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Urology pearls: An ounce of prevention can go a long way

Shahar Madjar, MD

I have told you about the association between erectile dysfunction and coronary artery disease. Erectile dysfunction is the inability to attain or maintain an erection sufficient for sexual performance. And coronary artery disease is the buildup of plaques in the arteries supplying blood to the heart–a process that can lead to chest pain, heart attacks, even sudden death. These conditions share the same risk factors, and are believed to be caused, in most cases, by plaque buildup and narrowing of blood vessels–arteries that supply the penis in the case of erectile dysfunction, and arteries that supply the heart in heart disease. But erectile dysfunction appears earlier than the symptoms of coronary artery disease, making it a suitable warning sign for heart disease–a canary in the coal mine.

When I see a patient with erectile dysfunction at my office, I first inquire as to the nature of his symptoms. I ask questions like: How long has it been since you have noticed difficulties with your erections? Are you able to obtain an erection, and to maintain it? Did your erectile dysfunction appear at once, or progressed gradually? Is the condition situational, or does it happen every time you are trying to get an erection? Do you wake up with a morning erection? How good is your libido–the desire to have sex? With each answer I gain a better understanding of the patient and his condition.

In some men, particularly younger men, the onset of erectile dysfunction is sudden; the difficulties arise with their partner, but not when they are alone; their libido is good, and their morning erections are perfectly fine–these particular answers make me think that the cause for their erectile dysfunction is psychological rather than organic.

But in most of my patients, and more so in older men, erectile dysfunction has been a problem for a longer period of time, sometimes years; a problem that has worsened gradually and has persisted no matter the circumstances. Some of these men have resigned to the idea that their erectile dyPhotina MT Bdsfunction is an infliction both permanent and incurable. Some have lost their desire to have sex, and are sent to me by their sexual partners. In my imagination, I see these men carrying a letter addressed to me, and in it a simple request: “Doctor, just fix him!”

In these group of men, the cause for erectile dysfunction isn’t psychological, but organic. The problem lies not in these poor men’s heads, but in the blood vessels supplying their penises. And their erectile dysfunction might indicate a more systemic, pervasive problem that might affect not just the blood supply to their penises, but a narrowing in the arteries supplying a variety of organs including the heart. Because the blood vessels supplying the penis are narrower than those supplying the heart, erectile dysfunction precedes the symptoms of coronary artery disease.

It is then that I direct my full attention to inquire about risks factors for heart attacks, strokes, and, yes, erectile dysfunction. I ask: Is there a history of high cholesterol levels, smoking, hypertension, diabetes, obesity, and sedentary life style? I also ask: Is there a family history of a heart attack, a stroke, or death from a heart disease at a young age?

The men who answer ‘yes’ to any of these questions are the ones I can save not only from erectile dysfunction, but from a heart attack, a stroke, and even an untimely death. Those who don’t know the answers to all of these questions may need further evaluation. I look at their blood pressure measurements and at their weight, I examine them thoroughly, and I order blood work for glucose, cholesterol, and other tests.

Those men who are at increased risk for coronary artery disease and stroke should be further evaluated and treated by their primary care providers, even a cardiologist. The goal isn’t necessarily to cure erectile dysfunction or to completely reverse the damage to the blood vessels supplying the heart. Instead, I aim to halt the progression of these conditions–and to prevent even worse outcomes.

What do I and most health care professional recommend for patients with erectile dysfunction? We recommend the same general measures of good health we recommend for the prevention of heart disease:

Don’t smoke!; eat a heart-healthy diet (the Mediterranean Diet is often recommended); exercise and maintain ideal body weight; control high lipid levels, blood pressure, and diabetes through diet and, if needed, by taking medications; and drink alcohol in moderation.

And what about treatments for erectile dysfunction? You ask. I will return with some more answers.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.

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