Erectile dysfunction may indicate other disorders - Urology - Brief Article

It is important for physicians in general and cardiologists in particular to identify men with erectile dysfunction (ED) and, if necessary, encourage them to seek treatment, according to Lawrence Levine, a urologist at Rush-Presbyterian-St. Luke's Medical Center, Chicago. He maintains that doctors should routinely inquire about their patients' erectile status because the diagnosis of ED may indicate progressive coronary or cerebrovascular disease as well as undiagnosed hypertension, diabetes, or other disorders.

ED and cardiovascular disease share many important and common risk factors, including diabetes, hypertension, and smoking. If there is damage in the cavernosal arteries--the primary blood vessels supplying penile erectile tissue--that same damage is likely to occur in the coronary arteries.

"Physicians should take the initiative to ask the patient about his erectile status," Levine stresses. "Embarrassment is a significant factor that makes the patient less likely to volunteer the information." A study presented at the 2000 American Urological Association meeting supports this notion. In a survey of 500 men who were seeing urologists for reasons other than ED, 44% of them had experienced ED, but failed to tell their physician about the problem. The reason cited by 74% of these men was embarrassment.

To reduce such feelings, Levine suggests doctors initiate conversation with their patients by being direct, forthright, and nonjudgmental. If a physician is uncomfortable asking questions or feels the patient is sensitive to the line of inquiry, the Sexual Health Inventory for Men is a valid and reliable questionnaire to use to initiate discussion. If there is a history of significant cardiovascular disease, the patient should undergo cardiac assessment before receiving any treatment for ED.

Because smoking is associated with an increased probability of ED, physicians should encourage patients to stop by reiterating the risk it poses to their sexual function. For some men, ED may be a more-real and threatening prospect than the abstract future risks of heart disease or cancer. There is growing evidence as well that sexual dysfunction is associated with significant mental or social health issues, including depression, anger, anxiety-related behavior, and antisocial activity, such as increased drug and alcohol abuse. Approximately, 30,000,000 American men currently experience partial or complete erectile dysfunction.

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