Transcription:

Scott Webb (Host): Welcome to Checkup Chat with EvergreenHealth. I'm Scott Webb. And on this episode, Dr. Kevin Ostrowski is back again, this time to discuss erectile dysfunction, a multifactorial condition for men, and one that is highly treatable. Doctor you're a physician at EvergreenHealth Urology and Urogynecology Care. So what is erectile dysfunction?

Kevin Ostrowski, MD (Guest): Erectile dysfunction, we consider as the inability to get or maintain an erection that's satisfactory for intercourse. And it is a lot more common than you think. If we look at guys, 50 and over, about half of those guys are gonna have some element of erectile dysfunction.

Host: What causes ED and are there both physical and psychological factors that can influence erectile dysfunction?

Dr. Ostrowski: I think in order to talk about what causes it, we first need to talk about how you get an erection and that's basically your body sends signals, it gets the idea that it wants to get an erection. It sends signals through your nerves, down to the blood vessels in your penis and tells those blood vessels to dilate. The dilation of those blood vessels brings blood into the penis, into the spongy tissue and it gets trapped there. And so when we think about things that cause issues with erections, we think about what along that pathway are issues that can cause problems with you getting or maintaining an erection.

So, obviously, anything that impacts those nerves, back surgery, spine surgery, prostate surgery, things like radiation to the prostate or things that are affecting those nerves and the ability for those nerves to carry those signals are all things that can affect erections.

Next, we think about those things that kind of help those arteries dilate. All guys as we age, those arteries aren't as pliable or stretchy as they were before. And so they don't dilate as well as they were before. So, things like heart disease, atherosclerosis, or clots in your arteries, all those things work on and affect those things.

Diabetes, high blood pressure are all causes, and then there's the psychological aspects, right? We're in the middle of all the stress of life and work and everything else that's going on in the environment out there. And so all those have impacts. So, there are a number of things that can have impacts on your erections.

And then lastly, there's the psychological factors, right? When you've had a new partner or it's been a while or things didn't work as well last time as you wanted them to, well that's in the back of your head and when that happens you're sending the signal, and your body is sending the signal, not to dilate those arteries, but to closes arteries off and to not dilate them and not bring that blood flow in that we want to have happen.

Host: And so when we try to diagnose whether this is a one-time thing or a sign that we actually have ED, what are some of the telltale signs? And is there a certain number of occurrences or instances when we reach that plateau so to speak, where we should maybe then see a doctor?

Dr. Ostrowski: I think anyone, when they have situations where maybe things aren't as successful as they were before or, that their erections aren't as strong or they were able to get an erection, but not maintain it. Those are all reasons. There are things telling us maybe that the erection isn't what we thought about. A lot of guys notice maybe their morning erections aren't as strong as they were before.

I don't know that there's necessarily a certain number of times that needs to happen for you to seek care. But I think every guy's a little bit different, but if things aren't working the way that you want them to, and your partner wants them to, then that's a reason to seek care because there are great options for treatment. And we talked already talked to them a little bit that there's oral options that can work for a lot of guys. And there's treatments and people out there to help you.

Host: Yeah. And we'll get to the treatment options here in a second, but can ED be prevented and what can men do to lower their risk of getting ED?

Dr. Ostrowski: All those things I talked about are all important things as the causes, right? And so controlling those things or preventing them are all things. And so things like exercise, especially cardiovascular exercise, controlling your blood pressure controlling your diabetes, weight loss, living an active, healthy lifestyle are all things that decrease your risk of erectile dysfunction.

Do they bring it down to zero? No, but they do decrease your risk significantly regarding the chance of you getting it, and, or if the medications are working, how long those medications are gonna work for.

Host: And as you mentioned, medications there, let's talk about them. What are the treatment options or medications that are available for men suffering from ED?

Dr. Ostrowski: We go from least invasive to kind of most invasive when we start talking about treatment options. And so the first option, the first line for most guys, is Viagra, Cialis or Levitra, which are the three oral medications, that work to help dilate those arteries and make those arteries dilate more. If those medications work for you, great. We start, at a medium dose and we'll go to a higher dose if we need to. If one is giving you side effects, we can switch over to another one from that standpoint. The next option, is basically a vacuum erection device, which basically pulls the blood into the penis and put a little constricted band at the base of the penis.

Now that basically helps, bring blood in. The issues with that are that a lot of guys find it uncomfortable, or if you're with a new partner, it can create issues, obviously, with how do you share that? How do you talk about it? Those sorts of things. Another option is injections. It's like an IV form of Viagra into the penis that basically helps the blood grow and helps those arteries dilate to bring blood into the penis itself. We can give you a higher, a more potent form of the medication, to help that erection, work. The problem is that you got to get an injection kind of every time in order to get an erection.

A lot of guys, also have heard about shockwave therapy, and that is basically, using shockwaves to affect those arteries and affect the plaques in those arteries to allow those arteries to dilate. That can work for mild forms of erectile dysfunction. And then lastly is, the penile implant and what that is basically a surgery where you’ve got a hydraulic pump that isn't working. We put in a new hydraulic pump. It's a kind of self-contained system that has two cylinders that go into your normal erection cylinders that gets connected to a little pump in the scrotum. And that gets connected to a little reservoir. All of that's internal to help you get and maintain a good erection that you can be in control of.

Host: Anything else we can tell people today about erectile dysfunction.

Dr. Ostrowski: I think that there are a lot of great options for guys. And the reality is, that seeking care from someone, and helping improve this, can really help your quality of life and help overall kind of the way that you're feeling, your relationship and your overall setup.

Host: These things can be difficult to talk about, but we need to talk about them. We need to be treated when necessary and so great to have you on. Your expertise, the way you explain things. Look forward to talking to you again, and you stay well.

Dr. Ostrowski: Thanks so much.

Host: And that wraps up this episode of Checkup Chat with EvergreenHealth. Head on over to our website@evergreenhealth.com for more information, and to get connected with one of our providers. And please remember to subscribe, rate and review this podcast and all the other EvergreenHealth podcasts. For more health tips and updates, follow us on your social channels.