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Pfenninger: Erectile dysfunction common
By Dr. John L. Pfenninger | Posted: Sunday, May 27, 2012 8:01 am
A study in Australia looked at sexual activity, preference, desire and satisfaction in 32,000 men between
the ages of 75 and 95. Although the amount of sex decreased with age, men of all ages tended to find it
rewarding and something to look forward to. Very few were uninterested. The amount of sexual activity
was associated with having a partner and whether or not the two of them were healthy. In that study,
taking medications seemed to reduce sexual activity. The major drug identified was a class called beta
blockers which is used for high blood pressure, heart disease. and arrhythmias. Antidepressants were
another main group.
Erectile dysfunction (ED) becomes more common as men age. ED is defined as the inability to achieve
or maintain an erection sufficient for satisfactory sexual performance. It is the most common sexual
problem in men and can have a profound effect on intimate relationships, quality of life, and overall self
esteem. ED often precedes other signs of heart disease and atherosclerosis. It is estimated that up to 50
percent of men with ED have cardiovascular problems, most of which are "silent." Symptoms of ED may
occur three years earlier on the average than symptoms of coronary artery disease. Men with ED have a
significantly greater likelihood of having angina (chest pain), myocardial infarction (heart attack), stroke,
heart failure or cardiac arrhythmias compared to men with out ED.
ED can be caused by blood flow problems (vascular), nerve problems, decreased hormones levels,
anatomic changes (nerve damage after a prostrate surgery), legal and illegal drugs, and psychological
conditions. Many times, it is a combination of these. Strong predictor factors for ED are obesity,
sedentary life style and smoking.
This week I reviewed a couple of interesting articles linking various medications and erectile
dysfunction. ED is more likely to occur, and with greater severity, as the number of medications a man
takes increases. This holds true when adjusted for the underlying medical conditions a man may have.
In one study, 38,000 men aged 45 to 69 were evaluated. Thirty percent reported having moderate to
severe ED. For those taking zero to two drugs, it was a 16 percent; for three to five drugs, 20 percent; six
to nine drugs, 26 percent; and 10 or more drugs, 31 percent. After adjusting for all their other medical
problems, men taking ten medications were twice as likely to have ED than men taking only three
medications. There is also a dose-response relationship, meaning that those who took higher doses of
drugs had more ED. The study emphasized that men would benefit from lifestyle changes to their diet as
well as regular exercise to treat various conditions in order to reduce the number of drugs used.
Another interesting study of 1200 men showed that the repeated exposure to advertisements for erectile
dysfunction drugs increased erectile dysfunction. The effect was greatest in young men.
Regular use of non-steroidal anti-inflammatory drugs (like ibuprofen, aspirin, etc.) increased erectile
dysfunction too. NSAID's have a protective effect against heart disease, so the finding was surprising. In
this study, 30 percent of 81,000 men aged 45 to 69 reported moderate or severe ED. Forty-seven percent
of those reporting ED took NSAIDs. Regular NSAID use increased from 35 percent in younger men, to
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4800 N Saginaw Rd Midland MI 48640 (989) 631-4545
Copyright 2012 John L Pfenninger MD
A Word from Dr. Pfenninger about:
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55 percent in the older men. ED increased from 13 percent to 42 percent in these groups. Men who used
NSAID's consistently showed a higher likelihood of having ED.
Simvastatin (Zocor) is a statin drug used to treat high cholesterol. Men with ED were selected and treated
with simvastatin or placebo. Before starting treatment, 26 percent of both groups presented with mild ED,
while 75 percent had moderate to severe ED. After six months of treatment, all patients from the
simvastatin group improved to only mild ED. Statins have many effects. It is postulated from this study
that they may change the functioning of the artery walls it improve erections. This could be a good reason
for men to treat their elevated cholesterol.
The evaluation for ED is fairly straightforward. Tests should be done to rule out diabetes, heart disease,
hormone problems, etc. The first line of treatment for ED consists of lifestyle interventions (weight loss,
increased exercise, and especially smoking cessation). There are known medications that cause ED and
they should be stopped if at all possible. In most instances, no matter the cause ED, phosphodiesterase
type 5 (PDE5) inhibitors can be used to treat it. These include tadalfil (Cialis), vardanafil (Levitra), and
sildenafil (Viagra). These are the medications that are being advertised all the time on TV. They work,
and generally are well-tolerated. They will often have mild transient adverse effects such as headache,
flushing, upset stomach, runny nose, and abnormal vision. However, based on the one study reported
here, you probably shouldn't watch too many of those ads.
Dr. John L. Pfenninger's column appears on Sundays. His office, Medical Procedures Center, is located
in Midland.
Medical Procedures Center PC
4800 N Saginaw Rd Midland MI 48640 (989) 631-4545
Copyright 2012 John L Pfenninger MD