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Evo Terra: As a 51 year old, I'm finding myself developing a closer relationship with physicians than ever before. More maintenance is often required for classics. Right. And as a 51 year old male, it's important for me to talk to my doctors about all aspects of my health, including men's sexual health. This is Healthy Conversations Podcast, the show by new Hanover Regional Medical Center. I am Evo Terra. Can we start Dr. Reeves by addressing this stigma that's associated with men's sexual health? Like when should men start talking about sexual health with their doctors?

Dr. Reeves: That's a great question. I think hopefully whenever they're comfortable doing it, I think that's a major change in society over the last couple of decades. You know, if you look at other countries throughout the world, like for instance, China, they don't talk about ED at all, that we're, we're much better at it now and I think we'll continue to do that as we do that. Then you'll see men at a younger age, you know, come forward, and not only talk to providers, but they need to talk to their partners as well. I think that makes for a more healthy situation overall. You know, it's not normal to start experiencing those kinds of things. But it's not unusual. So the sooner we can know about it and potentially intervene, the better off those individuals will be.

Host: Well, let's talk about the treatments. We know that it's not uncommon for men to experience some degree of erectile dysfunction as they age. What sort of treatment options are available?

Dr. Reeves: There are a few out there that are that are great. Yeah, I'm sure everyone's heard of the oral medications. There's a host of medications in that class that just augment the normal erectile pathway. So that's usually the starting point as far as therapy. Then they're mechanical devices such as vacuum pumps, they're surgically implantable mechanical devices and then a couple of other medication type therapies. There's suppositories that have active ingredients and can increase blood flow to the penis, and also injections where medications can be directly delivered. You know, and then with those things being mentioned, always kind of overlaying all of this is, you know, healthy lifestyle, exercise, appropriate diet, those kinds of things and you know, regular checkups with your internist or primary care provider.

Host: So we have options, which is great news as we continue to age. One of the things I've heard of, and I'm not really sure I fully understand, is as condition called Peyronie's disease. Can you talk about that for a minute and help me understand what that means?

Dr. Reeves: Yup. Peyronie's disease is often associated with erectile dysfunction. Our generic definition, erectile dysfunction is just a problem with your erections. It prohibits the ability to have an intercourse or completion of intercourse. So Peyronie's where it fits in, is it is a disease where you get abnormal curvature of the penis and it can be to such a degree where the erection is painful. It's uncomfortable to the partner or it's just physically impossible to have intercourse because the degrees of curvature as a problem with insertion and completion because of that. And as far as why that happens, I mean, the main theory behind this is that you have micro trauma to the penis that's going on over a period of months to years due to some subtle erectile dysfunctionality that's there. And then you build up scar tissue in the penis. And then what happens with scar tissue? Scar tissue doesn't act like normal tissue. So when you get that erection, it doesn't expand cause you have scar that's their. Scar is very inelastic and you're going to get this really, really abnormal profound curvature.

Host: And what's the fix? I mean, if you notice you have this and it, especially if it's causing pain or other security challenges, it doesn't sound like something that a little blue pill is going to fix.

Dr. Reeves: No, it's not. I mean, first of all, we need to figure out what kind of problem it's causing. So is it causing psychological bother? Is it causing bother to the partner? It can be, you know, an aesthetic problem. It can be actually a functional problems. We have to figure that out. Also important to figure out how many degrees of curvature is there. We do consider that there are some normal variations in penal deviations and so forth, which is normal. So anything over about 30 degrees is what we consider pathological. So problem number one, if we think that it's definitely coming from some erectile dysfunction, we've got to improve the quality of the erection. So we've got to improve rigidity, otherwise it's going to continue to curve and be more of a problem over time. And then that brings us to what are the treatment options, well there's a bunch of them out there, but really the groundbreaking treatment over the last decade has been this medication that you can actually inject into the scar tissue that literally eats scar tissue. It's an enzyme that cleaves the scar tissue bonds and breaks it down and softens it and you'll get some improvement in the degrees of curvature over time. So that's really changed the approach where in the past it used to be things like invasive options, surgeries to straighten the penis or just something like a penal implant that will override the curvature. So that's been an exciting thing over the last decade that we have is a treatment option there.

Host: That's also a great news. Now, speaking to you as a 51 year old male, I'm always hearing about low testosterone and the fact that testosterone drops, well for me about 10 years ago. Tell me a little bit more about that and, other than just simply men's sexual health, perhaps a lack of desire or other challenge with low testosterone. What else might I be in for?

Dr. Reeves: Yeah, I think that's a great question. I love to talk about the importance of testosterone in that it's not only a sexual hormone or, the purpose of is not just for having sex, it's important for so many other bodily functions. And like I mentioned earlier, with erectile dysfunction, you can see changes. You're also going to see some changes in your testosterone levels, but what's not normal is for someone to suddenly feel different. You know, a normal drop in testosterone with aging would be something that's not necessarily noticeable for a man. But if you're also noticing sudden changes in sex drive or libido, as we call it, your ability to concentrate your endurance throughout the day. So how fatigued you may feel it can have a real effect on your ability to shed unwanted pounds. You know, to get rid of fat, to maintain muscle mass, lean muscle mass is real important. And also insulin resistance, which is kind of on that diabetes spectrum. So those, you know, just to name a few is how important it is. And also the mind as well. So cognitive function is really important for that.

Host: So it sounds like it can impact lots of different areas of a man's life. I'm curious as we wrap things up here what should a man do if he notices the problems that you mentioned or some other symptoms that might lead him to believe that he might have a erectile dysfunction issue or some other men's sexual health issue. What should their first line of business be?

Dr. Reeves: I think to talk to their, their loved one, their spouse, you know, their partner. And even to take it a step further, talk to their provider who they trust maybe or to your urologist if they have a relationship with them. There's also a lot of options online as simple web search for these kind of problems like low testosterone, erectile dysfunction is going to get you lots of resources. It will also put you in front of certain questionnaires that you can answer that will kind of put you on a spectrum of how severe this problem could be and suggest what your options might be. And that'll kind of get the ball started as far as who you need to see. And how urgent it is to see him. Since I've become a men's health specialist, I do Evo, like to just harp on men if they're starting to see some subtle changes in sexual function desire.

And if they don't have a primary care doctor, it's really important for them to establish that relationship because it can be a sign of underlying diseases like cardiovascular disease, hypertension, diabetes. So whenever I see a young guy in their forties or 50s, and this is, you know, seeing me as the first doctor they've ever seen because of something like this, I do like to get them to see their primary care doctor. Because usually if you've got some kind of underlying process that's causing a sexual dysfunction, it could be harming you. You know, your body, otherwise, like your heart, your brain, your pancreas to name a few issues there. So I think that's really important and we like to think of ourselves as men's health specialist, that we're working in conjunction with, you know, the cardiologist, the endocrinologist, and the primary care providers.

Host: Great. Dr. Reeves, thanks for all the information. That's Dr. Hugh Mallory Reeves, a Urologist who specializes in men's health issues, including erectile dysfunction, BPH, male infertility, implants, and many other neurologic conditions. He's highly skilled in minimally invasive surgical techniques and is recognized as a Urolift center of excellence provider. Dr. Reeves welcomes patients at Atlantic Urology's, Wilmington and Jacksonville offices. Please call (910) 662-8765 to schedule an appointment with Dr. Reeves or visit nhrmcphysiciangroup.org to learn more. Thank you for listening to this episode of Healthy Conversations Podcast, the show by New Hanover Regional Medical Center. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes, which you can find at nhrmc.org.