Transcription:

Caitlin Whyte: Of all of the issues to bring up to your Doctor. Erectile dysfunction is probably one of the most difficult to talk about. So today we're going to talk warning signs, causes and some of the other basics, and hopefully make it a little easier for you to talk to your own doctor about ED. Joining us for that conversation is Dr. Bryan Shumaker, a Urologist at McLaren Health. This is McLaren's in Good Health, the podcast from McLaren. I'm Caitlin Whyte. So Dr. Shumaker, let's start with probably the most common question. How common is ED?

Dr. Shumaker: Well, I would think it's increasingly common as one gets older, by the time you hit your sixties probably 40% of men are having some degree of difficulty. And it continues to increase and probably stabilize around 80 years old. It doesn't seem to be much worse after that, but that's that window of time when you tend to get chronic illnesses. So that's probably why it's more apparent then.

Host: What are some symptoms of erectile dysfunction and do these symptoms always mean ED or is it, could they be something else?

Dr. Shumaker: Well, typically you have to understand ED is really a symptom of some generalized medical issue. It'd be a blood flow, be a diabetes, be it something, but heart disease, typically it's a blood vessel issue and if your blood vessels aren't good at your heart or your brain or anywhere else, you're not going to be very good to your genitals either. And that makes a big difference. And it's typically not hormonal. It's definitely not due to low testosterone, it's not due the injury or trauma. It's the very fact that there are underlying issues. And so actually when it first appears, we recommend that people go ahead and really get checked over carefully by their internist or primary care physician. That's to pickup things like high blood pressure, perhaps diabetes never been noticed before. Cardiac disease, high cholesterol, all those things contribute significantly to ED. As a matter of fact, I would say that if you have none of those diseases, it's pretty unlikely that they have ED. It's usually related to any of those. It's a vascular disease if anything else.

Host: That leads me to my next question. What are the causes of erectile dysfunction?

Dr. Shumaker: Things that have to do with the increased blood flow and cholesterol deposits anywhere. You know that we think about the heart and we think about the brain of course, cause we're worried about heart attacks and strokes, but the blood vessels to the penis are very small. So the same condition that's causing other problems, especially some of the other things like the diabetes which affects the smaller blood vessels particularly, those things are all major contributors to ED.

Host: Is there a way, you're saying that it's, you know, mainly in the blood vessels. Is there any way to prevent that?

Dr. Shumaker: Well generally the usual things. Keep your cholesterol normal and see your doctor and be in reasonably good shape and exercise frequently. Don't smoke. Smoking constricts the blood vessels and you want all the blood going you can down there. You know, those are the kinds of things that, common sense things to avoid. Things we all should be doing, which we typically don't do. As we get older we get complacent, you know?

Host: So is ED permanent and how effective is treatment?

Dr. Shumaker: Well, ED does not have to be permanent and there are things for it. It depends. I mean, everyone's aware, I think of the drugs that are available such as Viagra or Cialis or Levitra, and those work for a certain percentage of patients, they're not cheap anymore. They used to be quite inexpensive, but now like many meds, they're quite high. There are other things beyond that. There's ways you can actually inject medication into the penis, which sounds ghastly, but actually this isn't bad because it's a tiny needle like, when you get a TB skin test, it works quite well. It's effective. And for many men, that's not a bad option, especially when they're getting older. There's other things as well, right up to an external device, which is, it's almost like a pump you put over the penis and you pump it up. It kind of pulls blood into the penis and you put this rubber car on the base, take the pump part off, and now the penis is erect because the blood trapped in it. That's an external device. There is surgery. We put penile implants in, different kinds. So there's a whole bunch of options. It's just sort of depends what the patient wants to do or the patient's partner wants them to do. Probably more important.

Host: You know, I've heard about those pumps before and I thought they were kind of like urban lore. Like I never understood how they work, but that makes so much sense. So I know we're laughing, but what advice can you share with listeners who may be experiencing symptoms of ED?

Dr. Shumaker: Well, first and foremost is it's a good one up and wake up to get yourself checked over by your doctor. You know, men are going to notice that part first. Most men go to doctor because the spouses or the partners have them go. They don't go on their own. Typically, we're not real smart that way. And that's typical. So that's a good indicator. They need to go in and see the doctor. But there are many things that we can do. And as a rule we can find some happy ground where patients are really pretty comfortable what we picked out to do. Even people that are well up into the eighties.

Host: I mean, I'm sure you run into issues where people don't like, they don't want to bring this up and they're kind of nervous or just like embarrassed. I mean, how do you get past that when it comes to treatment?

Dr. Shumaker: Well, the men, that's a good question. The men typically are sheepish, you know, they feel that's a winner. You don't want to be a failure at particularly the women are, they often come with them, are much more matter of fact about it because they recognize as the men should and intellectually do, but not emotionally, recognize that it's no different than if you had a pulled muscle or a chronic knee or it's a part of the body. And when you think about it, but you know, in the States we're so wrapped up on the sex part of it and all that it implies. Not realizing that it's any other organs and other function thing. What could we do to fix it? And men I think are getting better, but it's still older men are still pretty sheepish about it. They don't want people to know, you know, they'll couch their terms if the medical sustentation of the room. So tell me why you're here to see the doctor. And they'll say, well here's some performance issues. They'll make it real vague. You know what I mean? So then they kind of go, so that's what it is. I know already they're sheepish. Most people are, they aren't like talk to them about it, they are real matter of fact about blood vessels and what the medicine is doing, most people are pretty good about it. You know, I think less even than 15 or 20 years ago, they're much, much more, I think want to listen and understand, and not be embarrassed. I mean it's a body function like anything else, you know?

Host: Absolutely. And that's interesting that there's like a generational like that you're seeing it kind of get less and less.

Dr. Shumaker: Yeah. Oh definitely. There is definitely, there is. It's surprising. It used to be you could really talk about it. You know, we don't look at it the same way. So it kind of makes a difference now. I think people, you still see that. It depends, I think geographically too.

Host: Thank you so much for your time today, Dr. Shumaker. That was Dr. Bryan Shumaker, a urologist at McLaren Health. To learn more about Dr. Shumaker or to submit a question, visit mclaren.org/shumaker that's S. H. U. M. A. K. E. R. If you enjoyed this podcast, you could find more like it in our podcast library and be sure to give us a like and to follow if you do. This has been McLaren's in Good Health, the podcast from McLaren Health. I'm Caitlin Whyte. Thanks for joining us.