There’s more to erectile dysfunction than sexual issues.
Erectile dysfunction (ED) can be a harbinger of systemic diseases,” pointed out Culley C. Carson, III, MD. “Specific diseases related to ED include diabetes, depression, and vascular diseases.
Carson spoke to an attentive audience at the annual meeting of the American Urological Association, held June 2-7, 2001, in Anaheim, California.
According to Carson, diabetes is the most common cause of ED in the United States. He suggests that many patients that present with ED may have undiagnosed diabetes or sugar abnormalities. Similar findings are found with ED and vascular diseases; many patients presenting with ED eventually are diagnosed with cardiovascular disease.
“Smoking is a major factor in ED and eventual vascular disease,” stated Carson. “The cause of all this comes down to endothelial cell function.”
Endothelial cells produce nitrous oxide (NO). NO is the primary neurotransmitter that allows penile erections to occur; the more efficient the production of NO, the better the erections and the function of the penis.
“Most of the systemic diseases I have mentioned cause endothelial cell dysfunction which results in ED,” he continued. “The risk factors we worry about most are age, diabetes, smoking, dyslipidemia, vascular disease, depression, chronic renal failure, and neuropathic diseases.”
Viagra is currently the only approved oral agent for the treatment of ED. Recent research has shown that Viagra works very well for all the subset populations Carson discussed. He noted that in diabetics, Viagra works better for those patients who do not have complications. If a diabetic patient has two or more complications, his response to Viagra is decreased to less than 60% as compared to a 70% response rate for diabetics without complications. There is no reported difference in response between patients with either type 1 or type 2 diabetes.
“Patients that do not respond well to Viagra do very well with penile prostheses,” reported Carson. “A study of patients with penile prostheses showed that 86% of the patients were very satisfied and would recommend implants to their friends. At 10 years, these patients used their prostheses greater than 80% of the time.”
It has been reported that depression is a very defined risk factor for ED. Depressed patients with ED respond very well to Viagra.
“We were part of an interesting study where a group of non-treated minimally depressed patients were treated with Viagra or placebo and followed for 12 weeks,” reported Carson. “As expected, patients responded well to Viagra, but the interesting part is that the responders (those responding to Viagra or placebo) at 12 weeks had more than a 50% decrease in their depression scale.
“We can’t treat depression with Viagra, but if we can improve someone’s quality of life, we can positively impact their depression and ED,” he said.
Carson emphasized that ED is an important health issue. “It is important that patients maintain their endothelial cells. They need to exercise, lose weight, quit smoking, see their physician, and have their hypertension, high cholesterol, heart disease, and diabetes treated and controlled,” he told the conference. “These changes will help improve their ED. If these changes are not enough by themselves, then they prime the body to respond better to additional ED treatments.”