Question: When is erectile dysfunction a sign of something more serious?
Answer: Pretty much always.
More and more researchers are recognizing the link between sexual health and long-term, chronic (and, as many people unfortunately think, inevitable) diseases like diabetes, high cholesterol and high blood pressure. The more advanced these diseases are, the more at risk a man is of erectile dysfunction, which means not being able to sustain an erection for as long as he would like, or not being able to get an erection at all.
(Warning: This article discusses erections and the male anatomy in explicit and candid terms, and there's a graphic, too.)
Men are less likely to be proactive about their health or see a doctor when they have these chronic health problems. It’s partly the reason why men tend to die about five years earlier than women, and are more likely to die from chronic disease like cancer and cardiovascular disease. But one thing that does bring patients to the doctor, said Dr. Kevin Billups, is erectile dysfunction.
Billups, who is the director of the Integrative Men’s Health Program at the Brady Urological Institute at Johns Hopkins, uses these doctor’s appointments about erectile dysfunction as a way to open up patients’ minds about health issues beyond the penis. He screens for blood sugar levels, blood pressure, cholesterol levels and sleep apnea, in addition to evaluating patients for the ED they’re concerned about. Billups says ED is often an opportunity for him to intervene and treat a whole host of other conditions, often catching people before their pre-diabetes becomes full-blown diabetes, or before that stroke or heart attack occurs.
“My whole practice is based on using sexual dysfunction as an early clinical indicator of increased risk of chronic disease,” said Billups. “[Erectile dysfunction] is the canary in the coal mine; it’s a barometer of health that not only men, but their partners can notice too.” And once Billups’ patients understand the link between sexual dysfunction and overall health, they’re often more motivated to go out and make the lifestyle changes that will benefit the rest of their body, as well.
“Erectile dysfunction is the canary in the coal mine; it’s a barometer of health that not only men, but their partners can notice too."
“I say to 90 percent of the men in practice that they should try the lifestyle changes first, whether they’re looking at erectile dysfunction or changes in testosterone,” he explained. “Even if I initially put them on a pill to get things going again, I tell them that if they ignore all this other [lifestyle] stuff, the pill is going to stop working, and we’re going to have to go to more aggressive management, like penile injections or surgery for implants."
The face of ED is changing
Like other chronic diseases, the risk for ED generally increases as a man ages. By 40, about 40 percent of men have some degree of ED, and the number increases to 70 percent in 70-year-olds. Erectile dysfunction is expected to affect an estimated 322 million men worldwide by 2025 -- up from an estimated 152 million men in 1995 -- partly because of our rapidly aging population.
Yet despite how common it is, ED is not a natural part of aging, according to the National Institutes of Health. Instead, can be a sign of disease; As overweight, obesity and diabetes start shifting toward younger, unhealthier generations, we should expect to see growing rates of ED in younger men, too, according to researchers. For instance, men with Type 2 diabetes are at risk for developing ED 10 to 15 years earlier than a man without diabetes.
That’s why Dr. Jacob Rajfer, a professor of urology at University of California, Los Angeles, thinks that re-framing a man's health in terms of sexual health couldn’t start early enough. Instead of catching middle-aged men who are well on their way to erectile dysfunction and chronic disease, as Billups does, he argues that appealing to sexual function might entice young men in their 20s and 30s to take a good diet, exercise routine and their overall health more seriously.
“A heart-healthy life is a penis-healthy life,” said Rajfer.
To understand ED, you must first understand erections
Erections happen when a man sees, hears, smells, tastes, touches, or thinks about something that stimulates him sexually. The brain then sends chemical signals through nerves that tell smooth muscles in the penis to relax, which allows blood to collect in the organ. The blood is then trapped in the penis, which stiffens until the sexual act is complete. After ejaculation, the smooth muscle begins to go back to its normal state, which leads to a man’s refractory period, or the time he needs to rest before having another erection. In high school boys, that period is almost nonexistent; by the time a man gets into his middle age, that refractory period may last two to three days at a time.
Graphic by Alissa Scheller for The Huffington Post.
And anything that interrupts that chain of events, whether it’s neurological, nerve-based or vascular, can interfere with erections. Type 2 diabetes or heart disease can damage blood vessels and nerves, while conditions like depression, anxiety and post-traumatic stress disorder can affect people’s brains, causing the ability to have an erection to deteriorate at a similar pace as the overarching chronic disease.
"As we live longer, we’re staying healthier longer, which means many men want to continue participating in sexual activity," said Rajfer. But the time to intervene is much earlier than when a man starts noticing ED symptoms, he added.
"Truth be told, we’re seeing men at the tail end [of their lives]," he said. "You don’t recognize it when you’re 20 or 30, but that’s when things start going south, and that’s the time to get in and make an impact.”
The case for exercise -- early and often
For men who suspect they might be inching toward erectile dysfunction, don’t wait until it gets to the point that you can no longer obtain an erection before seeing a doctor. Many people don’t realize, said Billups, that ED actually starts when men aren’t sustaining their erections for as long as they or their partners would like. Several studies have shown that changing your diet, exercise levels or other health habits have been shown to improve the symptoms of ED in men. Here are just a few of the most interesting lifestyle-change-as-cure studies:
Men with ED who were able to quit smoking cigarettes were able to improve their ED symptoms after one year, compared to the men who continued their tobacco habit. When it comes to exercise, a recent study of nearly 300 racially diverse men showed that physical activity was linked to improved sexual function and erectile dysfunction symptoms.Additionally, several experiments have randomized men with ED to either start an exercise regimen or continue with their sedentary lifestyle; they generally showed that men were able to improve ED symptoms after regular exercise, or that their ED medication had more of an impact after incorporating regular exercise into their lives.
When it comes to diet and weight, a study that randomized men with ED to either eat a Mediterranean diet or their regular diet found that focusing on vegetables, fruits, nuts, whole grains and olive oil improved their vascular health and decreased their inflammation, while a big longitudinal study showed men who became obese had a 40 percent increased risk of developing ED than those who didn’t become obese.
Dr. Michael Eisenberg, director of Male Reproductive Medicine and Surgery at Stanford Health care, warns that if a man hasn’t had an erection in the last five years, it’s unlikely that a lifestyle change will reverse his symptoms. On the other hand, he explained, if ED only happens 20 to 30 percent of the time, lifestyle changes will have a more “meaningful impact."
"I think giving people hope is very important; A lot of times, men are in dire straits, really concerned that they’re going to have to close a chapter on a big part of their life," added Eisenberg. “And that’s just not the case with the therapies we have now."
If you’re a man who already knows that they struggle with ED (as an estimated 30 million American men also are), don’t think it’s ever too late to make a lifestyle change. Research shows that drugs like Viagra or Cialis work better in men who exercise, control their diabetes better or manage to lose some weight.
So there you have it! Exercise and eating well will not only help you live a longer life free from disease, but it can also do wonders for your sex life.
"Ask Healthy Living" is for informational purposes only and is not a substitute for medical advice. Please consult a qualified health care professional for personalized medical advice.