Health Leader, Erectile Dysfunction

STORY BY

Nora K. Shire

In today’s quick-fix and instant-gratification society many men and women think that there is an instant answer to a problem like erectile dysfunction. Think again.

Erectile dysfunction (ED) means having difficulty maintaining or achieving an erect penis sufficient for sexual intercourse. This bedroom dilemma can be a symptom of medication interferences, systemic disease or blockages in blood vessels in other parts of the body.

Men, there might be a simpler way to remain sexually active as you age. Stay tuned.

“There are many reasons for erectile dysfunction including psychosocial issues, low testosterone and medications such as antidepressants, which can adversely influence orgasm, libido and arousal,” says Dr. Robert S. Tan, geriatrician and men’s health specialist in the Department of Family and Community Medicine at The University of Texas Medical School at Houston.

‘Prozac Swings Like a Pendulum Do…’

The most commonly prescribed group of antidepressants (Prozac, Paxil, Zoloft, Celexa), are categorized as SSRIs (selective serotonin reuptake inhibitors). While they are highly effective against depression, social anxiety, some obsessive-compulsive disorders and general mood disorders, they have a well-documented “downside.” They do contribute to ED, which can aggravate depression.

Research suggests that the tricyclic antidepressants (amitriptyline, nortriptyline and desipramine), produce the least problems with ED, but may be a problem for older patients.

And beta-blockers, a common group of drugs used to treat hypertension—often a stress-related condition—can have a negative effect on arousal.

In other words, if it’s not the stress that’s bringing you down, it’s the treatment for the stress. Which often causes more stress.

ED also Stands for ‘Early Distress’

ED affects about 52 percent of men between the ages of 40 and 70. The Massachusetts Male Aging Study says that the majority of cases are caused by conditions that affect blood flow to the penis, such as atherosclerosis and diabetes.

This can be an early warning of disease in blood vessels in other parts of his body. The researchers at St. Paul Heart Clinic in St. Paul, Minn., believe that since men with ED could develop heart attacks and strokes, the next steps would be to examine and follow them over time.

What goes on in the living room affects what goes on in the bedroom.

In a study published in the Journal of the American College of Cardiology, researchers compared 30 healthy men in their mid-40s with no major symptoms of heart disease but who suffered with ED with 27 age-matched men without ED. The groups appeared similar except that the men with ED had abnormal test findings on how well the blood vessels relaxed in response to stimulation with nitrates. Nitrates cause arteries to fill with blood, swell and lengthen. Not only was there a defect in the penile smooth muscle, there was also a defect in the smooth muscle in the brachial artery in the arm, illustrating a systemic defect.

The researchers’ conclusion was that doctors should ask their patients if they are experiencing erectile dysfunction because it may be an early sign of blood vessel disease in men without other known risk factors. More study is needed to determine if these same men are likely to develop heart disease.

Cupid’s Arrow has Three Prongs

“The prevalence of ED, depression and coronary heart disease (CHD) increases with age, and the symptoms related to these three illnesses are closely interlinked. The term DEC syndrome (Depression, Erectile Dysfunction and Coronary Heart Disease) is used to refer to this triad of conditions, so when a patient presents with one component, the physician should also screen for the other two,” Tan recommends.

Since some physicians consider these as separate conditions, the patient must ask his doctor to check all three.

A person’s body works as an interrelated system all of his or her life, but it comes together in a very sensitive way as the individual ages. The weakening of one body organ totally affects the entire “machine.”

“Older men with coronary heart disease are more likely to be depressed, and studies have found that approximately 45 percent of patients have been found to have either major or minor depression after a myocardial infarction (MI),” Tan explains. “Older post-heart attack patients with depression have nearly four times the risk of dying within the first four months after discharge, illustrating the link between depression and cardiac mortality after an MI.”

Studies have shown that patients with ED are often hypertensive and consequently have a higher prevalence of cardiovascular complications. The root cause may be a combination of arteriosclerosis (changes in the arteries), neurochemical imbalance (changes in brain chemistry), and hypogonadism (a reduction in or absence of the hormone secretions from the sex glands).

All occur as men age.

Predicting ED Decades Later

Some researchers believe that testosterone provides cardiovascular protection for males, thus a complex relationship exists between depression and coronary heart disease. The Normative Aging Study, which included 1,305 older men, demonstrated that depression is not only positively associated with CHD, it is an independent risk factor for developing it.

Another study reveals that age, obesity, high cholesterol and high triglyceride measurements in midlife predict not only heart disease risks, but also the likelihood of ED decades later.

The study included men who had participated in a heart disease risk trial in the mid-1970s and asked them to fill out a standard questionnaire of ED. It was not surprising that the men who were still alive and returned the follow-up survey appeared to be those who were healthier 25 years ago.

“Maybe this kind of information will encourage patients to be more interested in prevention,” Tan says.

He also adds that researchers may want to include ED as an outcome in trials of statin drugs such as Lipitor or Zocor, which are used to lower cholesterol.

Above-the-Waist Affects Below-the-Waist

In the Massachusetts Male Aging Study, a cross-sectional, community-based random survey, 52 percent had different stages of ED: minimal, moderate and complete. Other findings were that ED was directly correlated with treated hypertension, diabetes, depression and alcoholism.

Another study from Johns Hopkins Sexual Behaviors Consultation Unit revealed that approximately one in three men presenting with sexual dysfunction had psychiatric problems, including psychosocial stress and alcoholism.

Sometimes, improvement in ED is associated with improvement in depressive symptoms and quality of life. What goes on in the living room affects what goes on in the bedroom. Simply quitting smoking, for instance, cuts out nicotine, a major blood-vessel constrictor.

Often, the very medications used to “fix” lifestyle spin-outs, such as anti-hypertensives for blood pressure, antidepressants for stress-induced depression create the very condition that requires another “anti”-medication.

Tan suggests that the simpler approach might be to examine lifestyle issues at their core, before reaching for medications that might complicate the problem and then create a need for yet another pill.

“If men would just take good care of themselves—exercising regularly, getting an annual checkup, eating right—it would be possible to stay healthy and sexually active.”

UPDATED: 7-12-2004