Erectile dysfunction and Valentine’s Day are not a perfect pair. In fact, more than 30 million men in the United States suffer from erectile dysfunction. We sat down with Dr. Brian Christine to discuss men’s sexual dysfunction and the treatment options that could help keep the romance in your Valentine’s Day plans.

What are some sexual dysfunction conditions that can happen to men over 50 and what causes them?

The most common is erectile dysfunction or ED. Erectile dysfunction is the inability to achieve, or to maintain an erection that’s adequate for sexual intimacy. As men get older, especially in their 60s, 70s and 80s, it becomes more common for the same reason that other health issues such as heart attacks or strokes become more common. It’s all related to vascular (blood vessel) health, because an erection is blood flowing into the penis to make the penis rigid. As men get older, their vascular health tends to weaken. Conditions such as cholesterol or plaque buildup in the arteries make erectile dysfunction more common. That’s why good vascular health is critical.

A number of men with erectile dysfunction are prostate cancer survivors. Treatments such as radiation or surgical removal of the prostate can be very effective and save a man’s life, but it can cause erectile dysfunction. Prostate cancer survivors should know that they shouldn’t be embarrassed about losing their ability to perform sexually and that there are treatments.

What can men do to help prevent poor vascular health?

Maintaining a healthy lifestyle including a healthy diet and exercise is an important way for men to help prevent vascular disease that could lead to erectile dysfunction. Some suggested changes are moderating fatty and sugary foods, avoiding smoking, reducing alcohol consumption, and being active. Choosing a heart-healthy lifestyle not only lowers risk of heart attacks from vascular disease, but also lowers risks of erectile dysfunction.

Do you see men under 50 for erectile dysfunction?

Erectile dysfunction is certainly much less common in younger men in their 20s, 30s and 40s. Men in that age range typically don’t have the weakened vascular health or vascular disease that usually comes with advanced aging. However, there are certain medical conditions that can affect erectile function, such as spinal cord injuries and diabetes. Diabetes has a very negative effect on vascular health because the blood flow affects the blood vessels.

What is the emotional toll of Erectile Dysfunction?

Erectile dysfunction impacts both and their partners.  Erectile dysfunction is certainly a physical problem, because it makes intimacy difficult, but there’s also a tremendous emotional burden that comes along with that, too. Losing the benefits of physical intimacy can make a man and his partner feel emotionally compromised, and we know that men with erectile dysfunction have higher incidences of depression and low self-worth.

What is Peyronie’s Disease?

Peyronie’s disease is curvature of the penis and can prevent sexual intimacy. The curvature can be so severe that it makes sexual intimacy either impossible or painful. This disease is not uncommon, but could absolutely affect the quality of life. It occurs when scar tissue forms in the penis during penetrative sexual intimacy, and that causes the curvature. Fortunately, there are many treatment options with high success rates from oral medication and injections to surgery.

What treatment options are available to men suffering from erectile dysfunction?

So first line therapy for erectile dysfunction would be oral medication, like Viagra, Cialis or the generic equivalents of those medications. However, some men can experience certain uncomfortable side effects with those medicines, such as intense headaches, so for those patients the medications may not be the best option.

If a man doesn’t like oral therapy, there are other treatments. There’s something called penile injection therapy which is where a man gives himself an injection in the penis using a very small needle. At our clinic, our nurses teach our patients how to administer the injection so this is something they can do on their own. While it may sound on the surface like a very uncomfortable thing to do, it’s really not. A lot of men use injection therapy and do very well. If penile injection therapy is something a man would want to try, I highly recommend they speak to their urologist for their treatment rather than a shot clinic they may hear about on a TV commercial or radio ad.

Another treatment option would be penile implant surgery. It’s an implantable, prosthetic device in the penis that will allow a man to develop an erection. It has two inflatable cylinders that are implanted in the penis along with a little control pump in the scrotum. When a man wants to have an erection, he can feel the pump under the skin of the scrotum, and compresses it to inflate the penis. This requires outpatient surgery, and it’s also very effective.

What is the UCA Erectile Dysfunction Clinic?

The ED clinic is run by me and three nurses who are trained to treat ED. It is specifically set up to help men who choose to use injection therapy or other treatments beside oral medications. Our team is very compassionate, and our patients feel very comfortable working with us. We always follow up with our patients, and our nurses are available five days a week, 8 am to 5 pm, for questions and phone consultations.

What is the UCA Low Testosterone Clinic?

Testosterone is the hormone that is produced by the testicles. Simply put, it’s the hormone that gives men masculine traits, for instance, a deeper voice, body hair, beard growth and muscles. That’s all a result of testosterone influence on the human body.

Testosterone creates the desire for sexual intimacy. Testosterone levels are very closely related to the libido’s desire for intimacy. As men get older, testosterone levels tend to get lower. Other effects of low testosterone can be difficulty maintaining lean muscle mass, belly fat and fatigue. In the Low Testosterone Clinic, we check testosterone levels. If testosterone is low, we can treat it with topical testosterone gels that you put on the skin of the chest. We also teach men how to give themselves a testosterone injection to increase their levels. It’s very common, doesn’t hurt, and can work very well.

To be clear, low testosterone does not cause erectile dysfunction. Low testosterone can contribute to sexual difficulties because if your libido is low, the desire to sexually perform is low.

Is shockwave therapy a good solution to erectile dysfunction?

Currently, there is not enough data to support shockwave therapy as a viable option to treat erectile dysfunction. It’s what I would consider investigational treatment for erectile dysfunction, and from our understanding it’s typically cash pay.

The Sexual Medicine Society of North America, the premier organization for sexual medicine and sexual health in the United States, considers shockwave therapy to be experimental. The data is not robust enough to indicate that it works.

What would you say to men who may be embarrassed to talk to you?

Scheduling that first appointment can be tough, but once you get to the office, once we get face to face, my patients really tend to loosen up. They’re so happy to talk to someone who understands and listens to the problem. I will tell these men, “Listen, we’re going to get you back to good sexual function. We’re going to take care of this, because we have a lot of treatment options.” When a patient hears that, you can see the relief on their face.  And, if they’re there with the person they love, you can just see the emotional relief in their partner’s face, too. We’re here to reassure and help them, not judge them.

When a couple comes to you, is there a common misconception that the inability to perform sexually may be their partner’s fault?

Yes, oftentimes the partner will turn it on themselves. They may worry their spouse may not find them attractive anymore, and that’s why they’re having this problem. This goes back to that emotional pain partners also experience, and I think it’s really important to treat erectile dysfunction as a couple when possible.