nerves and cause erectile dysfunction.

Because high cholesterol, hypertension and atherosclerosis affect the blood vessels and blood flow, one of the diseases might also be the culprit. Other causes include smoking, which induces vasoconstriction in the penis and prompts the blood to leave it.

Because obesity is linked with heart disease and diabetes, it too can be a factor. Moreover, overweight men likely do not exercise and inactivity decreases production of testosterone. Testosterone is necessary for achieving an erection, and doctors will likely check the patient’s levels.

Certain medications can affect a man’s ability to get an erection, including drugs for treating enlarged prostates, hypertension and depression. Of course, an erection is also part psychological. If a man is already depressed, erectile dysfunction can exacerbate the condition, leading to an unhappy cycle. As a result, urologists must work with the man’s therapist to find a solution, Zaragoza says.

Exercising, losing weight and successfully managing conditions such as diabetes may help alleviate erectile dysfunction. Otherwise, doctors may look at treatment options, including medications such as Viagra, Cialis and Levitra.

Viagra and Levitra are taken one hour before sex, which means you need to plan ahead. They stay in your system for about four hours. “If you wait longer, you won’t get maximum results,” Zaragoza says. Cialis is good for up to 36 hours or more, which is better for those anticipating spontaneous sex or who are at risk of getting interrupted. It might seem that Cialis is the better bet. But the longer the drug lasts, the longer any side effects last. Better to have a headache for four hours than 36. Other side effects may include an upset stomach and a warm flush similar to a woman’s hot flashes. The choice of drug may depend on insurance reimbursement.

The medication, however, is not a cure-all for every man. If neuropathy is causing the problem, for instance, the drugs may not work. “The pills rely on the fact that nerves are working,” Kwan says. Men who are taking nitrate drugs, used to treat heart disease, cannot take drugs to treat erectile dysfunction.

Sex is a two-way street, and any treatment should take a partner into account. Kwan has had patients who never refilled their medication prescriptions. When he asked, they told him that their partners are simply not interested in sex or that their wives experience dryness that makes sex uncomfortable. Rather than address their mutual issues, the men give up. But there are treatments to address each partner’s concerns, Kwan says.

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Indeed, if you plan to see a doctor about sexual dysfunction, plan to openly discuss your relationship and your partner’s physical condition, Benge says. Be prepared to talk about your medical history and the frequency of the problem. “Realize,” Benge says, “that you are not alone. Don’t be afraid to talk about it.”


Common Complaints

Some conditions can be managed by exercise and weight loss.

Erectile Dysfunction
Causes: diabetes, hypertension, atherosclerosis, obesity, aging, some medications
Treatments: medication, exercise, weight loss

Premature Ejaculation
Causes: anxiety or depression
Treatments: counseling, anti-depressant medication

Delayed Ejaculation
Causes: nerve damage, diabetes, anxiety or depression, substance abuse
Treatments: managing diabetes, counseling, professional sexual therapy

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