Q&A Topic: Male Sexual Dysfunction

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Warren Bromberg, MD, FACS

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Q.  What is male sexual dysfunction?

A. Anything that affects sexual satisfaction or performance, but usually the most distressing aspect is erectile dysfunction (ED), the inability to achieve or maintain an erection sufficient for satisfactory sexual performance.

Q. What causes ED?  A. When everything is working properly, a normal level of testosterone sets the stage. The penis contains two tubes filled with vascular spongy tissue. An erection occurs when some form of stimulation excites the nervous system, causing extra blood flow into the tubes. There must also be an intact mechanism for preventing blood from immediately flowing out. Afterwards, blood drains from the two tubes and the erection disappears.The immediate causes of ED all relate to conditions that impair the flow of blood into the penis. That includes blood pressure medications, a spinal cord injury, and especially diabetes, which damages small blood vessels and nerves. ED can also be a sign of underlying heart disease from narrowing of the arteries in the heart and the penis.Smoking can cause ED by constricting blood vessels. Excessive alcohol intake can reduce testosterone levels and thereby cause erection problems. Depression and anxiety can also play a role in ED. Since obesity is associated with diabetes, being at your proper weight can lower your risk of ED.  Regular exercise improves blood flow. Less stress can improve sleep — and sex.

Q. What can I expect if I see a doctor about ED?

A. Primary care physicians can initially diagnose and treat ED with pills such as Viagra. But if, after hormone tests, oral medications and perhaps an adjustment to blood pressure medication, the problem persists, you’ll typically be referred to a urologist.As a urologist, I look at more subtle causes and fine-tune medications. If nothing works, I discuss at least four other treatments. Penile injection therapy involves self-injecting a medication into the penis that dilates blood vessels, usually producing an erection of 30 to 40 minutes. The vacuum erection device is a plastic cylinder that, when placed over the penis, creates a vacuum that pulls blood into the penis. A rubber ring placed around the base of the penis keeps the penis erect for 30 minutes after the ring is removed. Another option is a medicated suppository which is inserted into the urethra with a small applicator about 15 minutes before sexual activity. The blood-vessel-dilating drug in the pellet dissolves into the tissues of the penis, causing an erection. Surgical implantation of a penile prosthesis involves placing two cylinders within the penis, a pump in the scrotum, and a reservoir of salt water in the lower abdomen. You squeeze the pump to transfer fluid from the reservoir into the cylinders to create an erection. Everything is concealed and you can be totally spontaneous. This comes closest to the real experience. Men often find, much to their surprise, that their partner and physician are far more supportive than they’d imagined. And once a man discusses his ED, he feels tremendous relief.

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Learn More About Dr. Bromberg
Chief, Urology
Co-Director, Institute for Robotic & Minimally Invasive Surgery
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Bromberg: 
Prostate Cancer 
Incontinence In Women
Kidney Stones
Bladder Cancer

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