Erectile Dysfunction Is More Common Than You Know.

It is estimated that 10-15% of the male population in the US suffers from some form of ED. As men age, the incidence increases. For example, 50% of men in their 50s are affected by ED (University of Wisconsin Health, 2019). In Los Angeles County alone, with its current population of over 10 million, men comprise approximately 49% of that total, of which 47% of those are over the age of 40. If national trends hold, that means almost 890,000 men in Los Angeles County are potential candidates for some form of ED treatment.

Possibly because so many men are affected, the stigma associated with ED is diminishing. Accordingly, more and more men are seeking treatment. We know this because of increasing search engine interest in the subject and because annual sales of drugs specifically designed to try and address the issue are continuously increasing. According to Google metrics, erectile dysfunction was the most-searched topic in men’s health over the last 5 years in the United States; and sales of oral therapies for ED such as Viagra, Cialis and Levitra were around $3.8 billion in 2020. This clearly is a matter of importance to many men.

WHAT CAUSES ED?

While ED itself is primarily a result of a lack of blood flow to the penis, there are multiple causes of the condition. Heart disease, high cholesterol, obesity, coronary artery disease, diabetes mellitus, high blood pressure, metabolic syndrome, low testosterone levels, kidney disease, and prostate cancer are the most common risk factors of ED.

Blood pressure medications are the most common culprit in causing ED[1]. Heart and Vascular disease are the most common causes of naturally occurring ED, with 64% of erectile difficulties associated with heart attacks and 57% associated with bypass surgery[2]; 35% to 75% of men who have diabetes will also experience ED as will 40% of men with renal failure and 30% of men with COPD[3].

HOW IS IT COMMONLY TREATED?

The most commonly offered therapy for ED is oral drugs. While such drugs may be beneficial and sufficient for some ED sufferers, but won’t be effective in 40% of patients, according to The Journal of Urology. The efficacy of these medications depends on the root cause of ED. If the cause of ED is not due to a lack of blood flow to the penis, drugs won’t likely be helpful. Additionally, a physical cause of ED (i.e., hypertension) can damage blood vessels enough to the point that ED medications won’t work. If small blood vessels are damaged due to high blood pressure, elevated LDL cholesterol, or diabetes, the vessels will not respond well to these medications and men will report no benefit. Over time, these medications may lose their effectiveness due to progressive damage to small blood vessels.

Peptide Therapy is a recent innovation, specifically one known as PT141. This peptide, under the trade name Vyleesi, has been tested on men and in certain instances not only works to increase libido but also to strengthen and enhance erections. It can work when drugs like Cialis and Viagra do not. However, here too the effects are temporary, in this instance lasting from a few hours to up to a day. It is not an oral drug and is administered either through an intra nasal spray or a subcutaneous injection. To be clear, PT141 will not cure the underlying causes of ED in men nor is it a permanent fix for the problem. However in certain men it can be quite effective.

ARE THERE OTHER TREATMENT OPTIONS?

Again, oral drugs, even when they work, or peptide therapy, are only temporary fixes, and do not address the underlying causes of ED in most men, which in most instances is a reduced blood supply to the penis. Only by addressing the root causes for this reduction in the penile blood supply, or by somehow increasing vascularity and blood supply in the genital area, can a more long-term solution be found. Recent advancements in this area include the use of Low Intensity Extracorporeal Shockwave Therapy, Platelet Rich Fibrin, and Penile Modeling, which can work together very effectively.

These new innovations are recognized to be effective by those medical professionals who specialize in the treatment of Men’s Health issues including ED. In fact, when Survey Monkey recently polled members of the Sexual Medicine Society of North America and the European Society of Sexual Medicine, as to which treatments they themselves would undergo if they were suffering from some form of ED related to lack of blood supply, 40%, 38%, and 33% of providers indicated that they would use tadalafil (generic Cialis) daily, tadalafil on demand, or sildenafil(generic Viagra) on demand, respectively, as first-line phosphodiesterase 5 inhibitor therapy, followed by 74% who would incorporate low-intensity shockwave therapy, and a further 67% who would also utilize platelet rich plasma injections. Synergy and complimentary treatments increase effectiveness.

[1] Boston University School of Medicine, 2002

[2] Boston University School of Medicine, 2002

[3] Boston University School of Medicine, 2002